Developing Somaliland's Health Sector

DEVELOPMENT OF THE ACCREDITATION AND LICENSING SYSTEM IN THE
HEALTH SECTOR OF SOMALILAND”
EVOLVING WORKING PAPER
STATUS AS OF 03 AUGUST 2009
AND TASKS FOR THE FURTHER DEVELOPMENT
NATIONAL HEALTH PROFESSIONS COUNCIL (RE-)ESTABLISHMENT WORKING
GROUP
SAHRA ADAN GULAID
ABDUKARIM YUSUF MUSE
ABDULLAHI ABDURAHMAN OMAR
ISMAIL ADAM ABULLAHI
AHMED IBRAHIM BEDE
AHMED SULEIMAN OMER

NATIONAL HEALTH PROFESSIONS COUNCIL (RE-)ESTABLISHMENT WORKING GROUP
TABLE OF CONTENT
Table of Content...........................................................................................................................................2
Abbreviations ...............................................................................................................................................9
Definitions......................................................................................................................................................9
1 Purpose of this Document......................................................................................................................11
2 Background................................................................................................................................................12
3 Purpose of the Accreditation and Licensing System..........................................................................13
4 Methodology used in designing the Accreditation, Licensing and Register System.....................14
4.1 Adherence to the Principles of NHPC.........................................................................................14
4.2 Design in Consensus with Partners and Stakeholders...............................................................14
4.3 Utilisation of Experiences through Literature Review and Site Visits ...................................15
4.4 In Respect and Support of the Relationships between NHPC and MoHL...........................15
4.5 Mandate of SMA and SLNMA......................................................................................................16
5 Implementation Phases and modules – NHPC Concept Paper April 09.......................................17
5.1 Still Outstanding Preparatory Steps Other than the Accreditation system during 2009......17
5.2 Modules and Phases.........................................................................................................................17
5.2.1 Modules .....................................................................................................................................18
5.2.2 Phases .........................................................................................................................................18
6 Standards of Target Groups...................................................................................................................20
6.1 Individual Health Professionals ....................................................................................................20
6.1.1 Nurses and Auxiliary Nurses...................................................................................................20
6.1.2 Midwifes and Auxiliary Midwifes...........................................................................................20
6.1.3 Physicians ( General Practitioner, Specialists (Surgeon, Ophthalmologist, Internal
Medicine, Others)...............................................................................................................................20
6.1.4 Pharmacists and Laboratory Technicians ............................................................................21
6.1.5 Other Health Cadres working in Somaliland.......................................................................21
6.1.6 Cadres using Traditional Healing Procedures......................................................................21
6.2 Health Service Delivery Facilities .................................................................................................22
6.2.1 Primary level -Public and Private: Health Posts, Health Centres, Mother and Child
Health Centres (MCHs), Clinics etc................................................................................................22
6.2.2 Secondary level, public and private........................................................................................22
6.2.3 Tertiary level, public and private ...........................................................................................22
6.3 Basic and Continuous Medical/Health Education and Trainings...........................................22
6.3.1 Nursing and Midwifery Schools and Their Continuous Education.................................22
6.3.2 Other Institutions/Schools; Public and Private..................................................................22
6.3.3 Tutors .........................................................................................................................................22
6.3.4 Curriculum for Basic Education in Health...........................................................................22
6.3.5 Curriculum for Continuous Education in Health...............................................................22
STATUS AS OF 03 AUGUST 2009 AND TASKS FOR THE FURTHER DEVELOPMENT 2

6.3.6 Examination Process................................................................................................................22
6.4 “Traditional Health System” in Somaliland.................................................................................23
7 In Preparation of the Accreditation......................................................................................................24
7.1 Listing of Individuals and Services Currently Providing Health Care Services / Training. 24
7.1.1 Health Professionals ................................................................................................................24
7.1.2 Basic and Continuous Medical/Health Education and Trainings....................................24
7.1.3 Health Service Providers..........................................................................................................24
7.2 Assessment Validation Criteria Based on the Standards...........................................................25
7.2.1 Health Professionals ................................................................................................................25
7.2.2 Basic and Continuous Medical/Health Education and Trainings....................................25
7.2.3 Health Service Providers..........................................................................................................26
7.3 Assessment Tools.............................................................................................................................26
7.4 Selection Modalities of the Accreditation Committee Members.............................................26
8 Licensing and Re-licensing System and Procedure ............................................................................27
8.1 Purpose and Objectives of Licensing............................................................................................27
8.2 Accreditation and Licensing Relation...........................................................................................28
8.3 Types of License...............................................................................................................................28
8.3.1 Level and Grading of Licensing.............................................................................................28
8.3.2 Individual Licensure ................................................................................................................28
8.3.3 Institutional Licensure .............................................................................................................28
8.3.4 Suitability....................................................................................................................................28
8.4 Time Periods and Conditional Licence.........................................................................................29
8.4.1 Unconditional Licence.............................................................................................................29
8.4.2 Temporary / Conditional Licence.........................................................................................29
8.4.3 Rejected Licence........................................................................................................................29
8.5 Relicensing ........................................................................................................................................29
8.5.1 Procedural Steps........................................................................................................................29
9 Register system..........................................................................................................................................31
9.1.1 Definition ..................................................................................................................................31
9.1.2 Conditions to get registered....................................................................................................31
9.1.3 Maintenance of register............................................................................................................31
9.1.4 Paper based and IT Data base ...............................................................................................31
10 Accreditation Process............................................................................................................................32
10.1 Self Assessment .............................................................................................................................32
10.2 External Assessment .....................................................................................................................32
10.3 Decision ..........................................................................................................................................32
10.4 Licensing..........................................................................................................................................33
10.5 Registration......................................................................................................................................33
11 Appeal for disputed Assessments........................................................................................................35
11.1 Procedure ........................................................................................................................................35
11.2 Appeal Committee.........................................................................................................................35

11.3 Counselling......................................................................................................................................36
12 Accreditation, Licensing and Registration Tools..............................................................................36
13 Accompanying Mechanisms.................................................................................................................37
13.1 Capacity Building of NHPC Accreditation Unit.......................................................................37
13.2 Site Visits of NHPC staff and Committee Members ..............................................................37
13.3 Establishment of Fee Collection System....................................................................................37
14 Annex: .....................................................................................................................................................38
14.1 Standards (ST) Health Professionals Forms ST 1x................................................................38
14.1.1 Nurses (N) – Form ST 1.1./N/09................................................................................38
14.1.2 Auxiliary Nurses(AN) - Form ST 1.2./AN/09............................................................38
14.1.3 Midwifes (M) - Form ST 1.3./M/09............................................................................38
14.1.4 Auxiliary Midwifes (AM) - Form ST 1.4./AM/09........................................................38
14.1.5 General Practitioner (GP)- Form ST 1.5./GP/09......................................................38
14.1.6 Internal Medicine (IM) - Form ST 1.6./IM/09............................................................38
14.1.7 Ophthalmologist (OP) - Form ST 1.7./OP/09...........................................................38
14.1.8 Surgeon (SU) - Form ST 1.8./SU/09...........................................................................38
14.1.9 To be completed (others - Form AC/ST/PH/XX/09................................................39
14.1.10 Pharmacists (PH) - Form ST 1.9./PH/09.................................................................39
14.1.11 Laboratory technicians (LT) - Form ST 1.10./LT/09..............................................39
14.1.12 Laboratory technicians/Microscopists (MI) - Form ST 1.11./LT/MI/09...............39
14.1.13 Other cadres working in Somaliland - Form AC/ST/XX/09 ..................................39
14.1.14 To be completed (others - Form AC/ST/PH/XX/09...............................................39
14.2 Standards (ST) Health Service Delivery Facilities (HF) Forms ST 2x..................................40
14.2.1 Health post - Form ST 2.1./HP/09.............................................................................40
14.2.2 Health Centre - Form ST 2.2./HC/09.........................................................................40
14.2.3 Mother and child health centres (MCHs) – Form ST 2.3./MCH/09..........................40
14.2.4 Clinics - Form ST 2.4./CL/09......................................................................................40
14.2.5 Secondary level, public and private - Form ST 2.5./SL/09.........................................40
14.2.6 Tertiary level, public and private - Form ST 2.6./TL/09.............................................40
14.3 Standards (ST) • Basic and Continuous Medical/Health Education and Trainings (HT)
Forms ST 3x.............................................................................................................................................41
14.3.1 Nursing Schools; Public and Private - Form ST 3.1/NS/09........................................41
14.3.2 Midwifery Schools ; Public and Private Form ST 3.1/MS/09......................................41
14.3.3 Medical Schools ; Public and Private Form ST 3.1/MDS/09......................................41
14.3.4 Other Institutions/schools; public and private - Form ST 3.1/IN/09......................41
14.3.5 Tutors - Form ST 3.2./TU/09.....................................................................................41
14.3.6 Curriculum for Basic Nursing Education - Form ST 3.3/BNE/09............................41
14.3.7 Curriculum for Basic Midwifery Education - Form ST 3.3/BME/09.........................41

