Beyond the pandemic: strengthening Somalia’s health system

 Covid-19 has laid bare the fragility of Somalia’s health system. Decades of conflict, poverty-related deprivation and limited state capacity has meant that Somalia is one of the countries least capable of managing this mutually overlapping catastrophe.

Primarily delivered through a poorly regulated and uncoordinated network of humanitarians and the private sector, the health sector grapples with chronic shortfalls in capacity, infrastructure and medical personnel. The result is a healthcare system ill-equipped to manage the health needs of the majority of the population in normal times, let alone a global pandemic.

Most funding for the health sector comes from international donors and is ‘off-budget’. This means it is channeled directly to healthcare providers through a patchwork of projects and instruments, rather than through government systems and budgets. Although bypassing Somali systems is unsustainable and diminishes government accountability over the longer-term, this has been a pragmatic response to poor levels of donor confidence in weak government financial systems.

But there are grounds for optimism. Earlier this year, the Federal Government of Somalia (FGS) cleared its arrears to the International Development Association. This allows Somalia to access new resources and paves the way for debt relief. The World Bank and other health donors are gearing up for new projects and funding. There is widespread recognition that the current reliance on humanitarian funding and delivery is insufficient. The time is right to work towards a unified vision for the Somali health system.

In September, FGS’ Office of the Prime Minister and ODI’s Humanitarian Policy Group brought together 31 Somali and international actors to explore how Somalia can build a sustainable health system


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