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Project Case Study

Decentralising the Somali Health System

Supporting the Somali health authorities to improve health service delivery and increase government ownership

Health services in Somalia have previously been managed and delivered by a variety of international donors; agencies and NGOs.

With the increasing functionality of the Somali Government, and the creation of new states, the country is at a point whereby it can transition to a Government-owned, Government-led health sector.

Adam Smith International was engaged by the Health Consortium for the Somali people (HCS) to provide health systems strengthening expertise for the CHANGE programme.

Project info

Management Function for the Community Health and Nutrition through Local Governance and Empowerment (CHANGE)


  • Health Consortium for the Somali people (HCS)

The CHANGE programme, which delivers the Essential Package of Health Services in three regions across Somalia- Karkaar in Puntland; Gedo in Jubbaland and Sahil in Somaliland – is working with Government to improve the capacity of decentralised levels of the health system to manage the delivery of primary and secondary care. Our team of international and national experts conducted extensive consultations in-country with Government stakeholders for the purpose of determining a ‘snapshot’ of the current landscape and collected data regarding the gaps in the organisational capacity of the regional, district, facility and community levels of the health sector to manage the health system. With this information, our team worked with Government and the HCS to develop costed region specific implementation plans, to increase the capacity of each level to fulfil the management functions of the EPHS.

These included:

  • Planning and budgeting;
  • Governance and leadership;
  • Health management information systems;
  • Human resources for health;
  • Service delivery;
  • Health infrastructure (including commodity management).

Alongside these costed implementation plans, we developed structural and accountability frameworks, both for the CHANGE programme and for the health sector more generally. These are expected to be formally ratified by the respective health authorities in 2017. We also provided the HCS with an M&E framework to enable them to continue to measure their progress in implementing the plans and developing the EPHS management functions of government over the length of the programme.

The work conducted represents an important step in the trajectory of the Somali health sector: from a short-term humanitarian approach to a sustainable, evidence-based approach, that prioritises quality alongside quantity. Enabling a Government-owned health sector will enhance legitimacy of the Government, and as a result, increase the propensity of the respective states to succeed in their move towards the provision of high quality, decentralised, public services.

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