{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:53:35Z","timestamp":1793040815235,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:00:00Z","timestamp":1764633600000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,13]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The effectiveness of humanitarian health and nutrition programmes in Somalia is critically dependent on seamless collaboration and coordination among a diverse array of actors. While existing literature acknowledges broad challenges to coordination such as insecurity, resource competition and fragmentation, a significant gap remains in understanding how these barriers and their corresponding enablers actively manifest in the daily operations and decision-making processes of frontline practitioners.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to provide a systematic, in-depth exploration of the barriers and enablers influencing collaboration and coordination mechanisms from the perspective of those directly involved in the response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative study was conducted using semi-structured, in-depth interviews. Data were analysed using a deductive thematic approach guided by the Consolidated Framework for Implementation Research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted across the entire territory of Somalia, encompassing its five member states, the capital city Mogadishu, and the self-declared independent state of Somaliland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 26 participants, including executive directors, health and nutrition programme managers, coordinators from international and national non-governmental organisations (NGOs), government officials and community members, were interviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key barriers included poor adaptability and high complexity related to collaborative initiatives (intervention characteristics); armed conflicts, climatic shocks, deeply ingrained sociocultural practices and restrictive government policies (outer setting); inadequate information technology infrastructure and hierarchical communication (inner setting); high staff turnover (individual characteristics). Key enablers included strong inter-agency partnerships (outer setting); supportive organisational culture (inner setting); competent and motivated staff (individual characteristics); and robust planning, engaging and evaluation processes (process).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study highlights the complex contextual factors that impact the effectiveness of collaboration and coordination mechanisms among humanitarianorganisations operating in Somalia. Policymakers should unify governance, agencies prioritise localisation and donors allocate quotas to local NGOs to enhance aid delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101401","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:21:09Z","timestamp":1764786069000},"page":"e101401","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Barriers and enablers to effective collaboration and coordination mechanisms among humanitarian organisations delivering health and nutrition programmes in Somalia: an exploratory qualitative study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9134-8795","authenticated-orcid":false,"given":"Abdirahman Moallim","family":"Ibrahim","sequence":"first","affiliation":[{"name":"Department of Research, Jazeera University, Mogadishu, Banaadir, Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saadaq Adan","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department Mentorship, Benadir University, Mogadishu, Banaadir, Somalia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Osman","family":"Mohamed","sequence":"additional","affiliation":[{"name":"University for Peace, Ciudad Col\u00f3n, San Jos\u00e9, Costa Rica"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"2026010703453647000_15.12.e101401.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0137159","article-title":"Effectiveness of Mechanisms and Models of Coordination between Organizations, Agencies and Bodies Providing or Financing Health Services in Humanitarian Crises: A Systematic Review","volume":"10","author":"Akl","year":"2015","journal-title":"PLoS ONE"},{"key":"2026010703453647000_15.12.e101401.2","unstructured":"UNOCHA . HUMANITARIAN response plan. Available: https:\/\/somalia.un.org\/sites\/default\/files\/2021-12\/2022_Somalia_HRP.pdf"},{"key":"2026010703453647000_15.12.e101401.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-023-02092-1","article-title":"Health equity in Somalia? An evaluation of the progress made from 2006 to 2019 in reducing inequities in maternal and newborn health","volume":"23","author":"Morrison","year":"2024","journal-title":"Int J Equity Health"},{"key":"2026010703453647000_15.12.e101401.4","unstructured":"Global Nutrition Report . Country nutrition profiles. Global Nutrition Report. Available: https:\/\/globalnutritionreport.org\/resources\/nutrition-profiles\/africa\/eastern-africa\/somalia\/ [accessed 18 Oct 2025]"},{"key":"2026010703453647000_15.12.e101401.