The project was brought to an abrupt end by the civil war and the withdrawal of USAID and contractor staff. The project was about 4 years into what was designed as a 10 year effort. Because the war broke out, little to nothing remained of the work that was started. But the question still remains of whether we were on the right track and what might have been the benefits or results had the work continued as planned. That requires looking in more depth at the individual components of the project (see Somalia 5), and what happened during the project’s relatively brief life.
Ministry of Planning
The census of the population, was completed, following some very creative approaches to seeking an accurate count of the large proportion of the population that was nomadic. When the report was issued, however, the President of Somalia discredited it saying that the population was undercounted. The buzz in the USAID community was that the president didn’t want to accept the number of 6 million because it would affect the aid they would receive from international donors. It would also suggest that they were not as strong and powerful as they wanted other nations (particularly Ethiopia) to believe. The report was buried either because it did indeed undercount the population or because it was fairly accurate but politically inconvenient. We’ll never know. However, data from the study were used informally and unofficially by international development groups in their planning efforts. Of course all of the computer equipment provided to the Ministry was destroyed or looted during the civil war, so no capability for demographic studies/research was left behind.
The Somali Women’s Democratic Organization (SWDO)
The SWDO component to educate women about the dangers of female circumcision made a lot of sense, and for a variety of reasons, SWDO was a good group to carry out the effort. The President of SWDO was deeply committed to the effort (a sister had died as a result of being circumcised). SWDO also had a large network of women, and they were experienced in mobilizing them for political rallies and civic endeavors (e.g. clean-up days, get out the vote). They also appeared to have significant reach and credibility with women and of course, they were politically well connected to the power structure. However, their job involved changing deeply held religious beliefs and practices including the belief among women ( as well as men) that being uncircumcised meant that a woman was not marriageable (i.e, she was unclean and no man would marry her), and was likely to become a prostitute. The general public also mistakenly believed that it was a practice required by Islam and mandated by the Koran, and this too needed to be corrected in the public’s mind. SWDO focused their effort on raising awareness and educating women about the harmful effects of genital cutting bringing the issue into the public arena for education and discussion, which they believed would ultimately change public opinion, norms and practices. Because SWDO was the women’s arm of the party, and the government was run by the party, it is quite likely that had the project continued, some inroads to gaining support from the party/government as well as from the imans might have been made. In fact the imans in Egypt had issued an opinion clarifying that female cutting was not mandated by Islam. That fatwa (ruling) was widely circulated to important imans in Somalia, as part of winning support. Education/awareness raising was the first step in a long process but from what I could see SWDO was serious about doing that. But when the project ended, we were still at a very early stage of the educational process and it hard to know whether real inroads were made.
The Ministry of Health/ Division of Maternal and Child Health
The experience of working with Ministries of Health (MOH) in most African countries is an exercise in frustration, and Somalia was no exception. When I would mention to an expat that we were working with the MOH, eyes would roll. The reasons are numerous: --For one, the pay of government workers is extremely low and had not been increased for a number of years. Most doctors therefore work second jobs and are at the Ministry mainly in the morning, if they come at all. Consequently, meetings with senior MOH personnel could only be scheduled between 9 and 11 AM, a rather narrow window, as by noon most offices were empty and most officials (as well as staff) were gone.
--MOH doctors also ran private clinics at government facilities, using government equipment and sometimes even selling USAID donated contraceptives. Thus they were motivated to see clients at their private clinics where they were paid, rather than at Ministry clinics.
--Senior staff typically had multiple responsibilities running different projects, so getting their attention and commitment to a specific project or set of activities was challenging. The running of multiple projects was a way to “top” off their salaries, as each project paid them a stipend above their government salary for their additional responsibilities.
--Motivation to actually implement new services, in this case family planning, was also limited, as there was no pay-off for staff to take on additional work, particularly if they weren’t convinced of either the need or importance of the service. They often told us about how many jobs they had, how many services they had to offer and how busy they were. Since all the donors relied on the same group of front line workers to deliver the donor supported service, health workers indeed had many responsibilities, at least on paper though this was not always evident when visiting a clinic.
