Strengthening health system resilience in Somalia: The role of community health workers

Abstract

Community health workers (CHWs) may play an important role in strengthening health system resilience in fragile and conflict-affected settings. Global evidence suggests that CHWs can improve maternal and child health outcomes and expand access to essential care in low-resource contexts. In Somalia, where conflict, disease outbreaks, and workforce shortages constrain health service delivery, CHWs appear well-positioned to bridge gaps between communities and formal systems. Evidence from Somalia’s COVID-19 response indicates that CHWs identified approximately one-third of suspected cases and demonstrated higher case positivity rates than facility-based surveillance. CHWs have also contributed to maternal health service uptake in underserved areas. However, Somalia-specific evidence remains limited and context-dependent. Current CHW programs face challenges including inconsistent integration into national systems, variable supervision, and reliance on fragmented external support. Strengthening CHW contributions may require formal recognition within national health service frameworks, sustainable financing, standardized training protocols, and improved supervision mechanisms. While CHWs alone cannot resolve systemic health challenges, evidence suggests that deliberate investment in their capacity and integration could support broader health system resilience efforts in Somalia.