Reaching warring and nomadic populations

Despite many challenges related to war and nomadic migration, the TB grant to Somalia has achieved outstanding results: Over 20,000 TB patients have been diagnosed and treated in less than 2 years. Somalia, which has been at war since 1991, is now divided into three zones: Somaliland, Puntland and South Central Somalia. Somaliland and Puntland have mostly nomadic populations, constantly moving in search of pasture and markets for their animals. By contrast, South Central Somalia is inhabited by settled agro pastoralists who are constantly at war, which also tends to disrupt treatment.

In addition, implementers of Global Fund grants have to engage three Ministries of Health from the rival governments to decide on budgets, and to successfully implement projects. Dr. Vianney Rusagara is manager for the Global Fund’s TB grant with World Vision Somalia, which collaborates with a number of organizations. He explains how grant implementers and recipients have achieved and maintained these successes.

" When a service has good results it is appreciated even by the warring factions and they try as much as possible to protect it…we have a slogan: ‘Good projects are a security by themselves’"

" We try to be transparent…in our case where the total budget and summary of the Global Fund is on the website, it is not very difficult…in May we had the three Ministers of Health in a round table discussing the budget"

" We have been fighting to keep the patients on treatment throughout the 6 or 8-month period. In Somalia we have a system called ‘Dameen’ (Guarantor), when the patient is not seen, this person is supposed to bring them back"