- A community health project in Somalia's Puntland region, partly financed by the Red Crescent and the World Bank, has proven successful despite initial doubts. The project's health clinic even was maintained open through local means as the region was isolated from the outside world for over one year.
In Qarhis, located three hours from Garowe, a main town in Puntland, a community health project has surprised its donors. The World Bank and the International Red Cross and Red Crescent did not have high expectancies when funding a project in Somalia, which often has been described as the quintessential failed state.
By now, however, Priya Gajraj - the World Bank's country officer for Somalia - has no doubt about the dedication of the local community in Qarhis to keep their health clinic in operation.
Beginning in 2002, the clinic was shut off from the outside world for more than a year - a victim of local fighting. And for that long year, Ms Gajraj says the local community kept the doors of its health clinic open - without any outside international assistance.
Somalia has had no central government and been split among clan-based militias since the fall of the regime of Major General Mohamed Siad Barre in 1991. The years of civil war have exacted a severe toll. Indicators suggest health standards in Somalia are among the worst in Africa. Life expectancy is 47 years - one of the lowest in the world. Nearly one quarter of all children die before they reach their fifth birthday.
It was against that background, the World Bank became involved since 2000 in efforts to improve community health services in Somalia with funding from the Bank's Post-Conflict Fund. With no national government in place, the Bank joined forces with the Somalia Red Crescent Society and the International Red Cross/Crescent to fund health centres in Puntland and Somaliland.
- The Somalia Red Crescent Society was one of the only remaining institutions operating throughout the country after the collapse of the government, according to Ms Gajraj. The region of Puntland and the self-declared republic of Somaliland however have had internal peace since they set up government structures.
According to Sarah Cliffe, head of the World Bank's Low Income Country Under Stress (LICUS) unit, the health project in Somalia's Puntland represents a clear example of the Bank working with the non-government sector to improve the lives of those in difficult environments.
The Qarhis clinic is located in a sparsely populated area. "To get to the clinic you have to drive for several hours. It is complete desert and there - in the middle of nowhere - is a small community," says Ms Gajraj, describing her trip to Qarhis community clinic.
It is a health clinic that comes not only with a clinic and laboratory, but also with an enclosure so visitors to the clinic can house their livestock. "This is a pastoral nomadic community. Many patients, with their livestock, travel from far distances in Somalia and also from the border area with Ethiopia," Ms Gajraj explains.
Ms Gajraj says the aim was to build community ownership of the project - a feat that has being achieved. "In the last three years, the community has put in 15 percent of the running costs of the services," she says. "That shows it is a service they value and they have demonstrated their high level of commitment to the project."
A review of the project conducted for the World Bank through the Red Cross has found the project successfully improved the health condition of the most vulnerable - women and children - as well as men and the elderly, living close to the clinics. The people received basic curative care, using essential drugs, as well as antenatal and postnatal care and immunisation services.
The review says the "project impacted positively on the lives of the communities. It reduced mistrust of the health system, thereby motivating people to come for consultation, antenatal and postnatal care and treat. The health education caused a decline in the incidence of diarrhoeal diseases." Ms Gajraj says the intention now is to use the clinics as a model to replicate, adapting it to local context.
And in another venture in Somalia, the World Bank is seeking to work with local communities to provide support on animal health services at the community level. The World Bank's Country Re-Engagement Strategy for Somalia, which was approved by the Bank in 2003, cites livestock as an area for strategic intervention in the country.
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