14.3.8 Curriculum for Continuous Medical/Health Education – Form ST
3.4./CE/09..........................................................................................................................................41
14.3.9 Examination Process - Form ST 3.5/EM/09...............................................................42
14.3.10 “Traditional Health System” in Somaliland - Forum ST 3.10./TM/09......................43
14.4 Accreditation Procedure (AP) Forms AP 4x........................................................................44
14.4.1 List of Individuals who provide health services - Form AP 4.1./HPr/09.................44
14.4.2 List of Public and Private Facilities Form AP 4.2./HF/09.........................................44
14.4.3 List of Training Providers in Health - Form AP 4.3./HF/09......................................44
14.5 Selection Accreditation (Sub)Committees ((S)AC) Forms AC 6x.......................................45
14.5.1 Selection Accreditation Committees (AC) Nurses- Form AC 5.1./N/09....................45
14.5.2 Selection Accreditation Committee (AC) Midwifes (M) – Form AC
5.2./M/09............................................................................................................................................45
14.5.3 Selection Accreditation Subcommittee (AC) General Practitioner (GP) – Form
ASC 5.3./GP/09.................................................................................................................................45
14.5.4 Selection Accreditation Subcommittee (ASC) Specialised Physicians – Form
ASC 5.4./SP/09..................................................................................................................................45
14.5.5 Selection Accreditation Subcommittee (ASC) • Basic and Continuous
Medical/Health Education/Trainings - Nurses - Form ASC 5.5./HT/N/09.......................45
14.5.6 Selection Accreditation Subcommittee (ASC) Basic and Continuous Medical/Health
Education/Trainings - Midwifes - Form ASC 5.6./HT/M/09..................................................45
Education/Trainings – Physic. - Form ASC 5.7./HT/PH/09..................................................45
Education/Trainings – Pharm. - Form ASC 5.8./HT/PH/09..................................................46
Education/Trainings - laboratory Technicians – Form ASC 5.9./HT/LT/09............46
14.5.10 Selection Accreditation Subcommittee (ASC) Basic and Continuous
Medical/Health Education/Trainings - Other cadres – to be specified – Form ASC
5..XX./HT/XX/09............................................................................................................................46
14.5.11 Selection Accreditation Committee Appeal – Form ASC 5.11./App/09...................46
14.6 Assessment Tools (AT) Health Professionals ..........................................................................47
14.6.1 Assessment tool (AT) – Nurses/Self Assessment (SE) – Form AT 6.1.
/N/SE/09...........................................................................................................................................47
14.6.2 Assessment tool (AT) – Nurses/External Assessment (EE) – Form AT
6.2./N/EE/09....................................................................................................................................47
14.6.3 Assessment tool (AT) – Auxiliary Nurse /Self Assessment (SE) – Form AT
6.3./AN/SE/09..................................................................................................................................47
14.6.4 Assessment tool (AT) – Auxiliary Nurses/External Assessment (EE) – Form
AT 6.4./AN/EE/09..........................................................................................................................47
14.6.5 Assessment tool (AT) –Midwife/Self Assessment (SE) – Form AT
6.5./M/SE/09.....................................................................................................................................47

14.6.6 Assessment tool (AT) – Auxiliary Midwife/External Assessment (EE) – Form
AT 6.6./AM/EE/09..........................................................................................................................47
14.6.7 Assessment tool (AT) – Laboratory Technician/Self Assessment (SE) – Form
AT 6.7./LT/SE/09............................................................................................................................47
14.6.8 Assessment tool (AT) – Laboratory Technician/External Assessment (EE) -
Form AT 6.8./LT/EE/09................................................................................................................47
14.6.9 Assessment tool (AT) – Pharmacists/Self Assessment (SE) – Form AT
6.9./PH/SE/09...................................................................................................................................47
14.6.10 Assessment tool (AT) – Pharmacists/External Assessment (EE) – Form AT
6.10./PH/EE/09................................................................................................................................47
14.6.11 Assessment tool (AT) – General Practitioner/Self Assessment (SE) – Form
AT 6.11./GP/SE/09.........................................................................................................................47
14.6.12 Assessment tool (AT) – General Practitioner/External Assessment (EE) -
Form AT 6.12./GP/EE/09.............................................................................................................47
14.6.13 Assessment tool (AT) – Ophthalmologist/Self Assessment (SE) – Form AT
6.13./OP/SE/09................................................................................................................................47
14.6.14 Assessment tool (AT) – Ophthalmologist/External Assessment (EE) – Form
AT 6.14./OP/EE/09........................................................................................................................47
14.6.15 Assessment tool (AT) – Internal Medicine/Self Assessment (SE) – Form AT
6.15./SE/09.........................................................................................................................................48
14.6.16 Assessment tool (AT) – Internal Medicine/External Assessment (EE) – Form
AT 6.16./IM/EE/09.........................................................................................................................48
14.6.17 Assessment tool (AT) – Surgeon/Self Assessment (SE) – Form AT
6.17./SU/SE/09.................................................................................................................................48
14.6.18 Assessment tool (AT) – Surgeon/External Assessment (EE) – Form AT
6.18./SU/EE/09................................................................................................................................48
14.6.19 Assessment tool (AT) – others – to be extended – Form AT 6.XX/XX/09
................................................................................................................................................................48
14.7 Assessment Tool (AT) Health Service Providers.....................................................................49
14.7.1 Assessment tool (AT) – Health Post/Self Assessment (SE) – Form AT
7.1./HP/SE/09...................................................................................................................................50
14.7.2 Assessment tool (AT) – Health Post/External Assessment (EE) – Form AT
7.2./HP/EE/09..................................................................................................................................50
14.7.3 Assessment tool (AT) – Health Centre/Self Assessment (SE) – Form AT
7.3./HC/SE/09..................................................................................................................................50
14.7.4 Assessment tool (AT) – Health Centre/External Assessment (EE) – Form AT
7.4./HC/EE/09.................................................................................................................................50
14.7.5 Assessment tool (AT) – Mother and Child Health Centre/Self Assessment (SE) -
Form AT 7.5./MCH/SE/09............................................................................................................50
14.7.6 Assessment tool (AT) – Mother and Child Health Centre/External Assessment (EE)
- Form AT 7.6./MCH/EE/09...................................................................................................50

14.7.7 Assessment tool (AT) – Clinic/Self Assessment (SE) – Form AT
7.7./AT/CL/SE/09...........................................................................................................................50
14.7.8 Assessment tool (AT) – Clinic/External Assessment (EE) – Form AT
7.8./CL/EE/09..................................................................................................................................50
14.7.9 Assessment tool (AT) – Secondary Level Hospital (SLH)/Self Assessment (SE) -
Form AT 7.9./SLH/SE/09..............................................................................................................50
14.7.10 Assessment tool (AT) – Secondary Level Hospital (SLH)/External Assessment
(EE) - Form AT 7.10./SLH/EE/09.........................................................................................50
14.7.11 Assessment tool (AT) – Tertiary Level Hospital (TLH)/Self Assessment (SE) -
Form AT 7.11./TLH/SE/09...........................................................................................................50
14.7.12 Assessment tool (AT) – Tertiary Level Hospital (TLH)/External Assessment (EE) -
Form AT 7.12./TLH/EE/09..........................................................................................................50
14.7.13 Assessment tool (AT) – Pharmacy/Self Assessment (SE) – Form AT
7.13./PHa/SE/09...............................................................................................................................50
14.7.14 Assessment tool (AT) – Pharmacy/External Assessment (EE) – Form AT
7.14./Pha/EE/09...............................................................................................................................50
14.7.15 Assessment tool (AT) – Laboratory/Self Assessment (SE) – Form AT
7.15./AT/Lab/SE/09.......................................................................................................................51
14.7.16 Assessment tool (AT) – Laboratory/External Assessment (EE) – Form AT
7.16./Lab/EE/09...............................................................................................................................51
14.8 Assessment Tool (AT) Basic and Continuous Medical/Health Education and Trainings
52
14.8.1 Assessment tools (AT) – Institutions/schools/Self Assessment (SE) – Form
AT 8.1. /Ins/SE/09...........................................................................................................................52
14.8.2 Assessment tools (AT) – Institutions/schools/External Assessment (EE) -
Form AT 8.2./Ins/EE/09................................................................................................................52
14.8.3 Assessment tools (AT) Tutors - Self Assessment (SE) – Form AT
8.3./Tu/SE/09....................................................................................................................................52
14.8.4 Assessment tools (AT) – Tutors/External Assessment (EE) – Form AT
8.4./Tu/EE/09...................................................................................................................................52
14.8.5 Assessment tools (AT) Curriculum for basic education in health - Self Assessment
(SE) - Form AT 8.5./Cu-BE/SE/09........................................................................................52
14.8.6 Assessment tools (AT) – Curriculum for basic education in health/External
Assessment (EE) - Form AT 8.6./Cu-BE/EE/09....................................................................52
14.8.7 Assessment tools (AT) Curriculum for continuous education in health - Self
Assessment (SE) - Form AY 8.7./Cu-CE/SE/09...................................................................52
14.8.8 Assessment tools (AT) – Curriculum for continuous education/External Assessment
(EE) - Form Y 8.8./Cu-CE/EE/09.............................................................................................52
14.8.9 Assessment tools (AT) Examination process - Form AT 8.9./EM/09........................52
14.9 Assessment Reporting Template - Template /Rep/09..........................................................53
14.10 Licensing Forms Process - Form LI 10./Pr/09..................................................................54
14.11 Registration Forms Process - Form RE 11./Pr/09.............................................................54
14.12 Re-assessment Form Process - Form RA 12./Pr/09..........................................................54

