1. INFLUENCING NATIONAL POLICY OVERSEAS ‘experience from fragile states, a case of Somaliland

2. Health Consortium for the Somali People (HCS) THET Somaliland is a member of the Health Consortium for the Somali People (HCS): the HCS provides innovative and collaborative health solutions, bringing health experts together to deliver a holistic approach to better serve the Somali people. HCS was designed with both the public and private health sector in mind, ensuring equitable and efficient access to quality products and services. HCS is the most responsive implementing health partner operating in all 3 zones of Somalia. HCS has a proven track record of implementing EPHS service delivery in collaboration with the ministry of health

3. 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 and collaborative

4. WHAT HAS BEEN ACHIEVED ACHIEVEMENTS  MoH leadership mind-set change to embrace the set up of useful guiding policies and guidelines:  National Health Policy;  National mental health policy (together with GRT) ;  Human Resource development policy and 5 years strategic 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 no guiding policies to help shape the programmes;  Most of donor and implementing partners are keen to obtain immediate results of their investment and policy development is seen as a long, an expensive process with no immediate tangible results;  MOH team also advocates mainly for visible activities that are seen to be beneficial with less focus on policy development;  Traditionally, in most post conflict and fragile states health related policies is among the mandate of the WHO

5. 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 the implementation

6. 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 bureaucratic process 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.

7. IMMEDIATE OUTPUTS FROM INFLUENCING WITH OTHER ACTORS  USD 165, 000 & 388,535 received from WHO over two year period to support Community 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 and training module developed.

8. CHALLENGES  Stakeholder engagement delay the policy making process.  Policy dissemination poses challenges as its limited to the urban centres.  Lack of clarity on stakeholders and departmental roles in who is responsible for what creating competition.  Sometimes WHO think the mandate of policy development is solely theirs and no one else.  Religious and customary believers interfere with the processes.

9. RECOMMENDATIONS  A clear policy needs to be identified in the health sector strategic plan  A standby policy review committee should be constituted to minimise delay in policy review process  Fair-play by WHO and flexibility in their “political mandate” and allow other organisations with expertise and capacity to support MOH in policy development.  IMPORTANT: VERY CLOSE RELATIONSHIP WITH MoH

10. Thank You!