Maternal and newborn health prioritization in post-transition Somalia: Analysis of key stakeholder perspectives at the federal level

Abstract

This case study explored the current drivers of Maternal and Newborn Health (MNH) prioritization in Somalia, a fragile country with very high maternal and neonatal mortality rates. To enhance MNH prioritization and improve outcomes, we need to understand macro contextual and health system factors that influence the level of attention and investment since 2012 with the establishment of the federal government of Somalia. This study consisted of a desk review and 20 semi-structured interviews with stakeholders in MNH policy and implementation, including government, donors, private sector, and non-governmental and multilateral organizations. The Health Policy Analysis triangle guided the analysis of findings, to capture policy content, context, actors, and processes. Our findings show a complex picture for MNH prioritization in Somalia. There is a level of priority for MNH through technical advancements driven by international partners, including development of policies, strategies, and guidelines. However, there is inadequate government ownership of the MNH agenda through poor domestic financial investment and capacity for governance (including partner coordination) in the health sector. The study found gaps in implementation of programs, and competing priorities due to insecurity and other health and social needs. Respondents highlighted a need to address fragmented accountability and oversight processes, and ensure meaningful inclusion of actors such as the private sector and the diaspora and women leaders.