Photo story: Improving quality of healthcare in Somaliland

In partnership with Qatar Charity, the Ministry of Health Development (MOHD), THET and the World Health Organization, this two-year project is laying the foundations needed to transform the quality of care that patients receive, leading to better health outcomes for all.

KGHP is working with Somaliland’s Ministry of Health Development (MoHD) to develop a national strategy to address the key, underlying causes of poor-quality healthcare. By the end of the project, all of the country’s regional hospitals will have better systems, and a more skilled workforce with the knowledge and skills to improve the quality and safety of healthcare for their patients.

Infection Prevention Control challenges in Somaliland’s six regional hospitals

Cleanliness and safety of hospitals is an area which the MoHD has identified as requiring improvement.

Water supplies across all six hospitals are limited, making it a challenge to prevent and control the spread of infection.

“Waste should be segregated and different categories of waste placed into separate containers for disposal. This isn’t happening most of the time, mainly due to lack of staff training around the proper handling of waste.” Dr Ahmed Askar, Director of Hargeisa Group Hospital

“You might find hazardous waste like biological waste put into the general waste, or find sharp materials just scattered in the spaces of the hospital.” Dr Ahmed Askar, Director of Hargeisa Group Hospital

A key output of the project will be the rehabilitation of handwashing and sanitation facilities, as well as the purchase of essential cleaning and waste disposal equipment needed to keep hospitals clean.

Since the hospital was built decades ago, the buildings and infrastructure can make it difficult to implement IPC and patient safety measures.

“The laundry room for washing and cleaning at the hospital is supposed to have two doors – one entrance for dirty clothes and one exit for clean clothes. But here unfortunately, we only have one door for entrance and exit. We need a better building with two doors to [prevent the two loads crossing paths].” Dr Abdifatah Ileeye, IPC Officer, Borama Regional Hospital

Strengthening Somaliland’s hospitals to improve the quality of care

Since the project launched in April 2023, we have worked directly with the country's six, main public hospitals in Hargeisa, Berbera, Boroma, Erigavo, Ainaba and Burao to lay the foundations for improving quality of care.

Training in WHO’s Patient Safety Friendly Hospital Framework (PSFHF) and Infection Prevention Control Framework (IPCF)

In September, we ran a “Training of Trainers” course for regional hospital staff and Ministry of Health officials, on the WHO’s Patient Safety Friendly Hospital Framework (PSFHF) and Infection Prevention Control Framework (IPCF); and on how to conduct hospital assessments to monitor IPC and patient safety measures.

Hospital assessments on IPC and patient safety

After completing the training, regional hospital staff and Ministry of Health officials, worked with the WHO experts to conduct assessments of Somaliland’s six regional hospitals, where the national quality improvement programme (NQIP) is being rolled out.

The assessments carried out at the six, main public hospitals have identified the critical areas to prioritise, and provide a benchmark to measure improvement in IPC, better governance and policies, a more skilled workforce and improved WASH facilities. Over the course of two years, NQIP will deliver a comprehensive programme of staff training, for an estimated 700 healthcare workers (including leaders, clinical staff, cleaners and security) on preventing and controlling infection.

"Assessments like these motivate staff to improve safety and accountability to patients... There has previously been poor commitment and accountability amongst healthcare providers and managers at facility levels. This programme is making us alert to the quality of care we provide for people." Hodan Adam Mohamoud, Head of Public Hospitals at the Department of Health Services and Hospitals, MoHD; and Strategy Lead for the National Quality Improvement Programme

"This project will allow us to develop protocols and guidelines for prescribing drugs, so doctors and care providers do not put patients at risk by over-prescribing unnecessarily." Dr Ahmed Askar, Director of Hargeisa Group Hospital

Other activities under the National Quality Improvement Programme

Since the project launched, we have also supported MoHD to begin planning for a National Quality Policy and Strategy to improve care across the health system. A national People's Voice Survey will feed into this, which consults citizens on their perspectives on care and allows them to contribute to setting government priorities.

Work has also begun to strengthen higher education for doctors, nurses and midwives, in order to build a stronger healthcare workforce, equipped to deliver quality of care. This component of the project will strengthen the governance of postgraduate medical education, by developing a national plan for education of medical specialists, and supporting medical schools to adopt the new national curriculum for medical education.