There is empirical evidence which indicates that the few tuberculosis (TB) diagnostic machines that have been installed in Somaliland, particularly the Genexpert Machines, are not operating to their full capacity.
The average ratio of GeneXpert machine to the population is one machine serving a population of over 700,000 people and in some areas it is one machine serving a population of over 800,000 people.
Findings of an empirical study indicate that GeneXpert machines in Somaliland do not operate to full capacity due to long periods of downtime which are occasioned by machine breakdowns because of erratic service and maintenance schedules; and or due to the absence of the necessary utilities, such as electricity, and supplies, such as cartridges, that are required in order for the machines to function.
A major reason why erratic service and maintenance of machines occurs and why the insufficient provision of supplies has to do with insufficient funding provided for TB healthcare services.
According to the Ministry of Health (MOH):
Although 72% of households in Somaliland live within thirty kilometres from a health facility, utilisation is limited due to poor infrastructure, inadequate medicines and other health supplies, the shortage and low motivation of human resources.
Somalilands travel long distances seeking TB /HIV diagnostic services because most of the lower level health facilities – health centre Is, health centre IIs and health centre IIIs – are equipped, if at all, with obsolete light microscopes used to diagnose TB by the smear microscopy technique.
The first national TB Survey that was conducted by MOH in 2015, moreover, found that:
Smear microscopy, the main TB diagnostic test in the country, misses about 60% of the cases.
A finding which led the MOH to conclude that:
There is a need to update the country’s TB /HIV screening and diagnostic algorithms.
It is doubtful that the MOH in 2017, two years after the national TB Survey was conducted, has achieved significant change in upgrading TB diagnostic machines at lower level health facilities.
It is highly likely that TB/HIV machines in Somaliland are not fully utilised and worse still they remain too few for a country with such a high TB burden.
By Hussein Abdi Rageh
Phone NO: 252 63 4757880