Improving Private Sector Stewardship in Somalia and Somaliland

This blog is a part of PSI’s Health Systems Accelerator series: Big Ideas. Small Bites.

By Hilary Kinka, Private Sector Engagement Technical Advisor, Health Systems Accelerator, PSI

There is a lot we can do to shape stronger and more resilient mixed health systems, even in countries that are just beginning their journey toward Universal Health Coverage (UHC).  Somalia and Somaliland, for example, have been affected by decades of conflict which caused their public health infrastructure has crumble, opening an opportunity for private healthcare providers to fill the vacuum.  Although private providers offer services to around 90 percent of consumers, private sector health data is not reported into national Health Management Information Systems, and therefore Ministries of Health have no insight into the depth or breadth of private sector service delivery.

Beginning in 2018, PSI partnered with the Federal Government of Somalia, Ministries of Health in Puntland, Somaliland, and Jubaland, and other key development stakeholders to set strategy and introduce mechanisms to strengthen stewardship of the private health sector within their mixed health systems.  PSI supported three interventions designed to accelerate progress toward UHC:

  • Shaping strategy: We supported the Somaliland and Puntland Ministries of Health to finalize their Health Sector Strategic Plans, and the Federal Government of Somalia and the Ministry of Health of Somaliland to develop private sector engagement strategies.
  • Setting up systems for data collection and visualization: PSI worked with the Puntland, Somaliland and Jubaland Ministries of Health to roll out data-to-action frameworks that define how to analyze, visualize, and interpret health services data. We piloted national, regional and district level dashboards to measure progress against health sector strategic plan targets, and introduced an approach for Ministries of Health to assess the quality of data entered in the Health Management Information Systems (HMIS) and then to address gaps.
  • Integrating the private sector in the national HMIS: PSI supported the Somaliland Ministry of Health to pilot an approach to collect data from 17 private facilities, training their providers on the HMIS tools used by the public sector. Private providers used WhatsApp to share data, which was then aggregated in District Health Information System 2 (DHIS2). Through their DHIS2 dashboards, the Ministry of Health was able to view public and private sector data side by side for the first time in Somaliland, even if for just for the private health facilities in the pilot.

Reliable and timely health information is an important first step for health systems to strengthen their performance. These activities set the foundation for government officials to make evidence-based decisions to improve overall population health and pave the way for improved governance of the private sector. They established a positive relationship between private and public sector actors where no relationship may have previously existed, and it helped move towards public-private data integration. As a result of our work in the private sector, the public sector stakeholders now see PSI as a dynamic partner in helping to build a strong mixed health system.

Additionally, a functional health information system is a critical pre-condition for future health financing arrangements, and for the inclusion of the private sector in insurance mechanisms. The ability to participate in health financing options will also further incentivize private providers to regularly submit accurate data.

Our work in Somalia and Somaliland presents applicable learning that can inform how we — across countries and contexts — can build the foundation needed to progress toward UHC. It’s never too early to start.

We want to hear from you! How are you supporting governments to strengthen health systems? What have you learned? Email us: [email protected]

Banner photo credit: Sebastiano Rossi

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