in Somalia

Part 1: Delivering TB Services Successfully to Nomadic Populations

Q. Welcome, Dr. Rusagara, maybe you could begin by telling us about Tuberculosis in Somalia in general.

The disease in this country is considered to be quite prevalent, the figures we have indicate that it is one of the high burden countries in the region and in the world; TB is quite a big public health problem, it is also shared by the local health authorities, whenever they put their top priorities it comes in the top three.

Q. And what percentage of Somalia’s population is nomadic?

In the North, Somaliland and Puntland have a higher figure of nomadic communities than the south because in the South we have agro-pastoralists who are more or less settled. Probably it could be 40% nomadic and maybe 60% agro pastoral.

Q. How many TB patients have you reached and treated successfully?

Since the Global Fund programme started, we have seen a total of 22,178 TB patients, and this is actually up to end of June this year, so it is like a year and three quarters. Out of these 12,042 were smear positive. During the first year of the programme the treatment success rate has been 88.1 % .

Q. How do you manage to reach constantly migrating communities with treatment, especially since TB treatment needs continuous patient monitoring?

We have been trying to establish facilities in almost all regions, which we have achieved… there are 18 regions of Somalia; we have a facility at least in every region. With the nomads moving around it is quite a big challenge especially in the long drought months they can move hundreds of kilometers away sometimes even in other countries like in Ethiopia for example… so it’s a big challenge. However, when it’s not the long drought month there are predictable areas where they can be found and they do have a nucleus location where they sell their meat and milk and from these points they can access health facilities, but as I say it’s a major challenge really.

What the TB programme has been doing…through the health information system, if we know some patients who might move then they are transferred probably to the next facility because there has to be communication with a nearby facility where they could go, however of course some of these people may not go to areas where there are facilities. We have been having ideas of how to reach them, like mobile case findings, we have been discussing if possible, nomadic health workers who would be able to move to follow these people, and preferably from these communities who would ensure that at least the very necessary basic services can continue to be given to these communities.

The numbers have been very encouraging, there has been an increase of case detection of TB patients, and the Global Fund has accelerated this so much in the last 2 years since the Global Fund came in, we had about 30 TB centers across the country, now the number stands at 46. This has even provided services to remote areas than before.

Q. And what about staffing? Do you always have health personnel all through the year?

We train at least a minimum of two health workers to provide DOTS and a minimum of one laboratory microscopist who will do the diagnosis. Some of these trainees go and train the other workers at their health facilities, and in addition to that we have a team of supervisors, clinical and laboratory supervisors from the Somali nationals who are quite mobile and they monitor and do-on job training.