Integration of oral health into primary health care in Somalia: opportunities, barriers, and system-level implications for universal health coverage.

Authors

Saido Gedi, Salma Ali Ossoble, Mohamoud M Dahir, Nasra Abdulsamad Mohamud, Abubakar Ahmed, Jihaan Hassan, Maye Abu Omar

Published in

Frontiers in oral health. Volume 7. Pages 1930618. Epub Oct 07, 2026.

Abstract

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.
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.
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.
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.

PMID:
42908747
Bibliographic data and abstract were imported from PubMed on 23 Oct 2026.

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