FEDERAL REPUBLIC OF SOMALIA

MINISTRY OF HEALTH
& HUMAN SERVICES

DEVELOMENT OF HEALTH
FACILITIES IN SOMALIA
PREPARE BY Dipl., Eng., Arch., MOHAMED AHMED FAGHI (National Advisor of
HFI)
CONTENT PAGE

COVER PAGE 3
SOMALI ADMINISTRATIVE MAP 4
PROJECT PROPOSAL 5
HEALTH FACILITIES INFRASTRUCTURE 6
 INTRTODUCTION 6
 The Essential Package of Health Services 6
 The Primary Health Unit (PHU) 6
 Maternal and Child Health (MCH) Centres 7
 The Health Centre (HC) 7
 The Regional and Central Hospitals 7
PHYSICAL INFRASTRUCTURE AND EQUIPMENT 8
MAPPING 8
CONSTRAINTS 8
ORGANIZATION 8
MODEL 8
DISTRICT HOSPITAL 9
ANNUALISED RECURRENT COSTS 9
PLAN 10
REFERRAL HEALTH CENTER 11
ANNUALISED RECURRENT COSTS 11
PLAN 12
HEALTH CENTER 13
ANNUALISED RECURRENT COSTS 13
PLAN 14
PRIMARY HEALTH UNIT 15
ANNUALISED RECURRENT COSTS 15
PLAN 16
SUMMARY 17
PLAN OF HEALTH FACILITIES PER REGION 18
INTRODUCTION
Health Facilities are central to health systems development. Hospital sector reforms, and
changes in hospital policies and practices, have enormous impact on health care and health
systems at large, and being embedded in a broad complex environment, hospitals have to
constantly adapt to changing circumstances within and beyond health systems. Factors
influencing hospital development are going to continue to change, and policy makers, managers
and other health care professionals should focus their special attention on hospitals rethinking
their future roles, functions, organization and configuration to be ready to anticipate and respond
to those changes.

No standard layouts, nor building guidelines, have since collapsed former government in
1991 up to current time elaborated. Existing health facilities follow a variety of models and
standards.
The health facilities should be based on standard architectural plans. The gap in health
infrastructure was identified largely at the level of health facilities, apart from the up-grading of
health facilities. New construction of health facilities was therefore focused on Main Regions
and Districts. The rate and magnitude of health facilities construction was determined by the
availability of financial and human resources. The cost estimates for furniture, beds and medical
equipment was not included.
To my knowledge the demand for medical buildings is acutely felt all over Somalia. It is all too
easy in the individual situation to lose sight of the broader context within which any new
building project should be seen, the immediate and often urgent requirements tending to
overshadow the wider perspective.

CONSTRAINTS
Most hospitals are still overcrowded, while some regions and districts has no hospitals, and also
there are shortage of funds, qualified staff and regular supplies are the major constraints. The
challenge for anyone working in such a unit is, within the given financial framework to maintain
improve and extend the services and to make the best possible use of available staff, buildings
and equipment. This calls for considerable organizational effort in a wide range of activities,
non-medical as well as medical. It also calls for imagination and an ability and willingness to
improvise. Accepted procedures may need to be changed and existing facilities may need
modification

A nation’s good health status translates to human and social development. It also plays a crucial
role in the region’s socio economic development. The distance to the health facilities, the cost
and availability of health services are the major health problem facing the poor.
Most of the districts have the same problem which has some equipped hospitals compared to the
other districts of the region. The community elders further asserted that sometimes if a car
accident or any other incidents occur in the areas, the casualties are rushed to main cities which
is very far. This distance from the medical facilities mostly leads to death of a person who had he
or she receive medical attention immediate could have been saved.
INTRODUCTION
The health facilities should be based on standard architectural plans. The gap in health
infrastructure was identified largely at the level of health facilities, apart from the up-grading of
health facilities. New construction of health facilities was therefore focused on Main Regions
and Districts. The rate and magnitude of health facilities construction was determined by the
availability of financial and human resources. The cost estimates for furniture, beds and medical
equipment was not included.
To my knowledge the demand for medical buildings is acutely felt all over Somalia. It is all too
easy in the individual situation to lose sight of the broader context within which any new
building project should be seen, the immediate and often urgent requirements tending to
overshadow the wider perspective.

