UNICEF, together with other international and local NGOs, is currently developing a STD/HIV/AIDS prevention and control programme in Somalia. It was decided, therefore, that a situation analysis as well as a response analysis be conducted to inform the process of developing such a programme. Data from this situation analysis provides information on STDs services and HIV/AIDS interventions. This information can also serve as baseline measurements in the future to monitor and assess the impact of any STDs/HIV/AIDS intervention programmes. A second study, which is a response analysis, will form the second part of the study. This study also provided the opportunity to strengthen the Situation Analysis methodology. This relatively new approach has not been used in Somalia.
Purpose / Objective
The ultimate objective is to provide comprehensive information on the availability and functioning of STDs/HIV/AIDS services in Somalia, so that needed improvements and expansion can be planned and implemented.
- to document the level of preparedness (availability and function status) of STDs/HIV/AIDS programme's major subsystems to provide STDs and HIV/AIDS services using the integrated approach
- to determine the need for STDs/HIV/AIDS services among populations receiving these services at the health facilities
- to determine the integration of FP, STD management and AIDS prevention procedures at the clinic level
The study collected information from a total of 28 Non Governmental Organizations (NGOs) and International Agencies working in Somalia. Some of these NGOs and International Agencies are based in Nairobi. The regions covered by the study include: Benadir, Beletweyn, Hudur, Baidoa and Berdera in the Central and Southern zone; Bossaso, Garowe and Galkaio in Puntland in the North East zone; and Boroma and Hargeisa in Somaliland, North West zone. The study used a set of structured self-administered questionnaires. More than 40 questionnaires were distributed to the NGOs and Agencies, but only 28 were returned before the deadline. Of the 28 questionnaires that were returned, only 23 were adequately completed. The Situation Analysis covered in this preliminary report is, therefore, based only on 23 questionnaires with complete information.
Key Findings and Conclusions
The provision of family health services, including STD/HIV/AIDS services in Somalia, is largely dominated by NGOs and the International agencies, which comprise about 77.3%. Government and privately-owned health care services provide only limited services for the control of STDs.
Nearly half (45%) of the projects/programmes are located in major regional towns. 25% are located in major administrative capitals, mainly in Nairobi. Half of the projects have between one and two project sites, 18% did not indicate the number of project sites, and about one third have between three and sixteen project sites. Only 64% of the projects stated their project goals.
Nearly 96% of the organizations studied work in health projects while 41% work in emergency and water projects/programmes. More than 90% of the projects are have both clinic- and community-based services compared to only 18% with only clinic/facility-based services.
The services provided by the projects range from ante-natal (91%), post-natal (82%), curative (86%), control of sexually transmitted diseases (77%), well-baby clinics (child health) (68%), family planning (45.5%), and HIV education (36.4%).
Although majority of the projects target mainly the general population (86.4%), many have specific target audience, such as clients seeking MCH/FP services (55%), clients seeking STD treatment (55%) and women of reproductive age (68%). There appears to be less effort exerted to targeting adolescents (41%), in-school youth (30.4%) and out-of-school youth (27.3%).
Efforts are being made by some of the projects to screen clients for potential STD infections. About 46% of the projects confirmed that they do routinely screen their clients for STDs.
Laboratory services are lacking for many of the projects. This is confirmed by the finding, after having asked projects, of the methods their staff use to make diagnosis for specific STDs. The specific STDs were listed as syphilis, gonorrhoea, HIV/AIDS, candida and trichomoniasis, and the two main means of making diagnosis are laboratory and syndromic approach. Only 43% of the projects report that adolescents have access to information and services for STDs and HIV/AIDS. Topics covered during a typical STD counseling session include: prevention of STDs/HIV/AIDS (73%); risk reduction through safer sex (55%); treatment seeking practice/behavior (59%) and availability of treatment facilities (59%).
Free condom distribution and their use is not very popular/common in Somalia. Only 27% of the projects report that they provide free condoms to male clients presenting with STD symptoms, 14% provide condoms to female clients with STD symptoms, and 32% to female clients attending MCH/FP clinics, as contraception possibility. Less than 5% of the projects provide condoms to female adolescents, and 23% do provide condoms to male adolescent youth.
Only 14% of the projects report that they provide voluntary counseling and testing for HIV sero status.
All the projects interviewed did not report availability of community outreach services. Asked as to which IEC materials are available to clinic/facility staff to use, 46% of the projects mentioned posters, 32% mentioned pamphlets, 18% fact sheets and 9% mentioned other promotional materials and anatomical models, respectively. Less than 10% of the projects design/develop their own IEC materials, 14% get from national AIDS control programmes and NGOs, respectively, 23% get from international agencies and less than 5% get from other Ministry of Health departments.
More than 63% of the projects do not have budgets for STD/HIV/AIDS control programming.
There is need to provide staff of health facilities with adequate training in the whole range of reproductive health, especially STIs and HIV/AIDS. Apart from training service providers in the management skills for individual services, there is a need to train them on how to provide these services using the integrated approach. Providers must receive adequate training in counseling.
Provision of improved laboratory diagnostic equipment and supplies must be made to all the facilities currently providing blood screening and STI diagnosis. Efforts should be made to encourage free condom distribution in order to increase their use for double protection against unwanted pregnancy, and STI and HIV/AIDS infection.
The findings also suggest that adolescents do not receive adequate access to reproductive health information and services, as do adults. There is a need to design youth-focused and comprehensive youth-friendly reproductive health services, including STI and HIV/AIDS. Introduce school-based STI, HIV/AIDS and reproductive health services to in-school youth in order to target young adolescent girls and boys completing schools.
Introduce street theatres to target out-of-school youth with HIV/AIDS prevention information so that they can make informed decisions about their own sexual and reproductive health behavior. Provision of culturally-acceptable IEC materials should be increased to all static and outreach services so that information reaches those who are otherwise difficult to reach.
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HIV/AIDS - Situation Analysis