The Somalia Climate Health Systems Mapping project, supported by Save the Children US and guided by its Climate and Health Strategy, aims to address the critical nexus between climate change, health, and nutrition. As an initial step towards this goal, the project leverages systems-based tools to unravel the interconnections and dynamics among these factors. This initiative, aligned with Somalia’s Country Strategic Plan (CSP), targets key challenges such as malnutrition and the increasing impacts of climate change, using evidence-based frameworks to drive meaningful interventions.

Climate-induced shocks such as droughts, floods, and locust infestations have recurrently devastated Somalia, contributing to high malnutrition rates and strained health systems. The report emphasizes the scarcity of documented evidence on the specific pathways through which climate change exacerbates malnutrition. To address this gap, the project adopted a systems-thinking approach, employing Causal Loop Diagrams (CLDs) to visualize and analyze the interlinked variables influencing health and nutrition outcomes. These diagrams illustrate reinforcing and balancing feedback loops across multiple sectors, including food security, healthcare access, economic activities, and governance.
The findings from the systems mapping highlighted the complexity of these interactions, revealing that the existing CLDs were intricate and challenging for decision-makers to interpret. As a solution, the integrated CLD was deconstructed into three simplified thematic diagrams focusing on infrastructure, food access, and economic and livelihood activities. This approach ensures clarity, enabling policymakers to understand and act on the pathways more effectively.

The infrastructure-focused CLD identifies the critical role of health facilities and road networks in mitigating malnutrition and related diseases. Climate-related events, such as floods and droughts, damage infrastructure, reduce health worker availability, and disrupt access to essential services. The food access diagram emphasizes the impact of environmental shocks on livestock, agriculture, and household income, which in turn affect food availability, quality, and affordability. The economic CLD explores how household income influences healthcare and food affordability while noting how malnutrition adversely impacts workforce productivity and, consequently, GDP and government revenues. These findings align with and expand upon the UNICEF Conceptual Framework for Maternal and Child Nutrition, mapping the enabling, underlying, and immediate determinants of malnutrition in Somalia.

To enhance the robustness of the systems analysis, the project incorporated qualitative research. Insights were gathered through interviews with 23 key informants, including policymakers, health practitioners, and community members. These interviews highlighted the multifaceted impacts of climate change, such as displacement, resource depletion, and food insecurity, which disproportionately affect vulnerable groups like women and children. Cultural norms, inadequate governance, and socio-economic challenges further compound the crisis. For instance, traditional practices often leave women with insufficient food, while economic instability driven by climate shocks reduces household income and employment opportunities, exacerbating malnutrition rates.

Key stakeholders acknowledged the severe repercussions of climate events on maternal and child health, with malnutrition contributing to increased vulnerability to diseases, stunted cognitive development, and economic loss. Health workers and policymakers stressed the need for targeted interventions, including climate-resilient health systems, education on nutrition, and improved access to clean water and sanitation. Moreover, community members expressed a sense of helplessness in the face of climate change, although some emphasized the importance of local actions such as promoting breastfeeding and sustainable land management practices.

A cost-benefit analysis conducted as part of the CLD study demonstrated the economic viability of proposed interventions, including climate-resilient health facilities and sustainable agricultural practices. For every Somali Shilling invested, the alternative scenario yielded a return of 4.57 Shillings, making it a highly favorable investment. These findings informed the development of a concept note focused on sustainable energy use in health facilities, highlighting the potential for reducing carbon footprints while enhancing service delivery.

The report also outlines efforts to disseminate findings through policy briefs, conferences, and international platforms. The project’s results were presented at the First Climate and Health Africa Conference and the Global Health Systems Symposium, generating interest from global stakeholders, including the Systems Thinking Accelerator. Moving forward, the project plans to document evidence on the cost-effectiveness of key interventions, share insights at international events, and publish findings in peer-reviewed journals.
In conclusion, the Somalia Climate Health Systems Mapping initiative underscores the urgent need for integrated and actionable approaches to address the intersections of climate change, health, and nutrition. By simplifying complex relationships, incorporating qualitative insights, and demonstrating economic feasibility, the project provides a roadmap for fostering resilience and equity in Somalia’s health systems amidst the growing challenges of climate change.