6. Feed Charged:
In a cost-sharing arrangement, patient are charged one 30% of the total cost of
visit, in- patient room surgery or counselling, etc.
7. Relation with Galkajo
General Hospital
GMC has good working relation with Galkajo General Hospital. It supplied it some
medical experting and good amounts of medicines from time to time. The Galkajo
General Hospital also refers patients to GMC for visit, surgery or counseling.
There is regular consultation and cooperation between the two hospitals.
8. Prevalence of FGM
complication in surgical patients.
|
Year 2003 |
% |
Year 2004 |
% |
|
Total surgical
patient 180 |
|
Total surgical
patient 240 |
|
|
Complication
related to FGM |
27% |
Complication
related to FGM |
29% |
|
Fistulas
complications |
7% |
Fistulas
complications |
9% |
|
Vescical-vaginal
fistulas |
60% |
Vescical-vaginal
fistulas |
65% |
|
Recto-vaginal
fistulas |
25% |
Recto-vaginal
fistulas |
20% |
|
Ureter-vaginal
fistulas |
10% |
Ureter-vaginal
fistulas |
6% |
|
Recto-vescical
vaginal fistulas |
5% |
Recto-vescical
vaginal fistulas |
9% |
9. Percentage of
success of fistolectomy in GMC
• Vescico-vaginal fistulas 98%
• Rescto- vaginal fistulas 95%
• Uretro-vaginal fistulas 10%
RAPID
NEEDS ASSESMENT FOR MIDWIFERY AND REPRODUCTIVE HEALTH TRAINING IN PUNT LAND
SOMALIA
Background and purpose
To address the high level of maternal
and fetal mortality in Somalia, COMSED intends to contribute in the training of
community midwives through a quick start and rapid expansion approach to ensure
skilled attendance at birth. This strategy has been proven globally to be the
single most effective strategy to reduce maternal, fetal mortality and
morbidity. A skilled attendant must be an accredited health professional - such
as midwife, nurses, doctors. Who has been educated and trained to proficiency in
the skills needed to manage normal (uncomplicated) pregnancies, childbirth and
the immediate postnatal period, and in the identification management and
referral of complications in women and newborns.
Need Assessment for midwifery and reproductive health
training in Punt land
We all believe that the peace agreement and assessment at the government in
Somalia is the only matter that the Somaly people can enjoy improved quality of
life. However, Punt land lacks the necessary health workers to make this
transition and for this reason, we must embark on a process that ensures that
there are enough health workers to deal with health issues, specially the
reproductive health and to reduce maternal and fetal mortality and morbidity.
The maternal mortality rate is Somalia estimated the highest in the world, and
all social indicators are the lowest in developing world. These figures are
unacceptable and demonstrated a problem that needs addressing.
The key step would be:
1. Ensuring that every single delivery is attended by a skilled attendant. Basic
skills of handling a delivery and recognising complications during childbirth
and able to adequately respond to them.
2. Ensuring that when the patient requires special care there should be an
effective referral system.
3. Reduced frequency of births leads to reduction of maternal mortality. Various
health cadres should be trained with these minimum skills in the shortest time
possible. Therefore we should focus on the most cost effective interventions
for maximum impact.
Key
global strategies so far include skilled birth attendants, continuum of care,
advocacy and community awareness and full integration of maternal and child
health in a health system, and how these strategies can be effective in
reducing both maternal and child mortality.
Male must be
involved in maternal care issues of obstetric care and strategies, issues at
sexually transmitted diseases, impact of formal traditional practice (FGM) and
implications of these to poverty alleviation.
In Puntland
we don’t have reliable dates after the call apse of SIAD BARE’S regime, but we
believe it is with Hat Fertility Mate, no Antenatal Coverage, with a
Contraceptive prevalence rate of less than 1% only less more 5% of birth were
attended by skilled health staff. Maternal mortality Index is estimated to be
the highest in Africa. To reduce maternal and fetal mortality and morbidity
should be addressed at following fronts:
1. Family planning
2. Antenatal care
3. Skilled birth attendance at all birth
4. Emergency obstetric care.
To increase access to skilled birth attendance with focus in Underprivileged
areas (lack of transportation and inaccessible places, Heightened threats to
girls and women) it is necessary to ensure access to the skilled whit attendant:
• Regulation
• Standards
• Training (additional skill to the existing staff)
• Referral services
• Birth preparedness/ complication readiness
• Emergency transportation
• Supportive supervision and monitoring.
