Improving access and quality of maternal and newborn care through the newly established Ayaan Specialist Hospital in Bosaso City, Puntland State of Somalia

Somalia has one of the highest maternal mortality ratios globally, constituting an important public health issue for the country. The availability of free and quality obstetric and newborn care services is critical for reducing maternal and newborn deaths. The Ayaan Foundation for humanitarian assistance has established a specialized hospital in Bosaso, Puntland, Somalia and created a cost-free service for normal deliveries and caesarean sections with assistance from the UN Population Fund. The Ayaan Specialist Hospital aims to provide better health and free basic and emergency obstetric and neonatal services to reduce maternal and neonatal morbidity and mortality. The hospital has high standard facilities, equipment, and supplies and is run by a highly specialized medical team implementing advanced quality services and supported by well-trained midwives and nurses that are available around the clock. The hospital has a clinical diagnostic laboratory, medical imaging facilities and provides quality drugs. Services were initially paid out-of-pocket, which was a problem for low-income clients. Pregnant women now have access to a comprehensive package of services at the hospital regardless of their socioeconomic status. During the initial period of January 2020 to June 2021, only 223 pregnant women attended the hospital; however upon easing the requirement for payment between July 2021 and June 2022, a total of 1,213 women of childbearing age attended the hospital. Among the full-term mothers, 218 had a normal vaginal delivery (36%), while 386 (63%) underwent caesarean section. The majority (84%) of these were treated as situations of emergencies. This approach has successfully increased facility-based births among poor women in the city and its surrounding rural districts. The initiative to establish the hospital was taken in view of the need to promote a free maternal health care policy to effectively realize universal access to and the full utilization of facility-based delivery across the country.