Highlighting the achievements and challenges facing nursing and midwifery in Somaliland

SomalilandPress (London) In a world beset with difficulties and misunderstanding the work of organisations such as the Africa Research Institute (ARI) is all the more important. The ARI in its own words; “aims to reflect, understand and build on the dynamism in Africa today. We are a London-based think tank which looks for practical examples of achievement – by listening to the people who have created that success, often in adversity, and by communicating that experience to organisations, companies and policymakers. We are not guided by ideology and are strictly non-partisan.” A key part of its work is ensuring that a range of thought provoking and credible publications are brought to as wide an audience as possible. ARI’s Director, Edward Paice is a man of great integrity and someone who has visited Somaliland in order to gain a better understanding of the path it has travelled and the journey is still has to make. He has a deep empathy with the Somali peoples and a growing appreciation of what Somaliland has achieved, often against the odds,  and so it was indeed appropriate that the ARI should be the vehicle for launching a report by Fouzia Mohamed Ismail entitled:  ‘PATIENCE AND CARE Rebuilding nursing and midwifery, in Somaliland’ in its Policy Voices Series.

After some brief presentations concerning some of the background to Somaliland and the Diaspora perspective, Fouzia Mohamed Ismail, Executive Director of the Somaliland Nursing and Midwifery Association (SLNMA) stepped forward to set about elucidating the work being done by an association that only came into being in 2004. The near herculean task faced by health care professionals soon became evident, not least because the destruction and terror of the Said Barre Regime had resulted in the flattening of hospitals and clinics, as well as the killing of medical personnel or their flight from the country. In effect the nursing and midwifery service has had to be built from scratch. With a minute health budget it has been essential to seek guidance from a range of outside partners including the likes of King’s College Hospital, London – Tropical Health & Education Trust – Somaliland Partnership (KTSP). Such practical support has enabled the SLNMA to establish training and Continuous Professional Development (CPD) programmes, as well as seeking to extend its work nationwide. Facilities remain woefully inadequate, but as Fouzia Mohamed Ismael made clear capacity building is vital to progress. The report itself makes much of the vision and method of the SLNMA whilst highlighting serious a range of deficiencies and problems such as:

  • Inadequate salaries and the moonlighting
  • A lack of skilled personnel
  • A lack of management supervision
  • Poor facilities and equipment
  • A serious lack of reliable data to assist forward planning

With mental health issues an additional challenge in a post-conflict society it is clear that an annual health budget for Somaliland of between US$ 1-2 million is little short of scandal when it is meant to meet the needs of a nation of between 3.5 – 4.0 million people.

All present were struck by the humility and remarkable sense of purpose of Fouzia Mohamed Ismael. She was eager to ensure that her others received the praise. As for the report itself, it deserves to be widely read, not least because there are examples that will assist other health care professionals elsewhere in Africa and beyond.

Inevitably such a stimulating presentation generated a range of questions; one in particular from Nimko Ali of Daughters of Eve (http://www.dofeve.org) proved particularly problematic. Ms Ali raised the issue of female cutting or Female Genital Mutilation (FGM) and was eager to know how clear the guidance was in this regard and whether some poorly paid midwives might undertake such a damaging procedure for money. Whilst the Executive Director of SLNMA felt sure that none of her staff would engage in such activity, she explained that currently there were not legal safeguards in place to address such an eventuality. Further discussion ensued and it was made clear that judicial punishments would not be sufficient and that education is the key, along with the robust condemnation of such practices especially if issued by community and religious leaders. For all the good work, there was a sense that FGM and other issues of gender-based violence have yet to be firmly addressed in an unambiguous manner, one even sensed that some at the launch might have preferred that it had FGM not even been raised at all.

The presentation stimulated plenty of useful questions and one can only hope that this report will be widely read by Government Ministers in Somaliland and others in the position to affect change. There is a saying that; “Health is Wealth” and what ARI and Fouzia Mohamed Ismael have highlighted in this important report is that Somaliland has made significant progress in rebuilding its nursing and midwifery service but still requires far greater internal and external support.

Mark T Jones


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