1. Framework for Rebuilding Public Health Systems in Somalia Fozia Abrar, MD, MPH Department Head/Medical Director HealthPartners Occupational and Environmental Medicine

2. Facts Life expectancy at birth: 50 yrs. Maternal mortality ratio: 1044 per 100,000 live births ( WHO- world health statistics 2010) U5 mortality rate: 200 per 1,000 births Access of population to clean water: 29% national ( 59% urban, 11% rural) Infant mortality rate: 113/1000 Childhood immunization coverage<30%

3. Health It is estimated that Somali children have the highest infant and child mortality and morbidity rates in the world. Lack of access to primary and basic secondary health services. Lack of access to safe water and sanitation Lack of access to conduct vaccination and other life-saving activities in some regions continues to impact negatively on the health of children.

4. Leading causes of Death in Somalia Infectious Disease (HIV,TB) ARI (children) Diarrheal Diseases ( Children) Measles Poverty/Malnutrition

5. Contributing factors to Maternal Mortality FGM related complications Malnutrition/anemia in pregnancy Inadequate maternal health services Delayed referral systems Unskilled birth attendants

7. Major human costs of Somalia since 1991 450,000–1,500,000 excess deaths caused by Somalia’s intermittent conflicts Nearly one million Somalis live as refugees in Kenya, Djibouti, Ethiopia and one third of Somalis are currently displaced. 350,000 to 750,000 people are facing famine conditions and are at risk of death Disease Outbreaks are challenge in South Central Somalia. OCHA ( United Nation Office for the Coordination of Humanitarian Affairs)

8. Public health programs have an opportunity cost Difficult to attach value to something prevented The cost of providing services to thousands of polio victims if child was not vaccinated. Preventing HIV infection by changing behavior versus treating cases Preventing heart disease, stroke versus treating complications: death

9. Public health programs cont’d Preventing diabetes versus treating complications Reducing tobacco use versus treating lung, throat cancer, MI Access to prenatal care versus maternal and infant deaths Preventing maternal/infant HIV transmission versus treatment

10. Leading Causes of Death in USA ( Minino et al 2002 ) Heart Diseases Cancer Cerebrovascular Disease Chronic (lower) Respiratory Disease Unintentional Injuries Diabetes Mellitus Influenza

11. Recommendations for the Future Training community health care workers to work with and among pastoralist and agro-pastoralist communities Role of Diaspora is very important in rebuilding the health and education sector Strengthening MCH and Health posts Access to safe water and sanitation

12. Recommendation – Trained/motivated public Health workers – Money from major donors – Building public health clinics – Strengthening local health departments – Public/private initiatives – Investing in prevention/community medicine.

13. Investing in prevention Heath education Childhood immunization Maternal health programs

14. Role of the Diaspora Community Fundraising Teaching at local universities Visiting professors Sponsoring medical students

15. Role of donors Money Capacity-building

16. Role of the government Reestablishing the National Health Policy: to provide equitable and affordable preventive and curative health care services and thus ultimately better health status ie. reduce morbidity and mortality that will increase life expectancy” Building capacity of health centers

20. TTTT