Capacity Assessment Report

Rationale for Health Center Capacity Assessment

Our comprehensive survey was designed to assess the capacity of health centers operating in the Maroodi-jeex
(M.jeex) region. The evaluation encompassed a wide range of factors, including the composition and competence of
the workforce, the effectiveness and efficiency of health service delivery, the availability and accessibility of
essential health products and vaccines, the utilization of technology for healthcare delivery, the financing
mechanisms supporting the health system, the management of health information systems, and the leadership and
governance of these centers.
In order to gather reliable data, we conducted site visits to a total of 13 health centers located in various villages
within the M.jeex region, with an additional site situated in Borama, which lies outside the immediate region. To
ensure a comprehensive assessment, our chosen methodology relied on conducting open-ended interviews with key
stakeholders involved in the operations of these health centers. Through these interviews, we aimed to obtain in-
depth insights into the strengths, weaknesses, and potential areas for improvement within each center.
However, it is important to acknowledge that our survey faced certain limitations. One significant constraint was the
time constraints imposed on the study, which posed challenges to gathering extensive data and conducting more
thorough assessments. Additionally, we encountered difficulties due to recent changes in the organization and
management of the Targeted Supplementary Feeding Program (TSFP) by the Ministry of Health and Development
(MoHD). Previously administered by the World Food Programme (WFP), the program is now under the jurisdiction of
the MoHD for nationwide implementation. This transitional period caused some disruptions and challenges in
obtaining comprehensive and up-to-date information during our survey.
Despite these limitations and challenges, we were able to gather valuable insights and data on the capacity of the
health centers in the M.jeex region. This information will serve as a foundation for identifying areas of improvement,
formulating evidence-based recommendations, and supporting decision-making processes to strengthen the overall
healthcare system in the region.

Surveyed Health Centers’

From the initial pool of 20 health centers, a rigorous selection process was employed to identify the most suitable
candidates, resulting in the final selection of 13 Health Centers. This selection was made based on several key
factors, including the geographical area of the respective towns to the Maroodi-jeex region, the breadth and quality
of services provided at each site and the overall capacity of the facilities and staff.
Capacity Assessment Report

The selected health centers included Balligubadle Health Center, Daara-salaam Health Center, Jimcaale
Health Center, Dacarbudhuq Health Center, Gebiley Health Center, Sh. Nuur Health Center,
Sabawanaag Health Center, Sallaxley Health Center, Gumburaha Health Center, Arabsiyo Health
Center, Balli-cabbane Health Center, and the final site situated in Boorama known as Shifo Health Center.

Current Capacity of the Health Centers

All the Health Centers have confirmed their capacity to deliver fundamental nutrition services, such as providing
counselling on Infant and Young Child Feeding (IYCF). Additionally, they offer essential services including child
immunization, deworming, and community awareness programs on water, sanitation, and hygiene (WASH).
Table 1: Breakdown of health center Status in the surveyed sites
Item Count % Particulars
Health Centers who provide 13 100% Geed-deeble Health Center, Balligubadle Health
full Nutrition Services for Center, Daara-salaam Health Center, Jimcaale
children (including IYCF Health Center, Dacarbudhuq Health Center,
Gebiley Health Center, Sh. Nuur Health Center,
counselling), adults and for
Sallaxley Health Center, Sabowanaag Health
the pregnant Center, Gumburaha Health Center, Arabsiyo
Health Center, Balli-cabbane Health Center, and
Shifo Health Center.

Health Centers with full 11 84% Geed-deeble Health Center, Balligubadle Health
counselling services (HIV, TB, Center, Daara-salaam Health Center, Jimcaale
Malaria, WASH, BF) Health Center, Gebiley Health Center, Sh. Nuur
Health Center, Sallaxley Health Center,
Gumburaha Health Center, Arabsiyo Health
Center, Balli-cabbane Health Center, and Shifo
Health Center.

Health Centers who are fully 13 100% All

capable of managing SAM
(OTP)
Health Centers who are fully 13 100% Geed-deeble Health Center, Balligubadle Health
capable of managing MAM Center, Daara-salaam Health Center, Jimcaale
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(TSFP) Health Center, Dacarbudhuq Health Center,

Gebiley Health Center, Sh. Nuur Health Center,
Sallaxley Health Center, Sabowanaag Health
Center, Gumburaha Health Center, Arabsiyo
Health Center, Balli-cabbane Health Center, and
Shifo Health Center.

Health centers capable of 3 23% Sallaxley, Dacarbudhuq and Geed-deeble

stabilization of children with
SAM with medical
complications
N=13

Workforce of the respective Health Centers

We conducted visits to a total of 13 Health Centers, with only one located outside the M-jeex region. Among these, 12 Health Centers were
situated within the Maroodi-jeex area. Throughout these centers, a combined total of 271 individuals formed the staff personnel.

