Executive Summary

Over the past three decades, Somalia has been an arena for endless armed conflict and natural disasters. The consequences of these events on the health sector in general and the health workforce, in particular, have been devastating, affecting the entire health service delivery. This study, commissioned by the Heritage Institute for Policy Studies (HIPS) and City University of Mogadishu, was conducted to assess the state of

healthcare in Somalia as it relates to human capital in the sector. The study also aims to provide an analysis of current challenges but also to put forward remedial solutions for system-wide recovery strategies.

Specifically, the study sought to identify health workforce shortages and skills gaps and to explore ways to overcome human capital development-related challenges.

Moreover, the study looked into existing policies, programs and health professional education institutions. Health authorities at the federal and member state level, the private health sector, health professional training institutions, health professional associations and development partners assisted with this study. Qualitative interpretative research was used as well as data collection methods, including key informant interviews, document review and analysis and focus group discussions.

The overall findings of this study show that healthcare services in Somalia are highly inadequate and the health workforce lacks the skills, knowledge, legal instruments and the necessary resources to do their jobs. Other findings include:

● Healthcare services, both public and private, are ill equipped to meet even the primary health service needs of the bulk of the population;
● There is a scarcity of all categories of health workers, particularly mid-level professionals and physicians;

● There are considerable gaps in skills;
● There is an improper allocation of health workforce (urban rural);
● Retention and motivation schemes are weak;
● There is an inadequate enabling environment for the health workforce;
● Training institutions are substandard and unregulated;

● There is an absence of adequate government oversight for the health workforce; and
● There are few health professional training institutions in the face of a rapid population.

These systemic inadequacies and challenges require an urgent scale-up of the production, training and skills enhancement of the health workforce. A continuing education program is needed to secure the attainment of universal health coverage (UHC) and health-related sustainable development goals (SDGs) and targets. In- service training activities could increase the knowledge and skills of healthcare workers and

systematically and sustainably enable them to attain higher competencies that will help them to produce desired health outcomes. The study presents a strategic direction through which Somalia could overcome the current health workforce shortage and skills gaps through a development process that provides clear objectives and how to achieve them.