AT WHAT COST

Post-conflict Somalia was marked by total destruction of national institutions and social fabrics. The civil war affected the whole country politically, socially and economically. The health care system was not spared rather suffered the most severe form of destruction.  Somaliland has unilateral declared independence and started the rebuilding process.

Despite of tangible success in peace, reconciliation, rehabilitation and coordination of political institutions as well as democratization process, Somaliland has made little progress in health care delivery system. Apart from the inadequate funding of health care system, incompetent leaders at the ministry, lack of need-based well informed national health plan and insufficient trained health personnel; the Somaliland health system is ailing due to the burden of quack doctors, unregulated foreign health workers and the informal sector-traditional healers. The combined effect of these three factors is making Somaliland’s health care the most expensive one in Africa and is rendering young Somali doctors unemployed. This problem is stemming from the fact that there is no or little government oversight of the provision of medical services in the country. 

Due to the widespread privatization of health delivery, many private hospitals opted to bring expatriate doctors. This is because of the high illiteracy among the Somali masses that they think that every person with white skin is a good doctor. These doctors are not subjected to entrance examinations into the profession or at least not checked properly. On the other hand, many local quack doctors who have not attended medical school or are enrolled nurses are practicing in their private clinics as specialist. This people have adapted to the changing trends in the medical profession, though they have not attended medical school, they understood the dynamics of disease presentation. For instance if someone has a fever they will prescribe broad spectrum antibiotic, probably intravenous, an antivirus and an antifugal as well as strong pain killers and ant-inflammatories! A simple case of pneumonia may cost the patient an average of $100! This people are endangering the health and safety of the people and at the same time are competitively squeezing young newly trained doctors out of the market! No one is accountable to the negligence and medical abuse they do to our people. Their health service is very expensive due to their incompetence and ignorance!

The informal health sectors which is comprises the traditional healers, bone setter among others is also a major barrier to quality health services in the country. Though, they are more expensive than a medical practitioner, they still attract large number of clients. This is mainly because they dance to the tune of the masses. They give them meaningful cultural and religious explanation for their medical problems. For example if someone has presented with weakness of one side and deviated mouth due to stroke, these people tell the patient that an evil wind has struck them or a Jin has slapped them that is why they have a deviated mouth! For you as a doctor, it will be hard to convince the uneducated Somali patient that the cause of his deviated mouth is in the brain!

However, with the newly established NHPC (National Health Professional Council), there is some hope at the end of the tunnel. The NHPC have successfully started the registration and licensing process for all doctors and nurses in the country and this may alleviate some of the problem. It will be much better if the NHPC starts registering and licensing all health clinics so that no quack doctor runs a private clinic. This will create employment opportunities for young professionals who are the primary victims of this systemic deregulation. It will also be a great progress if the NHPC or the ministry controls the reliability and standards of the drugs brought into the country.  I also suggest that expatriate doctors should not come to work for us unless the skill they have is lacking in the country. What is the need of bringing physicians to work here?

Dr. Mohamed Bobe
Hingalool,  Sanaag.

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