By Hannah Burrows, Somaliland Programme Manager, Prepared for Practice Partnership, SPHEIR, King's College London

09 September 2019 - 13:32

Somaliland has some of the worst health indicators in the world, driven in part by a severe shortage of well-trained health workers. In 2015 a health workforce survey estimated that 197 doctors, 1,256 nurses and 344 midwives were serving the population of around 3.5 million, falling far short of the WHO-recommended minimum threshold of 23 health workers per 10,000 population. 

Whilst systemic challenges across the health system contribute to poor health outcomes, Somaliland’s health workforce crisis is rooted in challenges in the tertiary education sector. The country’s first university was not established until 1998, and whilst several health schools have since been set up, they are in their early years of graduating medical students. Critical gaps exist in the curricula and for many core health subjects, there is currently insufficient expertise within universities to design and deliver courses. Many academics have had no formal pedagogical training; their teaching practices focus on passive, didactic learning and students lack opportunities to develop their skills in clinical settings.

As a result, teaching institutions are unable to produce graduates who can apply their education to real world practice as health workers. Graduates lack the knowledge, skills, behaviours and practical experience they need to practice safe and quality healthcare. 

Prepared for Practice - addressing Somaliland's health workforce crisis 

Led by King’s Global Health Partnerships, PfP seeks to address Somaliland’s health workforce crisis through an integrated approach to health education system reform. Working at an individual level with students, at an institutional level with Hargeisa, Amoud and Edna Adan universities, and the national level with the ministries of education and health and development, the partnership seeks to graduate a new generation of health workers, and bring about sustainable, systemic change that will transform education for the health workers of the future.  

PfP supports the undergraduate education of medical, nursing and midwifery students at three of the country’s leading health schools. Through the design and delivery of online courses in subjects such as clinical reasoning and radiology, it delivers core components of the curriculum not currently delivered by universities. Online courses are delivered through MedicineAfrica, a digital educational platform that enables students in Somaliland to be taught part of their undergraduate courses by UK health workers. Small class sizes and live, interactive tutorials maximise discussion and feedback – an approach shown to be effective in developing clinical competencies. Students also participate in hospital ward rounds and field trips to health facilities to gain practical experience in a clinical setting.  

Systemic health reform through curriculum design

At an institutional level, the partnership is building the capacity of higher education personnel.  A certificate, diploma and master’s in health education – the first of its kind in Somaliland – builds the skills of health faculty to design and deliver engaging, student-centred courses. A postgraduate certificate in administration equips university administrators with the knowledge and skills to lead improvements in the management of their institutions. 

At the national level, the Tropical Health and Education Trust is leading a component to reform of the governance and management of health education. PfP supported the development of the first national Medical Education Policy which outlines how government, regulators, universities and other health system leaders can collaborate to produce a well-trained medical workforce to meet the health needs of people in Somaliland.  We also aim to support the development of a new national undergraduate medical education curriculum; standardised national medical examinations and an assessment of medical schools to ensure that institutions educating students meet internationally recognised education standards. 

Programme activities – from the development and delivery of courses, to curriculum development and technical assistance – are delivered by a network of over 100 volunteers who take time out of their work at the NHS and UK university sector to make this work possible. By October 2021, UK volunteers will have donated an estimated 24,000 hours, contributing time worth over £2 million.