Abstract
BACKGROUND: The recently published Somaliland Demographic and Health Survey indicated a growing prevalence of non-communicable diseases (NCDs) in Somaliland. However, evidence about the capacity of Somaliland's health system for effective management of NCDs is limited. This study assesses the capacity of hospitals selected from two regions of Somaliland for effective NCD management. METHODS: A previously validated questionnaire based on the World Health Organisation Package of Essential Noncommunicable Disease Intervention for Primary Health Care (WHO-PEN) was used to survey seven hospitals selected from Togdheer and Maroodi Jeex regions of Somaliland. The survey focused on assessing the capacity of selected hospitals in detecting and managing NCDs by collecting data on the availability of health workers, equipment, screening and management services, medications, and laboratory tests. The impact of location, level of care provided and source of funding on the capacity of hospitals was assessed. RESULTS: This study observed shortage of essential health workers and lack of workers with specialist knowledge across all hospitals surveyed. Higher average number of doctors in urban (4.3-fold, P < 0.001), referral centres (3.1-fold, P < 0.001) and public (3.1-fold, P < 0.001) hospitals compared to rural, general, and private hospitals respectively. A similar trend was observed for the number of nurses across the different category of hospitals. All hospitals have adequate quantity of functional basic equipment, but advanced diagnostic facilities were generally lacking. Where available, they were either not functional or there is a lack of expertise for effective utilization. Laboratories are across all hospitals categories were sufficiently staffed but there is a need for training in cutting edge diagnostic procedures. Imaging and laboratory services were observed as major cost drivers of NCDs expenditure. All hospitals surveyed have access to first line NCD medicines, lack community engagement activities, and have guidelines and referral systems that need updating. Imaging and laboratory services were observed as major cost drivers of NCDs expenditure. CONCLUSION: Though there are differences in the capacity of hospitals assessed, none of the hospitals met the WHO-PEN standard for human resources, equipment, and medicines for effective NCDs management. Interventions to train specialist health workers and laboratory technologists, procure advanced equipment, and update guidelines and referral systems in Somaliland are needed.