A Country with High Mortality Rate

During the past years, Somalia, one of the poorest and lawless countries in the world has been faced with economic and political challenges that led to copious crises.  It is one of the most erratic countries in Africa and the internal conflict that subsist continues to be a burden for policymaker which make it even a completely dysfunctional nation under self-governance or control detained by local leaders.  The population of Somalia is principally categorized by tests of poverty, suffering, relocation, death and health issues.  Given all these dreadful situations in which this population endure, several steps should be taken by the authority to relieve this hardship condition and diminish the rate of mortality and morbidity. Retrospective analyses of healthcare system of this country arouse us as future healthcare professional to select this country for this term paper (Lankarani, 2011; Mohamed, 2012; Roth, 2014)

Location/Geography

Somalia is situated in the easternmost part of the continent of Africa.  It is positioned alongside of the Gulf of Aden and the Indian Ocean.  This country is circumscribed by Djibouti in the northwest, Ethiopia in the west, and Kenya in the southwest. It has two main rivers which are Shebelle and the Juba (Cordes, 2014).  This fatherland comprises of four precincts and eighteen regions including the sovereign of Somaliland and Puntland. According to World Health Organization the population is estimated 8.7 million (World Health Organization, 2012).  The climate in Somalia is arid or semiarid and the land is typically consist of plateau consists of plateau region (Hadden, 2012).

The Population of Somalia

According to World Population Review, the census carried out on 01 January 2015 estimated the population of Somalia at 10 693 319 people (“Somalia population,” 2015). The population was 10 524 610 in 2014. It means that it has increased by 168 709 people being equivalent to the induction of 1.60% (“Somalia population,” 2015). Somalia experienced a positive rise in 2014 since the number of birth rates was higher than of death. However, external migration led to the decline in its population by about 124 296 (“Somalia population,” 2015). 0.984 was the sex ratio for the total population. It simply means 984 males per 1,000 females (“Somalia population,” 2015). This ratio is lower than the worldwide one being as 1,016 men per 1,000 women within the same period (“Somalia population,” 2015).

There were 449, 506 births in Somalia in 2014 and 156,501 deaths fixed (“Somalia population,” 2015). There was a natural increase of 293,005 people and a net migration of 124, 296 people (“Somalia population,” 2015). By 31 December 2014, the number of males had been 5, 303, 596 and 5, 389, 723 of females accordingly (“Somalia population,” 2015). According to Countrymeters, the population of Somalia is expected to increase by about 171, 414 people during 2015 and will continue to rise to 10,864, 733 by the beginning of the year 2016 (“Somalia population,” 2015). Somalia experiences more births than deaths during 2015. This number will be more by 297, 702 (“Somalia population,” 2015). In case the country experiences the same level of external migration as in 2014 then there will be a decline in its population by 126, 288 people due to migration issues (“Somalia population,” 2015).

Somalia is expected to have 1, 251 live births on average on a daily basis, which will be about 52.14 per hour (“Somalia population,” 2015). The number of deaths daily approximately will be 436. It is equivalent to 18.15 per hour. Therefore, the number of immigrants is projected to be 346 daily being equal to 14.42 per hour (“Somalia population,” 2015). Somalia will experience an increase in the number of its citizens. This figure will be 470 people per day during 2015 (“Somalia population,” 2015). As of November 2015, the population density of the country is 16.8 persons for each square kilometer (“Somalia population,” 2015). According to the United Nations Statistics Division, Somalia has the total area of 637 660 square km (“Somalia population,” 2015).

The Government of Somalia

President Siad Barre was overthrown in 1991 and the country had stayed without a formal parliament for over two decades (Njoku, 2013). Somalia had faced the years of anarchy until the internationally-backed government was put in place in 2012 (Njoku, 2013). It was the beginning of some form of stability for Somalia after a long time. Before it, the clan members and various senior figures tried to set up their own government in 2000 at the conference held in Djibouti (Njoku, 2013). Abdulkassim Salat Hassan was appointed as the president during this conference. The leaders came up with the transitional government aimed at reconciling warring militias. However, it made a small progress concerning creating the unity in the country by the time its mandate was coming to its end. Protracted talks were held in Kenya in 2004 between the main warlords and politicians (Njoku, 2013). They were able to sign a deal with an aim of setting up a new parliament. It even appointed the president later on. It was the 14th time that Somalia was attempting to set up the government starting from 1991 (Njoku, 2013).

