Population health trends and disease profile in Somalia 1990–2019, and projection to 2030: will the country achieve sustainable development goals 2 and 3?

Somalia has some of the lowest-ranked health indicators worldwide [1]. Several decades of civil war have diminished Somalia’s health system and displaced 2.6 million people within the country [2, 3]. The ongoing flooding, droughts, locust plagues, and conflict in Somalia have caused sustained food crises and, ultimately, famines during 2010–2012 [4]. The burden of malnutrition is a considerable health concern in Somalia and jeopardises the growth and development of children and young people [5]. Sustainable Development Goal–2 (SDG) aims to ‘end hunger, achieve food security and improved nutrition and promote sustainable agriculture by 2030’ [6].

In low- and middle-income countries, most maternal and infant deaths are preventable [7]. Over half of maternal deaths worldwide occur in sub-Saharan Africa, and the maternal mortality ratio in Somalia is one of the highest worldwide [8]. SDG-3 aims to ‘ensure healthy lives and promote well-being for all at all ages by 2030’ [9]. The SDGs establish ‘to leave no one behind’ as a core principle [10]. However, current Somali health and nutrition rankings do not bode well for progress towards reaching SDG 2–3 targets [11].

Good quality, up-to-date data are necessary for monitoring health outcomes, assessing progress in achieving SDGs and to inform policy [12]. This requirement is even more true in countries with fragile and fragmented health systems, such as Somalia, which has been in a protracted state of conflict for the last 30 years [4]. However, there is a sparseness of health information and evidence in Somalia [13]. Its Federal Ministry of Health (FMoH) collaborated with the country’s WHO regional office to develop a five-year strategic health plan (2021–2025). It covers a broad range of health concerns, such as communicable and non-communicable diseases and mother and child health. Together with the WHO country office in Somalia, this paper’s authors produced a report describing trends in population health and disease burden. The research evidence fed into the health plan and generated opportunities for further collaborative efforts between the FMoH and WHO. This study presents the report’s main findings.

This investigation describes trends in life expectancy and health-adjusted life expectancy (HALE) estimates, communicable and non-communicable diseases, mother and child health, injuries, and malnutrition in Somalia during 1990–2019. Projections for 2030 are presented to show whether Somalia will achieve SDG–2 and SDG–3 targets and where improvements exist and challenges persist.

Life expectancy in Somalia has increased since 1990 (Table 1). Nevertheless, sustained mortality levels caused by communicable diseases and child and maternal mortality have possibly caused life expectancy to remain below the sub-Saharan average in 2020 (63.9 years for females and 60.3 for males) [19]. The relative stability experienced in Somalia since its recovery in 2012 with the establishment of a transitional federal government has driven an increase in healthcare, creating opportunities for universal health coverage (UHC) [20, 21]. However, Somalia’s health system remains weak; the UN reports that one-fifth of the population in Somalia still lack access to healthcare, which continues to pose severe challenges to the population’s health [22]. In response to the gaps in Somalia’s health care system, humanitarian actors have provided the following essential services [23]. The UNDP has worked towards reducing HIV/AIDS since 2004 by creating knowledge and awareness programs, increasing testing, and lobbying for HIV/AIDS legislation [24]. Managed by UNICEF, WHO and the United Nations Population Fund (UNFPA), Somalia’s Joint Health and Nutrition Programme (JHNP) has supported the institutional development of the Somali healthcare system and provided the Essential Package of Health Services (EPHS) [25]. The JHNP assists neonatal and reproductive health and supports child immunisations, nutrition and treatment of diseases in Somalia [3, 26]. It has possibly contributed to this study’s maternal and infant mortality reductions [26]. Data from MICS 2006 and the SHDS 2020 report that the percentage of deliveries assisted by health attendants and rates of pregnant women receiving antenatal care in Somalia increased between 2000 and 2019 [27, 28]. However, maternal health care remains lower than the sub-Saharan average and has yet to reach women equally. In Somalia, women of low income and living in rural areas have inadequate coverage [28].

UNICEF and WHO provided a parental awareness campaign for infant care-seeking, the Integrated Community Case Management [29]. SDHS data report that healthcare seeking for children under five with diarrhoea increased from 2.8% among rural children and 9% among urban children in 2006 to 52.2 and 59.9% in 2020 [28]. Care-seeking for children under age five with acute respiratory infections (ARI) in Somalia increased to 22.5% in 2019, up from 13% in 2006 [30]. The increased access to health care for children has contributed to the reduction in under-five mortality reported in this study.

Unvaccinated children in fragile or humanitarian settings are among the most vulnerable to disease outbreaks [31]. The vaccine initiative that UNICEF and WHO launched in 2013 in Somalia rolled out at least 1.3 million doses of the ‘five-in-one’ vaccine and provided a parental vaccine awareness campaign [32]. The vaccination initiative helped reduce under-five mortality rates in Somalia between 1990 and 2019. Nevertheless, child vaccination rates in Somalia remain low; only 42% of children aged 12–23 months are immunised against diphtheria, pertussis and tetanus (DPT) [33], 46% are vaccinated against measles [34] and 60.3% did not receive any vaccinations.

Somalia will not reach health and nutrition SDG targets by 2030. The moderate improvements observed in Somalia over the past three decades could act as a roadmap to accelerate progress and achieve SDG–2 and 3 aims.

In Somalia, maternal, infant, and under-five mortality remain a significant health challenge. A modest decline in maternal, infant and under-five mortality has contributed to female and male life expectancy improvements over the past thirty years. This trend is forecasted to continue in Somalia. Nevertheless, Somalia’s maternal and infant mortality rates remain high and highlights the need for measures to increase prevention among vulnerable populations. Addressing malnutrition in Somalia and reducing child stunting remains essential.

Somalia is still in the early stages of the health transition. Non-communicable diseases’ contribution to mortality and disability will continue to increase. While communicable, maternal, neonatal, and nutritional diseases remain a major health concern.