Nikoloski Zlatko, Mohamoud Mubarik M, Mossialos Elias
LSE Health, LSE, London, UK.
Community Nexus Consulting, Hargeisa, Somalia.
Int J Equity Health. 2025 May 7;24(1):125. doi: 10.1186/s12939-025-02486-3.
Achieving Sustainable Development Goal (SDG) 3, which focuses on health, and more specifically SDG 3.8-universal health coverage (UHC)-by 2030 remains a critical objective for all nations. This paper presents an updated evaluation of Somalia's progress toward UHC. Additionally, by identifying key barriers to achieving UHC in Somalia, this study offers insights that may be valuable for other conflict-affected and post-conflict countries striving to improve healthcare access and financial protection.
To assess Somalia's progress at various levels, we developed a UHC index incorporating access to essential healthcare services and financial risk protection. Furthermore, we employed standard analytical methods, including equity analysis and logit modelling, to examine the key factors influencing both healthcare access and the financial burden associated with seeking medical care.
With an overall UHC index score of 33.5, Somalia ranks lowest among the countries previously analysed. While there is some regional variation in UHC scores, these differences are not as pronounced as the disparities in poverty rates, resulting in a weak correlation between regional socio-economic development (measured by poverty levels) and overall UHC performance. Equity analysis highlights that socio-economic status, educational attainment, and, to a lesser extent, healthcare infrastructure significantly contribute to disparities in access to essential health services, favouring wealthier populations. Additionally, financial risk protection analysis indicates that the most economically disadvantaged groups are at a higher risk of experiencing catastrophic healthcare expenditures.
Given Somalia's ongoing security challenges, achieving SDG 3.8 by 2030 remains a formidable task. However, targeted interventions that address key determinants-such as household income, education levels, and healthcare infrastructure-could help improve access to essential health services and reduce financial barriers to care.
实现可持续发展目标3（SDG 3），即专注于健康领域，更具体地说是到2030年实现全民健康覆盖（UHC），仍然是所有国家的关键目标。本文对索马里在全民健康覆盖方面的进展进行了最新评估。此外，通过确定索马里实现全民健康覆盖的关键障碍，本研究提供了一些见解，这些见解可能对其他受冲突影响和冲突后国家努力改善医疗服务可及性和财务保护具有重要价值。
为了评估索马里在各个层面的进展，我们制定了一个全民健康覆盖指数，该指数纳入了基本医疗服务的可及性和财务风险保护。此外，我们采用了标准分析方法，包括公平性分析和逻辑回归建模，以研究影响医疗服务可及性和就医财务负担的关键因素。
索马里的全民健康覆盖指数总分为33.5，在先前分析的国家中排名最低。虽然全民健康覆盖得分存在一些地区差异，但这些差异不如贫困率差异那么明显，导致地区社会经济发展（以贫困水平衡量）与总体全民健康覆盖表现之间的相关性较弱。公平性分析强调，社会经济地位、教育程度以及在较小程度上的医疗基础设施，对基本医疗服务可及性的差异有显著影响，有利于较富裕人群。此外，财务风险保护分析表明，经济上最弱势的群体面临灾难性医疗支出的风险更高。
鉴于索马里持续面临的安全挑战，到2030年实现可持续发展目标3.8仍然是一项艰巨的任务。然而，针对家庭收入、教育水平和医疗基础设施等关键决定因素的有针对性干预措施，有助于改善基本医疗服务的可及性并减少就医的财务障碍。
