Universal Health Coverage on $15 per Capita: Somalia's Health Financing Crisis and the Limits of Humanitarian Dependency

Abstract

ABSTRACT Universal health coverage (UHC) is unattainable without sustainable and equitable health financing. Somalia, operating with an estimated health expenditure of roughly $15 per capita, represents one of the starkest examples of the gap between global UHC ambitions and the realities of fragile‐state financing. This commentary examines how chronic underinvestment, heavy humanitarian dependency, fragmented donor financing and high out‐of‐pocket spending have undermined equitable healthcare access and financial protection in Somalia. Despite the lifesaving role of humanitarian assistance, prolonged reliance on externally driven and project‐based funding has weakened national stewardship, reinforced system fragmentation and limited long‐term resilience. We argue that Somalia's current financing architecture is fundamentally incompatible with sustainable UHC, particularly for rural, displaced and conflict‐affected populations. The article calls for urgent reforms centred on stronger domestic financing, pooled funding mechanisms, primary healthcare investment and alignment of external support with nationally led priorities. Somalia's experience highlights a broader global challenge: Without context‐sensitive financing reforms and sustained investment in fragile settings, UHC risks remaining an aspirational goal rather than a practical reality.