Yakub Burhan Abdullahi

Essential health services are central to universal health coverage; however, nominal service availability does not necessarily indicate that facilities are ready to deliver care safely, continuously and equitably. In Somalia, evidence on service availability and readiness remains dispersed across facility assessments, policy documents, programme reports and peer‐reviewed studies, limiting its use for planning and equitable resource allocation. This narrative review synthesizes Somalia‐specific evidence on service availability, facility readiness, readiness‐related delivery constraints and health‐system priorities for strengthening essential health services. Evidence was classified as direct facility‐readiness measures, readiness‐related delivery‐system indicators or coverage, programme‐performance and outcome indicators to distinguish structural readiness from indirect signals of delivery‐system performance. Available evidence suggests important readiness gaps across emergency and critical care, surgical services, maternal and newborn health, immunization, nutrition, communicable diseases and selected non‐communicable disease services. These gaps are reinforced by donor‐dependent and geographically uneven financing, fragile supply chains, workforce shortages and maldistribution, weak referral and emergency transport systems, fragmented public, private, NGO and humanitarian service delivery, and limited routine use of facility‐assessment data. Rural, displaced, nomadic, pastoralist and conflict‐affected populations experience substantial access barriers. Institutionalizing readiness monitoring and linking facility‐assessment evidence to planning, budgeting, supervision, supply allocation, donor coordination and accountability could help Somalia move from nominal service availability toward effective, continuous and equitable essential health‐service coverage.

Background and Aims: Internally displaced women in Somalia face major barriers to skilled maternal care. This study estimated the prevalence of skilled birth attendance (SBA) and identified factors associated with SBA among women living in internally displaced persons (IDP) camps in Mogadishu. Methods: A community‐based cross‐sectional study was conducted among women aged 15–49 years in IDP camps in Deynile, Kahda, and Garasbaaley districts, Mogadishu, in February 2026, using multistage sampling and interviewer‐administered questionnaires. The outcome was SBA at the most recent birth. Multivariable logistic regression estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs); tests were two‐sided (α = 0.05). Results: Of 384 women interviewed, 382 were eligible. SBA was reported by 68 of 381 women (17.8%; 95% CI: 14.3–22.0); 295 (77.4%) were assisted by traditional birth attendants and 255 of 382 (66.8%) delivered at home. Only 42 of 370 women (11.4%) received any antenatal care (ANC). In the adjusted model (n = 366; 67 events), SBA was associated with ANC attendance (AOR 3.17; 95% CI: 1.27–7.94) and Quranic education compared with no education (AOR 3.13; 95% CI: 1.61–6.10). Estimates for primary education (6 women; AOR 6.13; 95% CI: 1.05–35.91) and public transport (31 women; AOR 0.14; 95% CI: 0.02–0.77) were imprecise. The model discriminated well (AUC 0.79) but had few events per parameter (4.5). Conclusion: SBA was very low among displaced women in these camps. ANC attendance and basic education were associated with SBA. Given the cross‐sectional design, the sampling of selected camps, and imprecise subgroup estimates, these associations should not be interpreted as causal or generalized to all displaced populations in Somalia.

Disability inclusion in primary health care is not a peripheral issue but a fundamental test of whether health systems in sub-Saharan Africa are advancing