The most maternal and perinatal deaths and almost all maternal and newborn
morbidities were due to lack of quality care from skilled attendant and medical
staff.
The following skilled are necessary for any community. Based midwife:
• General professional ethical base
• Capacity of problem solving
• Community mobilization
• Health education and promotion
• Pre-pregnancy advice and family planning
• Pregnancy care
• Intra- partum care
• Post-partum care ( mother and baby)
• Recognition of complication in woman and newborns pre-referral
care and referral.
The key
health structure in the community, are the primary health care UNIT (PHCU) and
public heath care centre (PHCC). The functions of the primary health care unit
were quite basic and included:
• Treatment of common illnesses
• Provision of first aid to trauma cases
• Dress in of wounds
• Referral complicated cases
• Health education
• Promotional activities
• MCH and EPI
• Dispensary of essential drags
• Recording and reporting statistics on health activities.
Suggested draft for policy and standards of community midwifery training for
PUNTLAND- SOMALIA.
Definition of community midwife
Community midwives are skilled birth attendants who are trained and deployed to
primarily serve pregnant women and their newborn babies.
“The term “skilled attendant” refers exclusively to people with midwifery skills
(for example midwives, doctors and nurses) who have been trained to proficiency
in the skills necessary to manage deliveries and diagnose, manage or refer
obstetric complications. At minimum the person must be competent to manage
normal childbirth and be able to provide emergency (first line) obstetric care.
Not all skilled attendants can provide comprehensive emergency obstetric care
although they should have the skills to diagnose when such interventions are
needed and the capacity to refer women to a higher level of care” (UNFPA,
UNICEF, WHO & World Bank)
Thus, community midwives should be able to provide:
•
The full range of midwifery care, including antenatal, birth and postpartum care
• Management of complications, according to the principles of basic
emergency obstetric care (BEmOC)
• Newborn and infant care
• Selected reproductive health care
• Other complementary services outlined in the Basic Package of
Health Services (BPHS)
• Vital linkages between the women/families/communities and the
health system and facilities
Competencies of midwives
The required competencies for a midwife, in order to successfully perform the
stipulated services include:
Competency 1: Community midwives have the requisite
knowledge and skills in public health and ethics that form the basis of high
quality, culturally relevant, appropriate care for women, heir newborns, and
their families.
Competency 2: Community midwives provide high quality,
culturally sensitive health education and family planning services in the
community in order to promote healthy family life, planned pregnancies and
positive parenting.
•
Provide information and counselling on family planning.
• Provide all methods of non-surgical family planning services
(clinical and non-clinical).
• Provide counselling and referral information for surgical methods
of contraception.
Competency 3: Community midwives provide high quality
antenatal care to maximize the woman’s and foetal health during pregnancy,
detect early and treat any complications that may arise and refer if specialist
attention is required.
•
Diagnose pregnancy and perform antenatal history and examination
• Provide early detection and referral of non-emergent complications
• Provide tetanus toxoid immunization, iron and folic acid and other
antenatal preventive measures according to the BPHS
• Advise on development of birth plan, and promote the concept of
birth preparedness and complication readiness
• Counsel on prenatal self care, including nutrition, hygiene,
breastfeeding and danger signs in pregnancy and childbirth
• Identify conditions of pregnancy with potential risk of
complications and advise or refer
• Detect, manage and refer obstetric emergencies during pregnancy,
according to the principles of basic emergency obstetric care
• Provide prophylaxis for malaria as well as other preventive
measures like bed nets
Competency 4: Community midwives provide high quality,
culturally sensitive care during labour: conduct a clean, safe delivery, give
care to the newborn, and manage or refer emergencies effectively to prevent
maternal and neonatal mortality and morbidity.
•
Perform history and exam of the labouring woman and diagnose labour
• Manage normal labour and delivery, using the partograph
• Assist the woman in clean, safe and humanistic childbirth
• Conduct active management of the third stage of labour for
reduction of post partum haemorrhage
• Diagnose using the partograph and refer women with evidence of
prolonged or obstructed labour
• Treat postpartum haemorrhage including manual removal of placenta
and injection oxytocics. Stabilize and refer required cases
• Delect and manage all obstetric emergency during labour, according
to the principles of basic emergency obstetric care
• Perform and repair episiotomy when indicated
• Repair 1 St 2 nd 3 rd degree tear. Refer complications of labour
and birth when necessary
• Diagnose and refer cases of incomplete abortion
Competency 5: Community midwives provide comprehensive,
high quality, culturally sensitive postnatal care for women and newborn.
