Transforming Health in Post-Conflict Somalia: Priorities from a Multi-Stakeholder Roundtable on the 2025-2029 National Plan.

Abstract

Background: Somalia's health system remains among the world's most fragile, with a Universal Health Coverage index of only 25% and a critical health workforce density of 0.11 clinicians per 1000 population. While previous national strategies such as NDP-9 and HSSP III provided broad frameworks, the National Transformation Plan (NTP) 2025-2029 represents a paradigm shift toward multi-stakeholder engagement and evidence-based priority-setting for health system transformation.

Aim: This roundtable aimed to identify priority areas and implementation strategies for the NTP health pillar through structured stakeholder consultation, moving beyond traditional top-down planning approaches to incorporate diverse perspectives from Somalia's fragmented health landscape.

Methods: A qualitative multi-stakeholder roundtable was conducted in Mogadishu with 30 purposively sampled participants representing federal and state ministries, universities, public and private providers, non-governmental organizations, and civil society. Ethical approval was waived, and informed consent was obtained. Audio-recorded discussions were transcribed, translated, and analyzed thematically according to the four NTP health domains.

Results: Thematic analysis identified four critical priorities. Participants emphasized that primary health care expansion should prioritize female community health workers and rural facility rehabilitation to increase service coverage beyond the current 25%. Participants emphasized that health workforce constraints, with only 0.11 clinicians per 1000 population, require regional training hubs and rural deployment incentives. Participants emphasized that regulation and governance through the newly established National Health Professionals Council need sustainable funding and federal-state accountability frameworks. Participants emphasized that public-private partnerships and digital health integration could leverage telemedicine and private sector capacity for underserved areas.

Conclusion: The roundtable produced actionable strategies linking community-centered primary care, workforce development, regulatory strengthening, and technology-enabled partnerships. However, implementation faces significant constraints, including limited domestic financing, weak governance coordination, and ongoing fragility. Success will require sustained political commitment and innovative approaches adapted to Somalia's unique post-conflict context.