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. 2025 Jun 2;25(1):89.
doi: 10.1186/s12873-025-01234-8.

Emergency and critical care services in Somalia: a cross-sectional nationwide hospital assessment using the WHO Hospital Emergency Unit assessment tool

Haron Ndwiga Njiru  1 , Pryanka Relan  2 , Sk Md Mamunur Rahman Malik  3 , Azad Abdullah  4 , Mukhtar Shube  5 , Ali Haji Adam Abubakar  4 , Ibrahim Nur  6 , Abdinasir Yusuf Osman  6   7 , Paul Sonenthal  2 , Shada Rouhani  8 , Bernard Olayo  9 , Naoko Ohno  9 , Ireneaus Sebit Sindani  4 , Ali Abdirahman Osman  6 , Md Shajib Hossain  4 , Ndithia James  4 , Monther Alabesat  3 , Mohamed Derow  6
Affiliations

Emergency and critical care services in Somalia: a cross-sectional nationwide hospital assessment using the WHO Hospital Emergency Unit assessment tool

Haron Ndwiga Njiru et al. BMC Emerg Med. .

Erratum in

Abstract

Background: Data on emergency and critical care services in Somalia and other countries with fragile and conflict-affected (FCA) situations are limited, although the burden of emergency health conditions remain high. Improving emergency care services could significantly help improve health outcomes and realize the goals of achieving the Universal Health Coverage in these fragile countries.

Methods: We conducted a cross-sectional survey to assess the service availability and readiness for emergency and critical care (ECC) services in the country covering 131 hospitals in Somalia. The survey included both the public and private sector hospitals as well as those at the district, regional and national level hospitals representing the whole organizational structure of emergency health care system in the country. We administered the WHO Hospital Emergency Unit assessment tool which was slightly modified and adapted for this assessment. The survey included questions on the availability of staff, supplies/equipment, services, and systems. The respondents were hospital administrators and clinicians in outpatient departments, emergency departments and inpatient units. An overall median capacity score indicating the service availability and readiness for ECC was calculated for the country as well as for each hospital. Data were collected from December 2020 to March 2021.

Result: A total of 524 staff members across 131 hospitals participated in the survey. The median and interquartile range (IQR) ECC readiness score for all health facilities in the country was 0.31 (0.22-0.46) and only 26 (19.8%) facilities assessed had a median readiness score of more than 0.5 (p value = 0.001). Using the cut-off point of 0.5, over 80% of the hospitals assessed were not considered ready to provide ECC services in the country. The third-level hospitals of the private sector including those facilities situated in predominantly urban areas were found to have better readiness to provide ECC services. User fees, lack of equipment and the absence of staff availability around the clock were identified as the most common barriers to emergency and critical care readiness.

Conclusion: This is the first study of its kind to be conducted in Somalia using a standardized tool and methodology and provides a comprehensive understanding of emergency and critical care services available in Somalia by facility type and levels of care. The study highlighted that significant capacity gaps exist at all levels in the provision of emergency care services especially in the public sector and at the first-level of care. Investment in emergency care services is urgently needed in the country bringing the primary care into the care continuum for ECC services along with implementing a set of cost-efficient interventions at the first-level of care given the country's high burden of emergency health conditions.

Clinical trial number: Not applicable as this assessment was not a clinical trial.

Keywords: Critical care; Critical care readiness score; Cross-sectional survey; Emergency medical services; Emergency service; Hospital; Low- and middle-income countries; Somalia.

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Conflict of interest statement

Declarations. Ethical approval: This assessment was approved by the Somalia Federal Ministry of Health Research and Ethics Review Committee. Consent to participate: All participants provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Box plot showing the median values and interquartile range of emergency and critical care readiness (ECC) scores calculated for each level of hospital from 0 to 1. The vertical line inside the box represents the median value while the ends of the box represent the 75th percentile (Q3) and 25th percentile (Q1) values. The two lines outside the box represent the whiskers showing the maximum and minimum values
Fig. 2
Fig. 2
Box plot displaying the median values and interquartile range of emergency and critical care readiness (ECC) scores calculated by type of hospital from 0 to 1. The vertical line inside the box represents the median value while the ends of the box represent the 75th (Q3) and 25th (Q1) percentile values. The two lines outside the box represent the whiskers showing the maximum and minimum values
Fig. 3
Fig. 3
The proportion of major barriers to ECC readiness at first, second and third-level health facilities. The error bars represent 95% CI
See this image and copyright information in PMC

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