Building Resilient Primary Health Care in Somalia: Integrating Non-Communicable Disease and Mental Health Interventions for Universal Health Coverage amidst Fragility

Somalia’s health system is defined by extreme, chronic fragility, exemplified by a critically low Universal Health Coverage (UHC) index of 25% and a severe health workforce shortage, with only 0.11 clinicians per 1,000 population . This systemic weakness, a legacy of three decades of conflict and humanitarian crisis, intersects with an accelerating dual burden of Non-Communicable Diseases (NCDs) and Mental Health (MH) disorders. NCDs account for approximately 42% of total mortality , while the pervasive impact of violence and displacement means MH disorders affect an estimated one in three individuals . This manuscript presents a comprehensive health systems analysis and prospective economic projection of Somalia’s strategic shift toward an integrated Primary Health Care (PHC) model designed for resilience in fragile, conflict-affected settings (FCAS). Utilizing the rigorous One Health Tool (OHT) for the EPHS 2020 Implementation Strategic Plan (EPHS-ISP), we model the resource needs required to achieve 80% coverage by 2030. The analysis projects a total investment of US$3.1 billion over the decade. Critically, the economic findings confirm a profound structural transformation: the costs required for continuous chronic care—specifically essential medicines and supplies—will surge to constitute 60% of total implementation costs by 2030 . This finding mandates immediate operationalization of the strategic purchasing model, aggressive, utilization-driven task-sharing leveraging Female Health Workers (FHWs) trained in WHO-PEN/MhGAP protocols, and robust digital health integration for resilient supply chain management. We conclude that sustainable UHC and long-term health security in Somalia rely on institutionalizing chronic care resilience within the core PHC platform, supported by stable domestic financing and rigorous, performance-based governance.