• Provide immediate postpartum care, including history, examination
and counselling
• Provide postpartum assessment (s) of mother and infant
• Offer postpartum family planning counselling and services
• Counsel on breastfeeding and provide nutritional education to
women
• Diagnose, stabilize and refer postpartum complication when
necessary
Competency 6: Community midwives provide high quality
care for the newborn infant and surveillance and preventive care for young
children
• Provide immediate newborn care with a focus on airway, warmth and
breastfeeding
• Provide emergency measures for newborn resuscitation
• Provide routine newborn care, including physical examination and
care of the umbilical cord
• Provide emergency care for newborns including hypothermia, eye
infections or cord stump
• Encourage exclusive breastfeeding and provide nutrition
counselling to mothers on introduction of appropriate weaning foods
• Monitor the newborn
• Provide preventative care, ensuring immunization to newborns
• Identify and refer condition or complications beyond the scope of
their competency
Competency 7: Community midwives
participate in the promotion of health and wellness in the community and serve
as a link between the community and the health system
•
Support community health workers ( CHWs) in their provision of community-based
health care by participating in, and providing technical guidance ad required
• Provide supportive clinical supervision and technical
information to CHWs regarding maternal and newborn health
• Support CHW with respect to referral cases
• Work with CHW and community leaders to promote the concept of
birth preparedness and complication readiness related to pregnancy, delivery and
newborn care
• Create and support an environment where women con enjoy social
support during pregnancy and labour
Competency 8: Keep records on births and deaths and
prepare reports to higher level of service.
Competency 9: Be equipped with necessary knowledge and
skills for teaching-learning and supervisory skills to:
• Train student midwives
• Provide supportive supervision to TBAS.
Competency 10: Have requisite knowledge and skills in
communication to counsel and provide their clients with required information and
behaviour for health promotion.
• HIV/AIDS counselling for testing
• Advise women on measures to be taken based on their HIV7AIDS
status
Competency 11: Acquire basic skills in management
Position in the health system
The community midwife should be considered a senior member of the health team at
the primary level and must be supervised by the medical officer. She should be
considered senior to other peripheral health functionaries, including community
health workers (CHWs) and equivalent to the nurse.
There should be a separate cadre for community midwives in the existing
hierarchy of the health system. Midwives should be considered as regular
employees of the system with a monthly salary.
The committee
may consider another option where midwives may be paid a nominal salary and may
also be eligible for stipulated financial incentives from the beneficiaries for
conducting deliveries only.
Performance evaluation and promotion
The community midwife should be jointly evaluated for her performance on a
regular basis by the medical officer at the health centre, along with the health
authorities at the district/regional level.
The evaluation of the midwife will depend on the
following criteria:
• Number of deliveries conducted
• Number of complicated cases managed/referred
• Feedback from the community
• Records updated regularly and reports submitted on a regular basis
In order to make the evaluation more objective, a graded system of evaluation
may be developed. After a satisfactory performance of at least 10 years in the
rural areas, the midwife may be considered for a promotion as a district
nurse/midwife, if recommended by the community, the medical officer and the
appropriate authorities in the district. Alternatively, after a satisfactory
completion of eight years of services in the rural areas, the midwife may be
considered eligible for training of one year that should enable her to be
promoted to a district nurse/midwife.
Duties and responsibilities
The midwife will be based in the community and will be required to conduct home
visits on a periodic basic so as to facilitate early diagnosis of pregnancy and
complications.
As a
standard, a minimum of 3 antenatal visits and 3 postnatal visits will be
mandatory for all pregnant women. In case of PNC, the 3 visits will have to be
completed within the first 10 days of delivery (on days 1, 3 and 7-10)
Antenatal care
• Registration and proper record keeping for all pregnant
women
• History taking and examination
• Early detection and referral in case of complications
(complication readiness)
• Advise on birth preparedness including, identification of
attendant at birth, site of delivery, complication preparedness, transportation
arrangements for emergency referrals, financial arrangement, etc.
