Summary 

The Daami region of Hargeisa's Gacan Libax district is largely dominated by the Gaboye clan, a minority population that is home to thousands of Ethiopian refugees who were moved into the area ten years ago. Daami has a population of approximately 51,000 people; the majority of them are Gaboye, Yibir, and IDPs. The Gaboye clan is subjected to numerous forms of persecution throughout Somalia, including marginalization, discrimination, segregation, and hardship. They live in deplorable conditions and are cut off from other settlements. This has a negative impact on their social, psychological, and economic well-being. The Gaboye clan and IDPs predominate in the Daami area of the Gacan Libax district, with 73% of them being young adults (18-35 years old) and 22% being elderly (55 years and above). Women constitute 54% of the Daami population and are mostly in the age group of 17-35 years. They suffer from the prejudice and bias of other clans, which limits their access to adequate health and other services. The majority of the adults (90%) are illiterate and head most of the households. Illiteracy hinders their development and perpetuates their poverty cycle.

Based on the issues identified in our baseline survey and research, over 82% of multiparous and multigravida women deliver children at home with the assistance of a traditional birth attendant, and delivery at home is the most preferred choice of delivery by women in Daami, with only less than 18% delivering at facility-based maternal and child health centers. Over 1,750 women have been engaged and have a history of home delivery; 75% of them have difficulties connected to pregnancy and child delivery, all of which have been traced during or after delivery. Traditional birth attendants were preferred because of their close link with women, awareness of culture, religion, and family life, the maternal health care services they provide in the area, and their inexpensive charge. Despite the government's prohibition on TBAs engaging in child delivery, the practice is widespread and unabated. Negative experiences at local Mother and Child Health Centers are another issue discouraging women from using facility-based birth, owing to maltreatment by young nurses and midwives and their utter lack of comprehension of women's desires or intentions during delivery. It has been discovered that a significant barrier to facility-based childbirth in Hargeisa is the absence of a reproductive health agency model in more than 80% of MCHs, private and public hospitals. In addition to their propensity for home delivery, most Daami households prioritize it because of cost. The majority of women in the Daami area, estimated at 72%, smoke shisha, a trend and a reason linked to pregnancy troubles, which also include complications in children. These observations were made in addition to pregnancy-related issues. Over 450 homes were accessed, and it was found that there was an increase in the number of families in the area with children aged 1 to 5 years old in the last 7 or 8 years, with a household having 5 or 6 children.

Boqor Ahmed and his team have been working with the community and community leaders to build a primary health care facility; however, the facility could not function due to a lack of funding, staff, and medicine. Based on the foregoing, Boqor Ahmed and his team recommend "Transforming communities towards facility-based child delivery through midwife-led initiatives" that will target over 16,800 mothers and 6,000 young women. The initiative attempts to address the challenges by providing a standalone primary health and maternal health care service, a low-risk birthing delivery service, emergency and community-centered educational outreach services, and a family planning education and counseling facility. To accomplish its objectives, Boqor Ahmed plans to create a model for a reproductive health agency by implementing a respectable maternal care (RMC) strategy, practice, and policy at the facility through SBAs' evidence-based training and certification, incentivizing the TBAs, and involving them in midwives' patient referral programs for expectant mothers and other women. Boqor Ahmed's project aims to train volunteer health workers (VHWs) who will then work with TBAs to engage in community-led reproductive health education, women's group awareness and education on pregnancy risk and complications, family planning education and awareness, as well as youth-led reproductive health education, which will be a peer-to-peer initiative