Inconsistent healthcare delivery structures: Somaliland and Puntland have relatively structured public health systems governed by health authorities or by a variety of international and national NGOs or by a combination of the two, while in South Central Somalia the delivery of public health services is mainly by private and NGO actors with limited government oversight in most regions. The packages of services are not standardized and depend on NGO capacity rather than national norms and standards.
Low demand for health services: Given the high levels of illiteracy among women, and lack of awareness among families and communities about health benefits and risks related to common household practices there is low demand for preventive, promotive and curative health services for maternal and child health.
Low immunization coverage with polio and measles outbreaks: Low immunization coverage has led to an outbreak of polio and measles cases inside Somalia. Since May 2013, 199 polio cases have been reported, mostly from the South and Central areas and in 2014 five more cases were reported from Mudug region in Puntland. The last case was in August 2014 and in August 2015 the outbreak was officially declared over. An increased number of suspected measles cases (10,279 in 2014 and 6,304 from January to October 2015) have been reported. The present immunization coverage (DPT3) of about 43% in Somalia is far from sufficient to prevent a spread of vaccine preventable diseases.