• Tetanus Toxoid immunization (2 to 3 doses)
• RH Iso-immunization
• Iron and folic acid supplementation (minimum of 90 tablets)
• Advise on care of the pregnant woman
• Community and family orientation on early recognition of danger
signals
• Mobilize community support for emergency transportation
Labour and delivery care
• Provide obstetric first aid in case of emergencies and facilitate
emergency transportation
• Conduct clean and safe deliveries
• Refer complication when required
• Provide essential neonatal care and manage complications
• Manage postpartum haemorrhage and stabilize the case if referral
is required
Postpartum care
• Provide postpartum check for the mother (3 PNC visits to be completed in
the first 10 days post partum)
• Provide postpartum family planning counselling and services
• Counsel on maternal and child nutrition
• Promote exclusive breast feeding and counsel the mother about childhood
immunisations
• Manage or refer post partum complications, as appropriate
Care of the newborn (birth to 28 days)
• Conduct quick check and basic assessment of newborn
• Perform essential newborn care including, initiating breathing and
other resuscitation measures, general cleanliness, thermal protection, early and
exclusive breast feeding, eye care, immunization, Vitamin K
• Educate parents about newborn care and danger signals
(complication readiness)
• Provide emergency measures for emergency conditions in the
newborn, stabilise the newborn and refer
Child survival services
• Monitor the newborn as well as their growth and development
• Encourage breastfeeding and provide nutrition counselling to
mothers on introduction of appropriate weaning food for growth and development
of young children
• Have children adequately immunized against six target diseases
• Teach families to prepare and use oral rehydration solution
• Identify malnourished children and assist the family to manage the
condition
• Advise mothers to bring infant and children for regular medical
check up to detect abnormality early
• Advise mothers on prevention of home accidents.
Health education
• In the homes during routine home visits
• In the schools and community groups.
Community participation and coordination
•
Familiarize with local administrative structure
• Prepare comprehensive map of the services area
• Carry out community health survey
• Identify needs and problems of the community and the resources
available. Work out with the local community leaders and find the ways to meet
the identified needs to solve the problems.
• Promote community initiatives for health promotion, local
development and poverty alleviation.
Referral
• Identify condition beyond her competence and early referral to the
higher level of care or the appropriate source of assistance.
First aid and other medical care
1. Provide treatment for minor ailments and common condition
2. Maintain records and prepare records as assigned
3. Provide immediate treatment for all accidents, injuries and
emergencies
Record keeping and reports
1. Maintain records and prepare reports as assigned
2. Complete and check family card on each and every visit
3. The midwife should be able to maintain and regularly update at least 3
registers on a regular and continuous basis:
A. Couples register- to maintain details for al couples in the
reproductive age group, with details of their families
B. Register of pregnancies- to maintain the details and complete
records of all pregnant women, along with details of ANC, delivery PNC and
outcome of pregnancy
C. Under 5 register- to maintain a register of all under 5 years
children in the community served by the midwife
The responsibilities of the community midwife are to:
1. Give the necessary supervision, care and advice to women during
pregnancy, labour and the postpartum period
2. Conduct deliveries on her own and care for the newborn infant
3. Ensure planning for birth for all pregnant women, including complication
and emergency preparedness plan
4. Manage complications in pregnancy and childbirth, in accordance with the
principles of basic emergency obstetric care
5. Provide primary care to women of reproductive age, in accordance with the
Basic Package of Health Services (BPHS)
6. Counsel and educate women, the family and the community, in
relevant areas of health including preparation for parenthood and childbirth and
the danger signals of pregnancy
7. Provide all non-surgical methods of family planning and
counselling for surgical methods
8. Obtain specialized assistance as necessary
(consultation or referral)
9. Share knowledge, skill and expertise with midwifery,
medical and nursing students, and nursing and resident staff, in the management
of pregnancy and childbirth, acting as a clinical preceptor
10. Perform limited, select administrative duties such as patient
charting, recording and reporting of data; clinic management (as required); or
coordination of specific educational or outreach programs
11. Participate in research, professional organizations and
related committees; and in continuing education opportunities
12. Follow established health centre policies, procedures and
objectives; continuous quality improvement initiatives; safety, environmental,
and infection prevention standards
13. Participate in provision of 24-hour, 7-day maternity service,
which may require evening night ore-call duty
Role of the community midwife
As mentioned earlier, the primary responsibility of the community midwife is to
provide competent, essential obstetrical care, including basic emergency
obstetric care, to the community (ies) in the catchment area of the facility in
which s/he works. To do so, s/he must not only be able to provide skilled care,
but also:
• Understand the communities that she serves and their particular
needs
• Work with communities to provide health education, especially
birth preparedness and complication readiness
• Facilitate the community’s active participation in the health
system (e.g. their local service delivery site, health centre, CHC, hospital)
• Work with other health staff to identify pregnant women in the
community and to facilitate both the access of pregnant women to skilled care
and the access of skilled care gives to pregnant women
• Be familiar with the kinds of services offered in nearby hospitals
for both emergent and non-emergent care, and how to access those services
• Be provided with appropriate clinical supportive supervision from
facilities at the next higher level
The community midwife is meant to provide her services with extensive outreach
to the community, and collaboration with the community health workers. In
special circumstances, the community midwife may also work at the health centre
or at hospital level and serve the community that surrounds the hospital.
