Strengthening Primary Health Care for Improved Population Health and Health Equity in Somalia: A Narrative Review

Abstract

Primary health care (PHC) is widely recognized as the foundation of equitable health systems and is a critical pathway towards universal health coverage and improved population health. In fragile and conflict-affected settings, such as Somalia, weak PHC systems have contributed to persistently high maternal and child mortality, preventable infectious diseases, rising noncommunicable disease burdens, and profound health inequities affecting rural communities, internally displaced persons, women, and children. This narrative review examines how strengthening PHC can improve population health outcomes and advance health equity in Somalia. Drawing on peer-reviewed literature, global PHC frameworks, and Somalia-specific policy and health system evidence, this review synthesizes key challenges and opportunities across core PHC domains, including governance, financing, workforce development, service delivery, quality improvement, resilience, and community engagement. The findings highlight that fragmented governance, high out-of-pocket spending, workforce maldistribution, and limited rural and displacement-sensitive service delivery constrain PHC performance and reinforce inequality. Simultaneously, recent policy reforms, community health worker programs, and digital health innovations offer promising entry points for equity-oriented PHC transformation. The review concludes that PHC strengthening in Somalia must be pursued as a system-wide and political priority, anchored in progressive universalism and community partnerships, to deliver sustained improvements in population health while systematically reducing avoidable health disparities.