The 2020 GAP progress report highlighted work by GAP signatory agencies to support the Government of Somalia’s extensive efforts to recover from long-term instability and conflict by strengthening primary health care to achieve UHC. Since then, in the face of both the COVID-19 pandemic and alarming numbers of pneumonia-related child deaths, the GAP accelerator working group on innovation and access with leadership from the WHO innovation team has worked in the last year to support the urgent scale-up of medical oxygen in the country.
An infant battling pneumonia in De-Martini hospital, Somalia. ©WHO
In response to needs expressed by the Somali Ministry of Health in April 2020, WHO, UNICEF, UNFPA and other members of the GAP innovation and access accelerator working group sourced potential suppliers and funders of medical oxygen innovations among members of the International Development Innovation Alliance (IDIA). Grand Challenges Canada (GCC) was identified as a potential funder and suggested several mature innovations in medical oxygen in which it had already invested. The proposed innovations were then assessed by a technical respiratory expert panel convened by WHO. Agencies in the GAP accelerator working group (including WHO regional and country offices), the funder and the innovators then presented five innovations to the Somali Ministry of Health, which expressed particular interest in a solar-powered medical oxygen concentrator. In September 2020, GCC agreed to fund the first pilot installation of three solar-powered oxygen concentrators in Hanaano General Hospital, Dhushamareb, Galmudug state, and the equipment was installed in January 2021 with ongoing support from the WHO Innovation Team and regional and country offices. The WHO country office is also procuring three Pressure Swing Adsorption (PSA) oxygen plants. In addition, WHO and UNICEF have worked with other UN agencies to jointly procure and distribute 200 portable oxygen concentrators across the country. The UN Resident and Humanitarian Coordinator played a valuable role in engaging UN agencies in these efforts through the Somali UN Country Team.
The GAP working group on research and development, innovation and access aims to apply its successful experience in rapidly matching demand, supply and financing for solar-powered oxygen in Somalia to other countries and innovations, with a focus on supporting an equitable, PHC-led recovery from the COVID-19 pandemic.
Challenges posed by COVID-19 in the last year have further demonstrated the need to expand and improve essential services to the population and work continues in Somalia towards UHC through PHC. In March 2021, the Ministry of Health presented to the GAP PHC accelerator working group the valuable contributions of joint and coordinated support by GAP signatory agencies in several fields including the COVID-19 response and work to strengthen the essential package of health services and related health system components. The Government also outlined challenges inherent to the country context of protracted crisis and inequalities; fragmented, uncoordinated efforts among humanitarian and development programmes and partners, their lack of alignment with country priorities and the need to improve equity in health coverage.
Somalia’s request to GAP agencies is to support the country’s efforts to strengthen PHC as the backbone of UHC and health security. This implies further effort to translate GAP commitments made at the global level into closer collaboration and reduced fragmentation among partners at country level, with country offices mandated to respond to country needs. With such an approach, GAP agencies can support Somalia in:
- Enhancing the role and capability of the health authorities at federal and state levels in governance, regulation and management;
- Improving access to a high-quality essential package of health services with a stronger equity approach across states and attention to vulnerable and hard-to-reach populations;
- Strengthening emergency response capacity, as part of the UHC roadmap, through the new National Action Plan on Health Security and the operationalization of the humanitarian-development-peace nexus;
- Engaging private sector healthcare providers and other professionals to enhance progress toward UHC; and
- Building on the capacities enabled by the World Bank’s Pandemic Emergency Financing Project involving emergency and trauma care from community level to intensive care in hospitals for progress on PHC and UHC.
Overall, alignment by health and development partners to help improve PHC and implement a revised essential package of health services presents multiple opportunities for collaboration among GAP agencies across accelerator themes, including to operationalize the development-humanitarian-peace nexus and to capitalize on social interventions and networks to expand health service coverage and increase equity for the people of Somalia.