By David Ngira
Somalia’s healthcare sector is ailing. This is despite the country receiving USD 4.5 Billion debt relief from IMF and the World Bank last year which moved the country’s debt to GDP ratio from 64% to 6%. The relief followed protracted negotiations under the Highly indebted Poor Countries Initiative. The country’s investment in health has reduced, even though debt relief was premised on economic reforms including implementation of a poverty reduction strategy, increasing revenue collection, prioritization of spending on projects and enhancement of public finance and debt management capacity. Analysis indicates that Somalia’s health budget reduced significantly from 8.5% of the budget in 2023 to 4.8% in 2024 despite the reduction in debt repayment from 1.4% of the budget in 2023 to 0.12% of the budget in 2024. Incidentally, the increase in the overall budget by about 10% wasn’t felt in the health sector. This has called into question the country’s commitment to the right to health.
Amnesty International’s 2021 report on Somalia’s response to Covid-19 indicated that the country only spent 2% of the national budget on health in 2020 – far from the 15% obligation that African governments committed to allocating in the national health budgets in the Abuja Declaration. Three years on, Somalia’s poor health sector is still characterized by insufficient health personnel, high levels of child and maternal mortality, inadequate and largely under-equipped health facilities, low levels of immunization, and recurrent outbreaks of water borne diseases. All these undermine people’s right to adequate health. Although some progress has been made as reflected in the 2022-2026 strategic plan, the level of health provision still fails the expected human rights standards. This has worsened the suffering of people already struggling to adjust to the implications of the climate crisis on their livelihoods, including its impact on health, housing and food systems.
Somalia’s poor health sector is still characterized by insufficient health personnel, high levels of child and maternal mortality, inadequate and largely under-equipped health facilities, low levels of immunization, and recurrent outbreaks of water borne diseases.
David Ngira, ESCR Researcher, Amnesty International
Somalia’s 2021, 2022 and 2023 budgets show a significant variance between the health budget and expenditure. For instance, 2022 expenditure indicates that only 1.3% of the overall budget was actually spent on health, against an overall allocation of 10.6% of the budget. Similarly, in 2023 Somalia allocated 8.5% of the overall budget to the health sector but only spent 7% of the overall budget on the same.
According to Transparency International, corruption has had an important impact on Somalia’s health sector which may result in an unexplained variance between the health budget and expenditure. Authorities should investigate this to identify how much of this variance is due to mismanagement, if any, of the health budget and take legal action against those responsible. Somalia’s development partners should work with the government to strengthen accounting systems and encourage greater fiscal transparency and public participation in budgeting. Expenditures on employee payments which account for most of the health budget must be scrutinized to ensure that the money goes to actual health workers.
Somalia must also work to increase its revenue through increased trade, progressive taxes, widening tax base and grants. It must also seal all loopholes for illicit financial flows. This will enhance resources available for allocation to the health sector. Its therefore urgent for the international community to accelerate the development of a Tax Treaty to help countries like Somalia deal with illicit cash outflow.
Somalia must also work to increase its revenue through increased trade, progressive taxes, widening tax base and grants. It must also seal all loopholes for illicit financial flows.
David Ngira
To be sure, Somalia faces significant security and governance challenges. But military spending, which currently stands at 24% of the budget, must not prevent Somalia from matching its health policies and needs with appropriate budgetary allocations. This will enable the country to adhere to its constitutional and international obligations to guarantee accessible, affordable, and quality healthcare to its people.
Two years after coming into power, the Hassan Sheikh administration must now translate its political commitments into practical health gains for Somalis. This requires the government to allocate at least 15% of their budget to health, implement budgets prudently and ensure corruption doesn’t undermine the country’s progress towards health reforms and realization.
Dr. David Ngira is Economic, Social and Cultural Rights Researcher at Amnesty International’s Regional Office for East and Southern Africa