评价世界卫生组织2020-2025年在索马里的贡献：执行摘要

E x e c u t i v e s u m m a r y The content of this document is not final and the text may be subject to editorial revisions beforepublication. The content of this draft, however, will not undergo substantive changes. The documentmay not be reviewed, abstracted, quoted, reproduced, transmitted, distributed, translated oradapted, in part or in whole, in any form or by any means without the permission of the WorldHealth Organization Cover photo:National Immunization Days campaign in Somalia @WHO / Abdirahman Caaylawe Executive summary I n t r o d u c t i o n This independent evaluation of the contribution of the World Health Organization (WHO) in Somaliaduring the period 2020–2025 assesses country-level results against national priorities, in alignmentwith WHO’s global and regional agendas and the United Nations Sustainable DevelopmentCooperation Framework (UNSDCF). It documents WHO’s key contributions, achievements andstrategic approaches to improving health outcomes in Somalia, and also identifies success factors,gaps and lessons learned. The evaluation is framed by the Thirteenth General Programme of Work ofWHO (GPW 13, 2019–2025) and the Fourteenth General Programme of Work of WHO (GPW 14,2025–2028), which set WHO’s strategic priorities during and beyond the evaluation period. Thepurpose of the evaluation is to inform the strategic direction of the WHO Country Office (WCO),including the next Country Cooperation Strategy cycle. As part of WHO’s biennial evaluationworkplan for 2024–2025, the evaluation exercise underscores the Organization’s commitment toevidence-based decision-making, transparency and accountability to national governments,implementing partners, donors and Member States. The evaluation was jointly commissioned by theWHO Evaluation Office, the Regional Office for the Eastern Mediterranean and the WHO CountryOffice in Somalia and was conducted in accordance with the revised WHO Evaluation Policy (2025). 1 . 1C o n t e x t Somalia is classified as both a least developed country and a fragile state. The country remains in aprotracted post-conflict recovery situation and faces chronic food insecurity and recurrent droughtsand floods. Since 2007, it has been included in the World Bank list of fragile and conflict-affectedcountries since 2009(1), and the security situation remains precarious, with Mogadishu classified atlevel 5 under the United Nations (UN) security level system(2). In 2022, WHO declared a grade 3health emergency in Somalia – the highest emergency level recognized by the Organization(3).Decades of large-scale humanitarian assistance have sustained lives, but have also entrenchedparallel service delivery systems, leading to systemic post-delivery aid diversion and prompting high-level reforms(4). The population, estimated at 18.7 million in 2023, is exceptionally young (medianage 15.5 years), with 54% living below the poverty line(5). A compounding crisis of conflict andclimate shocks continues to drive disease outbreaks, with flooding linked to recurrent acute waterydiarrhoea and cholera outbreaks(6). Somalia’s health system is severely constrained by fragmentedgovernance, workforce shortages, chronic underfunding and unreliable data, and recenthumanitarian funding cuts have forced health facility closures(7). These challenges undermineprogress towards health equity and the WHO GPW 13 goal of “one billion more people with betterhealth and well-being”. 1 . 2O b j e c t The object of the evaluation is WHO’s portfolio of work at country level in Somalia from 2020-2025.The WHO Country Cooperation Strategy (CCS) for Somalia (2021–2025) provides the strategicframework guiding WHO’s work in the country(8). It is aligned with the national health anddevelopment agenda, the UNSDCF (2021–2025), GPW 13 and, prospectively, GPW 14. Developedthrough extensive consultations with federal and state health authorities and partners, the CCSarticulates WHO’s mission to promote health, and serve the vulnerable, translating global prioritiesinto country-specific actions. It focuses on four strategic priorities: advancing universal healthcoverage (UHC) through strengthened primary health care; enhancing health security by improvingemergency preparedness and response; promoting healthier populations through multisectoralapproaches; and strengthening health governance and partnerships. These priorities are pursuedthrough a mix of direct implementation, technical assistance and policy advocacy, supported bydefined progress indicators. Since 2020, WHO Somalia has mobilized about US$ 343 million inawarded funds, of which over US$ 304 million had been utilized by June 2025. Overall, WCOfinancing remains heavily dependent on emergency-driven resources, underscoring Somalia’scontinued reliance on humanitarian funding to sustain health service delivery. 1 . 3P u r p o s e ,o b j e c t i v e s a n d s c o p e The purpose of this evaluation is to support organizational learning and accountability for re