Implementing Protocols in Somalia’s Public Hospitals: A Success Story

Background information: Based on my extensive leadership at Demartino Public Hospital in Mogadishu and my involvement in coordinating Somalia's response to COVID-19, I have identified three key factors that influence the effectiveness of protocols: patient outcomes, the standard of care provided, and the dedication of healthcare professionals.

1) Patient performance: turning users into partners

In our setting, a patient's ability to participate is crucial for successful outcomes. It is essential for patients to arrive on time, provide accurate histories, follow treatment plans, and adhere to infection-prevention rules. We have shifted our approach from viewing compliance as a lecture to seeing it as a collaborative effort.

• We introduced 5-minute “explain back” moments at triage (patients restate key instructions).
• Visual cue cards in Somali and Arabic clarified hand hygiene, mask use, and ward routines.
• Family members were invited to a daily ward huddle so they could support nutrition, mobilization, and medication times.

Outcome: a reduction in missed doses, quicker patient discharges, and noticeably improved cleanliness of the wards (post-patient education swab audits showed consistent enhancement).

2) Quality of care: credibility that earns cooperation

When care feels safe, timely, and respectful, patients lean in. We focused on visible quality signals that patients could feel the same day:

• Posting daily bed-availability and lab turnaround times created predictability.
• A red rules list (e.g., no unlabelled syringes; mandatory time-outs before procedures) cut near-misses.
• Routine IPC walk-rounds using a simple checklist gave nurses permission to stop unsafe steps—no punishment, just fix and learn.

These measures enhanced trust and minimized disagreements at the patient's bedside. With the improvement in quality, there was a noticeable increase in patients' compliance with protocols, particularly those related to isolation, visiting hours, and discharge guidelines.
3) Professional conviction: why the rule exists matters

Even excellent SOPs fail when they feel foreign or impractical. We shifted from “obey this” to “own this”:
• Each new SOP launched with a 10-minute micro-class: the evidence, a local case, and what to do when the ideal isn’t available.
• We nominated protocol champions (one nurse, one clinician per ward) to adapt checklists to our supply realities—without diluting safety intent.
• Monthly audit & feedback was peer-led, not boss-led. Charts showed one improvement to celebrate and one bottleneck to fix.

Belief strengthened as the staff witnessed the tangible outcomes of their efforts. Dedication transformed into a sense of professional accomplishment, rather than mere following of rules.

How the three forces reinforce one another
• Quality → Patient performance: When patients experienced fewer delays and more respectful communication, adherence to isolation, meds, and follow-ups improved.
• Conviction → Quality: Staff who believed in the “why” delivered more consistent, evidence-based care.
• Patient performance → Conviction: Cooperative patients validated staff effort, boosting morale and making checklists feel worthwhile.

Leadership’s job is to stage these interactions—not by writing longer policies, but by designing daily routines where patients, providers, and processes lift each other.

Practical moves other resource-constrained hospitals can try next week

1. Explain-back at triage (no extra staff required).
2. Two-item ward dashboard (yesterday’s average lab TAT and today’s discharge goal).
3. 10-minute SOP launch (why it matters, one local case, one workaround).
4. Peer audit postcard (front: 5 checks; back: one story of success).
5. Family huddle (set visiting purpose: nutrition, mobility, meds reminders).

What I learned as a hospital leader
• Make the “first safe step” easy. In scarcity, perfect is the enemy of started.
• Show receipts. A tiny, credible metric moves culture more than a long memo.
• Honor constraints, protect intent. Let teams adapt steps while guarding the safety principle.
• Invite patients into the system. Engagement is not a campaign; it’s a daily practice design.

Why this matters for Somalia

Our hospitals will continue operating under pressure. But by aligning patient partnership, visible quality, and professional conviction, we can implement protocols reliably—even with limited resources—and protect more lives. That’s the kind of everyday resilience our health system can afford.

Examples above draw on my roles as Director General of Demartino Public Hospital and as a national incident manager during COVID-19, as detailed in my attached resume.