According to Njoku (2013), the authority of this government was compromised in 2006 when Islamists arose and took control of most parts of the south of the country including the capital. The move happened initiated by their militia who managed to kick out the warlords out of place being in control for about 15 years (Njoku, 2013). However, by the end of 2006, the interim had managed to take back its power from the Islamists with the help of Ethiopian troops being loyal to the administration (Njoku, 2013). The Islamists insurgents including Al-Shabab group fought both the Ethian forces and the government. They had managed to get back control of most parts of the Southern part by late 2008 (Njoku, 2013). Although the Ethiopian troops pulled out in 2009, Somalia continued to fight to establish peace. In 2012, they were able to elect officials to govern their country (Njoku, 2013). They selected a new speaker and a federal parliament, a new President by the name President Hassan Sheikh Mohamud, and the national constituent assembly. They even named their new prime minister and cabinet. On 17 January 2013, the United States gave the government of Somalia a formal recognition (Njoku, 2013).

The Economy of Somalia

According to Miller and Kim (2015), the economy of Somalia is largely informal and depends on its livestock, telecommunications and money transfer companies. The country largely relies on the agricultural sector more than any other areas. Within it, 40% of its GDP comes from livestock while over 50% is derived from export earnings (“Somalia economy profile 2014,” 2015). Most of the people living in Somali are either nomads or semi-pastoralists that mainly depend on livestock for their livelihood. Somalia has a variety of exports such as bananas, fish, sugar, machined goods, corn, and sorghum among others (“Somalia economic outlook,” 2015). This country consisted of a small industrial sector which thrived because of processing agricultural products. This area has experienced a lot of looting and even the machinery itself has been sold as scrap metal. Another sector which Somalia benefits from is the telecommunication industry. Such firms provide the cheapest call rates on the entire continent (“Somalia profile – Overview,” 2015). In addition to that, these companies offer wireless services to most major cities. The main market of Mogadishu has the selection of goods ranging from food to electronic gadgets. The private-security militias support hotels, which enable them to operate. Mogadishu being the capital city of Somalia has been able to develop. It has its own supermarkets, gas stations, and even flights between Europe and Mogadishu (“Somalia profile – Overview,” 2015). However, it is not the case for the rest of towns, which are still struggling to achieve this kind of economic growth (“Somalia economic outlook,” 2015).

State of Health

Somalia has been at civil war for approximately two decades. It is considered one of the most violent, poorest, and least developed countries in the world. Considerable population movement, especially in the south-central region has been caused by the extreme violence that has taken place. That situation is aggravated by austere floods and famine. Among the 9 million occupants, 1.5 million were internally displaced in 2011 (Sindani et al., 2013). The most common causes of illness and death are represented by communicable diseases, and the ratio of maternal mortality and deaths of children less than 5 years of age figures among the highest in the world (Sindani et al, 2013).

According to Sindani et al. (2013), Furthermore, in order to evaluate the effect of 18 months of violence and scarcity in Somalia in 2011, nutrition and mortality surveys were conducted across 17 zones of the southern part of the country. According to those surveys, the global acute malnutrition was superior to 20% in 15 zoned studied and the mortality rate among those less than 5 years of age was ranged from 4.1 to 20.3 deaths/10 000/ day ( CDC, Morbidity and Mortality Weekly Report, 2011). Along with violence and malnutrition, communicable diseases have also taken a gigantic toll on the Somalian population. Tuberculosis represents a serious health problem, in 2011, the incidence was 300 cases per 100 000 persons ( CDC, Morbidity and Mortality Weekly Report, 2011). Multidrug-resistant tuberculosis (MDR TB) was found in 5.2% of new treated and 40.8% of previously treated for tuberculosis ( CDC, Morbidity and Mortality Weekly Report, 2011). Among all the countries in Africa and the Middle East, Somalia MDR TB figures among the highest levels ever documented (Sindani et al, 2013).

