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Controlling Cholera in Somaliland



Coordinated responses, local volunteers, and swift action helped curb a major cholera outbreak in Somaliland.

In 2016, cholera cases emerged across the drought-weary, self-declared state. After a rapid assessment, the Somali Red Crescent Society positioned emergency response units and launched a multi-faceted prevention education campaign. Trained local volunteers ran oral rehydration units where they could refer severe cases to treatment and collect data for daily SMS reports. The Somaliland government coordinated with the UN and local NGOs to share information and remove bureaucratic roadblocks.

The robust response was successful in treating over 12,000 cholera cases and could be a helpful case study for other outbreaks.



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The Main Reasons for Absenteeism in Health Workers




Health worker absenteeism

As we know low health workers or any professional staff absenteeism causes low productivity for that business sub type,

As we are all serving clients whether they are business shops, Drug companies, Supermarkets, the bellow diagrams and points summarized and identified problems that are culprit for low work productivity in general not specific to a country or institution, reasons is to help my study assignments in learning MPH studies In John Hopkins University,(With my experience in working low in come countries as Clinician, Health workers supervisor, coordinator in both governmental and international NGOs/Humanitarians). I witnessed almost all this points for my time working in health sector.

  •  Health Facility In inefficiencies.
  •   Health Worker Absenteeism or Ghost workers in some countries.
  •   Low patient Demand. 
  •  In sufficient accountability.
  •  Low salary or external opportunities.
  •  poor work climate, low patient or client demand.
  •  In Security for the staff in some areas of the world (where I witnessed during my field worker south central Somalia).

Low health workforce productivity may be due to health worker absenteeism. Absenteeism is the chronic, unexcused absence from work. The definition of absenteeism can be extended to include excused absences—such as for training workshops, sickness, vacation, or scheduled leave for social obligations—which can also result in the interruption of health service delivery.

Absenteeism may vary from working reduced hours each day (i.e., arriving late, leaving early), only regularly working a few days per week, or even taking lengthy excused absences without having another worker fill in (e.g., health worker away at a one-year training program). In some cases, health workers may be assigned to a specific facility and may appear in official human resources for health (HRH) statistics without ever reporting to work.

Absenteeism can result in patients being turned away because the decreased number of health workers cannot attend to all the patients. In some cases, facilities may close for a period of time due to health workers not reporting to work. To compensate for high health worker absenteeism, facilities may hire additional staff to provide health services. The increase in health worker inputs will reduce productivity.

It can also decrease the number of patients seen, impose heavy and demotivating workloads for those health workers who are present, and/or lower the quality of services. Absenteeism can lower quality in a number of ways, including because the remaining health workers may experience the following:

  • Have many more patients to attend
  • Have to step in and perform tasks that they are not trained to do
  • Become demotivated by the absence of their colleagues and their increased workload.

Health worker absenteeism may be a result of one of more underlying causes:

  • Insufficient accountability: If accountability mechanisms to keep health workers on the job when they are supposed to be present are weak, then absenteeism may persist. Weak accountability mechanisms may also be related to issues of governance, leadership, and/or poor management.
  • Low salary and external income opportunities:An inadequate income can cause absenteeism for multiple reasons. On one level, health workers may become de-motivated by their low salaries and not want to go to work, thus resulting in absenteeism and its respective effects on service quality. To compensate for low salaries, health workers may engage in additional earning arrangements. This may be a clinical job in the private sector, or outside the health sector in agriculture, trade, or other businesses. Where such opportunities are available, health workers may absent themselves from their official work hours at the health facility to instead engage in their other income-generating activities. Delayed remuneration or payroll issues can also encourage health workers to be absent from work.
  • Poor work climate: Staff may more frequently be absent when there is an unsafe working environment in terms of occupational safety and health, sexual harassment, violence, or other security issues. The lack of adequate supplies and equipment could also contribute to a poor climate.
  • Low patient demand: Absenteeism could also be the result of low demand for services. If there are very few or no patients (maybe due to perceptions of poor quality, access issues, or other reasons), health workers may not come to work because they feel they are not needed. When patients do seek services, there may not be a health worker to attend to their needs. This can lead to a vicious cycle, creating poor perceptions of service quality on behalf of the patients who inform others of their experiences, thus possibly resulting in a further decrease in patients visiting the facility.
  • In Security for the staff in some areas of the world( where I witnessed during my field experience around the globe).


Written by: Dr Essa A Djama MD, MPH

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Young Somaliland Activist Dies During Childbirth




Hamda Ismail was Young, educated, activist and dreamer living in the Somaliland’s coastal town of Berbera. She have had high hopes for Somaliland youth and have been an icon among the society in Sahil region for the past years.

Hamda who was attending her last months of her university wanted to be a role model for her fellow and was optimistic to create a better life for thousands of youth in Berbera and for her family too. She her love of her life recently and got married but that did not stop her from her education and chasing her dreams to be part of the change in Somaliland.

Just few months before her university graduation and as she was getting ready to receive her first degree, Hamda was rushed to the hospital to give birth to her first child but sadly she died during the labor. With that not only she lost her life but also lost her dreams, family and passion.

Hamda is not the only one whose life was shattered by the poor health services in Somaliland, many others have been lost to maternity deaths each year without being reported by the media and the families just burry their loved ones in despair as they feel hopeless of the situation.

In 1997, 1,600 out of every 100,000 women giving birth were estimated to die in Somaliland. Anwar Mohamed Eggeh, Somaliland’s director-general in the Ministry of Health and Labour, told IRIN the rate in 2006 was 1,044 per 100,000.

“Most Somaliland mothers die because of prolonged bleeding, pre-eclampsia, hypertension, infection and malnutrition, caused by lack of a balanced diet” says Ugaso Jama Guled, a midwife and activist fighting female genital mutilation/cutting, which she said was a major contributor to the territory’s high rate of maternal deaths.

The Somaliland MDG report by UNDP predicted Somaliland maternal mortality ratio 995 in 2010 and 937 by 2015, which lags three times to achieve the MDG target of 337 by 2015. The predicted maternal mortality ratio of 995/100,000 in 2010 resulted that 1219 mothers die for child bearing and pregnancy related causes.

The story of Hamda is a reflection of the poor health facilities in Somaliland are alarming and needs special consideration from the new government as well as other health stakeholders. The situation is even worse in the remote areas of the country where accessibility is an issue before any services are installed.

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