MEDIA BRIEFING
Saving mothers and newborns in Somalia:
Five years of evidence from conflict, crisis, and community
EQUAL Research Consortium · Mogadishu, May 2026
International Rescue Committee (IRC) · Somali Research and Development Institute (SORDI) · Johns Hopkins Center for Humanitarian Health
Funded by UK International Development from the UK Government
Community health workers and Somalia’s new strategy
Somalia’s new Community Health Strategy commits to prioritising the hardest-to-reach communities. New field evidence shows what that takes — and what is lost when the model is not properly resourced.
Somalia has a new Community Health Strategy. It commits to reaching women in remote, insecure, displaced communities — exactly the women most likely to die in childbirth. EQUAL’s community-based programme in Galmudug just completed 24 months of implementation in eight of the most isolated villages in the country. The results are the best available evidence for what the strategy will need to deliver — and what will go wrong if it is underfunded.
The programme
Who: 34 trained female community health workers (CHWs), recruited from the same 8 villages as their clients
Where: Gadoon, Balicad, Mareerguur, Ceeldheere, Faragooy, Halanley, Haadfull and Olol — 20 to 65 km from the nearest town, Dhusamareb. No pre-existing health workers in these villages.
What: Home visits providing counselling, iron supplements, bed nets, water purification tablets, and support for breastfeeding, clean cord care and newborn thermal care
When: December 2023 – December 2025
Reached: 1,165 pregnant women; 5,335 antenatal visits; 1,780 postnatal visits
- CHW competency scores exceeded the 80% benchmark from the third assessment onward — and were sustained
- 98% CHW retention over the full 24 months
- Community-based care did not reduce women’s use of health facilities — it complemented it
Building trust — what it took
| “Every household calls them out of trust and confidence.”
— Community dialogue participant, Galmudug |
“Before, only traditional midwives helped. But now I follow the advice of CHWs, and I have seen the difference.”
— Woman client, Galmudug
| “Before those ladies came, we had no idea about exclusive breastfeeding. Now I follow what the CHW says, and I can see the difference in my baby’s health.”
— Mother-in-law, Galmudug |
Initial resistance was common: some families expected money or gifts; some elders rejected CHW advice; some husbands refused to allow their wives to participate. By the end of the programme, many of those same men had become active supporters. Trust was earned through consistency, cultural alignment and results — but it took sustained presence over months.
What the national strategy must get right
| 1. Recruit locally. CHWs were recruited from the communities they serve. Shared language, religion and social ties are what make home visits acceptable. Outsiders do not work.
2. Lower caseloads in rural areas. The national standard is 1 CHW per 150 households — designed for urban density. This programme used 1 per 50. In one village, households were 8–15 km apart on foot. The strategy must adopt a travel-time standard for rural areas, not a household count. 3. Pay CHWs fairly and reliably. CHWs were paid $100/month by IRC. The government rate is $120/month — but many CHWs in other programmes go unpaid. Unpaid volunteer CHWs are not a workforce. They are a temporary arrangement that collapses when donor funding ends. 4. Invest in supervision. Competency scores exceeded benchmarks because supervision was structured, regular and supportive. Where supervision was disrupted by distance and security, performance suffered. |
Contacts
General EQUAL enquiries: EQUAL@rescue.org
Dr. Abdi Dalmar (SORDI): drdalmar@sordi.so
Dr Mohamed Jimale (SORDI): mohamedjimale@sordi.so
Muna Jama (IRC, community programme): muna.jama@rescue.org
Website: www.EQUALresearch.org
About EQUAL
The EQUAL Research Consortium is funded by UK International Development from the UK Government and operates in Somalia, DRC, Nigeria and South Sudan. In Somalia, EQUAL is led by IRC, SORDI and Johns Hopkins Center for Humanitarian Health, in collaboration with Somalia’s Federal Ministry of Health. The programme runs July 2021 – April 2026.