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033148","article-title":"Malnutrition and morbidity trends in Somalia between 2007 and 2016: results from 291 cross-sectional surveys","volume":"10","author":"Martin-Canavate","year":"2020","journal-title":"BMJ Open"},{"key":"2026010703453647000_15.12.e101401.6","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1017\/S0020818314000381","article-title":"Compete or Coordinate? Aid Fragmentation and Lead Donorship","volume":"69","author":"Steinwand","year":"2015","journal-title":"Int Org"},{"key":"2026010703453647000_15.12.e101401.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jce.2008.09.005"},{"key":"2026010703453647000_15.12.e101401.8","unstructured":"The humanitarian situation in somalia remains extremely serious: assistance must be sustained and improved to continue to prevent famine. Available: https:\/\/www.unicef.org\/press-releases\/humanitarian-situation-somalia-remains-extremely-serious-assistance-must-be [Accessed 18 Jun 2023]."},{"key":"2026010703453647000_15.12.e101401.9","unstructured":"ReliefWeb . Somalia humanitarian country team centrality of protection strategy 2022-23 - Somalia. 2022. Available: https:\/\/reliefweb.int\/report\/somalia\/somalia-humanitarian-country-team-centrality-protection-strategy-2022-23 [Accessed 19 Jun 2023]."},{"key":"2026010703453647000_15.12.e101401.10","unstructured":"Somalia NGO Consortium . UN humanitarian coordination structures. Somalia NGO consortium. 2025. Available: http:\/\/somaliangoconsortium.org\/services\/coordination\/un-humanitarian-coordination-structures\/ [Accessed 12 Jul 2025]."},{"key":"2026010703453647000_15.12.e101401.11","unstructured":"United Nations Office for the Coordination of Humanitarian Affairs . Yemen humanitarian needs and response plan 2025. United Nations, 2025. Available: https:\/\/www.un-ilibrary.org\/content\/books\/9789211071719"},{"key":"2026010703453647000_15.12.e101401.12","unstructured":"Global humanitarian overview 2022 | global humanitarian overview. 2022. Available: http:\/\/gho-2022-site.docksal.site\/ [Accessed 18 Jun 2023]."},{"key":"2026010703453647000_15.12.e101401.13","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.foodpol.2016.11.001","article-title":"Facing famine: Somali experiences in the famine of 2011","volume":"65","author":"Maxwell","year":"2016","journal-title":"Food Policy"},{"key":"2026010703453647000_15.12.e101401.14","unstructured":"ReliefWeb . Somalia: health cluster. ReliefWeb Response. Available: https:\/\/response.reliefweb.int\/somalia\/health [Accessed 18 Oct 2025]."},{"key":"2026010703453647000_15.12.e101401.15","unstructured":"About the nutrition cluster. ReliefWeb Response. Available: https:\/\/response.reliefweb.int\/somalia\/about-nutrition-cluster [Accessed 18 Oct 2025]."},{"key":"2026010703453647000_15.12.e101401.16","unstructured":"Barnett M , Walker P . Regime change for humanitarian aid. 94. Foreign Aff, 2015.Available: https:\/\/www.foreignaffairs.com\/articles\/world\/2015-06-16\/regime-change-humanitarian-aid"},{"key":"2026010703453647000_15.12.e101401.17","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1080\/09692290.2016.1217902","article-title":"Cooperation, co-optation, competition, conflict: international bureaucracies and non-governmental organizations in an interdependent world","volume":"23","author":"Johnson","year":"2016","journal-title":"Rev Int Polit Econ"},{"key":"2026010703453647000_15.12.e101401.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2024-018331","article-title":"The localisation of humanitarian response to conflict and displacement: a scoping review from a health systems perspective","volume":"10","author":"McGrath","year":"2025","journal-title":"BMJ Glob Health"},{"key":"2026010703453647000_15.12.e101401.19","unstructured":"Gichuki L . Global squeeze: how governments are driving humanitarian groups out. DevelopmentAid. Available: https:\/\/www.developmentaid.org\/news-stream\/post\/199500\/governments-are-driving-humanitarian-groups-out [Accessed 18 Oct 2025]."},{"key":"2026010703453647000_15.12.e101401.20","doi-asserted-by":"crossref","first-page":"104527","DOI":"10.1016\/j.ijdrr.2024.104527","article-title":"Technological advancements in humanitarian aid","volume":"109","author":"Zarei","year":"2024","journal-title":"Int J Disaster Risk Reduct"},{"key":"2026010703453647000_15.12.e101401.21","first-page":"367","article-title":"DIFFUSION OF INNOVATIONS. By Everett M. Rogers. New York: The Free Press of Glencoe","volume":"41","author":"Wilkening","year":"1962","journal-title":"Soc Forces"},{"key":"2026010703453647000_15.12.e101401.