{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:56:39Z","timestamp":1790607399663,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Universal Health Coverage (UHC) aims to ensure equitable access to quality healthcare without financial hardship. Somalia presents a critical test case for UHC implementation in fragile and conflict\u2010affected settings due to decades of state collapse, weak governance, and heavy reliance on an unregulated private health sector. This commentary examines Somalia's policy paradox: the coexistence of formal commitment to UHC alongside a predominantly market\u2010driven, donor\u2010dependent, and weakly regulated healthcare system. Drawing on evidence from Somalia and comparable low\u2010income settings, the article argues that unregulated privatization structurally undermines equity, financial protection, and quality of care. High out\u2010of\u2010pocket expenditure, fragmented governance, weak regulatory oversight, urban\u2013rural disparities, and donor\u2010driven financing continue to impede progress toward universal and equitable healthcare access. Although private providers remain indispensable in Somalia's current context, market expansion alone cannot achieve UHC without effective state stewardship, pooled financing mechanisms, and robust regulatory institutions. The commentary concludes that Somalia's pathway toward UHC depends on transitioning from an unregulated commercialized health market toward a regulated mixed health system grounded in equity, accountability, and public\u2010sector governance.<\/jats:p>","DOI":"10.1002\/puh2.70333","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T10:11:39Z","timestamp":1787307099000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Can Universal Health Coverage Be Achieved Through an Unregulated Private Health System? Somalia's Policy Paradox"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7421-8638","authenticated-orcid":false,"given":"Ilyas Abdullahi","family":"Khalif","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences and Tropical Medicine Somali National University  Mogadishu Somalia"},{"name":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2567-892X","authenticated-orcid":false,"given":"Aniso Mohamed","family":"Abdi","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Tropical Medicine Somali National University  Mogadishu Somalia"},{"name":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7422-6868","authenticated-orcid":false,"given":"Yusuf Abdullahi","family":"Hubow","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Tropical Medicine Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5807-3075","authenticated-orcid":false,"given":"Ahmed Mohamed","family":"Omar","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Tropical Medicine Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6900-9870","authenticated-orcid":false,"given":"Sharmake Gaiye","family":"Bashir","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Tropical Medicine Somali National University  Mogadishu Somalia"},{"name":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"},{"name":"Faculty of Health Sciences Salaam University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9419-6379","authenticated-orcid":false,"given":"Nuradin Abdullahi Sheikh","family":"Rashid","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Tropical Medicine Somali National University  Mogadishu Somalia"},{"name":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8036-4489","authenticated-orcid":false,"given":"Ahmed Abdinasir","family":"Abdulle","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Tropical Medicine Somali National University  Mogadishu 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