14.13 Appeal (AP) ..................................................................................................................................54
14.13.1 Appeal Form - Form AP 13.1./Fo/09......................................................................54
14.13.2 Appeal Protocol Form - Form AP 13.2./Pr/09........................................................54
14.14 Fee Collection Form process - Form FE 14./09................................................................54
Figure 1: Relation between NHPC (Re-) establishment WG, Steering Committee and MoHL ...12
Figure 2: Relationships between NHPC and MoHL.............................................................................15
Figure 3: Sequence and flow......................................................................................................................33

ABBREVIATIONS
CPD Continuing professional development
ED Executive Director
EPHS Essential package of health services
GoS Government of Somaliland
H(M)IS Health (management) information system
HPC Health Professions Council
HR Human Resource
MCH Mother and Child Health
M&E Monitoring and evaluation
MoHL Ministry of Health and Labour
MOU Memorandum of Understanding
NHPC National Health Professions Council
RHO Regional Health Office
SLNMA Somaliland Nursing and Midwifery Association
SC Steering Committee
SMA Somaliland Medical Association
TOR Terms of reference
UNICEF United Nations Children’s Fund
WG Working Group
WHO World Health Organisation
DEFINITIONS
Several different definitions of accreditation, licensing and registration are internationally in use.
The NHPC WG aims at harmonising these definitions and formulates the following in the
context of regulating health care in Somaliland:

ACCOUNTABLE: - A liable health professional is responsible for the decisions made and can
justify them.
ACCREDITATION: is the process of assessing and confirming the qualifications of health care
practitioner (person or institution) seeking to get a license to practice..
SERVICE USER: is anyone who uses or is affected by the services
STANDARDS OF PROFICIENCY: formulate the requirements which ensure that a profession is
practiced safely and effectively. Health professionals and institutions must meet these standards
to become registered.
FIT FOR PRACTICE: refers to the skills, knowledge, competence and character to work safely
and effectively.
SCOPE OF PRACTICE: defines the range of responsibilities within which activities can and have
to be carried out by a health professional (e.g. “what does a nurse do or not do and what does a
doctor do or not do, what a laboratory technician or a physiotherapist etc”) and for which they
should be fit for practice.
HEALTH CARE SYSTEM: this term refers to a country's system of delivering services for the
prevention and treatment of diseases and for the promotion of physical and mental well-being.
Of particular interest to a health care system is how medical care is organised, financed, and
delivered.
HEALTH CARE: any care, treatment, service or procedure to maintain, diagnose, treat, or
otherwise affect an individual’s physical or mental condition, and includes medical care
HEALTH CARE (SERVICE) PROVIDER: A person, a body, organisation or institution
administering health care in the ordinary course of business or practice of a profession and
should be licensed, certified or otherwise authorised or permitted by the laws of this state to
perform.
HEALTH FACILITY: includes health posts, health centres, MCH clinics, secondary and tertiary
hospitals, private clinics etc. where medical, dental and other health services are provided.
LICENSE: is a formal registered permission from a constituted authority to perform a
business/professional/trade activity.

1 PURPOSE OF THIS DOCUMENT
This paper documents the CURRENT STAGE IN THE DEVELOPMENT of the
Accreditation/Licensing/Register system in the health sector in Somaliland. It lays out the
progress and identifies the areas of work which still need to be addressed, by whom and during
which time frame it will be completed before the NHPC commences its work.
This paper will evolve even further until the three implementation modules (see below) are
completed in three phases, initial experiences are captured and utilised for adequate adjustments.
This paper is set out to illustrate the present status in the design of accreditation, licensing and
registration.
• Hereby the document aims at informing and improving understanding of the (future)
NHPC staff, the health workers and institutions, the key stakeholders as well as potentially
the public on the purpose and process of accreditation and licensing.
• Simultaneously it contains the tools, forms, process steps etc for practical application by
the users.

2 BACKGROUND
In 1999 an Act of the Republic of Somaliland Parliament was passed to establish a Health
Professions Council (HPC). The Act defined the function of the Council which was planned to
register health professionals and facilities. Although the HPC was constituted in 2001, it was not
sustained and the Council was disbanded.
During consultations in November 2006 (as part of the development of a broader health systems
strengthening initiative), stakeholders confirmed the importance of and need for the HPC. In
2008, efforts were made to reconstitute the HPC and changes were made and/or envisioned to
be made to minimise past short comings and utilise the previous positive and constraining
experiences.
Despite the challenges, the HPC continued to be seen as a key platform in the health sector for
the overall promotion of standards and a central body for regulatory issues in the longer term. It
has become clear however that, while many of the ambitions of the Act remain as relevant and
valid today as in 1999, not only the Act needs to be updated, but also the overall concept and the
strategy of a HPC to reflect changes that have taken place in the health sector including, for
example, but not only, the emergence of professional associations and changes in the broader
regulatory and health service governing and delivering environment.
In view of the overall aim of the HPC as a statutory body with a mandate to protect the public,
all consumers of health care services, and to provide guidance on educational, professional and
ethical issues to practitioners, the need was formulated to review the Health Professions Council
concept, strategy and legislation, i.e. the Somaliland HPC Act (1999), and prepare the required
amendments to update the Act. Therefore a sustainable plan was required, with realistic and
achievable targets, for the start-up of the HPC.
Previous experiences in establishing the Council in Somaliland emphasised that, in order to
minimise the risk of another drawback, the foundation of the Council has to be first well
designed and formulated while ensuring consensus among the relevant stakeholders.
Furthermore, progress has to slow but steady after jointly designed steps are fully agreed and
FIGURE 1: RELATION BETWEEN NHPC (RE-) ESTABLISHMENT WG, STEERING COMMITTEE AND
MOHL
accepted. This calls for the
realisation through a
consensus-seeking process
in the development of
each of the elements and
documents required,
which was followed so far
in the development and
will be followed
throughout in the design
of the HPC components
and systems.
In February 2009 a
working group was formed
to re-establish the Council,
reporting to a Steering
Committee which consists
NHPC (Re-)establishment Structure
WG
The Vice
The
Chairman 5 other members
HE
MOHL
Steering
committee
Office secretary

of the Honourable Minister of Health and Labour, Mr. Abdi Haybe, the SMA- Chairman and the
SLNMA- Executive Director. The Working Group comprised two physicians, two nurses, one
laboratory technician, one pharmacist, one representative of MoHL, with support of the legal
Advisor (on request) and an administrator (permanent).
The name of “Health Professions Council” was changed during a Stakeholder Workshop on 15th
February 09 to “National Health Professions Council” to emphasise the national, country wide,
mandate. The name also reflects that it addresses regulations of not only health professionals but
will equally include equally facilities, institutions and bodies in health care service delivery and
health/medical education and training.
The NHPC Working Group and Steering Committee agreed on a work-plan with the objective
to create the foundations during 2009 and have the NHPC commence its function in January
2010. This preparatory work, establishing the foundation of the NHPC, includes in particular the
design of the Accreditation/Licensing/Registration System.
3 PURPOSE OF THE ACCREDITATION AND LICENSING SYSTEM
Accreditation, licensing and registration are the pillars of the NHPC mandate. The purpose of
accreditation is to preserve, protect and defend the community’s right for quality health care and
to establish also for the health service providers a safe framework in carrying out their
responsibilities. Hence it has to ensure that competency based standards of quality curative,
preventative and promoting health care are given to the public on primary, secondary and
tertiary level in both, the public and the private sector. Hereby it aims at protecting the right for
quality health care of the consumers as well as of the providers in carrying out their duties.
However, it is foremost a personal responsibility to make sure that the best interests of service
users are promoted and protected. Therefore factors affecting care or services must be respected
and taken into account.
The accreditation is the public mechanism to regulate that accredited and licensed health
institutions and individuals meet at least minimum quality standards in carrying their practice,
allowing the public getting the quality health care.
In order to save the community’s health and provide the maximum appropriate care to the
community, practitioners should be up to the standard. They are accredited and should be able
to provide high quality health care to the community and are hereby accountable and responsible
for their decisions.
The application of those standards determines who may or may not deliver health service, how
they are delivered and where and what kind of health services are offered. Licensing health care
institutions sets a minimum standard for each facility and their personnel as a group, and
applying the standard determines whether the institution may operate lawfully or not.
The licence is based on the accreditation process which in its turn refers to the minimum
standards for qualification, as will be elaborated in the following chapters.
The license is an official, legal permission that is indicating fit for practice and/or fit for purpose
as well as signifying the capacity to practice and hereby formalising accountability of service
providers.

