Saving Mothers and Newborns in Somalia: Five Years of Evidence from Conflict, Crisis, and Community

This case study presents field evidence and direct testimony on the delivery of community-based maternal and newborn health care in eight villages of Dhusamareb District, Galmudug State, Somalia, over a two-year implementation period. The study documents the working conditions and practices of community health workers (CHWs) serving communities where 82% of women had no formal education and 71% had previously delivered at home with a traditional birth attendant. It examines both the programme's successes in building community trust and changing health-seeking behaviour, and the operational limits encountered in geographically dispersed communities such as Haadfull, where standard caseload models proved unworkable without additional resourcing. The study concludes that a caseload standard designed for urban density cannot be directly applied to dispersed rural communities, and that reaching Somalia's hardest-to-reach populations will require adapted operational standards, sustained CHW compensation, standardised training, and dedicated supervision infrastructure.