Written by: Dr. Mariam Abdilahi Dahir
Somali community is distinguished for their richness of cultures and practices, these are tradition aimed at ensuring social cohesion, cultural identity and promotion of belongingness, the positive traditional sides included the extended family support for the women and sharing the difficulties, breastfeeding, childcare/spacing, caring for women in during maternity, all these positive traditional need to be promoted and use it within the younger generations.
Women is vulnerable when she is young although she receives lots of protection from her family (waa inan ha la xanaaneeyo) but she goes under cutting or FGM, she grows with the pain and struggles to survive with this trauma, this is the negative traditional practices that effect the women in the Somali community and effects all her life and risks her health and leaves with complication that can lead to fistula during childbirth or even death. Some researches highlighted that when the girls undergo the cutting they don’t ask support and advice directly from the health workers! and fewer have sought advice from their family members, that shows that the health seeking behavior among women is very low as well they don’t see the FGM complications is a health problem!
When the girls reaches puberty and receive the period they struggle alone, it’s a shame with in Somali community to talk about it even to seek advice from mothers is rare, that makes the girls mismanages and have difficulties sometime to handle properly it might cause drop out from the schools.
The period pain/irregularity and the hormonal changes is difficulties that girls face (unmarried) that is taboo to share with their peers and there is no specialized services in the country, the only time they come to seek health when it get worse or when they develop complications that sometimes difficult to manage.
Child birth is another challenging period that Somali women face, the culture and the traditions plays and important role to shape the mother’s life during this period, the family always connected to each other and take advices from elderly women (some of the positives) but the advices always its not appropriate or its not applicable to the current situation, in the first 3 months in the pregnancy women develops symptoms called morning sickness (walac) they experience nausea, vomiting and anorexia sometimes, this time is critical if they haven’t had the appropriate care and eat nutrients food and vitamins it will affect the growth of the infant, the elderly women or the peers advice the mothers to eat less and not to take any vitamins; their advice continues to the later stages of pregnancy that they warn the mother to eat good meals because the baby will grow and they will need surgery during the pregnancy, which is wrong it’s just a believe , pregnant mothers need 8 to 9 meals in the day.
When it comes to women’s rights to health or seek advice from health facilities she usually take the permission from her family/husband this is a challenge the health seeking behavior of the mothers, but the culture gives the husband a power of protecting his woman that makes him over protective and couldn’t understand why she needs to see a health worker/doctor for her health, we are losing a very big number of mother in Somaliland in the child bearing age and the leading cause is “wrong health seeking behavior” with other contributing factors such us limited access in rural areas and poverty.
As we are talking about good traditions we had practices of breastfeeding, some mothers use to breastfeed up to 2 years that was well appreciated but when the urbanization started that practices reduced and changed to bottle feeding that is not health for the mother neither for the child, we need to promote the breastfeeding and learn from our culture.
The child spacing is another huge challenge that health and believes don’t match, health promotes a healthy child spacing methods that supports the mother to have a good time between the pregnancies as well as the child get enough time to grow and thrive but there is some myths that people believes about the modern spacing (pills, injection and implants) that it’s a foreigner agenda that want us to not grow as a population this is a very challenge piece of work that health workers must work hard and promote healthy child spacing with the community.
Women use to walk long distance and still they are in the rural areas, they build their houses “Somali Huts” they care for their cattle, and move from one place to another by foot, that is healthy they were fit and they use to eat fiber rich foods and drink milk, these are good practices that the city life is reduced women can’t do, they are risk on obesity (baruurtu in kastoo qurux tahay somalida . being fat is beauty in Somali context) and other chronic disease like hypertension, osteoporosis (bone diseases) Vitamin D deficiency because they are always in their homes or in cars (some in offices) that reduces the sun exposure and other disease that come with immobility, healthy lifestyle is needed and fitness clubs for only women to be initiated.
Empowering Women- Health, Well-being and Development
Somaliland can reduce maternal and child mortality which is the highest in the world (High maternal (850/100,000 lb) and child mortality (146/ 1000 lb); for achieving the health goals the country must improve in terms of women empowerment and considering its fundamental value in improving women’s well-being and overall positive impact on the family, women empowerment must consider as an important and essential public policy goal. It has been argued that economically empowered women can play a more active role in household decision-making and have greater bargaining power to increase spending on education and health. Women empowerment expands the freedom of choice and action to shape women’s lives and in the long run not only contributes to individual woman, but to the family, society and the country as a whole. Women empowerment is considered as necessary condition for development, although it is not a sufficient condition. Women empowerment has several dimensional focuses and envisages greater access to knowledge, social and economic resources, and greater participation in economic and political decision making processes. It seeks change in the sexual division of labor, equal access to food, healthcare, education, employment opportunities, ownership of land and other assets and access to the media. Despite the involvement in numerous household and income generating activities women’s contribution to the family income is yet to be recognized equally.1
Women will be empowered and they will take care of their health when we understand the positives sides of our culture that promotes women’s health well-being and we discourage the negative practices, creating health promotion and health education starting from schools to peer groups, markets and within the communities/villages were women are available, letting women lead their programs and work to improve their health well-being and development, women need to be in the decision making positions but before that let them decide on their health to decide when to seek health and advices this to lead to let women legally sign the life asving surgical operations.
Somaliland Yaa u Maqan? – Who is Out there Working for Somaliland?
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
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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