4 METHODOLOGY USED IN DESIGNING THE ACCREDITATION,
LICENSING AND REGISTER SYSTEM
4.1 ADHERENCE TO THE PRINCIPLES OF NHPC
The accreditation, licensing and registration system is by nature complex, at the same time new
to the country and will require time to be understood, digested and well accepted by the service
providers and also by service consumers in order to prevent dangers and face challenges in the
utilisation and continuity of these systems.
Therefore the methodology in the design of the system keeps to the principles in the (re-)
establishment of the NHPC as stated in the Concept paper (April 2009):
“The NHPC requires a sound foundation and formulation prior to its actual commencement, to prevent repetition
of previous short comings which contributed to the halt of previous attempts to establish a Council. That
necessitates following thoroughly three guiding key principles:”
 SIMPLE AND START SMALL FIRST
 GET THE FOUNDATION RIGHT
 BASED ON CONSENSUS
These means in the present context in particular
• that the accreditation system should not enter sophistication at the beginning, and rather
focus on a PRACTICAL, PRAGMATIC way forward, while staying AMBITIOUS, ROBUST and
STRATEGIC.
• Getting the foundations right aims at the NHPC being perceived and seen by the public as
well as by health professionals as a RELIABLE body, with professional and institutional
CREDIBILITY, underlined by TRANSPARENCY and CONSISTENCY.
• The collaborative process used to elaborate and reach CONSENSUS in the work of the
NHPC WG must be transparent to all contributors in the collaboration as well as to the
public.
• At the initial stage the efforts will be central in Hargeisa, but with the intention not to be
centralised, i.e. when well established and if funding permits, NHPC could be AVAILABLE
and ACCESSIBLE also through offices the provinces, although in realistic terms, this is not
likely to be possible in the near future.
4.2 DESIGN IN CONSENSUS WITH PARTNERS AND STAKEHOLDERS
IT IS ESSENTIAL NOT ONLY IN THE ESTABLISHMENT OF THE NHPC, BUT ALSO IN THE
DESIGN OF THE VARIOUS ELEMENTS OF THE NHPC, LIKE THE ACCREDITATION AND
LICENSING, THAT THE PROCESS IS NEITHER TAKEN OVER, NOR DRIVEN BY EXTERNAL
SUPPORT OR CONSULTANTS, NOR THAT DOCUMENTS ARE BASED ONLY ON “LOCAL
CONSULTATION”, BUT THAT THE PROCESS IS STRONGLY IN THE HAND AND LED BY THE
NHPC WG, SC AND THEREAFTER BY THE ACTUAL NHPC, WHO IN THEIR TURN HAVE
TO ADOPT AN APPROACH WHICH ENSURES THAT THE KEY STAKEHOLDERS ARE UPDATED
ONGOING AND ALSO ACTIVELY INVOLVED IN THE DESIGN.
So far in the process there is a largely consensus among the main stakeholders on the key role
the accreditation, licensing and registration systems resume in the future progress of the health

sector of Somaliland in view of QUALITY CONTROL, PROTECTION OF CONSUMERS, RIGHT
TO QUALITY HEALTH CARE AND THE PROTECTION OF THE HEALTH CARE PROVIDERS.
 Regular meetings and events are required to be initiated by the NHPC WG to brief
and update partners and stakeholders on the progress and at the same occasion to
ask for and receive comments, questions on uncertainties and to incorporate
productive input after giving space for discussions, clarification and modifications.
 Therefore the accreditation, licensing and registration system requires, as foreseen
in the overall concept of NHPC, a strong marketing approach based on a well
thought through outlined, appropriately timed strategic approach for the various
target groups, i.e. health workers and service providers, politicians and general
population.
4.3 UTILISATION OF EXPERIENCES THROUGH LITERATURE REVIEW AND
SITE VISITS
The NHPC and in particular the Accreditation/Licensing/Registration shall not be designed in
isolation. Experiences from other countries, in particular on the African continent, will be
utilised through literature review and possibly, if funding permits, through site visits.
However, using experiences should not be mistaken as a copying exercise, but rather to identify
principles, pros and cons of methods and approaches as well as of institutional, organisational
and managerial set-ups and to use, avoid or adjust experiences as fit for Somaliland.
4.4 IN RESPECT AND SUPPORT OF THE RELATIONSHIPS BETWEEN NHPC
AND MOHL
A particular point for clarity is the position of NHPC as an independent body, but cooperating
closely with the Ministry of Health. It has to be strongly emphasised that the roles of MoHL and
NHPC are NOT OVERLAPPING, BUT COMPLEMENTARY. This implies being managerially and
financially INDEPENDENT FROM MOHL, WHILE IN CLOSE COOPERATION in related policy
development in the recognised mandate of the MoHL as the policy making, Governmental body.
FIGURE 2: RELATIONSHIPS BETWEEN NHPC AND MOHL
NHPC negotiates and
dialogues – requires mutuality
NHPC regulates and controls
quality - requires independence
The NHPC needs to be relying, in particular
for its accreditation and options for its
enforcement, on a comprehensive health
human resource policy and strategy with
strong political commitment for carrying this
strategy. Hereby the NHPC has to do both,
reply on MoHL to design the HR strategy
and also to advocate and contribute to its
development.
Policy and
Strategy
Health Care
provision
Public
Financing
Minister
MoHL
NHPC

 At the time of writing this paragraph the relation between MoHL and NHPC was
in the process to be discussed and formulated based on a recent draft of a Human
Resource Policy paper. The paragraph needs to be completed (by Ahmed and
Abdullahi) after this agreement is formalised.
4.5 MANDATE OF SMA AND SLNMA
 The above applies also to SMA and SLNMA. Their role in respect to NHPC will be
addressed and articulated during and within the same process as the relation
between MoHL and NHPC. The paragraph will be completed thereafter (by
Ahmed and Abdullahi).

5 IMPLEMENTATION PHASES AND MODULES – NHPC CONCEPT
PAPER APRIL 09
5.1 STILL OUTSTANDING PREPARATORY STEPS OTHER THAN THE
ACCREDITATION SYSTEM DURING 2009
The above implies that a series of PREPARATORY STEPS are required to establish, govern and
maintain the structure DURING 2009 (see also work-plan 2009 from February 2009):
1. SUBMISSION OF THE AMENDMENTS OF THE HPC ACT 99 TO THE PARLIAMENT
 The legal advisor to the NHPC WG / SG needs to review this document and
suggest if and which aspects require to be reflected in the Act Amendment.
2. STRATEGY AND OPERATIONAL PLAN 2010
3. ANNUAL OPERATIONAL PLAN 2010
4. NHPC MARKETING STRATEGY
5. IT SYSTEMS FOR ACCREDITATION, LICENSING AND REGISTRATION
6. TERMS OF REFERENCES for
• Board
• Chair of Board
• Executive Director
• Each technical unit
• NHPC administration
• NHPC finance
• Various committees and sub-comittees
7. A transparent RECRUITMENT PROCESS for the
• Executive director,
• NHPC personnel.
8. A transparent NOMINATION/ELECTION PROCESS for the
• Board members,
• Chair of the Board.
9. NHPC Office Organisational / Operational Manual
10.NHPC Finance Management System and Manual.
5.2 MODULES AND PHASES
The above also demands a complex process of high workload with some degree of specificity.
Since the NHPC is being established as a new organ in the country it is not feasible to include all
interventions, targets groups and procedures at once. This asks for a phased approach in
modules:

5.2.1 MODULES
MODULE 1 TARGET GROUPS:
• Health Professionals:
− Physicians incl. specialists
− Nurses with breakdown in type and level of nurses
− Midwifes with breakdown in type and level of nurses
− Pharmacists
• Basic and Continuous Medical/Health Education and Trainings:
− Nursing schools
− Midwifery schools
− Continuous trainings
• Health Service Providers:
− Primary care level, public and private, including clinics of physicians
• Health Professionals
− Laboratory technicians and other cadres working in laboratories, private and public
− “Dentists”
− Community Health Workers
− Other cadres working in the health sector in Somaliland, (x-ray technicians, orthopaedic
technicians, physiotherapists, psychotherapists etc), all of which are low in numbers;
public and private
• Basic and Continuous Medical/Health Education and Trainings:
− Medical schools and University health faculties
− Schools of other health cadres in Somaliland
• Health Service Providers
− Secondary and tertiary level, public and private
• Health Professionals
− Traditional Healers
− “Alternative medicine”
− Traditional birth attendants – depending policy of MoH (to be developed)
• Basic and Continuous Medical/Health Education and Trainings
− Fill gaps from module 1 and 2
• Health Service Providers
− Fill gaps from module 1 and 2
5.2.2 PHASES
PHASE 1
Includes:
• Governance and Management:
Set up of governance and management structure, management systems, office set up, staff
• Module 1 in urban areas (capital, regional and provincial centres)
• Marketing

