After a three-year civil war, Somaliland declared its independence from Somalia in 1991 and is now stable and peaceful with an impressive development record. However, the civil war destroyed most of Somaliland’s health care facilities. Many qualified health service staff migrated or died, resulting in a chronic lack of good, affordable health care.

In 2000, an exploratory visit was made to Somaliland from King’s College Hospital (UK), supported by the Tropical Health and Education Trust (THET), in response to a request from Abdirahman Ahmed Mohamed, a former medical director of the general hospital in Hargeisa (capital of Somaliland). As a result, a working agreement was reached to set up the KTSP (King’s, THET, Somaliland partnership) to address this crisis. The partnership has been studied and lessons learned have been applied. It is one of a growing movement linking National Health Service (NHS) trusts and teaching institutions in the UK with counterparts in developing countries. 

KTSP teams found that health indicators in Somaliland are among the worst in the world, even compared with other countries in sub-Saharan Africa. Like other post-conflict countries, Somaliland suffers from a shortage of qualified health professionals. In addition, a lack of resources to fund the health service has resulted in inadequate salaries for health workers and a weak service. Hospitals and health centres have been unable to teach and train new recruits.

So how did the partnership address these problems? It was fundamental that the southern partner should define their needs, and King’s/THET would respond. The focus was on communication between the partners in Hargeisa and London in order to identify areas where the UK could make the biggest difference. The partnership’s main achievements have included:

• Teaching nurses in the newly built Edna Adan Hospital; it has since become a referral teaching hospital for reproductive health across the entire Horn of Africa thanks to repeated follow-up visits where partners monitored progress, assisted with staff training and set up treatment protocols.
• Sending lecturers to fill gaps and support tutors at Borama University, its hospital and the local community. The first six students are due to qualify in 2007.
• Refurbishing and reorganising the accident and emergency department at Hargeisa Group Hospital alongside a two week emergency skills course and six month audit of the assessment of major trauma.
• Setting up a collaboration between Hargeisa Group Hospital, Edna Adan Hospital and primary health facilities, funded by Comic Relief, to provide accessible community health care at the point of need, including free care for the poorest people.
• Teaching doctors, nurses and traditional birth attendants, and developing a new national programme of training for health officers, as well as providing on-the-job training for managers, pharmacists, physiotherapists and laboratory technicians.

The researchers argue that lessons learnt from the partnership are transferable to other post-conflict countries, in particular the principles of mutual trust and a flexible, non-prescriptive approach. They conclude that:

• careful monitoring and evaluation is critical to ensure that work is effective and targeted to needs
• if all NHS trusts in the UK set up similar links, this would help address the growing problem of health worker migration from developing countries to richer nations 
• there remains a desperate need for resources to fund regular and realistic salaries for health care staff in Somaliland.

Source(s):
'Working together to rebuild health care in post-conflict Somaliland', The Lancet 368, pages 1119-25, by Andrew Leather et al, 2006

Funded by: Community Fund, the Association of Surgeons of Great Britain and Ireland; Comic Relief; British Embassy in Addis Ababa; King’s Development Award; UNDP; Zurich Financial Services Community Trust

id21 Research Highlight: 15 March 2007

Further Information:
Andrew Leather
Department of Surgery
King’s College Hospital
London
SE5 9RS
UK

Tel: +44 (0) 20 73463264
Fax: +44 (0) 20 73464439
Contact the contributor: Andy.Leather@kingsch.nhs.uk

King's College Hospital NHS Foundation NHS Trust, UK

Tropical Health and Education Trust (THET), UK

Other related links:
'Global health partnerships: the UK contribution to health in developing countries', the report of a review commissioned by The Prime Minister into how the UK could contribute to health in developing countries, by Lord Nigel Crisp, February 2007

Global Health Workforce Alliance

'Managing and financing health services during conflict in the DRC'

'NGOs take on health services in Afghanistan'

'Committing donors to building health workforces'

'Running battle - international intervention in post-conflict health care'

Eldis/DFID Health Resource Centre, Health Systems Resource Guide: governnance and health