Three decades of civil war and instability, coupled with natural disasters such as drought and floods, have weakened Somalia’s health system and contributed to it having some of the lowest health indicators in the world. Of the country’s 15 million people, 26–70% live in poverty, depending on the region, and an estimated 2.6 million people have been internally displaced.1,2 The country’s UHC index is 25 out of 100.
A mother and her children at an integrated measles, polio, vitamin A and deworming campaign held from August to September 2020. ©WHO
Although there are many health and social challenges in Somalia, emerging opportunities to strengthen PHC are being leveraged through the GAP to support the country in achieving UHC and other health- related SDGs.
The Somali Government is committed to using current opportunities to strengthen health and social development, including an improved security and political situation and the potential to leverage humanitarian funds to address longer-term health and development needs. A growing number of development partners are interested in health, and a large private health sector and a network of nongovernmental and civil society organizations could help improve access to health care. Opportunities for health sector development also include the availability of better data, recent progress in mass vaccination and forthcoming financing rounds of major global health funders, including GAP signatory agencies. The Somali National Development Plan for 2019–2024 and the Somali UHC Roadmap, launched in September 2019, identify PHC as the main approach to improving health outcomes in the country.
On the side-lines of a GFF workshop in Addis Ababa, Ethiopia, in October 2019, GAP agencies discussed opportunities for collaboration with Somalia to accelerate progress towards UHC through PHC. In January 2020, WHO undertook a mission to discuss further support needed; GAP agencies were invited to join the mission, and Gavi, UNICEF, the World Bank and bilateral donors were closely engaged. After the mission and further discussions in the country and among members of the GAP PHC accelerator working group and multilateral and bilateral partners, five priorities for enhanced collaboration were identified.
- Establish a health coordination mechanism: A new coordination body, the Health Sector Coordination Committee, has been established as the multisectoral national health platform, with support from GFF. GFF is also supporting resource mapping to align external and domestic financing for Government priorities. WHO and UNICEF are helping to set up an effective coordination mechanism for all health partners to strengthen PHC and fill gaps in services at the district level. An exercise to map the availability of services and health workers has begun to define options for scaling up PHC services and monitoring progress on the achievement of health- related SDGs at the state level.
- Improving access to a package of high-quality essential health services: WHO, UNICEF and other partners have provided support to update the country’s health services package, focusing on the addition of prevention and community-based components, communicable diseases, noncommunicable diseases and mental health. Once the package is finalized, costed and prioritized, additional capacity-building and financing will be required for implementation. Gavi, the Global Fund, GFF and the World Bank are working to align their financing with the National Development Plan to support PHC and the essential services package, strengthen national supply chain management systems and better operationalize activities at the nexus of humanitarian aid and development to reach vulnerable populations, including internally displaced people.
- Strengthening emergency preparedness and response through UHC: Somalia is prone to emergencies from natural disasters and disease outbreaks and is now responding to COVID-19. More work is needed to ensure that development activities
and humanitarian action are coordinated and mutually reinforcing. Opportunities for enhanced support from the GAP agencies include finalization and implementation
of components of the National Action Plan for Health Security (such as strengthening laboratory and early warning systems) and ensuring that the package of essential health services and key commodities are effectively delivered in humanitarian settings. - Strengthening the role and capacity of the Ministry of Health: This is essential to address fragmented health service delivery and funding arrangements; improve institutional capacity for policy-making, regulation, coordination, planning, management and contracting; and use of data in decision-making.
- Harnessing the private sector for UHC: Private health services and the pharmaceutical sector are largely unregulated in Somalia but could contribute to improving access and achieving UHC. Following the Global Fund’s lead, GAP agencies are exploring opportunities to support development and operationalization of a strategy for the private health sector, such as helping to assess its current role in service delivery and implement adequate regulatory frameworks and contracting mechanisms.
Although there are many health and social challenges in Somalia, emerging opportunities to strengthen PHC are being leveraged through the GAP to support the country in achieving UHC and other health-related SDG targets.
1: Somali poverty profile: findings from wave 1 of the Somali high frequency survey. Washington DC: World Bank Group; 2017 (accessed 5 May 2020).
2: CCCM cluster Somalia. Geneva: United Nations High Commissioner for Refugees; 2020 (accessed 5 May 2020).