ReviewTropical medicine and health2026
Prolonged multisectoral aid-driven reliance on health systems and governance post-conflict era in Somalia.
Review in Tropical medicine and health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Universal Health Coverage on $15 per Capita: Somalia's Health Financing Crisis and the Limits of Humanitarian Dependency.Public health challenges · 2026Article
- Beyond the funding gap: Somalia's aid shock is becoming a primary health-care crisis.Tropical medicine and health · 2026Article
- Can Universal Health Coverage Be Achieved Through an Unregulated Private Health System? Somalia's Policy Paradox.Public health challenges · 2026Article
- Somalia's new community health strategy: Strengthening primary health care and health system resilience.Preventive medicine reports · 2026Article
- Informal payments and the illusion of free care: a perspective from Somalia's fragile health system.International journal for equity in health · 2026Article
- Beyond food aid: leveraging Somalia's rich land and heritage to build a resilient food system.Tropical medicine and health · 2026Article
- Strengthening pandemic prevention, preparedness, and response in Somalia: strategic implications of health security financing.Frontiers in public health · 2026Article
- Antimicrobial Resistance in Somalia: Surveillance Gaps, Stewardship Barriers, and One Health Priorities.Infection and drug resistance · 2026Review
- Somalia's Drought-Disease Spiral: Climate Shocks as an Emerging Public Health Security Threat.Risk management and healthcare policy · 2026Article
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Authors and funding
21 authors.
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Abstract
introductionThe global development discourse primarily emphasizes the vital role of international aid in post-conflict health systems and governance. Somalia's post-conflict health recovery has relied heavily on multisectoral aid that saved lives but entrenched parallel systems. While the national budget rose from ~ SOS 200 million (2015) to ~ SOS 1.3 billion (2025), the Ministry of Health's share remained ≤ 7%, leaving sustainability and local ownership at risk. Recent funding cuts have reduced food, health, and WASH services, heightening disease and malnutrition risks. This review examines the long-term impacts of multisectoral aid on Somalia's health system and governance, focusing on its effectiveness, sustainability, and unintended consequences.
methodWe conducted a narrative review (1990-2024; final search April 25, 2025) across PubMed, Scopus, Web of Science, Google Scholar, and gray literature (WHO, UNICEF, World Bank, USAID, FMoH). Using SANRA guidance, two reviewers screened 221 records plus prior evidence; 334 studies/reports were synthesized via hybrid thematic coding (NVivo) across five domains: aid-driven system development; aid-governance interactions; consequences of dependency; comparative insights; and sustainability pathways.
resultsAid delivered tangible "fruits": expanded immunization and MCH coverage; high 2024 delivery performance (health 95% with US$69.8 M spent; nutrition 95.5% with US$73.9 M); and total donor inflows of ~ US$721.9 M fully deposited. However, most funds flowed off-budget through vertical programs and parallel supply/data chains, fragmenting governance and dampening state capacity. Despite the health share peaking at 7% (2023) and stabilizing near 6.8% (2025), cuts in 2025 curtailed essential services, leaving millions more vulnerable. Comparative cases (Liberia, Sierra Leone vs. South Sudan, Afghanistan) show sustainability improves when pooled funding, government payroll integration, and PHC-first strategies are adopted.
conclusionFor Somalia to transition from aid dependency to sustainable health governance, a deliberate shift is needed by strengthening FMoH leadership, funding PHC, unifying systems, integrating staff into public payroll, and ensuring epidemic readiness.
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