Somaliland is a self-declared but internationally unrecognised state in the Horn of Africa.

Following a brutal civil war which ended in 1991 most of the states health infrastructure had been destroyed and many of its health workers had been displaced.

Lack of access to primary health care, inadequate quality of service provision, poor hygiene and sanitation, and low supply levels are just some of the factors which contribute to the countries poor health indicators.

During the first thirteen years of the civil conflict (until 2003), not a single health training facility was operational and thus no health professionals of any cadre were produced.

Somaliland now suffers from a serious shortage of health workers, recently estimated at 197 doctors, 1,256 nurses and 344 midwives, serving a population of around 3.5 million. This level of coverage falls far short of the WHO-recommended minimum health worker/population ratio of 2.3/1,000.

This shortage is compounded by significant skills gaps in the workforce, with very few opportunities for clinicians to access formal postgraduate training, leading to the absence of specialists in most areas of clinical practice.

In 2000, there was limited obstetric cover, and this meant that young women often remained in labour for many, many hours, even days. The hazard of this is damage to the birth canal and surrounding tissues, which may lead to fistula formation – a serious and stigmatised condition. About a quarter of a mile from the centre of Boroma there was an area of farm land, which was identified as a suitable location for a much needed fistula hospital. This photograph was taken in 2007 and shows, among others, Dr Walhad (the Dean), Professor Sir Eldryd Parry, and Dr Suleiman (the Head of the Gynaecology) assessing the area.

“Amoud Medical School was the first medical in Somaliland. When we were starting there were 98 Doctors who were more concentrated in the main cities; 56 of them were in Hargeisa, 15 in Burco and 14 in Borama which means 83% were in three cities with only 17% for the rest the country. The majority of the population of Somaliland live in rural areas leaving little access for them. Caesarean section were available only in these cities and now every hospital in Somaliland has a graduate from Amoud or Hargeisa who is able to perform caesarean. This is just one indication of the achievements and significant advancement during this time of THET support.”

Dr Walhad, Principle, Amoud University

Somaliland has one of the worst maternal and child mortality rates in the world. With the majority of the population living in isolated, rural areas of the country, many people are unable to access healthcare. In 2014, THET worked in partnership with the Ministry of Health in Somaliland to develop the training of Community Health Workers (CHWs). In the first cohort, 39 CHWs were trained and returned to their local communities to provide care and support for the local population. 20 new trainers were also trained to deliver the course to new CHWs, ensuring improved sustainability and local ownership of the programme.

During the last year we have worked to support the King’s College led Prepared for Practice programme. This is funded through the FCDO Strategic Partnerships for Higher Education, Innovation and Reform (SPHEIR) programme. Under the leadership of the Ministries of Health and Education, a new Medical Education policy has been developed and approved and is in the early stages of implementation.

Read more about our work in Somaliland below:

Somaliland: Health After War 

Overwhelmed and Underprepared: Delivering Care in Somaliland

COVID-19 Case Management Training in Hargeisa, Somaliland

Securing Supplies in Somaliland

Somaliland Spotlight: Ensuring Gender Equity in Health Programming

Introduction to ‘Exploring Gender Equality in the Health Workforce: A study in Uganda and Somaliland’

Significant Strides in Somaliland

Experience in the King’s Health Partnership in Somaliland

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