The Culture and Traditional Medicine of Somali

The studies indicate that more than half of people of this country live in rural areas. Therefore, they prefer to be treated by traditional healers (Lewis, 2015). The people of Somalia have their beliefs when it comes to the causes of diseases and some ways to treat them. They believe in their ancestors just like many African societies. The Somali people attribute some illnesses to sin, supernatural causes, evil eye, and envy wronging and so on (Newland, 2012). They have different types of healers who play various roles in the society. Generally, two kinds of healing systems exist in Somalia. These are Cauterization and Traditional Bone-setting (Newland, 2012). Almost every Somali is cauterized during the childhood or adulthood. These people have the belief that a disease and fire cannot co-exist. Therefore, some illnesses are usually burnt. Such examples include facial paralysis, rachitis, hepatitis, and parotitis (Newland, 2012). A piece of wood, palm or even nails are the instruments normally used for the process of cauterization. The traditional bone-setting is now the most advanced form of healing. It requires elementary materials such as wood and cortex removed from particular plants to carry out the healing system. It is normally used to treat fractures (both simple and complex ones). A lot of people prefer this system due to the fact that it involves simple immobilization and also the fractured zone gets massaged (Lewis, 2015).

The Somali people have their own culture, which contains many things. A child is normally given three names; the first name belongs to that individual; the second one is the father’s name; and the third is that of the paternal grandfather (Capobianco & Naidu, 2011). The person’s status in community is determined by the way how strong his or her character is, the level of education, the wealth, the knowledge of the Qur’an, the family history, and so on (Capobianco & Naidu, 2011). The men are regarded as the heads of the household; and women have the responsibility of managing finances and caring for their children. The Somali community considers a family to be very sacred and the most important aspect of life. The person in this country normally lives with his or her parents until getting married. Somali people consider it disrespectful to refer to them in terms of clans or tribes due to the fact that the civil war in their country is based on the conflicts between fractional units (Lewis, 2015).

Healthcare System and Delivery

For several decades, the civil war has been conducted on the territory of Somali. Now, almost the three fourth of its economics is destroyed, which resulted in the significant changes in all spheres of people’s lives and livelihoods. This paper will discuss the situation concerning the healthcare system in Somalia.

Nowadays, Somalia is a federation, so, to analyze the real condition of the health service, one should review it dividing the country into 3 parts: the southern-central, north-eastern and north-western (World Health Organization, 2014). There is the Ministry of Health and Labor in Somalia, but its influence on the health service in different parts of the country is not equal (“Somalia Health Sector”, n. d.). It is located in the north-eastern Somalia, and it performs the role of the organization that coordinates the activities of the international and local nongovernmental ones. It has a quite weak influence in the south-central and north-western parts.

The healthcare personnel are quite poorly trained in Somalia. The latest survey of the healthcare workers was conducted in 2007 by the World Health Organization. According to this study (World Health Organization, 2014), there were approximately equal numbers of the physicians in different parts of the country in 2007: 94 in south-central part, and 85 and 74 in north-western and north-eastern areas respectively (World Health Organization, 2014). It made 3 doctors per 100,000 citizens (World Health Organization, 2014). The situation with the pharmacists was even worse. There were only four of them in the south-central and 17 in the north-eastern Somalia (World Health Organization, 2014). The situation with the qualified nurses is frightening as well, considering the repeating military clashes in the country. There were 189 nurses in the south-central part, and 336 nurses in each of another two (World Health Organization, 2014). So, it made 11 qualified nurses per 100,000 citizens (World Health Organization, 2014). Considering the enormous death rate among parturient women and babies, it is also necessary to pay attention to the number of the midwives in the country. The number of them was the following: 10, 59 and 47 midwifes in south-central, north-western, and north-eastern parts of Somalia respectively (World Health Organization, 2014). It made 2 qualified midwives per 100,000 citizens (World Health Organization, 2014). The healthcare personnel in Somalia also included the auxiliaries and technicians, whose number was 1412 in 2007 (World Health Organization, 2014).

