Clinical Excellence in the Somaliland Health System to Improve Patient Care

LSE Principal Investigator: Rocco Friebel
LSE team: Maeve Bognini, Meskerem Kebede, Mariam Dahir
Start Date: 01 June 2025
End Date: 31 December 2025
Funder: Global Health Partnerships
Partners: Population Services International (Lead)
Region(s): Africa
Countries: Somaliland
Keywords: Maternal and neonatal care; global surgery; Project ECHO; capacity building

The health system in Somaliland faces significant workforce challenges, including critical shortages of skilled health professionals, uneven distribution of staff across regions, and persistent gaps in competencies, supervision, performance, and retention. These issues present major barriers to the provision of safe, accessible, and high-quality maternal and neonatal care. The maternal mortality ratio (MMR) in the country was estimated to be 396 maternal deaths per 100,000 live births in 2020.

The GHWP-ECHO project seeks to address these challenges by adopting the Expanding Community Healthcare Outcomes (ECHO™) model to strengthen Basic and Comprehensive Emergency Obstetric and Newborn Care (BEmONC and CEmONC) services through sustainable, community-based tele-learning, knowledge transfer, and professional exchange.

Running from June to December 2025, the programme is being implemented across three regional hospitals, two district hospitals, and 23 health centres nationwide. By connecting specialist and non-specialist maternal and neonatal care providers, the project aims to build the capacity of the existing health workforce and contribute to achieving Somaliland’s National Vision 2030.

The Global Surgery Policy Unit is supporting the programme’s evaluation by tracking routine attendance data, administering knowledge and feedback surveys, and conducting focus group discussions with key stakeholders to assess programme benefits, impact, implementation challenges, and opportunities for improvement and sustainability.

The GSPU, in close collaboration with Population Services International (PSI), is also supporting the establishment and strengthening of Maternal and Perinatal Death Surveillance and Response (MPDSR) and Quality Improvement (QI) Committees in three regional and two district hospitals. Additionally, PSI is developing dashboards within District Health Information Software 2 (DHIS2) to inform Human Resources for Health planning. These efforts aim to enhance the Ministry of Health Development’s leadership and governance of the Essential Package of Health Services, fostering a culture of evidence-based decision-making to improve maternal and perinatal health outcomes in Somaliland.