The document summarizes a study assessing the readiness of Somali health systems to achieve universal health coverage, particularly for vulnerable populations in Somaliland. Interviews and focus groups were conducted with health experts. Most respondents felt universal health coverage by 2030 would not be realistic given Somaliland's poor economic conditions and complex situation. Currently, health care is largely out-of-pocket and donor dependent, leaving most of the population without coverage. National leadership and increased public spending on health are recommended to work towards covering health expenses for vulnerable populations in line with international goals.

1. Assessing the readiness of Somali health
systems for universal health coverage in
particular to vulnerable populations in
Somaliland: A qualitative Study
Dr Jibril I.M Handuleh, MD MPH
School of Medicine and public health
Amoud University
Borama, Somalia
Third Annual Conference-Somali National University
Higher Education in Post Conflict Societies
23-25 July 2019
Jazeera Hotel
Mogadishu, Somalia

2. Introduction
• Somaliland is stable de facto region in Northwestern Somalia. The territory is
relatively peaceful compared to the rest of the country.
• It has estimated population of 4 million people. Health systems is very much
donor dependent and weak in addressing the health needs of the populations.
• Health indicators as the rest of the country remain extremely alarming with very
high maternal and childhood mortality.
• Somaliland indicators are internationally reported in Somalia health performance
parameters.

3. What is universal health coverage?
• Universal Health Care Coverage means that all people can use the
promotive, preventive, curative, rehabilitative and palliative health care they
need, of sufficient quantity and also enshuring it does not expose them to
financial hardship.
• It address which populations to cover, what services to cover and who covers
costs.

4. Facts about UHC
• 400 million are at risk of being made poor by expending their money on
health.
• 100 million people are pushed into poverty by expending money on their
health
• It is measured by proportion of people that access essential quality health
care and proportion of population that spend large amount of their income
into their health care expenses.

5. Health financing
• Health care in the region is out of pocket spending where sick patients cover all of
their health expenses putting many patients on the break of poverty.
• Limited health services including some primary care services including vaccinations
are donor covered.
• In this background, health insurance companies are on the rise in the Somali regions
covering health care for those employed mainly by international non governmental
organizations.
• This leaves the majority of the population including unemployed and the vulnerable
with no coverage.

6. • The study aimed at studying how visible it is to undertake
innovative ways to secure fair health care funding universally for
everyone…
• Given the overall national poor economics, the study explored how
feasible its to fund health care for all in line with the sustainable
development goals and WHO’s universal health coverage roadmap
2030

7. Methodology
• In depth interviews with key public health informants, policy makers and
academics were made with 23 individuals who are experts in the field.
• Focus group discussions(3) were also done with medical doctors and public
health officials and other allied health professionals who are involved with
patients in both public and private care.
• FGDs were 3 groups of 8 people each who had shared their own
perceptions of the possibility of UHC in the health care systems.

8. In depth interviews and focus group discussion
groups
0
2
4
6
8
10
12
14
16
In depth interviews Focus Group Discussion
Number of people or groups involved
Number of people or groups involved

9. Results and discussion
• Respondents in the in-depth interviews had very negative impression of Somalia’s lack of
readiness in addressing universal health care coverage for the populations.
• Only 2 percent of the respondents expected it can happen in line with the SDG timeline of
2030.
• Only 5% of FDG group members believed UHC is realistic for the majority of populations.
Some emphasized even their salary is not addressed rather than health coverage.
• The study found that UHC is hard to achieve in particular to Somaliland given the complex
situation of the region.
• This will keep those who are already poor in their cycle of poverty and will hinder quality
health care for the poor population.

10. Conclusions
• The current status quo of booming market of private health insurance and
increasing expenditure of the health care for the poor populations means
shrinking the little access those populations have access to health care.
• The increasing cost of growing specialist practice both in public and private
are getting expensive to purchase in all specialties.
• Although, it is vital to prioritize UHC for the whole population its of
challenging task in fragile and poor conflict ridden countries but it is still
achievable if right solutions are found.

11. Recommendations
• UHC needs to be understood and led nationally by public health decision makers
including health policy makers, leading government planners and enough resource
for health being allocated for UHC coverage.
• International recommendations along with national leadership in coming up with
realistic, practical and SMART health coverage mechanism will address the Somali
case.
• Increasing public spending on health per GDP income is one of the main areas of
increasing access of vulnerable populations to health expenses coverage.

12. Thanks for listening and will take Q and
A after the lectures in the session
MAALIN WANAGSAN!