Strengthening Somalia’s Health Sector: Decentralization in a Federal System
In September 2024, the Heritage Institute for Policy Studies (HIPS) commissioned a comprehensive study of the structural and capacity challenges facing Somalia’s federal and state ministries of health. The study set out to inform the development of a resilient, sustainable, and decentralized healthcare system aligned with Somalia’s federal governance framework.
The findings point to significant weaknesses in policy formulation and limited use of evidence in decision-making, alongside overlapping and unclear mandates between federal and state entities that undermine coordination and accountability. Health planning remains largely donor-driven and poorly integrated across levels of government, reducing strategic coherence.
The study proposes a set of targeted recommendations: strengthening the Federal Ministry of Health’s planning capacity, policy development, and regulatory oversight through structured engagement with research institutions and international partners; empowering state and district authorities as the operational core of decentralized service delivery, with tailored support for planning and resource allocation; diversifying revenue through selective health-related taxes, including on tobacco, khat, and sugary drinks, and licensing of private health actors; and clearly defining federal and local planning responsibilities so that budgeting aligns with service delivery.
The report offers policymakers a strategic roadmap for advancing health sector decentralization. By addressing structural gaps, strengthening institutional capacity, and promoting inclusive governance, Somalia can build a health system that is more equitable, more responsive, and consistent with its federal aspirations.
Strengthening Somalia’s Health Sector: Decentralization in a Federal System