Securing Somalia's health: leveraging sin tax revenues to drive universal health coverage and financial protection for lifesaving care in Somalia's health system-scoping review.

introductionGlobal non-communicable diseases account for 74% of deaths worldwide, causing 15 million premature deaths each year, and the WHO warns this could rise to 55 million by 2030. Universal Health Coverage (UHC) is therefore central to SDG 3.8, aiming to ensure access to essential services without financial hardship. In Somalia, where tax revenue is low, increasing sin-tax rates could boost fiscal capacity for health initiatives. This study aims to explore how sin-tax revenues can serve as a sustainable financial mechanism to address Somalia's health-financing challenges, promote UHC and enhance financial protection while examining global best practices and the political economy of implementation in fragile states.

methodsThis review followed the PRISMA-ScR framework for scoping reviews and synthesised evidence from academic and grey-literature sources on sin-tax (health taxes) revenues, health financing and UHC in fragile states-particularly Somalia. An initial 194 records were identified; after screening, 92 studies met the inclusion criteria for full-text analysis.

resultsIn Fiscal Year 2024 Somalia collected US $ 369.35 million in revenue, a 12% rise from 2023; the additional US $ 40 million equals 0.35% of 2024 GDP. Estimates show that sin-tax instruments on tobacco and alcohol yield 0.01%-0.5% of GDP in fragile states. Sin-taxes in Somalia such as the khat tax in Somaliland, which generates about US $ 2 million annually demonstrate tangible scope to expand public-health financing while curbing harmful consumption.

conclusionSomalia's path to UHC remains constrained by reliance on external aid, out-of-pocket spending and a narrow domestic tax base. Well-designed sin-tax instruments on tobacco, alcohol, sugary drinks and khat especially where revenues are partially earmarked (hypothecated) for priority health services offer a dual opportunity: they curb risk-laden consumption and create predictable revenue that can be earmarked for essential services such as primary care, maternal-and-child health and NCD prevention. Evidence from peer countries shows that high rates, automatic inflation adjustment and robust enforcement are critical for maximizing both health gains and fiscal space.