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.0887-378X.2004.00325.x"},{"key":"2026010703453647000_15.12.e101401.23","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50"},{"key":"2026010703453647000_15.12.e101401.24","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"2026010703453647000_15.12.e101401.25","doi-asserted-by":"crossref","unstructured":"W\u00e6raas A . Thematic analysis: making values emerge from texts. In: Researching values: methodological approaches for understanding values work in organisations and leadership. Springer International Publishing, 2022: 153\u201370.","DOI":"10.1007\/978-3-030-90769-3_9"},{"key":"2026010703453647000_15.12.e101401.26","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2026010703453647000_15.12.e101401.27","first-page":"S105","article-title":"Aid in a city at war: the case of Mogadishu, Somalia","volume":"36 Suppl 1","author":"Gr\u00fcnewald","year":"2012","journal-title":"Disasters"},{"key":"2026010703453647000_15.12.e101401.28","doi-asserted-by":"crossref","first-page":"165506","DOI":"10.1016\/j.scitotenv.2023.165506","article-title":"Impact-based seasonal rainfall forecasting to trigger early action for droughts","volume":"898","author":"Busker","year":"2023","journal-title":"Sci Total Environ"},{"key":"2026010703453647000_15.12.e101401.29","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1111\/disa.12573","article-title":"The \u201cconflict paradox\u201d: humanitarian access, localisation, and (dis)empowerment in Myanmar, Somalia, and Somaliland","volume":"47","author":"Barter","year":"2023","journal-title":"Disasters"},{"key":"2026010703453647000_15.12.e101401.30","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czx031"},{"key":"2026010703453647000_15.12.e101401.31","doi-asserted-by":"crossref","DOI":"10.1186\/s41018-022-00117-y","article-title":"The National Health Cluster in Yemen: assessing the coordination of health response during humanitarian crises","volume":"7","author":"Al-Awlaqi","year":"2022","journal-title":"J Int Humanit Action"},{"key":"2026010703453647000_15.12.e101401.32","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1016\/S0140-6736(17)31328-4","article-title":"Attacks against health care in Syria, 2015\u201316: results from a real-time reporting tool","volume":"390","author":"Elamein","year":"2017","journal-title":"The Lancet"},{"key":"2026010703453647000_15.12.e101401.33","doi-asserted-by":"crossref","unstructured":"Yan W , Yi-Yuan T , Jinjun W . Cultural Differences in Donation Decision-Making. PLoS One 2015. doi:10.1371\/journal.pone.0138219","DOI":"10.1371\/journal.pone.0138219"},{"key":"2026010703453647000_15.12.e101401.34","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1108\/JHLSCM-06-2021-0059","article-title":"Security, sustainability and supply chain collaboration in the humanitarian space","volume":"11","author":"Larson","year":"2021","journal-title":"JHLSCM"},{"key":"2026010703453647000_15.12.e101401.35","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.puhe.2021.01.001","article-title":"The right to health, public health and COVID-19: a discourse on the importance of the enforcement of humanitarian and human rights law in conflict settings for the future management of zoonotic pandemic diseases","volume":"192","author":"Van Hout","year":"2021","journal-title":"Public Health (Fairfax)"},{"key":"2026010703453647000_15.12.e101401.36","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/S0140-6736(20)30153-7","article-title":"Humanitarian crises: needs grow as health funding falls","volume":"395","author":"Zarocostas","year":"2020","journal-title":"The Lancet"},{"key":"2026010703453647000_15.12.e101401.37","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1111\/poms.12107","article-title":"Improving Humanitarian Operations through Technology\u2010Enabled Collaboration","volume":"23","author":"Ergun","year":"2014","journal-title":"Production and Operations Management"},{"key":"2026010703453647000_15.12.e101401.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jesp.2010.01.005"},{"key":"2026010703453647000_15.12.e101401.39","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1108\/JFC-02-2019-0017","article-title":"Assessment of corruption in the humanitarian assistance in Puntland State of Somalia","volume":"27","author":"Sofe","year":"2020","journal-title":"JFC"},{"key":"2026010703453647000_15.12.e101401.40","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.seps.2016.05.001","article-title":"Exploratory analyses of relief and development operations using social networks","volume":"56","author":"Urrea","year":"2016","journal-title":"Socioecon Plann Sci"},{"key":"2026010703453647000_15.12.e101401.41","doi-asserted-by":"crossref","first-page":"3982","DOI":"10.1111\/poms.13798","article-title":"Aid worker adaptability in humanitarian operations: Interplay of prosocial motivation and authoritarian leadership","volume":"31","author":"Salem","year":"2022","journal-title":"Prod Oper Manag"},{"key":"2026010703453647000_15.12.e101401.42","doi-asserted-by":"publisher","DOI":"10.1177\/0021886315617530"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-101401","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:45:56Z","timestamp":1767786356000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-101401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":42,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,3]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjopen-2025-101401"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-101401","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}