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
| BRIEFING · ON THE GROUND
What it actually takes to save a mother’s life in rural Somalia Eight villages. 34 women recruited from their own communities. Two years of home visits through drought, insecurity and seasonal floods. This is what evidence-based maternal healthcare looks like in practice. |
The debate about community health workers is often abstract — numbers, coverage rates, policy commitments. This section draws on field evidence and direct testimony to describe what it actually looks and feels like to deliver maternal health care in one of the most isolated corners of Somalia: what works, what breaks down, and what the communities themselves say.
The terrain
Eight villages in Dhusamareb District, Galmudug State. The nearest town is between 20 and 65 kilometres away over dirt roads that flood in the rainy season. There were no health workers here before this programme began. 82% of women had no formal education. 71% had delivered their last baby at home, assisted by a traditional birth attendant. 59% could not access the nearest facility without a car — a significant financial burden for households living in poverty.
A CHW’s week
Each community health worker carries iron supplements, mosquito bed nets, water purification tablets and soap on foot visits that can take 20–90 minutes each way. She counsels on danger signs in pregnancy, clean cord care for the newborn, the importance of skin-to-skin contact — a practice that conflicts with cultural norms about modesty in the presence of family and required sustained, sensitive negotiation over many months. She uses a WhatsApp group to reach her supervisor in real time when she encounters a complication she has not seen before.
| “Awareness gained in sessions spreads beyond participants — mothers share lessons with relatives, who carry these practices back to their own communities.”
— Programme monitoring narrative, Galmudug |
Where the model hit limits
One village — Haadfull — illustrates what happens when a programme designed for average conditions meets extreme geography. Households were 8–15 km apart. There was no central meeting point. Group sessions were impossible. CHWs could not reach households on foot. The programme team arranged a private vehicle for supervision visits — a cost not in any budget line. Some planned activities did not happen. Women in Haadfull received less than women in other villages.
EQUAL’s research is direct about what this means for the national strategy: a caseload standard designed for urban density cannot be applied to dispersed rural communities. The commitment to reach the hardest-to-reach will remain aspirational unless the operational standards change.
What the community said
| “Before, only traditional midwives helped. But now I follow the advice of CHWs, and I have seen the difference.”
— Woman client, Galmudug |
| “Resistance was due to lack of understanding, not cultural incompatibility.”
— Community dialogue participant, Galmudug — reflecting on initial resistance to the programme |
Sceptical mothers-in-law acknowledged that prior practices had been wrong. Husbands who had refused to allow their wives to participate became active supporters after observing health improvements. The shift took time — and consistent presence over two years.
| There are 34 trained, experienced community health workers in Galmudug right now. They have two years of evidence behind them. Their communities trust them. Somalia has a launched Community Health Strategy. The question is whether the system will act on what it knows — by funding their pay, standardising their training, and building the supervision infrastructure that made them effective. |
Contacts
General EQUAL enquiries: EQUAL@rescue.org
Dr. Abdi Dalmar (SORDI): drdalmar@sordi.so
Dr. Hawa Abdullahi (SORDI, midwifery study): hawa.abdi@sordi.so
Asia Mohamed (SORDI, Midwifery specialist): asia@sordi.so
Shatha Elnakib (Johns Hopkins, midwifery study): selnaki1@jhu.edu
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.
