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<p>Somalia’s Universal Health Coverage (UHC) service coverage index improved from 22% in 2019 to 27% in 2024, remaining the lowest globally. This five-year retrospective review synthesizes 78 government strategies, WHO and donor reports, peer-reviewed studies, and grey literature (2019–2024) using the WHO Health System Building Blocks framework. The analysis identifies governance, health financing, and digital health as transformative drivers underpinning modest UHC gains. Despite the 2019–2023 UHC Roadmap and the 2022–2026 Health Sector Strategic Plan (HSSP III), gaps in federal–state coordination, accountability, and financing persist. Community-based health insurance pilots have reduced catastrophic spending, yet domestic health expenditure remains below 1.5% of GDP, with over 90% dependence on external donors. Digital platforms such as DHIS2 (91% reporting coverage), CaafimaadPlus, and telemedicine have improved data timeliness, stock management, and access to specialist care, though interoperability and connectivity challenges continue. Human resources remain critically constrained, with only 4.3 core health workers and 0.4 physicians per 10,000 population, compounded by 20% clinician emigration and persistent rural distribution gaps. A reinforcing cycle of conflict, displacement, financing shortfalls, and workforce attrition continues to limit progress. To accelerate toward the 40% UHC target by 2029, Somalia must strengthen federal–state governance, expand community insurance and performance-based financing, enhance health workforce retention, and invest in interoperable digital health infrastructure within conflict-sensitive service delivery models.</p>

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Achieving universal health coverage in Somalia: a five-year retrospective on progress, emerging opportunities, and new challenges

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年12月29日

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  • Yakub Burhan Abdullahi,
  • Naima Ibrahim Ahmed,
  • Sharmake Gaiye Bashir,
  • Yusuf Hared Abdi,
  • Mohamed Sharif Abdi

摘要

Somalia’s Universal Health Coverage (UHC) service coverage index improved from 22% in 2019 to 27% in 2024, remaining the lowest globally. This five-year retrospective review synthesizes 78 government strategies, WHO and donor reports, peer-reviewed studies, and grey literature (2019–2024) using the WHO Health System Building Blocks framework. The analysis identifies governance, health financing, and digital health as transformative drivers underpinning modest UHC gains. Despite the 2019–2023 UHC Roadmap and the 2022–2026 Health Sector Strategic Plan (HSSP III), gaps in federal–state coordination, accountability, and financing persist. Community-based health insurance pilots have reduced catastrophic spending, yet domestic health expenditure remains below 1.5% of GDP, with over 90% dependence on external donors. Digital platforms such as DHIS2 (91% reporting coverage), CaafimaadPlus, and telemedicine have improved data timeliness, stock management, and access to specialist care, though interoperability and connectivity challenges continue. Human resources remain critically constrained, with only 4.3 core health workers and 0.4 physicians per 10,000 population, compounded by 20% clinician emigration and persistent rural distribution gaps. A reinforcing cycle of conflict, displacement, financing shortfalls, and workforce attrition continues to limit progress. To accelerate toward the 40% UHC target by 2029, Somalia must strengthen federal–state governance, expand community insurance and performance-based financing, enhance health workforce retention, and invest in interoperable digital health infrastructure within conflict-sensitive service delivery models.