--The staff was, however, highly motivated to be trained as they received a stipend ( per diem) when they attended training. As a result a lot of training was carried on in spite of the fact that little got translated into services. Another element of motivation had to do with the attitudes of MOH staff towards family planning or child spacing. Many of the nurses had large families and numerous children and were probably unconvinced about the importance of promoting and providing family planning. That is a process that takes time, and we were really at the early stages of changing attitudes, belief and practices, including among MOH nurses.
Another element that constrained our progress was the fact that our counterpart, Dr. Rukia, the Director of Maternal and Child Health Services, was a Russian trained physician married to another Russian trained doctor working in Italy. That meant that Dr Rukia was out of the country probably an average of 10 or more days a month, and in her absence no decisions could be made.
Nevertheless, I did meet some nurses who were motivated and hard working and did what they could to further the program objectives.
The Women’s Education Department (WED) of the Ministry of Education
The head of WED, Asha Mohamed, also happened to be the wife of the Minister of Education and I suspect that played no small part in including WED in this project. WED was responsible for non-formal education for women, and their involvement in the project, from that point of view made a lot of sense. They were charged by the project with including family planning education in their women’s education activities and materials. Asha Mohamed was also one of the brightest and most “westernized” of the counterpart staff we worked with, so her involvement in the project was a supportive and positive influence. In addition to helping to pay for the development and production of curricula and materials for women, the project also helped to purchase a significant number of sewing machines used in the WED program.
The Curriculum Development Department (CDD) of the Ministry of Education
The CDD was the unit charged with developing school curricula for the primary schools and a major overhaul of the school curriculum was envisioned when the design for this project was developed. Our project supported the development of a new science curriculum and the inclusion of units dealing with population and demography and its effect on the well-being of a country and its people. This fell under what the UN referred to as population education as opposed to education about family planning. Again, conceptually this made a lot of sense and good progress towards that goal was made with project support and substantial assistance from a Nigerian science educator named Mike Savage, who had developed science curricula elsewhere in Africa. The project also paid for the production of thousands of sets of the science curriculum for grades 1-6. Even though this component of the project took a long view about how opinions need to be changed, it was concrete, addressed an important need in the country and proved to be successful in meeting its objectives. The Somali who directed the CDD, an iman, was a man of integrity and commitment and he was serious in wanting to see the work done and done well. In some ways it was also one of the easier activities to accomplish as it did not rely on changing attitudes and winning support, but just developing and producing a specific product that was needed and wanted.
The Somali Family Health Care Association (SFHCA)
The SFHCA, was created by the project to establish private family planning clinics and serve as the coordinating agency for project planning and implementation. It also served as the secretariat for the Project Coordinating Committee, a high level committee described earlier, chaired by the Minister of Planning. Shortly after creating SFHCA, whose Board included the heads of the collaborating agencies described above, SFHCA became affiliated with the International Planned Parenthood Association. This was a way of ensuring support for SFHCA after the project ended. It received technical support from IPPF and equipment for its family planning clinics, which though well equipped had few clients. The project also provided substantial support to SFHCA in the area of communications and research. Two of the project’s long-term advisers, one in communications and the second in research were based in SFHCA, supporting them and other project partners. The project also established a media center in SFHCA, providing it with state-of-the art printing and video equipment to use in informational and educational efforts. The purchase and shipment of equipment represented both a substantial outlay of funds and a very time intensive effort. Unfortunately, equipping the center took time as it involved following AID regulations to mainly buy American products, though European products might have been more easily and cheaply acquired. The center was hardly up and running when the war broke out, our staff evacuated and the project ended.
So sadly, though some progress in building local capacity for changing attitudes, beliefs and practices about family planning and family planning services was in process, nothing remained when the country fell into strife and civil war which has lasted more than a decade. And when peace finally comes, it is very unlikely that this area will be a high priority for the new government.