世界卫生组织2020-2025年在索马里的贡献：评估简报

CoherenceThere was moderate technical and opera�onal coherence, with B a c k g r o u n dThis independent evalua�on of the World Health Organiza�on’s strong alignment in ver�cal programmes such as polio andimmuniza�on across WHO’s three levels. Coherence was weaker inemergency response, UHC, and health systems strengthening dueto funding constraints, communica�on gaps, and the absence of aCCS mid-term review. While WHO was recognized as a technicallead and coordina�on convener, fragmenta�on, donor-drivenpriori�es, and parallel systems limited harmoniza�on with partners (WHO) contribu�on in Somalia has been jointly commissioned bythe WHO Evalua�on Office (EVL), the Regional Office for the EasternMediterranean (EMRO), and the WHO Somalia Country Office, and It documents WHO’s key contribu�ons, achievements, successfactors, gaps, lessons learned and strategic approaches to improvinghealth outcomes in Somalia. The evalua�on is framed by WHO’sThirteenth General Programme of Work (GPW13, 2019–2025) andtheFourteenth General Programme of Work (GPW14, 2025–2028), Effec�venessWHO demonstrated strong effec�veness in immuniza�on, P u r p o s ea n d s c o p eThe purpose of this evalua�on is to support organiza�onal learning surveillance, and emergency response, achieving improvementssuch as higher Penta-3 coverage (70% in 2024), stronger cold-chainsystems, and reduced cholera fatality rates (0.06%). Its support toIntegrated disease surveillance and response (IDSR)and laboratorysystems enhanced outbreak detec�on and response �meliness,though recurrent epidemics highlight ongoing fragility. WHO’sconvening power advanced key frameworks such as such as theEssen�al Package of Health Services(EPHS)2020,andReproduc�ve, and accountability for results among external and internal WHOstakeholders.Theevalua�on assesses country-level results againstna�onal priori�es in alignment with WHO’s global and regionalagendas and the United Na�ons Sustainable DevelopmentCoopera�on Framework (UNSDCF).Itsaimsto inform the strategicdirec�on of the WHO Country Office, including the next CountryCoopera�on Strategy (CCS) cycle.The evalua�on covered WHO M e t h o d sThe evalua�on used a non-experimental, mixed-methods, u�liza�on-focused, and theory-based approach to assess how andwhy WHO’s interven�ons contributed to health outcomes inSomalia. A reconstructed Theory of Change (ToC) guided theanalysis of causal pathways and enabling factors. Data collec�onincluded a desk review, quan�ta�ve analysis, and extensivequalita�ve inquiry–78 key informant interviews, seven focus groupdiscussions, a par�cipatory workshop with nine state healthdirectors, and a percep�on survey of 47 WHO and partner staff. The Efficiency WHO Somalia’s por�olio showed low efficiency, constrained byreliance on emergency and ver�cal funding, persistent Base-Strategic Priorityfinancing gaps, and high opera�onal costs thatlimited strategic resource alloca�on. The absence of an integratedperformance framework and reliance on upward global repor�ngweakened adap�ve management, obscured value-for-money, andskewed delivery toward short-term emergency priori�es. K e yf i n d i n g s SustainabilityWHO’s contribu�on to sustainability in Somalia is mixed. Financial RelevanceBetween 2020 and 2025, WHO’s strategies in Somalia were well sustainability remains low due to reliance on earmarked emergencyfunding and limited government financing, leaving health gainsfragile and the workforce dependent on donor support. Ins�tu�onalsustainability is moderate, with Federal Ministry of Healthownership of the CCS, but fragmenta�on, weak RMNCAHintegra�on, and the absence of a coherent na�onal care model aligned with na�onal and local health priori�es. The Organiza�onserved as a key norma�ve anchor, providing technical guidance andcoordina�on while demonstra�ng flexibility in responding to crisessuch as COVID-19, droughts, and recurrent outbreaks. The ToCwasconceptually rigorous and relevant but limited by weak con�ngencyplanning and par�al misalignment with opera�onal reali�es.Somalia’s protracted crisis context led WHO’s por�olio to focusheavily on emergency response and health security, constraining Recommenda�on3: Strengthen M&E and equity-disaggregateddata(CO-led, with EMRO technical support) C o n c l u s i o n sWHO’s country programme in Somalia (2020–2025) was broadly Develop an integrated monitoring framework linking CCS outputs and outcomes to GPW13/14+ indicators with equity disaggrega�on.Improve the roll out of Health Informa�on System (HIS) withdistrict-level DHIS2 dashboards and rou�ne data reviews at sub- relevant and adap�ve, with strong alignment to na�onal priori�esand clear effec�veness in immuniza�on, surveillance, andemergency response, where outputs were closely linked tooutcomes. Its norma�ve leadership and convening power Recommenda�on4: Improve resilience and sustainability of thehealth system(CO-led, in partnership with Government and UNagencies)Co-develop a