Digital Health – An Emerging Hope for Pastoralist Communities of Ethiopia and Somalia

With the money he received from his relatives abroad, Wolli Edris Ahmad (his actual name is changed for privacy reasons) bought a handful of consumable goods and spent most of it buying medicines his family and relatives would need back in the village. 

The following day he would depart from the capital, Addis Ababa, to visit his pastoralist relatives who reside 946 KMs away in Dollo Addo Woreda, Liban Zone of Ethiopia's Somali Region, which shares a long open border with the Federal Republic of Somalia.

“Dollo Ado is predominantly populated by pastoralist communities that cross the international border several times a month, a week, or even a day in search of water, animal fodder, and services. Until last week, I knew my family members were in Ethiopia. This week they could be inside the Somalia Republic." Wolli Says.

Inaccessible health systems in underprivileged pastoral areas like Dollo Ado significantly impede achieving Universal Health Coverage (UHC). In addition to the weak health systems, poverty, and recurring drought predispose the communities to a higher risk of ill health and undernutrition. 

The sparse settlement, the seasonal movement of the pastoralist communities, lack of infrastructure, lack of access to service delivery points, low service utilization, and high turnover of service providers at all health system levels further exacerbate the problem, thereby making conventional health service delivery methods ineffective. 

"When my children were ill in the past, it was tough to get treatment. One must travel a long distance to reach the closest clinic, and even then, the clinic might not have the required material or services. This happened frequently on both sides of the countries” Wolli recounts his experience. 

Recent data showed that Ethiopia's pastoralist communities experience the highest child micronutrient deficiencies and the highest prevalence of wasting and underweight. According to the 2019 Ethiopian Mini Demographic Health Survey (Mini-EDHS), the highest prevalence of wasting (21%) and the lowest dietary diversity (1%) are observed in the Somali Region of Ethiopia.

These problems required an innovative project that employs a digital platform to improve access to nutrition services and ensure continued care for the pastoralist communities. It was also necessary to install a system that enables the countries, health facilities, and service providers to share information and monitor child growth for corrective interventions wherever they move.  

With support from the Italian Agency for Development Cooperation (AICS), the World Health Organization (WHO) initiated a cross-border project in Ethiopia and Somalia that envisages increasing access to nutrition services and ensuring a continuum of care among migrant cross-border communities like Wolli Edris and his family members.

Through adapting and placing a digital platform (Nutrition Tracker) in the health system, the project initiative intends to increase the number of children and pregnant mothers attending the nutritional screening and counseling sessions linked to treatment by 10% minimum.

It is also designed to consolidate the collaboration between the governments of Ethiopia and Somalia to improve access to healthcare and nutrition services for pastoralists and vulnerable populations.  

In this regard, an inception note was produced in 2021 entitled "Identifying and Strengthening Capacity for Nutrition Services to Contribute to Universal Health Coverage (UHC): A Regional Approach Targeting Vulnerable Groups Seeking Healthcare Cross-borders Using Innovative Technology (Somalia and Ethiopia).”

Shortly, an anthropological study that showed access (interruptions in service provision, weak referral linkage, medical supply pipeline breakage, poor service-seeking behavior of the community, deficient health information system, rampant, unacceptable dietary diversity practices, and sub-optimal breastfeeding practices, etc.) followed the inception note.  

The study findings further revealed the nature of community mobility and the underserved communities in the area and hence called for  WHO to play its health diplomatic brokering functions in bringing the two countries for collaboration on innovative, integrated healthcare approaches across the borders. 

WHO played its brokering role and summoned an intercountry coordination meeting attended by the Health Ministries of Ethiopia, Somalia, and other stakeholders.  One agenda item discussed was the preparation of a generic business requirement and a health facility readiness assessment for a digital solution, including a data-sharing framework across the two countries. 

WHO is inching closer to successfully completing the second and preparatory phase with an intercountry coordination meeting planned for early July 2023. The end of the second phase entails the finalization of the digital solution (DHIS II Tracker) implementation, which will be implemented in places across targeted facilities: Liben Zone, Dollo Addo, Filtu (Ethiopia), and Dellow district (Somalia). 

WHO is now accelerating to start the next level of the project, which plans to benefit more than 14,800 pregnant and lactating mothers and 30,000 children aged 0-5 years in hard-to-reach areas of project sites in Ethiopia.  In addition, pastoralists primarily residing in the Somalia Republic, who cross the border looking for pasture, will also benefit from the service. 

The capacity building of the service providers and performance monitoring using the DHIS tracking will also be enhanced; hence the quality of health and nutrition care ensuring universal health coverage shall be realized.

WHO HQ and regional offices (AFRO and EMRO) are expected to assist in engaging regional agencies like IGAD (Inter Governmental Authority on Development) and mobilize resources for possible scaling up and rollout of the project to cover more expansive areas and countries.