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Principal Investigator: Dr Rocco Friebel


The absence of paediatric surgeons represents a key barrier to the provision of safe and accessible surgical care for children in Somaliland.

SPACES-ECHO aims to assess whether paediatric surgical care can be strengthened through the adoption of the ‘Expanding Community Healthcare Outcomes’ (ECHO™) model for sustainable community-based tele-learning, knowledge transfer and exchange. This programme, running from April 2023, will target children with burns and pyloric stenosis. It will be implemented across seven healthcare facilities in Somaliland, comprising one ECHO-Hub (the only paediatric referral centre in the country) and six ECHO-Spoke district hospitals.

By connecting specialist and non-specialist providers of paediatric surgical care, SPACES-ECHO will contribute to capacity building efforts among the existing healthcare workforce and support Somaliland’s National Vision 2030. The ECHO Model will be leveraged to increase the knowledge and skills of non-surgically trained healthcare workforce and improve clinical outcomes of children with burns and pyloric stenosis.

Findings from this research project will contribute to shaping key targets for children’s surgery defined in Somaliland’s NSOAP 10-Year Action Plan.

Dr Mariam Dahir

in-country coordinator

Enhancing knowledge of pediatric surgery in Somaliland among healthcare workers participating in SPACES-ECHO is critical to improving surgical outcomes and ensuring the provision of high-quality care to children. This project has the potential to provide valuable insight into effective strategies for improving surgical care across our country.

Dr Hassan Daoud

in-country coordinator

The major hospitals in Somaliland provide care for one out of every four children who need surgical intervention. Physicians, Trainees, and Practitioners currently operate with limited resources, guidelines, and supervisors. The SPACES-ECHO Project will have a direct impact on care providers, supporting their skills and confidence. Moreover, it will enhance the community's knowledge by encouraging families to recognize and refer children for treatment at the earliest possible stage. Community engagement will increase people's awareness of the most prevalent paediatric conditions (such as burns, pyloric stenosis, hydrocephalus, and other congenital anomalies).

Expected Outcomes

In order to strengthen delivery of paediatric surgery in Somaliland through implementation of the ECHO Model, the following outcomes must be achieved:

  • Increase in the knowledge and skills of the surgical workforce across the ECHO-Hub and ECHO-Spokes hospitals.
  • Healthcare professionals’ satisfaction with the SPACES-ECHO programme.
  • Step-changes in paediatric outcomes of children undergoing surgery for burns and pyloric stenosis in the intervention hospitals.

A mixed-methods developmental, process and outcome evaluation has been selected to determine the impact of SPACES-ECHO. Focus groups will highlight the strengths and opportunities of SPACES-ECHO and ensure that it is tailored to healthcare workers and patients’ needs. Quantitative research methods (including survey methodology and an interrupted time-series analysis) will be adopted to quantify the effectiveness of the intervention.

The evaluation of SPACES-ECHO will be led by local researchers from Amoud University, with training and support by the Global Surgery Policy Unit team.

MAS Hospital, representing surgical delivery in Somaliland
MAS Hospital, representing surgical delivery in Somaliland


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