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1. Innovative Approaches to Health Policy and Governance in Somalia: Strengthening Health Systems for Sustainable Development , proposal Defense By:   DR. SAED S upervisors : Prof.

2. CHAPTERONE INTRODUCTION This chapter highlighted the following sections; Background of the study ,problem statement of the study, Research objectives, Research questions, Scope of the study, Significance of the study and conceptual frame work of the study

3. Background of the Study Health system is a procedure, and frameworks put in place to supervise and control a nation's between many players and stakeholders in the healthcare industry, such as governmental bodies, private sector companies, patients and their families, individuals and communities, and civil society organizations. Assuring the existence and integration of strategic policy frameworks with efficient oversight, coalition building, appropriate regulation and incentive provision, system design consideration, and accountability are all components of health systems governance (WHO, 2024). Ensuring universal access to high-quality, economical, efficient, and equitable healthcare services is contingent upon the implementation of effective governance practices for health systems. This calls for the effective and fair distribution of healthcare resources, the existence of laws and rules governing the provision of healthcare, and systems for keeping an eye on, assessing, and analyzing the effectiveness of the healthcare system (WHO, 2024). healthcare system are referred to as health systems governance. It oversees the interactions.

4. Background of the Study Cont.. Globally The status of health systems in less developed countries Thus, it appears that the primary issue facing health systems in developing nations is a lack of medical professionals. According to WHO projections, at least 4.3 million health workers will be absent from 27 countries in Africa and Asia. Real health system failures are caused by the worldwide scarcity of health workers, its effects, and the large number of individuals (more than 100 million) who become destitute each year as a result of having to pay for their own medical bills (World Health Organisation, 2009). In order to solve these issues, public health systems must be improved. Only then can the most vulnerable and impoverished individuals be guaranteed access to the essential services, According to the World Health Organisation (2008), the development of local food systems that guarantee access to a variety of nutrient-dense foods is the first step towards addressing the many concerns that are fundamental to peoples' lives and are related to health. (World Health Organization, 2009).

5. Background of the Study However, the most crucial factor is to understand how to provide potential beneficiaries with the available health interventions through the functioning of health systems, with their policies, organisations, and programmes, rather than conducting research on aspects related to the functions of health systems, such as governance structures, funding and resource allocation systems, management systems, and, above all, the methods of service delivery ( Pelto G, Bertozzi SM. 2007). The population health of developing nations may be significantly improved by new ideas on how to enhance access to healthcare. According to a recent study, improvements in the use of services (constant technology) could prevent almost two thirds of deaths in poor countries, while technological advancements might potentially prevent about a fifth of deaths in children under the age of five. Regrettably, research on health systems is a field that is significantly underutilised. In developing nations, health systems research expenditures are anticipated to account for less than 0.02% of total healthcare funding. A World Health Organisation Task Force suggests that governments in developing nations and the international community should contribute more money to health system research. It also suggests that national health system research institutes be established in these nations, with a portion of health programme funding going towards health system research,( Leroy JL, Habicht JP, Pelto G, Bertozzi SM. 2007).

6. Background of the Study Sub-Saharan African countries, as well as those with high mortality rates in Asia, Central and South America, and the Eastern Mediterranean, are among the group of extremely poor countries, and the statistical data from these countries indicates a widening gap between them and the rest of the world. From this vantage point, the pursuit of improved health undoubtedly plays a significant role in human mobility and is the root cause of global migration ( Habicht JP, Pelto G, Bertozzi SM. 2007). In Africa health service delivery accounts for a big chunk of global maternal deaths, in 2013 about 289,000 women worldwide died during pregnancy or childbirth, and of those deaths, 62% occurred in sub-Saharan Africa. Trends in Maternal Mortality: 1990 to 2013. The report adds that in 2013, the maternal mortality ratio in developing countries was 230 women per 100,000 births, versus 16 women per 100,000 in developed countries