The Candidate
•
Sex: Female
• Age: range between minimum 18 years old and maximum 25, with older
candidates being equally preferable. Age and experience impact significantly on
the respect and support that a community will provide both as an applicant
and eventually as a health care provider for the community. Community midwives
are likely to have strong ties o the community.
• Educational background: the candidate should be able to read and
write with a minimum of 8 years of formal schooling, high school, and midwife
certificate from accredited institution.
• Motivation: the community midwife must be motivated and willing to
work in remote and rural areas, which includes any agreement or concurrence
necessary from her husband and/or family. It is hoped that the candidate
would commit to serving for a period of minimum 5 years in the community that
supported and sponsored her application.
• Mobility: the community midwife must be able and willing to
relocate to the training/clinical site for the full period of the educational
program, i.e., 18 months. She and her family should be aware of breaks
built into the schedule that allow her to visit her home and family, which is
approximately every 3-6 months.
• Willingness to adhere to work condition: the newly qualified
candidate must be aware of and willing to work according to the anticipated
schedule of a community midwife, meaning working in a health centre with
other staff, and sometimes working out of normal hours.
The training
Competency-based training with a problem focused approach
To accomplish an effective and efficient education program for community
midwives, numerous tools and methodologies have been developed to facilitate the
development of clinical decision making abilities and critical clinical skills.
These include the use of
- Illustrated lecture and discussion, for the transfer of knowledge
- Case studies, for the detailed discussion of cases which allows
trainers to follow and assess the students clinical decision making skills
- Role plays, for the practicing of counselling and interpersonal
communication skills
- Anatomic models, which provide focused practice before entering
the clinical arena
- Learning guides, which detail all the specific steps (and their
sequence, if necessary) that must be followed in a particular clinical procedure
- Checklists, which allow for specific and constructive feedback to
students so that they may take directed, corrective measures to improve their
performance
- Clinical drills or simulation, for practicing skill and management
approaches for uncommon clinical scenarios (e.g. response to eclamptic
convulsions)
The training program will have to be designed in a modular way so as to enable
the candidates to complete specific modules and also to standardize the training
program. In case of long leaves (for various reasons) the candidate can always
come back and complete the remaining modules.
Length of training
The training programme for community midwives will consist of 18 months, which
will include theory, practice, and field experience. An additional 3-months
training is recommended after a community posting of 12 months and an additional
training of 3 months duration after completing 1 more year after the additional
training (total 24 months of services in the community)
Number of students
While the need for community midwives may be the driving influence behind
establishment and conducting of community midwife training, it cannot determine
the number of students. Student number must be determined by the clinical,
educational and physical capacity of the training site, rather than by the need
for a predetermined number of graduate community midwives. This means that, if
there is adequate clinical volume for only 20 students to effectively learn, and
then the class size should not exceed that number.
Increasing the number of students beyond the educational capacity of the
training centre will have a negative impact on the training of all students.
This may result in a poor quality training program with no competent graduates.
In most situations, it is unlikely for a rural training facility to accommodate
more than 20-25 students per batch.
It must be kept in mind, given that the course is an 18-month program that two
batches of students may overlap each year. If the capacity is inadequate for two
batches at the same time, the training site may consider running sequential
18-month courses, rather than having an intake at the same time each year. The
program schedule can be adjusted to allow two concurrent batches of students,
making an allowance to prevent crowding in the clinical area.
Student incentives
In many societies, professional education itself, with its enhancement of an
individual’s personal, professional and financial potential, is sufficient
incentive for a student. However, in a situation where some incentive must be
provided to students, it may take both monetary and non-monetary forms. These
include learning materials, clinical supplies; promise of employment in a local
NGO- managed facility or stipend for home leave.
