Abstract
Somalia's health security is shaped less by the absence of emergency interventions than by the limited institutional capacity to convert them into durable public functions. Conflict, climate shocks, displacement, fragmented authority and externally financed delivery interact to produce recurrent outbreaks and service interruptions. This article synthesizes policy and health-systems evidence to identify an institutional pathway beyond emergency aid. It argues that resilience should be assessed as the capacity to maintain essential services, detect and respond to threats, learn across shocks, and do so through legitimate federal and state institutions. The analysis proposes five mutually reinforcing priorities: predictable domestic financing; a negotiated federal-state delivery compact; a professional, paid and supervised frontline workforce; interoperable surveillance, laboratories and logistics; and climate-resilient primary health care linked to water, sanitation and social protection. An illustrative, explicitly synthetic 60-respondent priority exercise is included only to demonstrate a reporting format; it is not presented as human-subject evidence. The central implication is that humanitarian support should increasingly purchase public capability—common standards, payroll systems, routine data use and accountable local delivery—while preserving life-saving surge capacity. This approach avoids a false choice between aid and state building and offers a sequenced route to health security in a fragile federal context.
Academians Publishers