7. Background of the Study In Somalia has faced decades of civil war followed by unstable governments which causes disruption its health institutions and infrastructure. A Basic health indicators like life expectancy and child mortality are among the worst globally after the collapse of the central government in 1991, the health sector remains in disintegration status with no unified leadership or policy framework. International aid partners stepped in to fill the gaps but in an uncoordinated manner in the post-2011 period as the Federal Government of Somalia was established, rebuilding resilient health systems became a priority . There was a National Development Plan and a National Health Policy developed. The problems of poor governance, underfunded amenities, and insecurity remained, nevertheless. In order to address Somalia's extreme health vulnerabilities, new strategies for strengthening governance, financing, service delivery, and human resources were required. These strategies entailed starting from scratch and creating public services that are robust, effective, and led by Somalia. According to WHO (2007),

8. Background of the Study Somalia is among the 15 countries that WHO marked as very high alert countries for maternal deaths. Somalia has one of the worst maternal conditions in the world (Adam, Magan, & Ali Omar, 2021). The Maternal Mortality Ratio (MMR) is 692/100,000 live births where 1 in 20 women would die from pregnancy-related causes during their reproductive lifetime. Four in 100 Somali children die during the first month of life, eight in 100 before their first birthday, and 1 in 8 before they turn five. Many die or suffer near misses due to lack of access or lack of knowledge of health services (Adam, Magan, & Ali Omar, 2021). this study aims to develop and sustain Somalia's health systems through the use of innovative approaches in health policy and governance. Both a national development plan and a national health policy were created. But problems with poor governance, inadequate amenities, and insecurity remained. Rebuilding effective, resilient, and domestically-led public services from the ground up is necessary to address Somalia's severe health vulnerabilities. New strategies were required to strengthen governance, financing, service delivery, and human resources in a sustainable manner. The goal of this project is to develop and sustain Somalia's health systems through the use of innovative approaches in health policy and governance (WHO, 2007).

9. Statement of the Problem Somalia , faces a pressing and complex challenge concerning the health of mothers and children. Despite global efforts to improve maternal and child health, this region continues to grapple with high rates of maternal and child morbidity and mortality. The intersection of socio-economic, political, and healthcare system challenges creates a multifaceted problem that demands urgent attention and targeted interventions ( Reliefweb , 2021). Somalia witnesses alarmingly high maternal mortality rates, with many mothers succumbing to preventable complications during pregnancy and childbirth. Limited access to quality prenatal and obstetric care, compounded by a shortage of skilled healthcare professionals, exacerbates the vulnerability of pregnant women. Cultural factors, including traditional birthing practices, often contribute to delays in seeking medical assistance, putting mothers at increased risk (Somali Health Advisory Board , 2015). Thus, mother and child mortality rates remain a significant concern in Somalia, but many practitioners believe that health decentralization can improve the health of mothers and children.

10. Statement of the Problem Cont . Decades of conflict have severely damaged Somalia's health institutions, governance structures and service delivery capacity. While international organizations have helped fill gaps, the health system remains highly fragmented, under-resourced and dependent on external aid. As rebuilding efforts progress, sustainable solutions are needed to strengthen leadership, coordination, financing and resilience within the confines of Somalia's fragile context, ( Abdirazak Yusuf Ahmed 2023 ). However, decentralization reforms are bound to have varying levels of success in achieving their intended effects on health systems, such as equity in population health outcomes, health system efficiency, and health system resilience, including how community engagement influences these effects ( Seye , Leonard, & Maryam, 2019). Thus, there still exist a gap in This research seeks to contribute knowledge for doing so within the country's challenging post-conflict context. ( Abdirazak Yusuf Ahmed 2023 ). This study aims to explore the Innovative approaches implemented in health policy and governance and strengthening   and sustainability of the health systems in Somalia.

