PSI update Jan-Nov 2014

INFLUENCING NATIONAL POLICYOVERSEAS ‘experience from fragilestates, a case of Somaliland

Health Consortium for the Somali People(HCS)

THET Somaliland is a member of the HealthConsortium for the Somali People (HCS):the HCS provides innovative andcollaborative health solutions, bringinghealth experts together to deliver a holisticapproach to better serve the Somali people.

•HCS was designed with both the public andprivate health sector in mind, ensuringequitable and efficient access to qualityproducts and services.

•HCS is the most responsive implementinghealth partner operating in all 3 zones ofSomalia.

•HCS has a proven track record ofimplementing EPHS service delivery incollaboration with the ministry of health

INTRODUCTION

Working with MOH –Somaliland since 2009

support is mainly on Health Systems Strengthening with focus on HRH:

Leadership, governance and management;

Health policy development;

curriculum review and development;

Task shifting approach to deliver quality health care in rural and hard to reach areas:

CHW;

Clinical Officers

Internship programme to enhance quality and better skilled young medical graduates

Policy, curriculum development and task shifting is core in HSS in fragile state

Requires profound and tactful policy influencing skills at national and regional level;

THET-MOH working relationship, the senior management team at MOH were very supportive andcollaborative

WHAT HAS BEEN ACHIEVED

ACHIEVEMENTS

MoH leadership mind-set change to embrace theset up of useful guiding policies and guidelines:

National Health Policy;

National mental health policy (together with GRT) ;

Human Resource development policy and 5 yearsstrategic plan;

Health Care Waste Management Policy;

In-Service training Policy and long term strategic plan(on going);

CPD accreditation guidelines (on going);

Integrated Supportive Supervision

CHALLENGES ENCOUNTERED

At the beginning of the joint journey, there were noguiding policies to help shape the programmes;

Most of donor and implementing partners are keen toobtain immediate results of their investment and policydevelopment is seen as a long, an expensive processwith no immediate tangible results;

MOH team also advocates mainly for visible activitiesthat are seen to be beneficial with less focus on policydevelopment;

Traditionally, in most post conflict and fragile stateshealth related policies is among the mandate of theWHO

Policy development process

The need identified jointly between MOH and THET team

Terms of reference are developed and advertised in the newspapers if:

required resource person cannot be accessed from the volunteers and/or staff

Establishment of a small multi-faceted taskforce to lead the overall work

draft is developed by the expert

Review and inputs/comments by the task force (MoH, Key stakeholders: UN &INGOs, LNGO and CSO)

Large sharing with all stakeholders and inputs/comments through consultative workshops;

Technical final review and validation by MoH senior Management

Technical validation by the stakeholders and donor community;

Endorsement by MoH leadership and presentation to the Cabinet for approval and commitment to support theimplementation

Policy influencing with other actors

Outstanding relationship with MoH developed and the capacity shown to deliver high quality outputs

 Inability of UN agencies working in Somaliland to implement their annual work plans due to bureaucraticprocess over the last two years of their operations

MoH convinced UN agencies to:

 Imitate THET operational strategies

Release financial resources to THET to deliver

THET team lobbied MOH team to jointly approach the UN agencies especially WHO and UNFPA

THET has been awarded 3 grants:

 Training 22 CHWs for 9 months

Support internship program for 35 interns;

18 months training for midwives in one of undersved region of Somaliland.

IMMEDIATE OUTPUTS FROMINFLUENCING WITH OTHER ACTORS

USD 165, 000 & 388,535 received from WHO over two year period to supportCommunity workers training and internship programme.

USD 134, 000 received from UNFPA to support a public health training institute.

Improved collaboration and working relationship with WHO and other actors.

Minimized competitions and duplication of activities.

UNICEF nutrition scoping study in Somalia worth USD 123,000.

Improved consultation and coordination at MOH level.

National Health policy and other key policies developed and implemented.

One frontline cadre training and another in the piper line with curriculum andtraining module developed.

CHALLENGES

Stakeholder engagement delay the policy making process.

Policy dissemination poses challenges as its limited to theurban centres.

Lack of clarity on stakeholders and departmental roles inwho is responsible for what creating competition.

Sometimes WHO think the mandate of policy developmentis solely theirs and no one else.

Religious and customary believers interfere with theprocesses.

RECOMMENDATIONS

A clear policy needs to be identified in the health sector strategic plan

 A standby policy review committee should be constituted to minimisedelay in policy review process

Fair-play by WHO and flexibility in their “political mandate” and allowother organisations with expertise and capacity to support MOH inpolicy development.

IMPORTANT: VERY CLOSE RELATIONSHIP WITH MoH

Thank You!