Out of this total staff, approximately 46.5% (126 individuals) received incentives as their remuneration, while 10.3% (28 individuals) were
officially registered and listed on the Ministry of Health and Development (MoHD) payroll. Notably, about 43.2% (117 individuals) of the staff
neither received incentives nor were registered on the payroll.
Table of workforce compensation paid for their services

Sites Total No. of Receive Receive Those who % of those

staff MoHD Incentives Receive who don’t
Salary Neither receive
neither salary
nor incentive
per HC
Geed-deeble MCH 14 0 14 0%
Daara-salaam MCH 13 0 0 13 100%
Balligubadle MCH 29 0 29 100%
Jimcaale MCH 26 3 17 6 23%
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Shifo/Borama MCH 20 4 14 2 10%

Dacarbudhuq MCH 20 0 16 4 20%
Gebiley MCH 15 2 10 3 20%
Sh. Nuur MCH 52 14 14 24 46.2%
Sabawanaag MCH 10 0 0 10 100%
Sallaxley MCH 27 0 0 27 100%
Gumburaha MCH 23 0 0 23 100%
Arabsiyo MCH
Balli-cabbane MCH 22 5 12 5 22.7%

Total 271 28 126 117

Percentile 100% 10.3% 46.5% 43.2%

Facility Structure and Rehabilitation

The number of rooms in the 13 observed health centers exhibits variability across the centers, with each center having a distinct count. Among
them, Geed-deeble and Jimcaale MCH present the lowest room numbers and consequently face challenges in accommodating the diverse range
of services they provide. Jimcaale Health Center, specifically, lacks an incinerator for the safe disposal of contaminated waste, while also
encountering issues with malfunctioning latrines. On the other hand, Balligubadle Health Center possesses seven rooms that are utilized for
various activities and services, despite lacking essential amenities such as water, electricity, and an incinerator.

Conversely, Daara-salaam HC, Shifo HC in Boorama, Dacarbudhuq HC, Gebiley HC, Sh. Nuur, Sabawanaag HC, Sallaxley HC, Arabsiyo HC, and
Gumburaha HC demonstrate favorable facility conditions in terms of structural integrity, room capacity, availability of equipment, provision of a
placenta pit, access to electricity and water supply, and the presence of functioning incinerators. Gumburaha HC, although in good overall
condition, requires the rehabilitation or replacement of solar batteries, while also lacking a designated placenta pit.

In contrast, Balli-cabbane HC encounters difficulties related to water supply as it is not connected to a water source, and water trucking services
are unavailable. Additionally, it lacks adequate provision of latrines

Referral System of the Health Centers

Children classified as moderately malnourished (Mid-Upper Arm Circumference (MUAC) between 11.5-12.5) and Pregnant and Lactating Women
(PLW) were frequently referred to the Outpatient Therapeutic Program (OTP) by the majority of Health Centers, with the exception of
Sabawanaag, which referred them to either Sallaxley Hospital or Hargeisa Hospital. Health Centers uniformly referred severely malnourished
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children to the Stabilization Center (SC) department. Once children who experienced a positive response to treatment transitioned from
Moderate Acute Malnutrition (MAM) to a normal MUAC level (MUAC >12.5), they were admitted to the OTP program for continued care and
monitoring.

In the case of pregnant women facing complications during delivery, they were typically referred to Hargeisa Group Hospital. However, Gebiley,
Sabawanaag, and Sh. Nuur Health Centers deviated from this pattern and referred them to an alternative healthcare facility.

These referral processes were established to ensure appropriate and specialized care for individuals with specific needs, providing them with the
best possible outcomes and increasing their chances of successful treatment and recovery.

Drugs and medical supplies

Geed-deeble and Sallaxley MCH were the worst of those health centers we have toured, because they almost lacked every drug including
antibiotics, vitamins and examination gloves as well as bandages. Balli-cabbane and Boorama/Shifo HC were short in a couple of drugs including
ferrous sulphate & antiseptic solutions and medical equipments like bandages and gloves. While the rest of 9 health centers including Daara-
salaam, Sallaxley, Sabawanaag, Jimcaale, Dacarbudhuq, Gebiley, Sh. Nuur, Gumburaha and Arabsiyo were having a good medical supply despite
complaining of an in-adequacy issue.
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Drugs Geed- Daara- Balligu Jimcaal Borama Dacarbud Gebile Sh. Sabawa Sallaxle Gumburaha Arabsiyo Balli-
deeble salaam badle e MCH MCH huq MCH y MCH Nuu naag y MCH MCH MCH cabbane
MCH MCH MCH r MCH MCH
MCH
Anti Yes Yes Yes and Yes and Yes and its Yes and its Yes Yes Yes and Yes and Yes and its Yes and Yes and its
Malarial and its and its its its adequate adequate and its and its its adequate its adequate
drugs adequa adequa adequa adequat adequa its adequat adequat adequate
(Adult and te te te e te adeq e e
Child) uate

ORS
Zinc
Tablets
Co
Trimoxzol
e (Adult
and Child
doses)
Metronid
azole
(Adult and
Child
doses)
Amoxicilli
n (Adult
and Child
doses)

Tetracycli
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ne Eye
ointement

Zinc
oxide/whi
tefields
skin
ointement
Paracete
mol/
ibuprofen

Ferrous
sulphate
Vitamin A
Examinati
on Gloves
Antiseptic
Sollution
Bandages/
Gauze
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