Somaliland. Capacity Building within Healthcare (CBH) – Final Evaluation Report

Background:

Capacity Building within Healthcare (CBH) is a project implemented in Somaliland by the Norwegian Lutheran Mission (NLM) operating under the local name Nooleynta Naruurada Mustaqbalka (NNM). The project has been piloted since 2008/9 in partnership with Somaliland Ministry of Health, Edna Adan Hospital, Hargeisa Group Hospital and the University of Hargeisa Medical Faculty. The evaluation of this project is carried out between October 6th and November 1st 2014.

Since 1991, Somalia has been without a functioning central government and has experienced a prolonged humanitarian crisis due to a civil war that still affects large parts of the country. The civil war destroyed most of the infrastructure, displaced large populations, and took a heavy human and financial toll on the Somali population (World Bank 2006). In 1991, the Northwest declared the independent state of Somaliland. Several other regions have since declared independence unilaterally and implemented semi-autonomy over their population (Sorbye and Leigh 2009). Since its self-declaration of independence in 1991, Somaliland has against many odds established a system of democratic governance and embarked upon an ambitious development agenda including designing a National Development Plan (NDP 2012-2016).

The immediate beneficiaries of the CBH project’s pilot phase were the medical and nursing students, clinical workers at partner hospitals and academic staff at health teaching institutions. The projects’ long term beneficiaries were the general population of Somaliland with particular focus on mothers and children.

Purpose/objective:

The main purpose of the evaluation was to establish the achievements, effectiveness and impact of the CBH strategy as well as take cognizance of the termination process and lessons learnt with regard to empowering health care workers in Somaliland through capacity building and knowledge transfer activities.

Methodology:

The evaluation utilized a triangulation approach in data collection. The data collection methods included documentary analysis of all project documents and a purposive selection of 22 key informants was interviewed. The respondents were selected from within the CBH project team (both local and expatriate), partner facilities specifically Edna Adan Hospital and Hargeisa Group Hospital, development partner agencies and learning institutions. Both quantitative and qualitative research methods were applied to enrich the content of the evaluation report.  Site visits; the evaluation team also conducted site observations and two focus group discussions with midwives and 5th year medical students.

Key findings:

The evaluation exercise revealed that the CBH project has greatly contributed in assisting the MoH address its main challenges that pertain to the health workforce by:

• Capacity building of health care workers through trainings in neonatology, ETAT+, Helping Baby Breath (HBB), anesthesia and developing a neonatal unit in Hargeisa Group Hospital.
• Supervision of medical students during clinical rotations.
• Establishment of a clinical coordination unit at HGH that rationalizes clinical rotations for medical doctor students.

CBH has succeeded in improving the clinical knowledge and skills of prospective health care workers and ensuring academic staff are linked to teaching institutions. Additionally, the CBH project has provided health care workers with the requisite competencies to not only deliver good medical care but to also act as change agents that catalyzes and inculcate medical ethics and values.

Recommendations:

Several recommendations emanated from the evaluation exercise ad were outlined in the following thematic areas

1. For capacity building efforts- implementing a pragmatic approach; a logical framework design for capacity building and; understanding contextual factors
2. For Future work in Somaliland – applying an ethnocentric approach and developing a technical expertise within SMEA
3. For approaches to capacity building- different approaches for considerations
4. For data demand information use and quality improvement
5. For scaling up- use of a diffusion approach and e-learning platforms.

Comments from the organisation, if any: CBH had contributed greatly to the future of medical workers in Somaliland despite the challenges and complexities in the region. The CBH team acknowledged the conclusions and recommendations in the report with some remarks: “there are many interesting thoughts in the recommendation section that we think are valid. The only suggestion we disagree with is the suggestion that the Somaliland society is receptive for a top-down approach. We rather think the strategy of NNM, starting with the grass-root and working towards the MoH level is the right approach. The lack of break-through in the advocacy level is more related to issues around expectations of personal gain, lack of clear authority lines and low ability the systematize change”.