• Advocacy
• Grievances
• Health HR development
• Capacity building
• NHPC M&E and audit
Timeframe: January 2010 – December 2011
PHASE 2:
Includes:
• Module 1 in rural areas
• Module 2 in urban areas (capital, regional and provincial centres)
• Marketing
• Advocacy
• Grievances
PHASE 3:
Includes:
• Module 2 in rural settings in all provinces
• Module 3 in entire country
• Marketing
• Advocacy
• Grievances

6 STANDARDS OF TARGET GROUPS
The term “standard” in this context refers to the minimum qualifications, competencies,
capacities and conditions, respectively scope of work and quality of performance, as applicable
for each category of health professionals, medical/health education- and training institutions and
courses and health care providing institutions, in the public as well as private sector. These
standards are setting the norm in Somaliland which have to be complied with in order to get
accredited and receive a licence.
These standards and norms are not to be set in isolation but in close collaboration and
consensus among the key stakeholders, with reference to international standards, however not
copied but rather adjusted to the realities in Somaliland.
At this stage only few of these references exist in Somaliland as further elaborated below.
6.1 INDIVIDUAL HEALTH PROFESSIONALS
6.1.1 NURSES AND AUXILIARY NURSES
Two groups of nurses are existing in Somaliland: qualified nurses (senior and junior) and
auxiliary nurse (short term trainings and/or long time service exposure). Most of the health
services in the country depend on these two professions. However, their qualification and
experience vary markedly. Under the initiative and lead of the Somaliland Nursing and Midwifery
Association the following references were developed:
 Code of Conduct for Nurses; SLNMA
 Professionals Standards of Nursing Practice (2006)
The SLNMA have also conducted a survey on existing staff and it is the only group of health
professions with recent, updated information.
 Standards of the nursing professions will be defined based on the consensus
among key stakeholders under the lead of the NHPC WG and endorsed by MoHL
till end October 2009 (due to expected delays during the Ramadam period end
August – end September, the upcoming political campaign and elections).
6.1.2 MIDWIFES AND AUXILIARY MIDWIFES
Similar as above applies for midwifery and it is referred to the same document mentioned above.
The above mentioned survey included midwifes and auxiliary midwifes.
 As above, the standards of the midwifery professions will be defined based on the
consensus among key stakeholders under the lead of the NHPC WG and endorsed
by MoHL till end October 2009 (due to expected delays during the Ramadam
period end August – end September, the upcoming political campaign and
elections).
6.1.3 PHYSICIANS ( GENERAL PRACTITIONER, SPECIALISTS (SURGEON,
OPHTHALMOLOGIST, INTERNAL MEDICINE, OTHERS)
This group of staff with its specialised subgroups entail currently largely two types, i.e. seniors
and juniors). Seniors may be those graduated from the Somali National University and those
from outside country Medical Education Institutions, while this may be the case for all juniors.
Therefore, an evaluation of the non–Somaliland degrees in terms of authenticity and recognition
of the sources/ institutions by the respective National Health Authority are essential.

Also, the duration of the academic year for a doctor to be accredited for a speciality presents an
additional crucial factor.
 As of to date, no such policy or Act is available in country and needs to be
established on consensus between MoHL, the Universities and SMA under the
lead of the NHPC WG within the remaining calendar year.
The SMA published however a reference, though not as definition of the professional standard:
Medical Ethics Manual; First Publication; Somaliland Medical Association; prepared by Dr.
Suleiman Abdi Guleid; Chairman of SMA; May 2008
 The standards will be defined based on the consensus among key stakeholders
under the lead of the NHPC WG and endorsed by MoHL till mid October 2009.
6.1.4 PHARMACISTS AND LABORATORY TECHNICIANS
In a brief summary, by and large, these two categories can be seen collectively as a group under
the title of allied health sciences. These cadres differ from the above since there is currently no
recognised institution in country that would produce them at national level. However, there are
very few graduates from overseas institutions and seniors from the Somali National Health
Institution, however decades ago).
Allied sciences available now in the both private and public health facilities are either assistants
(short term training) or auxiliary (field service exposures). As of today, there is no policy or Act
for these groups. It is therefore apparent that there is a need to develop evaluation tools and to
conduct a survey to establish an updated number of particularly for these groups.
 The standards for the pharmacists will be defined based on the consensus among
key stakeholders under the lead of the NHPC WG and endorsed by MoHL till till
end October 2009 (due to expected delays during the Ramadam period end August
– end September, the upcoming political campaign and elections).
 The standards for the professions of other allied health sciences will be defined
based on the consensus among key stakeholders under the lead of the NHPC and
endorsed by MoHL following the phases and modules designed in the NHPC re-
establishment concept.
6.1.5 OTHER HEALTH CADRES WORKING IN SOMALILAND
Little is known as of to date about the variety of other cadres, their type, quantity and location of
operations.
 Equally here a survey and a standard policy are required, which is foreseen to be
accomplished during the second half the first working year of the NHPC.
6.1.6 CADRES USING TRADITIONAL HEALING PROCEDURES
Cadres using herbals and traditional healing procedures are working mostly of unknown origin in
terms of qualification, background etc
 It is foreseen that these cadres will be addressed during the-second half of the
second phase in order to be ready for accreditation during the third phase of the
functioning of NHPC - see below.

6.2 HEALTH SERVICE DELIVERY FACILITIES
6.2.1 PRIMARY LEVEL -PUBLIC AND PRIVATE: HEALTH POSTS, HEALTH CENTRES,
MOTHER AND CHILD HEALTH CENTRES (MCHS), CLINICS ETC
 To be completed till end October 2009 (due to expected delays during the
Ramadam period end August – end September, the upcoming political campaign
and elections).
6.2.2 SECONDARY LEVEL, PUBLIC AND PRIVATE
 See below – to be completed following the NHPC Concept phases and modules
6.2.3 TERTIARY LEVEL, PUBLIC AND PRIVATE
Similar to above applies for the health service delivery facilities, no standards exist in Somaliland
and need to be designed, agreed in consensus and endorsed by MoHL.
 This should be completed in the same approach as above, as a consensus among
key stakeholders under the lead of the NHPC WG and endorsed by MoHL, up to
mid November 2009.
6.3 BASIC AND CONTINUOUS MEDICAL/HEALTH EDUCATION AND
TRAININGS
6.3.1 NURSING AND MIDWIFERY SCHOOLS AND THEIR CONTINUOUS EDUCATION
 To be completed till end October 2009 (due to expected delays during the
and elections).
6.3.2 OTHER INSTITUTIONS/SCHOOLS; PUBLIC AND PRIVATE
6.3.3 TUTORS
6.3.4 CURRICULUM FOR BASIC EDUCATION IN HEALTH
6.3.5 CURRICULUM FOR CONTINUOUS EDUCATION IN HEALTH
6.3.6 EXAMINATION PROCESS
Also in respect to health trainings and training institutions, only few standards were described so
far:
 An overview of the related, existing standards will be completed till end October
2009 (due to expected delays during the Ramadam period end August – end
September, the upcoming political campaign and elections).

A substantial amount of time and efforts will have to be invested till the standards and hereby
the references for accreditation are formulated and officialised.
 These will be addressed over time and following set priorities, in consensus among
key stakeholders under the lead of the NHPC and endorsed by MoHL following
the phases and modules designed in the NHPC re-establishment concept (see in
annex).
6.4 “TRADITIONAL HEALTH SYSTEM” IN SOMALILAND
 To be defined probably during second half of phase 2 in order to be ready for phase
3.

7 IN PREPARATION OF THE ACCREDITATION
7.1 LISTING OF INDIVIDUALS AND SERVICES CURRENTLY PROVIDING
HEALTH CARE SERVICES / TRAINING
7.1.1 HEALTH PROFESSIONALS
A list of the individuals providing health care in Somaliland in their various capacities will serve
as the baseline reference for the NHPC being able to estimate the Council’s progress in coverage
and the extend of reaching the health workers for accreditation.
It might also assist in the management of the initial, first round in accrediting individuals, the
required time, financial and human resources.
However first hand collection or survey will only be needed for those professions where no
reliable, secondary information exist. Possible secondary data could be searched from MoHL,
health service providers, SMA, SLNMA etc. However at this stage only SLNMA can offer
adequate updated data with required accuracy and reliability for nurses and midwifes.
 Surveys to establish baseline information on existing physicians and pharmacists in
Somaliland needs to be conducted in the first quarter of the functioning of NHPC
in cooperation with the SMA.
 Surveys of all other health cadres will be conducted by the NHPC, following the
outlined modules and phases of the target groups (see below).
7.1.2 BASIC AND CONTINUOUS MEDICAL/HEALTH EDUCATION AND TRAININGS
This sub-chapter deals with the following training related components
• The basic medical/health training institutions/schools
• Continuous education
• Formal and informal training programmes including types and curricula of the health
institutions
• Trainers, teachers and tutors
A list of all basic and continuous training providers in health in Somaliland will serve as the
baseline reference for the NHPC to estimate the Council’s progress in coverage and the extent
of reaching those providers.
It might also assist in the management of the initial, first round in accrediting institutions, the
 However first hand collection or survey will only be needed if existing, secondary
information is not or insufficient reliable, comprehensive and accurate. Possible
secondary data could be searched from MoH, health education/training providers,
SMA, SLNMA etc. However at this stage only SLNMA can offer adequate updated
data on nursing schools.
7.1.3 HEALTH SERVICE PROVIDERS
A list of all primary, secondary and tertiary health facilities in the public and in the private sector
including pharmacies, clinics etc providing health care services in Somaliland will serve as the
baseline reference for the NHPC being able to estimate the Council’s progress in coverage and
the extend of reaching the health facilities for accreditation.

