Somaliland is a self-declared but internationally unrecognised state in the Horn of Africa. A brutal civil war ending in 1991 destroyed much of Somaliland’s health infrastructure and displaced many of its health workers.
Somaliland has some of the world’s worst health indicators and a healthcare system beset by problems at the institutional and individual levels. Institutions suffer from weak leadership and management, poor coordination and regulation, and over-stretched, under-resourced staff. There is a serious shortage of health workers, recently estimated at 197 doctors, 1,256 nurses and 344 midwives, serving a population of around 3.5 million. This level of coverage falls far short of the WHO-recommended minimum health worker/population ratio of 2.3/1,000. This shortage is compounded by significant skills gaps in the workforce, with very few opportunities for clinicians to access formal postgraduate training, leading to the absence of specialists in most areas of clinical practice.
Despite these problems, optimism surrounds Somaliland, which has been described as an overlooked African ‘success story’. Emerging from a conflict that ended only 25 years ago, Somaliland is a young democracy that has held successive free and fair elections and remains peaceful and stable in a tumultuous region. The health sector has made remarkable progress since 2000, the date KSP volunteers first visited, when there were no medical schools, no regulatory body, only one nurse training course and few hospitals.