HEALTH FACILITIES
While there has been no systematic review of Somalia’s health infrastructure, it is clear that both
the extent and the condition of the country’s infrastructure are poor. Limited funding is available
for infrastructure from development partners and the Government does not have a budget line for
infrastructure development. There is no database of facilities or policy and plan for improvement
of infrastructure or medical equipment based on population need. Infrastructure based on
population need can contribute to reducing inequalities but improving access, for example by
increased services (and healthcare worker housing) for rural populations, separate toilets for
male and female patients and staff, or access for people with physical disabilities.

SITUATION ANALYSIS
The physical infrastructure of public health facilities refers to the state of the buildings, the
water, electricity and communications technology available, the quality of access roads, and the
availability of equipment (both medical and non-medical) in working condition. Delivering
healthcare above a certain level of complexity is difficult in the absence of good infrastructure.
Shelter for patients and staff, drinkable water and a source of electricity for, among other things,
refrigeration for vaccinations, are fundamental for the safe provision of healthcare. A working
communications mechanism is necessary for the functioning of a referral system, as well as to
enable the provision of support services (such as laboratory services) to the facility.
There has been no systematic study on the conditions of Somalia’s public health infrastructure
over the years.
IN THE NAME OF ALLAH, MOST GRACIOUS, MOST MERCIFUL.

To: OIC (HEALTH)

Fr: FAGHI CONSULTING ENGINEER

DT: 26/04/2014

Subject: DEVELOPMENT OF HEALTH FACILITIES

Dear Sir,

We are pleased to submit to you the above-mentioned proposal for your consideration.
We think that the scope of this project is in line with the priorities of the program of action at this
stage. Therefore, we will appreciate if you consider if favorable. We will be glad to provide for any
further information that you might need in this respect.

In the meantime, we are ready to undertake the preparation of the executive design of the project if
you are entrusted to do so. We do have the capabilities and expertise to implement such project on
schedule and agreed terms.

We hope that this work achieves its purposes and goals; we look forward to receiving your comments.

Your prompt will be highly appreciated.

Thank you in advance for your cooperation

Yours truly,

DIRECTOR OF FAGHI CONSULTING ENGINEER

Dipl., Eng., arch., Mohamed Ahmed Faghi
 DISTRIBUTION OF HEALTH FACILITIES BY REGIONS & DISTRICTS
SN REGIONS AREA Km2 DISTRICTS POPULATION DH RHC HC PHU
1 Awdal Borama 215,616
1 4 10
Baki 25,500
10 6
Lughaye 36,104
1 4 7
Zeylac 28,235
1 1 5 5
2 TOTAL 576,543 4 395,455
2 2 23 28
Woqooyi Galbeed Hargeysa 560,028
2 6 10
Berbera 60,753
2 - 28 19
Gebiley 79,564
5 34 29
3 TOTAL 1,311,946 3 700,345 9 68 58
Togdheer Burco 288,211 4 2
Buuhoodle 38,428 1 13 15
Owdweyne 42,031 2 3 12
Sheikh 33,625
TOTAL 780,092 4 3 20 29
4 Sool Laas 75,436 1 2 5
Caanood
Caynabo 30,702 2 5
Taleex 25,354 1 10 7
Xudun 18,785 2 14 17
TOTAL 497,571 4
5 Sanaag Ceerigaabo 114,846
3 8 8
Ceel Afweyn 65,797
2 3 6
Laasqoray 34,724
1 5 11
Badhan 55,000
3 16 25
 TOTAL 388,559 4
3 8 8

6 Bari Armo 164,906 1 2 5

Bossaso 70,000 1 8 7
Iskushuban 5,759 1 3 7
Caluula 40,002 2 9
Ufain 45,027 1 2 15
TOTAL 1,116,850 6
7 Nugaal Garoowe 57,991 1 - 9 13
Burtinle 34,674 1 - 9 5
Eyl 32,345 1 - 6 5
Dan Goranyo 20,331 1 - 5 -
TOTAL 572,647 7
8 Mudug Gaalkacyo 137,667 1 1 13
Galdogob 40,433 1 1 4 6
Hobyo 67,249 - - 16 16
Jariiban 39,207
Xarardheere 65,543
TOTAL 817,701
9 Galgaduud Dhuusamarreeb 91,260 3 - 5 1
Cabudwaaq 41,067 7 - 7 5
Cadaado 45,630 2 - 6 4
Ceel Buur 79,092 - - 1 -
Ceel Dheer 73,008 - - 6 7
TOTAL 736,546
10 Hiraan Belet Weyne 144,345 1 - 14 2
Bulo Burto 89,120 1 - 5 -
Jalalaqsi 46,724 - - 1 -
Maxaas 21,918 - - 7 -
Matabaan 27,704 - - 7 -
TOTAL 457,546
11 Shabelle Dhexe Jowhar 218,027
Adan Yabaal 62,917
Balcad 120,434
Cadale 46,720
Warsheikh 15,573
Mahaday 51,230
Raaga
Run-Nirgod
Waberi
 TOTAL 918,463

