{
  "abstract": "Universal health coverage (UHC) requires both access to needed services and protection from financial hardship, yet Somalia's health system depends heavily on out-of-pocket (OOP) payments. This narrative review synthesizes recent evidence on the magnitude, drivers, and consequences of OOP spending in Somalia and identifies policy options to strengthen financial protection. OOP payments account for 44.9% of total health expenditure, far above the global (18.6%) and sub-Saharan African (35.7%) averages, while government financing and insurance coverage of about 3.5% remain minimal. Weak public financing, a dominant and largely unregulated private sector, and fragmented donor aid sustain this reliance. Roughly 24% of households experience catastrophic health expenditure, commonly resorting to borrowing, asset sales, and reduced consumption, and many forgo care altogether. These burdens fall disproportionately on the poor, women, rural populations, and internally displaced persons, leaving Somalia with the lowest UHC index among 120 countries at 33.5. Experiences from Rwanda, Ghana, and Ethiopia show that reducing OOP reliance depends on increased public financing, pooled prepayment, and pro-poor subsidies rather than insurance laws alone, supporting a phased, subsidy-backed reform agenda.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Public Health, Faculty of Medicine and Health Science, Hormuud University"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sharmake Gaiye Bashir"
    },
    {
      "affs": [
        0
      ],
      "name": "Ilyas Abdullahi khalif"
    },
    {
      "affs": [
        0
      ],
      "name": "Mohamed Sharif Abdi"
    },
    {
      "affs": [
        0
      ],
      "name": "Yakub Burhan Abdullahi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/04jqj62e99kwc.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1917671",
  "fulltext_url": "https://europepmc.org/articles/PMC13711032",
  "id": "04jqj62e99kwc",
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    "2296-2565"
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  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1917671/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2003|Healthcare Systems and Reforms"
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  "openalex": "W7221649726",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1917671/pdf",
  "pmcid": "PMC13711032",
  "pmid": "42948335",
  "published": "2026-10-13",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/04jqj62e99kwc.ris",
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    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2296-2565",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Out-of-pocket health expenditures as a barrier to healthcare access, financial protection, and progress toward universal health coverage: a narrative review from Somalia",
  "title_text": "Out-of-pocket health expenditures as a barrier to healthcare access, financial protection, and progress toward universal health coverage: a narrative review from Somalia",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:21:53Z",
  "url": "https://research.draconitic.com/paper/04jqj62e99kwc",
  "venue": "Frontiers in Public Health",
  "versions": []
}