The Silent Epidemic: Strengthening Governance and Health System Resilience against Non-Communicable Diseases in Somalia

Background Non-Communicable diseases (NCDs) such as cardiovascular issues, diabetes, various cancers, and chronic respiratory diseases are becoming a significant public health issue in Somalia, a country affected by conflict and instability. Traditionally, Somalia has faced challenges from communicable diseases, but the landscape is shifting. NCDs now contribute to roughly 30% of premature mortality in the nation. This desk review explores the prevalence of these diseases, the governance challenges that exist, and the opportunities for enhancing health system responses to the increasing burden of NCDs in Somalia. Methodology The methodology implemented a dual-modal search strategy to ensure maximal evidence capture. First, we performed a systematic sweep of the academic landscape using key platforms: PubMed, Scopus, and Google Scholar. Second, we conducted a parallel review of crucial grey literature, actively seeking policy documents and national reports from organizations like the WHO and the Somali Ministry of Health. Only material published in English within the past ten years, and specific to NCDs in Somalia, was deemed eligible. Following data extraction, the information was thematically consolidated and rigorously appraised, with each source’s quality being judged by its underlying study methodology and organizational authority. Results NCDs account for approximately 30% of premature deaths in Somalia. Hypertension (33%) and diabetes (20%) being the most prevalent. Women, urban residents, older adults, and wealthier individuals report higher prevalence. Challenges include a fragile health system, with only 29% of facilities offering cardiovascular and diabetes services, a severe shortage of skilled health workers, and limited diagnostic and treatment capacity. Recurrent humanitarian crises exacerbate NCD risk factors and disrupt care. Opportunities include leveraging community health worker programs, engaging the Somali diaspora, and adapting WHO’s Package of Essential NCD Interventions (PEN). The ongoing development of the national NCD policy signals progress. Conclusion The escalation of NCDs in Somalia demands urgent, coordinated efforts. The primary recommendations for action include: fully implementing the national NCD policy, integrating NCD treatment into primary healthcare, scaling up Community Health Worker (CHW) capabilities, and increasing the mobilization of the diaspora. Success hinges on adapting interventions locally and ensuring a multi-sectoral response is sustained to effectively improve public health and contribute to Sustainable Development Goal 3 (SDG 3) attainment.