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The Current State of Somalia's Health Regulations and Compliance: A Call for
By Dr. Abdulkadir Shire (Dr. Daaci)
Tuesday March 21, 2023


At the end of her six-day trip to Somalia in April 2022, the UN's Independent Expert on the Status of Human Rights in Somalia, Isha Dyfan, warned that "access to health care in the country remains alarmingly poor." She also called further attention to the fact that "just one government hospital serves the whole city of Mogadishu, so most residents have no choice but to travel to a private clinic or hospital and pay exorbitant fees for treatment." "Child and maternal mortality rates are high because only the wealthy can afford these treatments." (Reliefweb, 2022)
Her worries show how hard it is for Somalia to give its people good health care. There aren't many public hospitals, and a lot of people are poor, so private medical care is out of reach for the vast majority of the population.
Something must be done, and done promptly. Healthcare systems are essential to a country's prosperity. When people are sick, the country is sick, so to speak. Hence, although Somalia has achieved significant progress in other areas, including security, technology, education, and the overall economy (with a predicted GDP increase of 3.6% for 2023), the country must be cautious not to overlook healthcare. (Bank, 2021)

The Status of Somalia's Health Regulations and Compliance in 2023
First, let's agree that the government has done a lot to improve healthcare. During the last several years, Somalia has enacted a number of laws and recommendations meant to raise the bar on medical practice and patient safety. Particularly noteworthy is the Health Sector Strategy Plan 2022–2026 (HSSP III) (MOH, 2021), a highly comprehensive and ambitious plan that intends to address the fundamental difficulties confronting the health sector in Somalia. The HSSP III has six strategic objectives, namely: to improve maternal, and child health; to prevent and control communicable diseases; to improve the management of non- communicable diseases and injuries; to strengthen health systems; to promote healthy lifestyles; and to strengthen partnerships and coordination among stakeholders in the health sector, including government, civil society, and the private sector. With this plan, the Ministry of Health has developed a system for licensing and certifying healthcare institutions and implemented recommendations for infection prevention and control in healthcare settings.
Somalia has also made a National Action Plan for Health Security. This plan explains the country's goals and steps for putting the IRR into place and getting better at recognizing and responding to public health crises (MOH, 2021). As part of the plan, systems for tracking diseases will be improved, lab capabilities will be expanded, and the healthcare system's ability to be ready and respond will be strengthened.

International Regulations
Somalia is also regulated by a number of international laws. Somalia, like other nations, must comply with the International Health Regulations (IHR), a legally binding document to prevent, guard against, regulate, and provide a public health response to the worldwide spread of illness.
A national IHR focal point has been set up by the government to coordinate and keep tabs on how the rules are being put into practice. The point of coordination is to be in charge of monitoring, early detection, and responses to public health emergencies around the world, as well as coordinating with other countries and international groups (WHO, 2023).

In the same way, international groups like the World Health Organization (WHO) are trying to help the Somali government improve its health care system and make sure health rules are followed.

Challenges to Enforcement
Somalia has struggled for decades with political instability, violence, and poverty. This has led to weak government structures and institutions, especially in the public health field. So lack of money, bad health systems, few resources, corruption, cultural beliefs, poor infrastructure, and instability in the country have all made it harder to follow the rules in Somalia.

Political Instability
Political instability in Somalia has made it very hard to make sure that healthcare rules are followed. This has led to a lack of institutional capacity, service interruptions, and corruption in the healthcare sector. While the country has had relative peace and security over the last decade or two, insecurity is still a problem that the country grapples with.
The widespread fear in the world today is a direct result of the breakdown of institutions that used to work. Most government agencies that are in charge of making sure healthcare laws are followed are weak, underfunded, and unable to do their jobs well. This may result in a lack of responsibility for healthcare practitioners who break rules, as well as a lack of control and monitoring of healthcare institutions.
The interruption of healthcare services and the relocation of healthcare professionals that often happen in the midst of instability may be even more difficult to deal with. When there is war or violence, medical facilities are often shut down for good, medical supplies and equipment are destroyed, and the medical staff has to move. This has made it hard for Somali patients to get the care they need.
As a result of the widespread insecurity, aid groups have also struggled to do their work effectively.

Blockages in the financial system
In general, Somalia's healthcare system lacks enough resources. The World Bank reported in 2021 that Somalia's health expenditure was just 1.3% of overall government spending, which was much below the 15% Abuja Declaration objective set by African Union members (Bank, 2021). This is terribly insufficient to meet the healthcare demands of the community.
It all comes down to the reality that the Somali government has extremely little resources and ability to police health rules and compliance, particularly in places outside the big towns.
Because of this, many health standards are either not enforced at all or are enforced in a way that isn't consistent, leaving room for both people and businesses to break the rules.
However, the majority of Somalia's population lives in poverty, which makes it difficult for them to receive medical treatment or basic needs like food and shelter. A lack of money

means that many individuals can't afford to use the bathroom or get a drink of water, all of which may contribute to the spread of illness. Poverty is a big problem when it comes to getting health care, which is important for regulations to work.