12 Banadir Xamar Weyne 43,309 1 1

Hodan 71,590 2
Wardhiigleey 53,619 1 5
Boondheere 61,143 5
Xamar Jabjab 36,331 2
Waaberi 50,864 3
Wadajir 50,110 2
Kaaraan 123,171 1 3
Yaaqshiid 128,488 3
Shibis 79,751 1 4
Cabdulcasiis 22,153 2
Hawl Wadaag 39,114 1
Shangaani 24,368 2
Heliwaa 43,420 2 4
Dharkenley 40,983 4
Dayniile 32,769 4
TOTAL 2,874,431
13 Shabelle Hoose Marka 192,939 1 - 14 2
Afgooye 135,012 2 - 11
Baraawe 57,652 1 - 1
Kurtunwaarey 55,445 - - 3
Qoryooley 134,205 1 1 1 1
 Sablaale 43,055 - - 2 -
Wanla Weyn 155,643
Aw Dheegle 76,700 - - 2 -
TOTAL 1,477,523
14 Bay Baidoa 22 - 2 -
Buur Hakaba 227,761 1 - 1 -
Qansax Dheere 75,769 - - 2 -
Bardaale 98,714 - - 3 1

TOTAL 1,131,121 Xudur 93,049 2 - 4 1

TOTAL Ceel Barde
29,179 - - 4 1
Tayeeglow 81,053 - - 2 1
Waajid 69,694 - - 2 -
Rab Dhuure 37,652 - - 3 -

16 Gedo Garbahaarey 38,017 1 - 6 3

Baardheere 106,172 8 1 1 1
Belet Xaawo 55,989 1 - 6 8
Ceel Waaq 19,996 1 - 2 5
Doolow 26,495 1 - 6 5
Luuq 62,703 1 - 23 6
Buur Dhuubo 19,006 - - 1 6
TOTAL Yed
17 Jubada dnexe Banada - - 1 - -
Buale 1 3
Dhakaje - - 1 -
Duyac Garoon 1 - - 1 -
Fargurow - - 1 -
Jilib 1 - 3 -
Kaytoy - -
Marerey 1 - 1
Sakow 1
Salagle - - 1 -
Xaramka - - 1 -
TOTAL 1,049,796
18 Juba Hoose Kismaayo 166,667 2 - 1 3
Afmadow 51,334 1 - 3 -
Badhaadhe 38,640 3 - - -
Jamaame 129,149 1 1 2
Dhobely 1 1 2
Jamam 1 3 1
Hagar 1 1
 TOTAL

PROJECT FOR SOMALI REPUBLIC

PROJECT PROPOSAL

PROJECT TITLE: NEW PROJECT FOR HF

SUBJECT: HEALTH FACILITIES DEVELOPMENT 5 YEAR PLAN

DURATION: 1 MONTH

PROJECT SITE: SOMALI REGIONS

FUNDING AGENCY: MOH

EXECUTING AGENCY: MOH

BRIEF DESCRIPTION: This project is formulated to the construction and upgrading of

most health care facilities extensive damage during the civil war,
and most of the country’s trained physicians have left the country.
Consequently, Somalia faces a serious shortage of both trained
health workers and operative health centres. The Health Facilities
that do provide care tend to be concentrated in a few large cities,
and are heavily dependent on external support. Health care services
are heavily dependent on donor aid, equipment and materials as
well as salaries. The consultant will prepare new model of Health
Facilities.

