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Abstract
Until the beginning of 1991, Somalia had a reasonable health care system with a good number of tertiary hospitals in Mogadishu and Hargeisa, some regional hospitals, district hospitals, clinics, child and mother health centres (CMH) and out-patient dispensaries. However, the conflict resulting from the civil war has destroyed the public health care system which existed in the country. Somalia was not alone in having conflicts. The total number of conflicts in the world in 2017 was 49, many of them have now entered post-conflict phases, where open warfare has come to an end. There is growing evidence that conflict has a devastating impact on health systems and the health status of the population. In Somalia, the post-conflict phase provides a unique window of opportunity for health sector development and reform. At this juncture, health systems in Somalia face the double burden of a flawed pre-conflict health system, characterised by deficiencies and inequities, and the long-term impact of conflict on the health status of the population and its resultant strain on the health system. This review article analyses the framework for the rehabilitation of health systems in post-conflict countries. Such knowledge can be applied in the rehabilitation and development of health systems in Somalia along the lines of the World Health Organization’s health system building blocks. The impact of conflict on the health status of the population as well as the health system can be catastrophic and be felt for years after the State has entered the post-conflict phase, but also provides an opportunity for reforms of the affected State’s health sector.
Highlights
Until the end of 1990 and prior to the collapse of its state in early 1991, Somalia had a good number of general hospitals, some regional hospitals, clinics, mother and child health (MCH) centres, outpatient dispensaries and a public health system [1]
Healthcare has been largely concentrated in the private sector and international aid agencies, the end of the conflict has resulted in the Somali Federal Government alongside international and domestic partners beginning the process of rebuilding its national health system
The framework used in this review focuses on six building blocks - service delivery, health workforce, health information systems, access to essential medicines, financing and leadership/governance; as these are key to realising more equitable and sustained improvements across health services and health outcomes [12]
Summary
Until the end of 1990 and prior to the collapse of its state in early 1991, Somalia had a good number of general hospitals (though they were mainly concentrated in big urban areas, like Mogadishu), some regional hospitals, clinics, mother and child health (MCH) centres, outpatient dispensaries and a public health system [1]. Starting from the early 1970s, for instance, the number of physicians increased significantly, the greater proportion of them being native Somalis. Healthcare has been largely concentrated in the private sector and international aid agencies, the end of the conflict has resulted in the Somali Federal Government alongside international and domestic partners beginning the process of rebuilding its national health system.
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