Somaliland, as a nascent nation-state with previous difficult history, has begun almost everything from the scratch. During the devastative, bloody wars—which were mainly caused by the brutality and the abuses of Siyad’s regime, all sectors including health sector were destroyed. Moreover, some researchers, who write about the Somali history and state, argue that the health sector of the former Somali state was one of the most drastically-affected areas as health facilities and training institutions were severely demolished. The country’s primary public assets including health equipments were looted. The abuses against the rule of law became obvious in all spheres of citizens’ lives, particularly in the health sector. The economic and social infrastructures were also annihilated to the extent that an alien could feel nothing about even their existence at one time in the history! This phenomenon of mayhem and catastrophes has been an opportunity for literally all evils to come in and streamline in the people’s lifestyle. Corruption at different levels became business as usual and unfortunately turned into a value that is usually and expectedly possessed by the so-called elites of the society including the medical practitioners who have been serving during post Siyad Barre’s era. In this regard, nothing of the state machinery was in the public domain as such. Thus, the absence of the entire social services particularly health amenities worsened the situation and accordingly put the public to a tight corner. Though Somaliland was reborn with the vision of excluding itself from the dreadful context of the other Somali territories, it had to still struggle with the ramifications of the failed Somali state. As a result, people in Somaliland found difficult in coping with the limitations of the health sector. Since 2005, it has been very rare to see qualified medical practitioners serving at the public health centers in Somaliland. In this situation, a vacuum literally came to light. This vacuum— characterized by an absence of quality medication and accessible health services—provided an opportunity to a vast number of untrained practitioners who claim that they have experiences on medicine and more surprisingly treat patients by resorting to mendacity and erratic prescriptions that consist of herbal and even chemical drugs. Because health conditions of most of the people is poor and people are eager to commit any resources they could afford to pay in order to seek treatments, the health sector had gradually seemed as a highly profitable business niche! Though it is inhumane to seek profits in such critically humanitarian work, yet there are a lot of medical service providers who pursue health services as commercial engagements. It is absolutely no astonishing to stumble upon a person who is complaining about illnesses and at the same time conducting prescriptions by lavishly purchasing drugs from the untrained pharmacists. In this regard, you cannot be blamed if you describe this patient as a patient-doctor. Similarly, there is a huge misperception on both medicines and medications. Doctors are not often approached as first patient’s resort. Traditional medications are used and sometimes traditional healers are referred to. Consequently, there are an imaginable number of malpractices caused by the incumbent context of absent medical regulations, untrained and/or negligent practitioners and poor amenities.
The health centers functioning in the country are not all proper and responsible institutions. A lot of them are traditional medical centers, such as Elajis—sort of traditional healing small centers, which provide treatments based on assumptions and uncalculated guesses. These centers pose challenges to the safety of the community as they are neither organized in a proper way nor equipped with medical expertise or proper facilities. As a result, there are numerous ill-treated victims at these centers whose cases are unfortunately difficult to be now managed by even professional medical doctors.
Furthermore, when it comes to maladministration and ineffectiveness, the traditional health centers cannot only be blamed. But, hospitals should be also impugned. Our hospitals seem incapable of addressing the vast health needs of the public. Therefore, their administration and service delivery capacities are feeble and need to be critically promoted. The unawareness of the public of their rights to enjoy with medical safety and access to proper medication drastically magnified the challenges of the poor service delivery of the medical institutions of the country. Because there should be a space to enjoy and a way to escape in where there is no adequate public awareness and effective regulatory framework that could pose accountability, checks and balances.
In this note, I would like to describe the critical need for unanimous collaborations and commitment to promote the health sector of our country. Nevertheless, I acknowledge both the gradual increase of the government budget on health sector and the substantial focus of the NGOs on the areas of health awareness and services for the communities in need. I believe that we need to triple the current efforts and cooperate for ensuring coordinated, strategic and effective health sector.
To put down my central point of my article, I would highlight the fact that there is undeniable vast public misperception of the realities of health and medication. As a result of this misperception and unawareness on health and medication issues, negative ramifications— ranging from inadequacy of community access to proper medication to absence of mechanisms of accountability for controlling health sector actors and practitioners—transpired as realities on the ground.
In conclusion, I would like to underline the following points as my recommendations for overcoming the challenges I have mentioned above:
- Pursue effective public awareness-raising on health and medication;
- Coordinate stakeholders in implementing the national health policy and ensure effective and integrated policy and programme frameworks for promoting the capacities of health posts, centers and institutions and enhancing public access to health services and facilities;
- Strengthen medical training institutions for pursuing comprehensive studies and surveys on the health issues of the country;
- Upscale the capacity of the concerned government agencies on health issues and promote the effectiveness of the Somaliland medical association;
- Strengthen the existing supervision and monitoring mechanisms for bolstering the accountability and the sound practice of the health sector;
- Increase the national budget allocation for the programmes on health;
- Establish coordinated and comprehensive national service of mobile medical campaigns so as to enhance the health of the rural and poor communities and in order to fight against the ill-practicing traditional healing practitioners and the spread of wrongful, incorrect information and perceptions on health and medications.
N.B: This article was first published in Amoud Medical Journal two years and 6 months ago, during my internship period.
General Physician at Manhal speciality Hospital