The Unrecognized Challenge: A Value-Based Policy Approach to Combat Non-Communicable Diseases in Somalia's Health Sector

Background Non-Communicable Diseases (NCDs), encompassing conditions such as hypertension, diabetes, and cancers, have rapidly transitioned from a secondary concern to a significant public health threat in Somalia. This epidemiological shift necessitates urgent examination of the healthcare system’s fundamental capacity to address chronic conditions. NCDs currently account for an estimated 25% to 30% of all fatalities, highlighting the severe disconnect between the traditional acute-care focus of the Somali health system and the requirements of long-term chronic disease management. This report analyzes the systemic barriers inhibiting effective NCD control and proposes a Value-Based Care (VBC) centered policy roadmap for sustainable health system transformation. Methodology: A systematic policy synthesis was conducted, aligning with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework. The analysis included a comprehensive review of peer-reviewed literature indexed in databases such as PubMed, Scopus, and Google Scholar, alongside grey literature from the World Health Organization (WHO), the Global Burden of Disease (GBD) project, and official Somali Ministry of Health reports published within the last decade. Data were thematically synthesized using the WHO Health Systems Building Blocks as the a priori analytical framework, and policy recommendations were graded using established criteria to assess the certainty of evidence. Results Key findings confirm a severe NCD burden (e.g., hypertension affecting approximately 33% and diabetes affecting 20% of the adult population). Systemic challenges are categorized under four pillars: (1) Governance, characterized by service fragmentation and a weak regulatory environment; (2) Financing, dominated by a fee-for-service model and resulting in high catastrophic health expenditure (CHE) for NCD households; (3) Workforce, facing an acute scarcity (0.11 clinicians per 1,000 population) and training misalignment; and (4) Information, plagued by low reporting rates in the DHIS2 system (around 50%). A crucial finding is the unique role of Khat chewing as a major behavioral and policy target driving hypertension and complicating mental health integration. Conclusion Somalia faces a multi-faceted crisis requiring a comprehensive, multi-sectoral response. The adoption of a phased VBC roadmap, focusing on financial model revision, task-shifting integration (WHO PEN/HEARTS), and rigorous, adapted outcome measurement (PROMs/ObSROMs), is essential. Strategic policy alignment, including finalizing the National NCD Policy and strengthening federal-state accountability, is necessary to transition the health system from a reactive model to one capable of achieving global targets for NCD control (SDG 3.4).