11. General Objective The general objectives of this research are to find out Innovative Approaches to Health Policy and Governance in Somalia: Strengthening Health Systems for Sustainable Development. Specific Objectives Investigate the innovative approaches employed in health policy and governance within Somalia. Evaluate the impact of these innovative approaches on strengthening healthcare systems in Somalia. Propose strategies for enhancing the sustainability of healthcare systems based on the findings of the investigation

12. Research questions What innovative approaches are being utilized in health policy and governance within Somalia? How do these innovative approaches contribute to the strengthening of healthcare systems in Somalia? What strategies can be recommended to improve the sustainability of healthcare systems in Somalia based on the identified innovative approaches?

13. Significant of the Study Healthcare Professionals and Providers Community Members and Local Authorities Policy Makers and Government Authorities Development Organizations and NGOs Researchers and Academics Scope of the Study The scope of a study out the Innovative Approaches to Health Policy and Governance in Somalia: Strengthening Health Systems for Sustainable Development. The study will conduct from May 2024 up to June 2024 . Content Scope The content scope of this study was confined to identifying the Innovative Approaches to Health Policy and Governance in Somalia: Strengthening Health Systems for Sustainable Development.

14. Theoretical Review Social Determinants of Health (SDH) Theory: This theory posits that health outcomes are influenced not only by individual behaviors and medical care but also by social, economic, and environmental factors. SDH theory emphasizes that community development efforts, such as improving education, housing, employment opportunities, and access to nutritious food, can have a profound impact on the health of a population. By addressing the root causes of health disparities through community development, better health outcomes can be achieved. United Nations, 2010 (United Nations, 2010 ) . Theory Health literacy Theory According to this theory, health literacy encompasses more than just basic reading and numeracy skills - it involves a complex set of cognitive and social skills which evolve over an individual's lifetime ( Sorensen et al., 2012 ). Diffusion of Innovations Theory Diffusion of Innovations Theory with citations: Diffusion of Innovations Theory was developed by Everett Rogers in 1962 to explain how new ideas and technologies spread through populations over time. At its core, it describes the process by which an innovation is communicated and adopted by members of a social system ( Rogers, 2003 ).

15. Figure 2.1: The Conceptual Framework Innovative approaches contribute to the strengthening of healthcare systems Leadership and governance Health care financing Health work force   Strategies for enhancing the sustainability of healthcare systems Environmental sustainability Social sustainability Economical sustainability Innovative approaches employed in health policy and governance Accountability Participation Transparency Equity Efficiency   Strengthening of healthcare systems Improved Health Level and Equity Health Workforce Responsiveness Health Information Systems Access to Essential Medicines  

16. RESEARCH METHODOLOGY This study used descriptive research design. Descriptive research design wills the most suitable because it describes phenomena. Kothari (2011) notes that, descriptive study is most suited when studying relationship between variables that describe and explain phenomenon as the case of finding out the Innovative Approaches to Health Policy and Governance in Somalia: Strengthening Health Systems for Sustainable Development Target Population Target population includes the entire specimen under study. It covers all items and people with the same characteristic under study. The target population of this research will be 60 of health experts in Somalia. This is because the health experts have the right information and knowledge health policy and governance, as they have been involved directly in health service delivery activities in Mogadishu-Somalia. Sampling Frame A sampling frame will list of population from which the sample size will show drawn. The sampling frame must contain the same characteristics as the target population. The sample frame will be sixty (60) health experts in Banadir region Somalia. Sampling and Sample Size Sampling is the process of identifying the sample size from the target population. Stratified sampling method used to classify the target population in to two strata; male gender and female gender. Using the Solvin’s formulae, n= = = 52 Where: N = Total population, n = Sample population, α = Sampling error which is 0.05 Sampling Technique –  

17. Male and female gender Target Population sample size Male 30 26 Female 30 26 Total 60 52 Table 3. 1: Sampling and Sample Size

18. Data Processing, Analysis and Presentation Data will analyze qualitatively method of Descriptive statistics and will also generate the Data will present in both figures and tables. The collect data will analyze quantitatively and qualitatively. Descriptive and inferential statistics will generate using SPSS version 26. And model summary will generate. Fraenkel and Wallen , (2011) argue that working out of a statistical relationship between one or more variables.

19. Thank you.