Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study
Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study
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DOI：
10.1186/s13031-019-0241-x
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发表时间：
2020-05-27
影响因子：
3.6
通讯作者：
Dalmar, Abdirisak A.
中科院分区：
文献类型：
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作者：
Ahmed, Zahra;Ataullahjan, Anushka;Dalmar, Abdirisak A.
背景索马里遭受了20多年的武装冲突的蹂躏，对该国的基础设施造成了巨大的破坏，并在其人民中造成了大规模的流离失所和痛苦。在整个冲突期间，大量人道主义行为体涌入，试图提供基本服务，包括为妇女和儿童提供保健服务。本研究旨在更好地了解自2000年以来索马里妇女和儿童的人道主义卫生反应。我们整理了来自现有大规模家庭调查的干预覆盖率数据，并与来自政府，联合国机构，非政府组织和卫生机构工作人员的代表进行了32次访谈。定性数据进行了分析，使用潜在的内容analysis.ResultsThe可用的定量数据在索马里的干预覆盖面是非常有限的，很难辨别模式或趋势随着时间的推移或按区域。对妇女和儿童的人道主义保健反应影响最大的社会文化和其他背景因素包括部族动态和妇女赋权。最突出的业务影响包括对人口需求的评估、捐助者的优先事项以及供资不足和缺乏灵活性。提供服务的主要障碍包括商品和人力资源长期短缺、基础设施薄弱以及接触高度弱势群体的机会有限，所有这些都是在持续不安全的背景下发生的。与会者讨论了缓解这些障碍的各种战略。随着时间的推移，国内人道主义卫生行为体及其活动的协调得到了改善，联邦和州一级的卫生部发挥越来越积极的作用。ConclusionsEmerging建议包括进一步探索政府与私营部门服务提供商的伙伴关系，使整个索马里免费提供服务，进一步研究创新的技术使用，以帮助到达偏远和交通不便的地区。为了缓解长期以来熟练保健工作者短缺的问题，需要对扩大使用社区保健工作者进行更多的业务研究。必须解决整个统一体在提供服务方面持续存在的差距，包括例如为青少年提供服务。此外，还显然需要更长期的发展重点，以便能够为妇女和儿童提供除经常性应急措施之外的保健和营养服务。
BackgroundSomalia has been ravaged by more than two decades of armed conflict causing immense damage to the country's infrastructure and mass displacement and suffering among its people. An influx of humanitarian actors has sought to provide basic services, including health services for women and children, throughout the conflict. This study aimed to better understand the humanitarian health response for women and children in Somalia since 2000.MethodsThe study utilized a mixed-methods design. We collated intervention coverage data from publically available large-scale household surveys and we conducted 32 interviews with representatives from government, UN agencies, NGOs, and health facility staff. Qualitative data were analyzed using latent content analysis.ResultsThe available quantitative data on intervention coverage in Somalia are extremely limited, making it difficult to discern patterns or trends over time or by region. Underlying sociocultural and other contextual factors most strongly affecting the humanitarian health response for women and children included clan dynamics and female disempowerment. The most salient operational influences included the assessment of population needs, donors' priorities, and insufficient and inflexible funding. Key barriers to service delivery included chronic commodity and human resource shortages, poor infrastructure, and limited access to highly vulnerable populations, all against the backdrop of ongoing insecurity. Various strategies to mitigate these barriers were discussed. In-country coordination of humanitarian health actors and their activities has improved over time, with federal and state-level ministries of health playing increasingly active roles.ConclusionsEmerging recommendations include further exploration of government partnerships with private-sector service providers to make services available throughout Somalia free of charge, with further research on innovative uses of technology to help reaches remote and inaccessible areas. To mitigate chronic skilled health worker shortages, more operational research is needed on the expanded use of community health workers. Persistent gaps in service provision across the continuum must be addressed, including for adolescents, for example. The is also a clear need for longer term development focus to enable the provision of health and nutrition services for women and children beyond those included in recurrent emergency response.