Peer-reviewed article
Integration of oral health into primary health care in Somalia: opportunities, barriers, and system-level implications for universal health coverage
Saido Gedi, Salma Ali Ossoble, Mohamoud M. Dahir, Nasra Abdulsamad Mohamud, Abubakar Ahmed et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study looks at how oral health fits into Somalia's national health policies and primary health care. It combines a review of policy documents with 13 interviews with policymakers, advisers, regulators, academics and providers. It finds that oral health is recognised in policy but is rarely put into practice in routine primary care. Services are mostly treatment-focused, urban, hospital-based and paid for out of pocket. The authors suggest a phased approach that builds on governance, a minimum oral health package, task-sharing, referral and data systems.
Key points
- Stakeholders described a persistent gap between policy recognition of oral health and its implementation in routine primary health care.
- Seven themes were identified, including fragmented governance, weak regulation, reliance on out-of-pocket and private-sector financing, and workforce and task-sharing constraints.
- Services are mainly curative, urban and hospital-based, with weak links to maternal and child health and primary health care.
- Limited oral health data and evidence generation were noted, and the authors propose adding oral health indicators to DHIS2.
- Opportunities for phased integration were identified through primary health care, maternal and child health, school health, community health workers and NCD platforms.
Limitations
The study is qualitative, based on documentary review and only 13 key-informant interviews, so it cannot measure how common oral disease is among children or show whether any integration approach improves outcomes. The abstract also gives little child-specific detail.
Abstract
Background Oral diseases are among the most common noncommunicable conditions globally, yet oral health remains poorly integrated into primary health care (PHC) and universal health coverage, especially in fragile, low-limited settings. As Somalia rebuilds its health system through the Health Sector Strategic Plan III 2022–2026, the Essential Package of Health Services 2020, the Investment Case for the Somali Health Sector 2022–2027, and community health reforms, this study examined the place of oral health within national health policies. It identified barriers to integration and explored feasible pathways for strengthening PHC-based oral health. Methods The study used a qualitative policy and health-systems analysis combining documentary review with 13 key-informant interviews. Participants represented national policymakers, health-system technical advisers, regulators, academics, professional associations, and providers at public hospital, and private dental settings. Data were analyzed thematically and mapped against the WHO health-system building blocks, PHC principles, and the WHO Global Strategy and Action Plan on Oral Health 2023–2030. Results Somalia's policy environment offers opportunities for oral health integration, but stakeholders highlighted a persistent gap between policy recognition and implementation within routine PHC. Seven interrelated themes were identified: (1) policy recognition without operationalization; (2) fragmented governance, weak regulation, and limited coordination; (3) reliance on out-of-pocket financing and private-sector; (4) workforce, education, and task-sharing constraints; (5) predominantly curative, urban, hospital-based service with weak linkage to maternal and child health (MCH) and PHC; (6) limited oral health data and evidence generation; and (7) opportunities for phased integration through PHC, MCH, school health, community health workers, and NCD platforms Policymakers emphasized the need for stronger policy implementation, financing, regulation, standards, and data systems, while service providers highlighted unaffordable care, delayed care-seeking, workforce and infrastructure shortages, and missed opportunities for prevention. Conclusion Oral health integration in Somalia is a broader health system challenge rather than solely a dental-service issue. The most feasible approach is a phased, system-based model that prioritizes strengthened governance, a defined minimum oral health within PHC, workforce task-sharing, screening, counselling, referral pathways, private-sector regulation, essential commodities, and oral health indicators in District Health Information System 2 (DHIS2), followed by the gradual expansion of curative and rehabilitative services.