Elsevier

The Lancet

Volume 368, Issue 9541, 23–29 September 2006, Pages 1119-1125
The Lancet

Public Health
Working together to rebuild health care in post-conflict Somaliland

https://doi.org/10.1016/S0140-6736(06)69047-8Get rights and content

Summary

In 1991, the Somali National Movement fighters recaptured the Somaliland capital city of Hargeisa after a 3-year civil war. The government troops of the dictator General Mohamed Siad Barre fled south, plunging most of Somalia into a state of anarchy that persists to this day. In the north of the region, the redeclaration of independence of Somaliland took place on May 18, 1991. Despite some sporadic civil unrest between 1994 and 1996, and a few tragic killings of members of the international community, the country has enjoyed peace and stability and has an impressive development record. However, Somaliland continues to await international recognition. The civil war resulted in the destruction of most of Somaliland's health-care facilities, compounded by mass migration or death of trained health personnel. Access to good, affordable health care for the average Somali remains greatly compromised. A former medical director of the general hospital of Hargeisa, Abdirahman Ahmed Mohamed, suggested the idea of a link between King's College Hospital in London, UK, and Somaliland. With support from two British colleagues, a fact-finding trip sponsored by the Tropical Health and Education Trust (THET) took place in July, 2000, followed by a needs assessment by a THET programme coordinator. Here, we describe the challenges of health-care reconstruction in Somaliland and the evolving role of the partnership between King's College Hospital, THET, and Somaliland within the context of the growing movement to link UK NHS trusts and teaching institutions with counterparts in developing countries.

Section snippets

UK response from the Tropical Health and Education Trust and King's College Hospital

Faced with the size of these challenges, to see how a small group (initially, of UK health professionals) might respond could be difficult. We approached this task from the outset as a partnership (namely KTSP—King's College Hospital [panel 1], Tropical Health and Education Trust [THET, panel 2], a1nd Somaliland Partnership), talking and listening to each other in Hargeisa and London, and so we were able to identify areas for which input from the UK could make a difference. We have set

Early visits to Edna Adan Hospital

The Edna Adan Hospital (figure 4, panel 3) was still a building site in 2000 during the initial fact-finding visit. However on March 9, 2002, patients were admitted and 1 week later the first KTSP team visit took place. Within hours of their arrival, the first caesarean section was undertaken. Repeated follow-up visits have monitored progress, assisted staff training, and helped to start treatment protocols and improve care. As a result, the hospital has become a referral teaching hospital for

What are the benefits?

No programme of this sort, which is active across many disciplines, should proceed without careful monitoring and evaluation. For all the activities, we have put into place methods to monitor what is done to ensure work is effective and targeted to needs. Assessment techniques have included end-of-course examinations and questionnaires and assessments by student participants, structured interviews by visiting assessors from THET, audits of physical and structural changes in Somaliland, and

Legitimacy, migration, and sustainability

“Many rehabilitation interventions are implemented outside the state structures and therefore do not serve to strengthen these institutions in the longer term.”4 Although KTSP started informally outside state links, through individual invitations to help at Edna Adan Hospital and later at Hargeisa Group Hospital, the ensuing partnerships with government institutions have been strengthened. The work of KTSP is ultimately accountable to the Ministry of Health and Labour, and one of our team (EAI)

References (8)

  • Rebuilding Somaliland issues and possibilities

    (2005)
  • P Hansen

    Migrant transfers as a development tool: the case of Somaliland

    (2004)
  • II Ahmed

    Remittances and their economic impact in post-war Somaliland

    Disasters

    (2000)
  • T Vaux et al.

    Service delivery in countries emerging from conflict: report for DFID

    (2005)
There are more references available in the full text version of this article.

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