{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:56:22Z","timestamp":1790826982709,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"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":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Universal health coverage (UHC) is unattainable without sustainable and equitable health financing. Somalia, operating with an estimated health expenditure of roughly $15 per capita, represents one of the starkest examples of the gap between global UHC ambitions and the realities of fragile\u2010state financing. This commentary examines how chronic underinvestment, heavy humanitarian dependency, fragmented donor financing and high out\u2010of\u2010pocket spending have undermined equitable healthcare access and financial protection in Somalia. Despite the lifesaving role of humanitarian assistance, prolonged reliance on externally driven and project\u2010based funding has weakened national stewardship, reinforced system fragmentation and limited long\u2010term resilience. We argue that Somalia's current financing architecture is fundamentally incompatible with sustainable UHC, particularly for rural, displaced and conflict\u2010affected populations. The article calls for urgent reforms centred on stronger domestic financing, pooled funding mechanisms, primary healthcare investment and alignment of external support with nationally led priorities. Somalia's experience highlights a broader global challenge: Without context\u2010sensitive financing reforms and sustained investment in fragile settings, UHC risks remaining an aspirational goal rather than a practical reality.<\/jats:p>","DOI":"10.1002\/puh2.70392","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:15:29Z","timestamp":1790824529000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Universal Health Coverage on $15 per Capita: Somalia's Health Financing Crisis and the Limits of Humanitarian Dependency"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8036-4489","authenticated-orcid":false,"given":"Ahmed Abdinasir","family":"Abdulle","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences Mogadishu University  Mogadishu Somalia"},{"name":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7421-8638","authenticated-orcid":false,"given":"Ilyas Abdullahi","family":"Khalif","sequence":"additional","affiliation":[{"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":"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":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour Ahmed","family":"Dahir","sequence":"additional","affiliation":[{"name":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2786-6849","authenticated-orcid":false,"given":"Abdirahman Mohamed","family":"Adan","sequence":"additional","affiliation":[{"name":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmake Gaiye","family":"Bashir","sequence":"additional","affiliation":[{"name":"Center for Health Research and Innovation Somali National 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":"Center for Health Research and Innovation Somali National University  Mogadishu Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"WHO Tracking Universal Health Coverage 2023 Global Monitoring Executive Summary(World Health Organization 2023)."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939\u2010025\u201002486\u20103"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.4236\/health.2023.1511085"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(22)00005\u20105"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0305234"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/FPUBH.2024.1205327"},{"key":"e_1_2_12_8_1","unstructured":"World Health Organization Regional Office for the Eastern Mediterranean Understanding the Private Health Sector in Somalia(WHO 2024)."},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/S13561\u2010025\u201000703\u2010X"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0291371"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41256\u2010021\u201000190\u20107"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/S41182\u2010025\u201000861\u2010Y"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.2147\/JHL.S541966"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/SD.70874"},{"key":"e_1_2_12_15_1","unstructured":"World Bank Group Country Private Sector Diagnostic: Creating Markets in Somalia\u2014Unlocking Private Sector\u2010Led Growth at a Critical Juncture of Somalia's Development(World Bank Group n.d.) 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