Continuous professional trainings
Community midwives should be provided with updates and refresher training
according to a schedule established for them by the Health Secretariat. If
community midwives do not maintain or refresh their clinical skills with some
regularity (especially skills to manage rare or uncommon events) then they will
not be effective as providers due to deterioration of skills.
There could be system whereby, a brief re-orientation on specific skills may be
introduced regularly when the midwives come to submit their routine progress
reports at the health centres or the District.
Certification
At the end of the program, the candidates will be granted a certificate in
midwifery by the Health Secretariat, in collaboration with the training centre
that conducted the training.
Curriculum design
It is proposed that the curriculum be designed in such a way as to provide
maximum hands on practical training and skills to the midwives. Therefore, more
emphasis needs to be placed on the practical components of the training
programme:
• Total duration = 18 months
• Additional 3 months training = after 12 months community postings
• Another 3 months training = after 12 more months of community
service (total duration of community service = 24 months)
• 60% of the training = practical skills
• 30% of the training = theory
• 10% of the training = field experience, including reports, problem
solving, team building, communication, community participation
• 3 months in training school
• 9 months in hospital
• 2 months at the health centre
• 2 months in the community
• 2 months for record keeping, community mobilization, health
education activities.
All candidates will also be required to maintain a record of work done and this
will have to be counter-signed by the supervisor. As an example, the minimum
acceptable level of training may include, at least 60 ANCs, observation of 30
deliveries, conduct 60 deliveries of which at least 15 should be home deliveries
and 10 should be episiotomies, conduct 60 PNCs, etc.
Contents of the training
The following is an approximate list of topics to be
included in the various modules of the training program:
• Basics of human anatomy, physiology (including physiology of
reproduction, menstruation/menopause), pharmacology, pathology, microbiology,
gynaecology and obstetrics and human nutrition
•
Birth spacing
• Pregnancy and its complications and primary management of ANC and
PNC
• Normal delivery
• Complicated deliveries and their primary management
• Management of shock and other obstetric emergencies
• Newborn care, IMCI and basic resuscitation of the newborn
• Care of LBW and high risk infants
• STIs and HIV/AIDS
• Infection control
• Health of adolescents and young people
• Communication and counselling
• Causes of MMR and IMR, including U5MR and their prevention
• Basic nursing procedures, including complete physical examination
and checking blood pressure
• Role of midwives
• Health policies and programs
• Human rights and ethics, medico-legal implications of practice
• Problem solving
• Records, supervision and organizational hierarchy
• Community mobilization and health education
Registration and licensing
After successful completion of an accredited community midwifery education
programme and passing of the certification examination, the community midwife
shall be licensed to practice and deliver EOC services. This license will be
granted by the Health Secretariat.
The Health Secretariat will also provide the trained midwives with 4 uniforms in
the first year after graduation, along with a badge and identity card.
Subsequently, all trained midwives will have to be provided at least 3 uniforms
per year and badges/identity cards will have to be renewed after every 2 years.
The provision of delivery kits will also be the responsibility of the Health
Secretariat.
It will also be necessary to ensure an uninterrupted supply of RH commodities to
the midwife, as well as the replenishment/replacement of the kits on a periodic
basis. The Health Secretariat will also be the competent authority for granting
certificates/licenses to organizations/institutions that will be considered
eligible for training of midwives. Minimum standards of a training centre should
be developed, along with the outlines of the curriculum. The Health Secretariat
will issue accreditation certificate for interested training centres.
|
Galkayo Medical Centre (GMC) is a non-profit and non-governmental
organization in the health sector based in Galkayo, North Mudug, Punt land,
Somalia. It has been operating in this area for the last 7 years. The GMC is a
healthcare facility, which consists of a Day-Care Clinic and a fully-fledged
hospital. Cooperation for Medical Services Development (COMSED), and NGO based
in Italy, supports GMC with finance, medical expertise and supply of both
medicines and equipment. GMC is a health institution registered with the
authorities in Puntland and Mudug Region. The Hospital and the Day-Care, with
fulltime personnel of 23 and a number of casuals as required, are situated
within a compound of 6000 sq/metres of land owned by the GMC. As the need for
medical services for both urban and rural communities is so great, the current
limited facilities and resources of the GMC require to be expanded and improved
quantitatively and qualitatively. It has Board of Directors and a Director
General.