Remittances, household health spending and care-seeking in Somalia: evidence from the Somali Integrated Household Budget Survey (SIHBS) 2022
Year: 2026
Type: preprint
Abstract: Background Somalia has almost no health insurance, and households pay for much of their care directly. It is also one of the most remittance-dependent countries in the world. Studies elsewhere show that remittances raise household health spending, but none has examined this for Somalia. This study assessed whether Somali households that receive remittances are more likely to spend on health care, spend more, and seek care when a member is ill, and whether this differs between remittances from abroad and from within Somalia. Methods This study analysed the nationally representative, cross-sectional Somali Integrated Household Budget Survey (SIHBS) 2022. The analysis covered 7,152 households and 1,663 members who were ill or injured in the past month. Health spending combined 12-month spending on health services and 6-month spending on medicines. Survey-weighted two-part models were fitted (logistic regression for any health spending; linear regression of log per-capita spending among spenders) and logistic regression for care-seeking, adjusted for household demographic, health and locational characteristics. Inverse-probability weighting was used as a second estimator. Results About one in five households (21.7%) received remittances, and 73.4% reported some health spending. Recipient households had higher odds of any health spending (AOR 1.29, 95% CI 1.07–1.55). The association was confined to remittances from abroad (AOR 1.49, 95% CI 1.20–1.85); remittances from within Somalia showed none (AOR 0.91, 95% CI 0.68–1.23). Among spending households, recipients spent 15% more per person (ratio 1.15, 95% CI 1.02–1.30), but the difference in dollars was not significant after weighting, and the health share of the household budget did not differ. Ill members of recipient households were more likely to receive care (AOR 1.65, 95% CI 1.04–2.62) and less likely to go without care because they could not afford it (AOR 0.53, 95% CI 0.31–0.91). Conclusions Remittances from abroad are associated with a higher likelihood of health spending and of care-seeking in Somalia, consistent with remittances acting as informal health financing. The evidence is cross-sectional and weaker for the amount spent. Health financing policy should recognise that four in five households lack this buffer, and that protecting remittance channels also protects access to care.
Source: Research Square
Author: Mohamed Kalid Ali
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225828418