Poor health systems
One of Somalia's largest legacies from its historical turmoil is a broken healthcare system. Somalia's healthcare system is inadequate due to a lack of funding, facilities, medical supplies, trained personnel, and infrastructure. Somalia has minimal health infrastructure, including hospitals, clinics, and labs. In Mogadishu, the nation's capital, there is only one government hospital; thus, most people must resort to a private health institution, where they must pay very expensive out-of-pocket costs for their care.

This means that the government can't handle health emergencies or make sure health rules are followed. Child and maternal mortality rates are too high because only rich people can pay for private care (Reliefweb, 2022). Hence, citizens, especially in more rural parts of the county, lack access to basic medical care; this is a time bomb that must be defused.

Even though Somalia has made a lot of progress in recent years, it is still a young democracy, so corruption is still a problem there. The years of violence and bad government made the country especially vulnerable to corruption in the healthcare sector. This made it difficult to keep track of and control healthcare facilities and services, as well as unlicensed healthcare worker malpractice throughout the country.

The biggest problem is that it takes money away from health services and programs that are needed to improve the health and well-being of the community. Corruption usually involves the misuse of money, equipment, and other resources that are supposed to help with healthcare projects, as well as the theft of drugs and other medical supplies that are needed to treat patients. Companies sometimes pay government authorities to ignore violations of health standards. Corrupt officials may divert healthcare funds for their own personal gain or turn a blind eye to violations of healthcare regulations.

Cultural and Traditional Practices
Culture, tradition, and religion have often hurt the way healthcare is regulated and followed in Somalia by making it harder for people to use modern methods and technology. Some traditional behaviors and beliefs are bad for your health; others go against what science says, and some religious beliefs may stop you from getting certain medical treatments, like vaccines or blood transfusions. Vaccination is a very important public health measure, but some Somali communities have been resistant to it. Traditional practices like female genital mutilation may lead to long-term health consequences for women. It is particularly tough to address these activities via legislation because of the cultural sensitivities involved and the unwillingness to change.

What must be done right away?
After completing her mission in Somalia, UN Independent Expert Dyfan asked the rest of the world to make sure that all children, especially girls, have access to drinking water, sanitation facilities, housing, and health care education in the country (Reliefweb, 2022). She also asked the government to extend the supply of public health services and provide more money for its health care system, in light of what was learned during the SARS and EV-D68 pandemics. (MOH, 2021) (Reliefweb, 2022)

In addition to this, the three most important things that need to be done right away are:

We must first increase the power of our institutions.

1.    Institutional capacity needs to be strengthened
The Somali government needs to improve the ability of its regulatory agencies, especially the Ministry of Health, to monitor and enforce healthcare laws right away by giving regulatory officers more money and training. Healthcare is one of the most important parts of society, so more of the national budget needs to go toward it. According to the Abuja Declaration, at least 15% of the budget should be set aside for health care. Capacity development must also include clear ways to monitor and enforce rules, as well as investments in infrastructure to help with regulatory tasks.

2.    Transparency and accountability have to become a priority.
Integrity has to be a big part of Somali culture if corruption is really going to stop in Somalia. Starting with the government is the first step. To encourage accountability and avoid corrupt practices, the Somali government has to create extremely clear accountability mechanisms for healthcare practitioners and make information about healthcare rules and compliance publicly accessible so that there is broad knowledge in the nation. Local communities need to be included in this process since they are frequently complicit when it comes to corruption.

3.    Collaborate with international donors.
The Somali government shouldn't be afraid to ask for help from the rest of the world and from donor institutions. Instead, the government should use the good relationship the administration has with the rest of the world to improve its ability to regulate and enforce health care laws.
The government needs to work with international groups like the World Health Organization and UNICEF to share best practices and global standards for healthcare regulation and compliance. It also needs to find financial and technical help quickly so that Somalia's health laws can be put into place and enforced. This would include funds for regulatory actions like inspections and investigations as well as technical help in areas like capacity development and data management.

A Call to Action

Even though it's clear that Somalia's health laws and compliance have improved over the past few years, it would be wrong to ignore the fact that the country still has a long way to go before it meets international health care standards and compliance. There are still a lot of problems, and sometimes the government's laws and policies can't be carried out because there aren't enough resources: not enough money, not enough healthcare workers, not enough infrastructure, and a lot of violence in the country. So, to deal with these problems properly, the government and the rest of the world need to keep giving them help.
I would like to ask the President of Somalia, His Excellency Hassan Sheikh Mohamud, to make healthcare compliance and regulatory enforcement a matter of urgency in Somalia. As Somalia's leader, you can make a significant difference in the country's healthcare system by making healthcare compliance and regulation a top priority.

The Somali Federal Government can do a lot more to guarantee that healthcare providers are held responsible and patients get the treatment they deserve by allocating more of the national budget toward the creation and implementation of laws and compliance procedures. This will require a commitment to building the capacity of institutions, promoting openness and accountability, including local people, and working with international organizations and funding agencies.

I also asked the Somali people and the international community to support the administration. We must continue to assist and encourage the Somali government in its efforts to reform the healthcare sector.
I have the highest trust in the capacity of the president and his cabinet to do the right thing. I have no doubt that if Somalia follows and enforces all relevant healthcare laws and standards, it will go a long way toward improving the quality and availability of healthcare services, which are important for the health of its people.

Dr. Abdulkadir Shire (Dr. Daaci)
[email protected]


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