It might also assist in the management of the initial, first round in accrediting facilities, the
However first hand collection or survey will only be needed for those facilities, where no reliable,
secondary information exist. Possible secondary data could be searched from MoHL, SMA,
SLNMA etc.
 Therefore surveys will be conducted by the NHPC, as far as necessary (see below).
7.2 ASSESSMENT VALIDATION CRITERIA BASED ON THE STANDARDS
 As on the first assignments after the Board of the NHPC appoints the
Accreditation Committee (see below), the Committee will identify the criteria,
based on the standards and which will also serve as the documentation to be filed
and archived for each individual.
7.2.1 HEALTH PROFESSIONALS
The Accreditation Committees will initially set criteria specific for each profession corresponding
to the standards. For professions for whom such criteria already exist up to the time the
Accreditation Committee commences work, as e.g. for the nurses and midwifes, the
Accreditation Committee will make use of those, in light to stay harmonised and in close
cooperation with the key partners, the SMA, SLNMA, MoHL and the Universities.
Specific approaches will be elaborated for cases which require specific clarifications, as e.g.
new/recent graduates, lost certificates, or certificates from institutions in foreign countries etc.
This will be looked at case by case and the approach approved by the board of the NHPC and
carried out by the Accreditation Committee.
The selection of the criteria will, reflecting the standards:
1. Educational level: to be specified per each cadre, i.e. doctors, nurses, auxiliary nurses,,
paramedical etc., i.e. degree, diplomas from recognised University and/or Health/Medical
Education Institutions.
2. Knowledge: Personal knowledge to be examined by the Accreditation Committee
3. Skills: Personal skills to be examined by the Accreditation Committee; certificates and/or
testimonial provided by a known and recognised health institutions
4. Competencies to be examined by the Accreditation Committee
7.2.2 BASIC AND CONTINUOUS MEDICAL/HEALTH EDUCATION AND TRAININGS
The Accreditation Committees will initially set specific criteria corresponding to the standards,
which, as stated above, will be set in cooperation with MoH, MoE, University, SMA and
SLNMA.
If such criteria already exist up to the time the Accreditation Committee commences work, the
Accreditation Committee will make use of those in light to stay harmonised and in close
cooperation with the key partners, the SMA, SLNMA, MoHL and the Universities.
This will be looked at case by case and the approach approved by the board of the NHPC and
carried out by the Accreditation Committee.
The selection of the criteria will, reflecting the standards, include:
1. Teaching staff to be specified per each cadre, i.e. doctors, nurses, auxiliary nurses,,
paramedical etc.

2. Curricula: Personal knowledge to be examined by the Accreditation Committee
3. Infrastructure
4. Teaching material and equipment
5. Number of students
6. Enrolment procedure and requirements
7. Examination procedures
7.2.3 HEALTH SERVICE PROVIDERS
The Accreditation Committees will initially set criteria specific for each type of facility
corresponding to the standards. For facilities for which type such criteria already exist up to the
time the Accreditation Committee commences work, the Accreditation Committee will make use
of those, in light to stay harmonised and in close cooperation with the key partners.
The selection of the criteria will, reflecting the standards, include:
1. Staff composition and competencies
2. Infrastructure and equipment
3. Management systems
4. Competencies
7.3 ASSESSMENT TOOLS
In this context the Assessment tools are the checklists, forms and examination documents.
 They need to be prepared by the Accreditation Committee and will also serve as
the documentation to be filed and archived for each individual.
7.4 SELECTION MODALITIES OF THE ACCREDITATION COMMITTEE
MEMBERS
The Committees should be based only on technical capacities of the committee members,
irrespective their position and their professional affiliations (e.g. preferably if they belong to an
Association, University, working privately etc).
Since the Accreditation Committee needs to be specifically competent for each cadres it does not
require to be multidisciplinary, but rather give weight to its sound capacity for each discipline.
 The Board of the NHPC will select three Accreditation Committee Members for
each cadre using agreed criteria which reflect technical capacities only.
 Among the Committee members the colleague with the longest work experience
shall serve as the Committee lead and spokes person.
 Hereby the selection is should depicts competence, fairness and transparency.

8 LICENSING AND RE-LICENSING SYSTEM AND PROCEDURE
Licence is the official and by the MoHL recognised document - through its recognition of the
NHOC’s mandate -, which certifies that a person or institutions are fit for practice, fit for
purpose and that they warrant to provide service, specified by capacity and the time period.
Under certain circumstances a conditional licence for a shorter period might be issued after
which it will be assessed if the conditions were met.
The licence is based on the accreditation process which in its turn refers to the minimum
standards for qualification, as elaborated in the previous chapters.
8.1 PURPOSE AND OBJECTIVES OF LICENSING1
The PURPOSE OF LICENSING is to ensure that licensed and approved health facilities and
professionals remain up to date and continue to be fit to practice.
Licensing has three elements:
A. To confirm that licensed health professionals practice in agreement with the
NHPC general standards.
B. To confirm that health training institutions meet the standards appropriate for their
trainings.
C. To identify that health care providing bodies deserve to continue their work, and
that they are fit for purpose, fit for practice according the NHPC standard2
.
For this purpose the licensing aims at achieving the following objectives:
I. To ensure public safety.
II. To signify who is a health professional.
III. To categorise health care facilities and professionals
IV. The development of high quality public health service.
V. The protection of public from harm.
VI. The prevention of crime and disorder.
Licensing also:
• Licensing is one the several mechanisms to improve the quality of the health care and
health service of the community.
• Gives further focus and motivation to health professionals in their desire to keep up to
date and improve their practice through continuous professional development and
reflective practice.
• Aims to enhance and sustain public confidence in the profession as a whole by providing
periodic declaration that health professionals continue to be fit to practice.
• Provides a process through which health professionals who may fall short of professional
standards in some respects can be supported.
• Identifies the (hopefully small) proportion of professionals who are unable to work after
important shortfall in their practice and remove them from the register of their profession.
1
Expanded from the Health Professional Council of the United Kingdom, sector of accreditation,
licensing and registration.
2
Expanded from the Health Professional Council of the United Kingdom, sector of accreditation,
licensing and registration.

8.2 ACCREDITATION AND LICENSING RELATION
The fundamental requirement of a functional accreditation system is that the system is
trustworthy and recognised by all, i.e. by the medical schools, the students, the professions, the
public and the private health care sectors and the public.
Trust must be based on the academic competence, efficiency and fairness of the system. These
characteristics of the system must be known by the users and consequently the system.
ACCREDITATION will assess strength from CREDIBILITY, which comes from CONTENT and
that depends on COMPETENCE for which CAPABILITY is necessary. The accreditation is the
guidance, leader and instructor of the license, i.e. it will indicate if the person or institution is fit
for practice, fit for purpose and deserve licensing3
. The licence will be based on the outcome of
the accreditation which will declare that either the person and institution will be awarded or
revoked, and if awarded which sort of license will be awarded. The accreditation unit, based on
the recommendations for the accreditation committee, are the decision makers for the license.
8.3 TYPES OF LICENSE
8.3.1 LEVEL AND GRADING OF LICENSING
A complete and comprehensive licensing system foresees also different levels and grading. Since
the health system in general, its human resources and the (re-)establishment of the National
Health Professional Council still face challenges to be well understood by authorities in its
conceptualisation and numerous managerial, financial and in case of the NHPC also political
constraints, both the introduction of levels and grades as well as the their licensing would be
overburdening and complicating the process and is therefore premature. At a later stage, when
circumstances are more stabilised and well founded the accreditation and licensing can move to a
more advance and complex structure.
8.3.2 INDIVIDUAL LICENSURE
The granting of a legal permit that is personal and cannot be transferred to another person. The
individual seeking the licensure must meet the standards for practice as established by the
National Health Professions Council. In most instances the initial license is granted upon
successful completion of an examination administered by the Accreditation Committee.
8.3.3 INSTITUTIONAL LICENSURE
It is the licensing of an organisation, institution or similar body providing
medical/nursing/paramedical education and/or continuous training or a health care service in
health care to the public in the public sector or in the private sector.
This can be general hospitals or private clinics of health professionals such as physicians, nurses,
laboratory technicians etc or for the supply of medical products.
8.3.4 SUITABILITY
This aspect dictates a license will be granted, conditions identified or the license refused. The
suitability mentions the category deserved and found appropriate which can be different from or
the same as the previous license.
3
See Essential Package of Health Service; 2008

