Equity in Health Funding: An Analysis of the Essential Package of Health Services (EPHS) in Somalia (2021–2026)

Background Somalia’s Essential Package of Health Services (EPHS) is the national framework for delivering basic health interventions, with particular emphasis on maternal, newborn and child health. However, achieving the EPHS goals depends on equitable distribution of funds across regions and services. Somalia’s health sector is heavily reliant on external aid: donors finance over 90% of public health spending while households also bear a high out-of-pocket burden. This fragmented funding landscape may not align with population health needs and equity goals. This study examines donor and government funding for the EPHS (2021–2026) to assess whether resource allocation is aligned with population health needs and equity objectives. Methods We conducted a retrospective analysis of Somalia’s EPHS funding using government and donor data. The primary data source was the Ministry of Health’s Resource Mapping and Expenditure Tracking (RMET) reports (2022–2023), which compile donor and government budget commitments by program and region. We tabulated funding totals by EPHS program area (e.g. reproductive/maternal health, child health, communicable diseases, etc.) and by Federal Member State. We also performed key informant interviews with policymakers and donor representatives to contextualize funding decisions. Equity was assessed by comparing funding shares to population size and health indicators (e.g. under-five mortality) for each region. Results For 2021–2026, external donors provided approximately 90% of the EPHS budget. More than half (≈55%) of total funding was devoted to reproductive, maternal and newborn health (RMNH). Other core services (child health, communicable disease control, first aid/critical care, etc.) each received much smaller shares (roughly 5–15%). Geographically, funding was uneven: relatively stable or donor-prioritized regions (e.g. Puntland, Somaliland) received far higher per-capita allocations, while conflict-affected and remote regions received much less. For example, per-capita funding was roughly three times higher in the most financed states compared to the least funded ones. These patterns indicate that many high-need populations and health areas may be underserved. Conclusions Our analysis reveals significant inequities in Somalia’s EPHS funding distribution. The heavy concentration of resources in RMNH and the uneven geographic allocation suggest that universal health coverage goals will remain elusive under the current funding patterns. Strengthening domestic health financing and coordination (for example, through a dedicated health financing unit) could improve transparency and alignment. Policymakers and donors should use these findings to adjust planning and ensure that EPHS funding more closely matches population needs and equity principles.