Reimagining Healthcare Management and Leadership in Somalia: A Commentary Proposing an Eight-Pillar Conceptual Framework for a Mixed Public–Private Health System
Year: 2026
Type: article
Abstract: Somalia's health system is a fragmented mixed market. Private for-profit and not-for-profit providers deliver most curative care, external donors finance most health spending, and the instruments needed to regulate this market remain largely in draft or unenforced. National plans set out what the system should deliver, but they say less about how leaders and managers should run organizations and purchasing arrangements within such a market. This evidence-informed policy commentary addresses that gap. It is not a systematic review: sources were selected purposively by the author from peer-reviewed literature and from official Somali, World Health Organization, and World Bank Group-supported reports, without a protocol-driven search or formal quality appraisal. From these sources the author proposes an eight-pillar conceptual framework: public stewardship of the healthcare market; accountable public-private partnerships; value-based management; sustainable healthcare financing; a national quality and accreditation system; digital and managerial innovation; procurement and supply-chain reform; and leadership and the healthcare workforce. The central argument is that leadership and stewardship capacity, more than the number of providers, is the binding constraint, and that management instruments borrowed from business strategy help only when they are sequenced behind that capacity and kept subordinate to equity, quality, and patient safety. The pillars largely reorganize established health-system strengthening principles; the contribution lies in linking each to a documented Somali problem, a leadership requirement, and a feasibility condition. The framework is author-generated and has not been validated through stakeholder consultation, costing, or empirical testing, and the evidence for several of its instruments, including contracting, performance-based payment, and community-based insurance, is mixed. It should therefore be read as a set of policy considerations for consultation, piloting, and evaluation, not as a demonstrated solution.
Source: Journal of Healthcare Leadership
DOI: 10.2147/jhl.s644322
Author: Abdullahi Ilyas Osman
Institution: Mogadishu University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,320
OpenAlex ID: W7223562574