8.4 TIME PERIODS AND CONDITIONAL LICENCE
8.4.1 UNCONDITIONAL LICENCE
A complete licence is valid for three years, after which period it has to be renewed.
8.4.2 TEMPORARY / CONDITIONAL LICENCE
A conditional and temporary license can be issued for an institution or an individual when the
accreditation committee does not grant full performance of the desired standards. Its purpose is
to declare that this individual or institution is accredited but there is a weakness which has to be
addressed as a condition to receive the full license.
The accreditation committee will set a period of time during which the individual or the
institution has to fulfil the conditions and will be re-assessed. The period will vary according to
the condition specified. If the conditions are not met, the license will be rejected, respectively
suspended.
After the accreditation process the accreditation committee submits its report including its
decision to the licensing unit of the NHPC which is processing the license issue according to the
decision taken by the accreditation committee.
8.4.3 REJECTED LICENCE
If the accreditation committee concludes that the assessment shows an un-improvable outcome
or the required improvements made are not satisfactory, the licence can be rejected without
options of conditions.
8.5 RELICENSING
The licences have a time frame of validity and require relicensing. A relicense can be issued to a
person or an institution which can be different to the previous one. If the type of the licence
remains the same, the previous licence will be renewed.
A licence has to be renewed every three years on the dates set by the NHPC. A licence subject to
renewal or relicensing shall be re-issued on or before the date set by the council on the licence. If
this not completed in time the licence lapses. In time means within one month starting from the
license expired date.
8.5.1 PROCEDURAL STEPS
1. The accreditation and licence has to be initiated by the applying person or body with the
completion of the application form, copies of documents etc and payment4
. Only after the
licence unit of NHPC receives the completed application form, the payment and the
required documents as specified in the application form, the accreditation and licensing
process will commence.
2. The NHPC licensing unit shall require the following minimum information from each
individual or institution as part of the first license and as part of any renewal of such
license:-
a) The name, the address, and telephone number of the licensee;
b) Facility or professional names used by the licensee;
4
THE PAYMENT MECHANISM AND THE MANAGEMENT OF THE COLLECTED FEES WILL BE
ELABORATED IN THE NHPC OFFICE ORGANISATIONAL MANUAL AND THE NHPC FINANCE
MANAGEMENT SYSTEM.

c) Addresses, telephone numbers, and the names of contact persons for all facilities used
by the licensee for the storage, handling, and distribution, if applicable.
d) The type of ownership or operation (i.e., partnership, corporation, or sole
proprietorship); and
e) The name(s) of the owner and/or operator of the licensee, including:
i. If a person, the name of the person, if a partnership, the name of each partner, and
the name of the partnership;
ii. If a corporation, the name and title of each corporate officer and director, the
corporate names, and the name of the State of incorporation.
3. Within two working days the NHPC licensing unit will forward the file to the accreditation
unit, which in its turn has to be commence processing the file within two working days.
4. License renewal must be initiated by the applicant not less than 30 days before the license
period ends through submission of the application form for the renewal of the license and
the payment.
5. If an application accompanied by the renewal fee is not brought to the licensing unit by
that date the license expires, the license is irrecoverable unless the application, fee and
additional “delay fee” are received within 14 calendar days.
6. A further delay for reasons other than force majeur will result in having to commence the
process as a new applicant till which time the licence is not valid.
7. The license is a legal document so that no part of this document may be reproduced. It
indicates that the person or institution is legally recognised to provide services to the
community.
8. The NHPC licensing authority may provide for a single license for a facility unit operating
more than one facility within that position or for a facility with various sub-facilities when
activities are conducted at more than one location.

9 REGISTER SYSTEM
9.1.1 DEFINITION
The accreditation and licensing system is outlined above in line with the concept paper of NHPC
(April 09). In this chapter a few significant points are being emphasised. “Register” in this
context is defined as
i. To register ONLY LICENSED HEALTH PROFESSIONALS by their categories.
ii. To register ONLY THE LICENSED HEALTH FACILITIES AND BASIC AND
CONTINUOUS MEDICAL/HEALTH EDUCATION AND TRAININGS in Somaliland by
category.
iii. To update the reassessed, previously licensed, registered, categorised health facilities
and health professionals through standardised criteria.
9.1.2 CONDITIONS TO GET REGISTERED
Fulfilment of the preconditions and requirements of eligibility to be licensed and receipt of the
licensure as a health professional or health service providing facility or health training institute.
9.1.3 MAINTENANCE OF REGISTER
The NHPC/registration unit is responsible to establish, maintain and update continuously the
register systems.
The latest three working days after a licence has been issued, the unit has to enter the new
information/data into the register system.
The unit is also responsible of reviewing of both licensing and registration of all health
professionals and health care providing facilities and training institutions producing health cadre
of different disciplines, on periodic, i.e. quarterly bases.
9.1.4 PAPER BASED AND IT DATA BASE
The NHPC WG will initiate the design and installation of a simple, user friendly and robust
electronic as well as, initially, paper based data base.
 The initial work plan had foreseen to have this systems completed by mid year
2009. Due to funding delays the deadline has to be postponed till end October 2009,
accepting that this will have be carried out in addition to the activities already
planned for this period without postponing these activities.

10 ACCREDITATION PROCESS
The process of accreditation follows several steps before the register unit of NHPC can issue a
licence. Upon receiving an application the Accreditation Unit and the License Unit carry the
administratively the process with decision making by a technically posted Accreditation
Committee, which applies to all three groups:
1. Self assessment
2. External assessment
3. Decision and report by Accreditation Committee
4. Licensing or possible appeal
5. Registration
10.1 SELF ASSESSMENT
Self assessment is a step providing self compliance, in which a self improvement process is
expected to be initiated. After receipt of an application the applicant will be invited to conduct
this assessment, based on a form, specific for each group and category:
 Self assessment forms, specific for each category in the 1st
phase will be developed
under the lead of the NHPC WG will until end October 2009 (due to expected
delays during the Ramadam period end August – end September, the upcoming
political campaign and elections).
10.2 EXTERNAL ASSESSMENT
Within 12 working days after the receipt of the filled self assessment, the Accreditation
Committee will communicate to the applicant a date and time for the external assessment, within
8 working weeks.
The communication will state the location and process foreseen for the external assessment,
which differs between health professionals, training institutions and service providers.
 The external assessment process will be designed and specified by the
Accreditation Committees within the first 12 working days of their appointments,
with logistic and administrative support and collaboration by the NHPC.
10.3 DECISION
The conclusion and decision of the Accreditation Committee will be communicated to the
NHPC Accreditation Unit in writing, following a specific format, within two working days after
the assessment is completed.
The Accreditation Unit will communicate the decision, following the format, and after re-
verifying that the procedure was followed, to the applicant within two working days after receipt
of the Committee’s decision.
Simultaneously, within NHPC, the file of the applicant will be handed to the Licensing Unit to
process licensing and archiving.

 Until end October 2009 the NHPC WG will design templates for the Accreditation
Committees’ invitations of applicants, a template for the reports and the letter of
outcome to the applicant.
10.4 LICENSING
According to the NHPC concept April 2009. The offices of NHPC proceed and offer the ward
of licensing upon meeting criteria.
Applicants will be assessed in order for eligibility for licensing criteria.
The Licensing Unit will issue the license to the applicant within two working days, after re-
verifying that all fees were paid, and archive the file.
 During the first quarter of its operation the NHPC will design and establish a safe,
robust and easy to use archiving system.
10.5 REGISTRATION
As stated above, only those applicants or applying institutions that are accredited and receive a
license will enter the registration system. This is the last step in the process.
 During the first quarter of its operation the NHPC will design and establish a safe,
robust and easy to use archiving system.
FIGURE 3: SEQUENCE AND FLOW
Sequence and flow
Applicant NHPC
sends application
LU
prepares and hands over file
AU
prepares and hands over file
AC sends invitation with
date of assessment
self assessment and self assessment form
sends self
assessment AC
meets AC assessment
decision
prepares report and hands over file
LU issue licence
prepares and hands over file to
RU enters data to register
archives file
LU Licensing Unit
AU Accreditation Unit