AMOUNT: UNKNOWN

CONSULTANT : AGHI CONSULTING ENGINEER

CONSULTANT FEE: US 4
SUBMISSION DATE: 2014

Service Delivery Situation

Service Delivery Situation Analysis Health service delivery remains a key challenge in Somalia.
The existing functional health facilities are inadequate and inequitably distributed across regions
and districts thus prompting the Ministry to increase the number of health facilities in order to
bring them closer to the beneficiaries. They are also poorly equipped to provide quality
healthcare services. In brief, the Somali health situation is one of the worst in the world, and the
country will be unable to achieve its SDGs related to health if concerted, coordinated and
consolidated efforts are not made to revitalize the health system. As noted in section two, the
burden of disease is heavily dominated by communicable diseases, reproductive health problems
and under-nutrition issues, although non communicable diseases and mental disorders are also on
the rise. Routine immunization coverage remains very low. The planning of hospitals requires
sound knowledge of the appropriate relationships between the various components. Certain areas
or Functional Planning Units need to be adjacent or close to other areas to ensure good planning
relationships that will result in efficient, easy to operate facilities. Inadequate relationships may
result in increased running costs, unsafe practises and a lack of flexibility to adapt to future
growth and change. The planning of a complex health facility is based on applying commonly
recognized ‘good relationships’ as well as taking into consideration site constraints and
conformity with various codes and guidelines. In theory, it is possible to go back to the basics
every time, however in practice; designers soon discover that this is an inefficient way of
planning. As with other building types, health facilities have evolved around a number of
workable Planning Models which can be used as templates, modules, prototypes or patterns for
the design of new facilities. TAHPI has expertise in determining the optimal relationships to
ensure the best outcome for each facility, along with a comprehensive suite of prototypes,
standards, templates and tools to aid in the process of complete health facility planning.

NUMBER OF HEALTH FACILITIES BY TYPE

REGIONS DH RHC HC PHU TOTAL
BENADIR 5 1 46 0 47
GALMUDUG 19 9 47 47 75
HIRSHABELE 8 - 74 21 193
ISWA 11 - 83 5 49
JUBALAND 14 - 12 72 98
PUNTLAND 12 9 67 114 138
TOTAL 57 19 135 259 481
DISTRICT HOSPITAL
TOTAL NET AREA OF FUNCTIONAL SPACE SQ.M. 1,714.50
COST PER SQ.M. in US $ 300.00

BUILDING COST US $ 514,350.00

INFRASTRUCTURE:
1. Generator 10 KV 20,000.00
2. Outdoor electrical installation 25,000.00
3. Outdoor water Supply & elevated water tank 35,000.00
4. Sewage system & septic tank 30,000.00
5. Roads 18,000.00
6. Covered passage 12,000.00
7. Landscaping 15,000.00
8. Boundary Wall 180,000.00

TOTAL US $ 295,000.00

GRAND TOTAL IN US $ 809,350.00

DISTRICT HOSPITAL - ANNUALISED RECURRENT COSTS

Annual recurrent costs Recurrent costs Annual recurrent costs

Staff salaries 166,980.00 166,980.00
Drug supply
Medium utilization 8,390.16 8,390.16
Freight (sea) 15% 1,258.52
Overland shipping 20% 1,678.03
Total in US $ 11,326.71
Medical supplies; other consumables
Medium utilization 48,991.40 48,991.40
Freight (sea) 15% 7,348.71
Overland shipping 20% 9,798.28
Total in US $ 66,138.36
Transportation operation & maintenance 374,877.00 374,877.00
Health equipment maintenance & repair (15%
annualised capital cost) 4,362.14
DH maintenance, repair & utilities (110% of annual
equipment maintenance budget) 4,726.80
Other (e.g., in-service training) 35,000.00
Total annual recurrent costs in US $ 659,410.97
Annualised cost for a District Hospital in US $ 659,410.97

SN DESCRIPTION AMOUNT US $
1 CONSTRUCTION 809,350.00
2 ANNUALISED COST 659,410.97
3 CONSULTANT FEE 40,000.00
4 CONTINGENCY 80,000.00
TOTAL IN US $ 1,588,760.97
HEALTH CENTER
TOTAL NET AREA OF FUNCTIONAL SPACE SQ.M. 304.40
COST PER SQ.M. in US $ 300.00
BUILDING COST US $ 91,320.00

INFRASTRUCTURE:
1. Generator 10 KV 5,000.00
2. Outdoor electrical installation 8,000.00
3. Outdoor water Supply & elevated water tank 5,000.00
4. Sewage system & septic tank 6,000.00
5. Roads 5,000.00
6. Landscaping 3,000.00
7. Boundary Wall 50,000.00

