Universal health coverage in fragile and conflict-affected States: insights from Somalia

Nikoloski, Zlatko ORCID: 0000-0003-0609-5832, Mohamoud, Mubarik M. and Mossialos, Elias ORCID: 0000-0001-8664-9297 (2025) Universal health coverage in fragile and conflict-affected States: insights from Somalia. International Journal for Equity in Health, 24. ISSN 1475-9276

Text (s12939-025-02486-3) - Published Version Available under License Creative Commons Attribution. Download (1MB)

• Scopus publication

Abstract

Introduction: Achieving Sustainable Development Goal (SDG) 3, which focuses on health, and more specifically SDG 3.8—universal health coverage (UHC)—by 2030 remains a critical objective for all nations. This paper presents an updated evaluation of Somalia’s progress toward UHC. Additionally, by identifying key barriers to achieving UHC in Somalia, this study offers insights that may be valuable for other conflict-affected and post-conflict countries striving to improve healthcare access and financial protection. Methodology: To assess Somalia’s progress at various levels, we developed a UHC index incorporating access to essential healthcare services and financial risk protection. Furthermore, we employed standard analytical methods, including equity analysis and logit modelling, to examine the key factors influencing both healthcare access and the financial burden associated with seeking medical care. Results: With an overall UHC index score of 33.5, Somalia ranks lowest among the countries previously analysed. While there is some regional variation in UHC scores, these differences are not as pronounced as the disparities in poverty rates, resulting in a weak correlation between regional socio-economic development (measured by poverty levels) and overall UHC performance. Equity analysis highlights that socio-economic status, educational attainment, and, to a lesser extent, healthcare infrastructure significantly contribute to disparities in access to essential health services, favouring wealthier populations. Additionally, financial risk protection analysis indicates that the most economically disadvantaged groups are at a higher risk of experiencing catastrophic healthcare expenditures. Implications: Given Somalia’s ongoing security challenges, achieving SDG 3.8 by 2030 remains a formidable task. However, targeted interventions that address key determinants—such as household income, education levels, and healthcare infrastructure—could help improve access to essential health services and reduce financial barriers to care.

Item Type:	Article
Additional Information:	© 2025 The Author(s)
Divisions:	LSE Health Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	02 May 2025 13:54
Last Modified:	17 Jun 2025 19:57
URI:	http://eprints.lse.ac.uk/id/eprint/128049

Actions (login required)

View Item