AC Accreditation Committee
RU Register Unit

11APPEAL FOR DISPUTED ASSESSMENTS
Decisions of the accreditation and licensing should have options to be appealed again because
erroneous decisions might be biased. Errors can occur and unfavourable decisions are rather
accepted through convincing and removal of possible biases than only through and authoritative
decisions, even if the decision is correct.
11.1 PROCEDURE
The decision of the Accreditation Committee can be appealed by submitting a letter, stating the
reasoning of the appeal, within two weeks after receipt of the Committee’s decision. The letter
has to be addressed to the NHPC licensing unit with copy to the chair of the board of the
NHPC.
An Appeal Committee will review the process and the conclusion of the Accreditation
Committee within 12 working days calendar days after receipt of the appeal, and will invite the
applicant for the opportunity to reason the appeal in person within 12 working days after
submission of the invitation.
The Appeal Committee might seek advice from the legal advisor to the NHPC Board if deemed
necessary.
The Appeal Committee cannot overturn the decision of the Accreditation Committee, but can
decide to forward the appeal to the Accreditation Committee for a review with either
• to revisit and change of the decision with justification of the alterations, or
• provision of the a sounder foundation of the decision, or
• invite the applicant to re-take all or part of the assessment process.
The Accreditation Committee has to communicate to the applicant on the further process within
six working days.
In any case the Accreditation Committee and the Appeal Committee have to reach a joint
decision within four working weeks. If the Committees fail to do so, the case shall be presented
and discussed in the NHPC board with the spokes persons of both committees and the final
decision made within four working weeks after the board being presented with the case (receipt
of the file).
11.2 APPEAL COMMITTEE
The Appeal Committee will be constituted of three of four members to be appointed by the
NHPC.
For disputes by health professionals and Teaching Institutes/school and continuous education:
the members of the Appeal Committee are the highest representative of the respective
cadres/category in respect to their education (e.g. the Dean of the medical faculty for the
physicians), to their professional representation (e.g. Chair of the SMA) and the Head of Human
Resources in MoHL.
Until the other health professionals are well organised and can represent themselves, the Chair of
the SMA or the executive director of the SLNMA will fulfil this role in the Appeal Committee
also for the other health professions.

In case the decision is disputed by a health care provider, the Head (for doctors) or Matron (for
nurses) of the Teaching Hospital, the Head of the Health Services in MoHL and both, the Chair
of SMA and the Executive Director of the SLNMA will form the Appeal Committee.
 The Terms of Reference for the Appeal Committee have to be drafted by the
NHPC WG, agreed by the NHPC (Re-)establishment Steering Committee and key
stakeholders, and finalised by end October 09.
11.3 COUNSELLING
Since accreditation and licensing will be newly introduced in the country it might happen that
unfavourable decisions with consequences on the professional life of individuals occur. In such
cases NHPC will offer counselling and (non financial) support in the search of alternative paths
of life. Naturally no promises can be made for satisfying solutions, but an effort will made not to
let affected persons feel being dropped without at least the attempt to assist, although those
identified as cheating or forging will not be able to receive much attention.
12 ACCREDITATION, LICENSING AND REGISTRATION TOOLS
The terms “tools” refers in this context to all forms, templates, IT software required for a
standardised and systematic process of assessment, accrediting, licensing, registration and the
involved communication.
 The completion of these tools has to be completed for module 1 before the
operationalisation of the NHPC commences – see annexes. Those for module 2
and 3 will be designed and established over time, but not later than the start of the
work on the modules – see annexes.

13 ACCOMPANYING MECHANISMS
13.1 CAPACITY BUILDING OF NHPC ACCREDITATION UNIT
Since a functional NHPC and its responsibilities are new to the country, its professionals and the
population, it can be assumed the staff to be recruited, the Executive Director and possibly the
Board might benefit from technical and/or managerial support and advice.
 The specifics of such capacity building, in addition to a thorough briefing on
NHPC, can be identified and planned for after the recruitment is completed and a
detailed needs assessment of the NHPC and its Board is conducted. Therefore its
inclusion in the first year’s work-plan and budget has to be generously estimated
when budget requirements have to be calculated before the needs are assessed.
13.2 SITE VISITS OF NHPC STAFF AND COMMITTEE MEMBERS
Site visits to other countries’ Councils, especially South Africa or Rwanda, were foreseen already
for the NHPC WG and SA. So far funds did not permit to conduct these visits.
 Following the above, such site visits need to be planned for the NHPC staff, the
Board and possibly the Committees.
13.3 ESTABLISHMENT OF FEE COLLECTION SYSTEM
 The payment mechanism and the management of the collected fees will be
elaborated in the NHPC office organisational manual and the NHPC finance
management system before the end of the year.

14 ANNEX:
14.1 STANDARDS (ST) HEALTH PROFESSIONALS FORMS ST 1X
14.1.1 NURSES (N) – FORM ST 1.1./N/09
 To be completed until end October 2009 (due to expected delays during the
and elections).
14.1.2 AUXILIARY NURSES(AN) - FORM ST 1.2./AN/09
and elections).
14.1.3 MIDWIFES (M) - FORM ST 1.3./M/09
and elections).
14.1.4 AUXILIARY MIDWIFES (AM) - FORM ST 1.4./AM/09
and elections).
14.1.5 GENERAL PRACTITIONER (GP)- FORM ST 1.5./GP/09
and elections).
14.1.6 INTERNAL MEDICINE (IM) - FORM ST 1.6./IM/09
and elections).
14.1.7 OPHTHALMOLOGIST (OP) - FORM ST 1.7./OP/09
and elections).
14.1.8 SURGEON (SU) - FORM ST 1.8./SU/09
and elections).

14.1.9 TO BE COMPLETED (OTHERS - FORM AC/ST/PH/XX/09
and elections).
14.1.10 PHARMACISTS (PH) - FORM ST 1.9./PH/09
and elections).
14.1.11 LABORATORY TECHNICIANS (LT) - FORM ST
1.10./LT/09
 Those for module 2 and 3 will be designed and established over time, but not later
than the start of the work on the modules.
14.1.12 LABORATORY TECHNICIANS/MICROSCOPISTS (MI) - FORM ST 1.11./LT/MI/09
14.1.13 OTHER CADRES WORKING IN SOMALILAND - FORM AC/ST/XX/09
14.1.14 TO BE COMPLETED (OTHERS - FORM AC/ST/PH/XX/09

14.2 STANDARDS (ST) HEALTH SERVICE DELIVERY FACILITIES (HF)
FORMS ST 2X
14.2.1 HEALTH POST - FORM ST 2.1./HP/09
and elections).
14.2.2 HEALTH CENTRE - FORM ST 2.2./HC/09
and elections).
14.2.3 MOTHER AND CHILD HEALTH CENTRES (MCHS) – FORM ST 2.3./MCH/09
and elections).
14.2.4 CLINICS - FORM ST 2.4./CL/09
and elections).
14.2.5 SECONDARY LEVEL, PUBLIC AND PRIVATE - FORM ST
2.5./SL/09
14.2.6 TERTIARY LEVEL, PUBLIC AND PRIVATE - FORM ST 2.6./TL/09

14.3 STANDARDS (ST) • BASIC AND CONTINUOUS MEDICAL/HEALTH
EDUCATION AND TRAININGS (HT) FORMS ST 3X
14.3.1 NURSING SCHOOLS; PUBLIC AND PRIVATE - FORM ST 3.1/NS/09
and elections).
14.3.2 MIDWIFERY SCHOOLS ; PUBLIC AND PRIVATE FORM ST 3.1/MS/09
and elections).
14.3.3 MEDICAL SCHOOLS ; PUBLIC AND PRIVATE FORM ST
3.1/MDS/09
14.3.4 OTHER INSTITUTIONS/SCHOOLS; PUBLIC AND PRIVATE - FORM ST
3.1/IN/09
14.3.5 TUTORS - FORM ST 3.2./TU/09
14.3.6 CURRICULUM FOR BASIC NURSING EDUCATION - FORM ST 3.3/BNE/09
and elections).
14.3.7 CURRICULUM FOR BASIC MIDWIFERY EDUCATION - FORM ST 3.3/BME/09
and elections).
14.3.8 CURRICULUM FOR CONTINUOUS MEDICAL/HEALTH EDUCATION –
FORM ST 3.4./CE/09
and elections).

14.3.9 EXAMINATION PROCESS - FORM ST 3.5/EM/09

14.3.10 “TRADITIONAL HEALTH SYSTEM” IN SOMALILAND - FORUM ST 3.10./TM/09
 To be completed during second phase, not later than the start of the work on the
third module.

14.4 ACCREDITATION PROCEDURE (AP) FORMS AP 4X
14.4.1 LIST OF INDIVIDUALS WHO PROVIDE HEALTH SERVICES - FORM AP
4.1./HPR/09
and elections), if reliable secondary data are existing.
 To be completed through a survey during the first quarter of NHPC.
14.4.2 LIST OF PUBLIC AND PRIVATE FACILITIES FORM AP 4.2./HF/09
 To be completed during survey in the first quarter of NHPC, unless reliable
secondary data are existing.
 To be completed through a survey during the first quarter of NHPC.
14.4.3 LIST OF TRAINING PROVIDERS IN HEALTH - FORM AP 4.3./HF/09
 To be completed during survey in the first quarter during first quarter of NHPC
unless reliable secondary data are existing.

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