As there is an extreme lack of the healthcare personnel in Somalia, almost all nursing educational programs are sponsored by the foreign organizations. Due to the small number of the educational establishments that provide the nursing training (UNICEF, n. d.) they are basically focused in the capital of the country. Thus, one of the biggest centers of the nursing education is Mogadishu University of Somalia. As to the other educational programs, so-called SOS programs of Somalia are available here, and the SOS Vocational Training Center was established here too. In this center, people can pass the 3-year training and become the qualified nurse or midwife (Standun, 2012). There are also some SOS programs sponsored by famous American healthcare company Johnson & Johnson, which support the nursing class in Mogadishu and train the nurses in different spheres (Standun, 2012). There is also a nursing school funded by the Turkish Red Crescent in the capital of the Somalia. One should also mention the Amoud University, which has the baccalaureate in nursing and trains the qualified nurses (Standun, 2012).

In Somalia, there is the Somaliland Nursing and Midwifery Association, established in 2004, which protects the nurses’ rights, assists them in getting the qualified education and tries to control the level of their knowledge (Somaliland Nursing and Midwifery Association, 2014).

Despite almost complete devastation of the country, the Somalia healthcare system was not entirely destroyed and is now recovering due to the foreign help. However, the situation with the doctors, nurses and midwives is quite pitiable. Their number is too small in proportion to the number of Somalis. Still, due to the increasing number of training centers, which provide the education of the healthcare personnel, one can suppose that their qualification and number will improve in the near future.

Health Priorities

Somalia has a moderately structured public health system. The health authorities and some international as well as national NGOs are responsible for governing this public flow (Capobianco & Naidu, 2011). The research shows that the South Central region of the country has the limited government when it comes to delivering public health services. Health facilities across Somalia provide low quality maternal and child health provisions. Most of facilities operate at the level that is below the standard capacity. There is the lack of skilled staff. They are paid insufficient salaries, which prevent them from delivering top quality health services (Miller & Kim, 2015). The supervision and management status does not help affairs as they are ad-hoc.

Somalia meets high levels of illiteracy and isolation particularly among women. There is the little knowledge on the issues concerning health risks normally associated with pregnancy and childbirth (“Somalia population,” 2015). Most of these women do not have any information on the modern medical practices. In addition to that, they do not trust preventive medicine like birth spacing and vaccination. Only few females seek out these services. Poverty is prevalent in the country coupled with illiteracy, the lack of power to make decisions among women, and the low value placed on the health of females (“Somalia population,” 2015). Decision making with regards to reproduction is also challenging due to some existing social and cultural norms of reproduction. Therefore, it significantly reduces the rate of positive outcome for mothers and children. The number of immunization is low in Somalia, which is about 30% to 40% for children (“Somalia population,” 2015). It, therefore, puts them at a higher risk of getting vaccine preventable diseases. Some of them are fatal to their lives.

Nursing Implications

The people of Somalia have experienced the worst health problems in the world even as other states are having an improved health sector (Capobianco & Naidu, 2011). This country has one of the highest mortality rates even though the efforts have been made to change this. The nursing profession in conjunction with the government and health organizations can play a great role in improving the health area of the country. It can come up with a strategic plan that focuses on building the capacity of the government towards improving health services. This plan should have a realistic and clear framework of how national resources can be allocated to benefit this area (Capobianco & Naidu, 2011). The health services in some areas particularly South Central Somalia are almost destroyed. Therefore, their priority should be to consolidate and maintain the very crucial utilities in these zones in addition to providing access and security permits (“Somalia economy profile 2014,” 2015).

The health department can work together with the local and international organizations to expand the service coverage and provide basic health care needs. Individual and organizations related to the environmental health can incorporate school based education in order to increase awareness about modern health services. It can work if there is a good level of coordination among various humanitarian and development agencies. Since Somalia is facing high illiteracy levels, many professionals in nursing can develop their studies to be able to provide better health care services to the general population. It will also solve the problem of severe shortage of qualified health practitioners which the country is currently facing. This process will increase the number of nurses, staff, doctors, and midwives. In addition to that, community health workers will need to expand their services to rural areas where they are also required. It will involve setting up many more health centers and hospitals.

Conclusion

Somalia is a country that has faced many problems over last years. They have negatively affected the country as well as its health sector. That is why Somalia falls under the category of those states with the highest mortality rates. Looking at various aspects such as the culture, people, population, health priorities, and so on gives the one a better understanding of its situation. It makes it easier think about the solutions to these challenges and how Somalia can rise and greatly improve its health area.

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