Njiru Haron Ndwiga, Relan Pryanka, Malik Sk Md Mamunur Rahman, Abdullah Azad, Shube Mukhtar, Abubakar Ali Haji Adam, Nur Ibrahim, Osman Abdinasir Yusuf, Sonethal Paul, Rouhani Shada, Olayo Bernard, Ohno Naoko, Sindani Ireneaus Sebit, Osman Ali Abdirahman, Hossain Md Shajib, James Ndithia, Alabesat Monther, Derow Mohamed
World Health Organization, Country Office, Mogadishu, Somalia.
World Health Organization, Geneva, Switzerland.
BMC Emerg Med. 2025 Jun 2;25(1):89. doi: 10.1186/s12873-025-01234-8.
Data on emergency and critical care services in Somalia and other countries with fragile and conflict-affected (FCA) situations are limited, although the burden of emergency health conditions remain high. Improving emergency care services could significantly help improve health outcomes and realize the goals of achieving the Universal Health Coverage in these fragile countries.
We conducted a cross-sectional survey to assess the service availability and readiness for emergency and critical care (ECC) services in the country covering 131 hospitals in Somalia. The survey included both the public and private sector hospitals as well as those at the district, regional and national level hospitals representing the whole organizational structure of emergency health care system in the country. We administered the WHO Hospital Emergency Unit assessment tool which was slightly modified and adapted for this assessment. The survey included questions on the availability of staff, supplies/equipment, services, and systems. The respondents were hospital administrators and clinicians in outpatient departments, emergency departments and inpatient units. An overall median capacity score indicating the service availability and readiness for ECC was calculated for the country as well as for each hospital. Data were collected from December 2020 to March 2021.
A total of 524 staff members across 131 hospitals participated in the survey. The median and interquartile range (IQR) ECC readiness score for all health facilities in the country was 0.31 (0.22-0.46) and only 26 (19.8%) facilities assessed had a median readiness score of more than 0.5 (p value = 0.001). Using the cut-off point of 0.5, over 80% of the hospitals assessed were not considered ready to provide ECC services in the country. The third-level hospitals of the private sector including those facilities situated in predominantly urban areas were found to have better readiness to provide ECC services. User fees, lack of equipment and the absence of staff availability around the clock were identified as the most common barriers to emergency and critical care readiness.
This is the first study of its kind to be conducted in Somalia using a standardized tool and methodology and provides a comprehensive understanding of emergency and critical care services available in Somalia by facility type and levels of care. The study highlighted that significant capacity gaps exist at all levels in the provision of emergency care services especially in the public sector and at the first-level of care. Investment in emergency care services is urgently needed in the country bringing the primary care into the care continuum for ECC services along with implementing a set of cost-efficient interventions at the first-level of care given the country's high burden of emergency health conditions.
Not applicable as this assessment was not a clinical trial.
索马里以及其他处于脆弱和受冲突影响（FCA）状况的国家，关于紧急和重症护理服务的数据有限，尽管紧急健康状况的负担仍然很高。改善紧急护理服务可显著有助于改善健康结果，并实现这些脆弱国家实现全民健康覆盖的目标。
我们进行了一项横断面调查，以评估该国131家索马里医院的紧急和重症护理（ECC）服务的可用性和准备情况。该调查涵盖了公立和私立医院，以及代表该国紧急医疗保健系统整个组织结构的地区、区域和国家级医院。我们使用了世界卫生组织医院急诊科评估工具，并对此进行了轻微修改以适用于本次评估。该调查包括有关人员配备、物资/设备、服务和系统可用性的问题。受访者是门诊、急诊科和住院部的医院管理人员和临床医生。计算了该国以及每家医院的总体中位数能力得分，以表明ECC服务的可用性和准备情况。数据收集于2020年12月至2021年3月。
131家医院的总共524名工作人员参与了调查。该国所有医疗机构的ECC准备情况中位数和四分位间距（IQR）得分为0.31（0.22 - 0.46），只有26家（19.8%）评估的机构中位数准备得分超过0.5（p值 = 0.001）。以0.5为临界点，该国超过80%的评估医院被认为没有准备好提供ECC服务。包括那些主要位于城市地区的私立部门三级医院，被发现有更好的准备提供ECC服务。用户费用、设备短缺以及全天候工作人员不足被确定为紧急和重症护理准备的最常见障碍。
这是在索马里首次使用标准化工具和方法进行的此类研究，并通过设施类型和护理级别全面了解了索马里现有的紧急和重症护理服务。该研究强调，在提供紧急护理服务方面，各级都存在重大能力差距，特别是在公共部门和初级护理层面。鉴于该国紧急健康状况负担沉重，该国迫切需要对紧急护理服务进行投资，将初级护理纳入ECC服务的护理连续体，并在初级护理层面实施一系列具有成本效益的干预措施。
由于本次评估不是临床试验，因此不适用。
