世界卫生组织2020-2025年在索马里的贡献：评估简报

E v a l u a t i o nb r i e f CoherenceThere was moderate technical and opera�onal coherence, with B a c k g r o u n dThis independent evalua�on of the World Health Organiza�on’s strong alignment in ver�cal programmes such as polio andimmuniza�on across WHO’s three levels. Coherence was weaker inemergency response, UHC, and health systems strengthening dueto funding constraints, communica�on gaps, and the absence of aCCS mid-term review. While WHO was recognized as a technicallead and coordina�on convener, fragmenta�on, donor-drivenpriori�es, and parallel systems limited harmoniza�on with partnersand internalprogramme integra�on. WHO’s strong field presenceenhanced coordina�on and credibility, though persistent challengessuch as duplica�on and limited subna�onal ownership underscoredthe need to strengthen the emerging Area-Based Coordina�on(ABC)model to improve alignment and accountability. (WHO) contribu�on in Somalia has been jointly commissioned bythe WHO Evalua�on Office (EVL), the Regional Office for the EasternMediterranean (EMRO), and the WHO Somalia Country Office, andconducted in accordance with the revised WHO Evalua�on Policy(2025).It documents WHO’s key contribu�ons, achievements, success factors, gaps, lessons learned and strategic approaches to improvinghealth outcomes in Somalia. The evalua�on is framed by WHO’sThirteenth General Programme of Work (GPW13, 2019–2025) andtheFourteenth General Programme of Work (GPW14, 2025–2028),which set WHO’s strategic priori�es during and beyond theevalua�on period. Effec�venessWHO demonstrated strong effec�veness in immuniza�on, P u r p o s ea n d s c o p eThe purpose of this evalua�on is to support organiza�onal learning surveillance, and emergency response, achieving improvementssuch as higher Penta-3 coverage (70% in 2024), stronger cold-chainsystems, and reduced cholera fatality rates (0.06%). Its support toIntegrated disease surveillance and response (IDSR)and laboratorysystems enhanced outbreak detec�on and response �meliness,though recurrent epidemics highlight ongoing fragility. WHO’sconvening power advanced key frameworks such as such as theEssen�al Package of Health Services(EPHS)2020,andReproduc�ve,Maternal, Neonatal, Child and Adolescent Health(RMNCAH)strategies, but measurement gaps and misalignment betweenoutputs and outcome indicators obscure the full extent of itscontribu�ons. Overall, WHO’s technical authority and policyinfluence were evident, yet effec�venesswasconstrained byfunding dependence, insecurity, and limited ins�tu�onal capacity. and accountability for results among external and internal WHOstakeholders.Theevalua�on assesses country-level results againstna�onal priori�es in alignment with WHO’s global and regionalagendas and the United Na�ons Sustainable DevelopmentCoopera�on Framework (UNSDCF).Itsaimsto inform the strategicdirec�on of the WHO Country Office, including the next CountryCoopera�on Strategy (CCS) cycle.The evalua�on covered WHOinterven�ons across all regions of Somalia, including urban, ruraland hard-to-reach areas,and reviewed the full por�olio of WHOSomalia work from 2020-2025. M e t h o d sThe evalua�on used a non-experimental, mixed-methods, u�liza�on-focused, and theory-based approach to assess how andwhy WHO’s interven�ons contributed to health outcomes inSomalia. A reconstructed Theory of Change (ToC) guided theanalysis of causal pathways and enabling factors. Data collec�onincluded a desk review, quan�ta�ve analysis, and extensivequalita�ve inquiry–78 key informant interviews, seven focus groupdiscussions, a par�cipatory workshop with nine state healthdirectors, and a percep�on survey of 47 WHO and partner staff. Theassessment applied adapted OECD-DAC criteria for humanitariancontexts–relevance, coherence, effec�veness, efficiency, andsustainability/connectedness, integra�ng gender, human rights,equity and disability inclusion throughout. EfficiencyWHO Somalia’s por�olio showed low efficiency, constrained by reliance on emergency and ver�cal funding, persistent Base-Strategic Priorityfinancing gaps, and high opera�onal costs thatlimited strategic resource alloca�on. The absence of an integratedperformance framework and reliance on upward global repor�ngweakened adap�ve management, obscured value-for-money, andskewed delivery toward short-term emergency priori�es.Nonetheless, emerging prac�ces, such as pooled UN logis�cs,shared security services, and harmonized health informa�onsystems, offer a poten�al pathway to greater efficiency ifins�tu�onalized. K e yf i n d i n g s SustainabilityWHO’s contribu�on to sustainability in Somalia is mixed. Financial RelevanceBetween 2020 and 2025, WHO’s strategies in Somalia were well sustainability remains low due to reliance on earmarked emergencyfunding and limited government financing, leaving health gainsfragile and the workforce dependent on donor support. Ins�tu�onalsustainability is moderate, with Federal Ministry of Healthownership of the CCS, but f