TOTAL US $ 82,000.00
GRAND TOTAL IN US $ 173,320.00

HEALTH CENTER - ANNUALIZED RECURRENT COSTS

Annual recurrent costs Recurrent costs Annual recurrent costs
Staff salaries 21,840.00 21,840.00
Drug supply
Medium utilization 1,886.74 1,886.74
Freight (sea) 0.15 283.00
Overland shipping 0.20 377.35
Total in US $ 2,547.09
Medical supplies; other consumables
Medium utilization 13,128.00 13,128.00
Freight (sea) 0.15 1,969.20
Overland shipping 0.20 2,625.60
Total in US $ 17,722.80
Transportation operation & maintenance 60.00 60.00
Health equipment maintenance & repair (15%
annualised capital cost) 1,303.74 1,303.74
HC maintenance, repair & utilities (110% of annual
equipment maintenance budget) 1,434.11 1,434.11
Other (e.g., in-service training) 10,500.00 10,500.00
Total annual recurrent costs in US $ 120,570.86
Annualised cost for a Health Center in US $ 175,978.60
SN DESCRIPTION AMOUNT US $
1 CONSTRUCTION 173,320.00
2 ANNUALISED COST 175,978.60
3 CONSULTANT FEE 10,000.00
4 CONTINGENCY 20,000.00
TOTAL IN US $ 379,298.60
PRIMARY HEALTH UNIT
TOTAL NET AREA OF FUNCTIONAL SPACE SQ.M. 61.40
COST PER SQ.M. in US $ 300.00

BUILDING COST US $ 18,420.00

INFRASTRUCTURE:
1. Generator 10 KV 2,500.00
2. Outdoor electrical installation 3,500.00
3. Outdoor water Supply & elevated water tank 4,000.00
4. Sewage system & septic tank 3,000.00
5. Landscaping 3,000.00
6. Boundary Wall 20,000.00

TOTAL US $ 36,000.00

GRAND TOTAL IN US $ 54,420.00

PRIMARY HEALTH UNIT - ANNUALISED RECURRENT COSTS
Annual recurrent costs Recurrent costs Annual recurrent costs
Staff salaries 6,920.00 6,920.00
Drug supply
Medium utilization 1,494.78 1,494.78
Freight (sea) 0.15 224.22
Overland shipping 0.20 298.96
Total in US $ 717.96
Medical supplies; other consumables
Medium utilization 4,072.00 4,072.00
Freight (sea) 0.15 610.80
Overland shipping 0.20 814.40
Total in US $ 5,497.20
Transportation operation & maintenance 260.00 260.00
Health equipment maintenance & repair (15% 355.79 355.79
annualised capital cost)
PHU maintenance, repair & utilities (110% of 391.37
annual equipment maintenance budget)
Other (e.g., in-service training) 4,500.00 4,500.00
Total annual recurrent costs in US $ 25,253.96
Annualised cost for a Primary Health Unit in US $ 25,253.96
SN DESCRIPTION AMOUNT US $
1 CONSTRUCTION 32,520.00
2 ANNUALISED COST 25,253.96
3 CONSULTANT FEE 5,000.00
4 CONTINGENCY 7,000.00
TOTAL IN US $ 69,773.96
DISTRIBUTION OF HEALTH FACILITIES BY REGIONS & DISTRICTS SN REGIONS

SUMMARY OF CAPITAL COSTS

Number Construction Vehicle Non consumable Total in US $
Health facilities of health costs per health supplies &
facilities facilities equipment
District Hospital 1 929,350.00 169,000.00 157,560.00 1,255,910.00
Referral Health Centres 1 698,620.00 39,000.00 109,627.30 847,247.30
Health Centres 1 44,520.00 400.00 43,457.98 88,377.98
Primary Health Units 1 44,520.00 200.00 11,859.67 56,579.67

SUMMARY OF RECURRENT COSTS

Health Facilities Staffing Drug Consumable Maint of Maint, repair Operation & Total
supply supply equip non-cons. of equip maintenance in US $
District Hospital 90,060.00 37,994.03 290,809.03 4,726.80 5,126.00 77,440.27 506,156.13
Referral H. Centres 44,280.00 28,139.72 214,459.50 3,288.82 3,617.70 36,795.70 330,581.44
Health Centres 21,840.00 16,980.66 50,705.44 1,303.74 1,434.11 120.00 92,383.95
Primary H. Units 6,920.00 13,453.02 36,648.00 355.79 391.37 60.00 57,828.18

SUMMAY OF ANNUALISED COST

Health Facilities Capital Costs Recurrent Costs Total
Total in US $ Total in US $ in US $
District Hospital 1,255,910.00 506,156.13 1,762,066.13
Referral Health Centres 847,247.30 330,581.44 1,177,828.74
Health Centres 88,377.98 92,383.95 180,761.93
Primary Health Units 56,579.67 57,828.18 114,407.85