Reported Health Workforce Stock, Staffing Adequacy, and Reporting Completeness in Somalia: A Secondary Analysis of 2024 DHIS2 Data
This 2024 secondary analysis of Somalia's DHIS2 data reveals that the country's health workforce is characterized by limited capacity, uneven subnational distribution, and incomplete reporting, with only 39.8% of reporting facilities meeting minimum staffing requirements for the Essential Package of Health Services.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
To keep a nation healthy, you need more than just medicine and buildings; you need people. Doctors, nurses, midwives, and community health workers are the engine of any healthcare system, and knowing exactly who is available, where they are, and whether they are enough to do the job is the first step toward saving lives. In countries where resources are scarce and systems are fragile, this knowledge is often the hardest to come by. Without a clear picture of the workforce, leaders cannot plan where to send help, how to train new staff, or whether their current teams can handle the daily needs of the population. The challenge is not just counting heads, but understanding if those heads are in the right places, if they have the right skills, and if the system used to count them is actually capturing the whole story.
A recent study focused on Somalia, a nation working to rebuild its health services, to see what its own records could tell us about the people working in its clinics and hospitals. The researchers looked at data collected in 2024 through a national digital system that health facilities use to report their workforce numbers. They wanted to know three main things: how many health workers were actually reported, what kinds of jobs they held, and whether the facilities had enough staff to meet the country's minimum standards for care. They also checked how complete the reporting was, because a number is only as good as the information behind it. If a clinic does not send in its report, it disappears from the count, making it look like there are fewer workers than there really are.
The study found that across the regions included in the analysis, a total of 10,928 health workers were reported in the system. The largest group by far was nurses, who made up more than a third of the workforce. Midwives and community health workers, who often serve as the first point of contact for families in villages, formed the next biggest groups. Doctors and other specialized medical staff were present but represented a much smaller slice of the total. This mix of roles is common in many places where the focus is on basic, frontline care, but it also highlights a gap in specialized skills needed for more complex treatments. The researchers noted that a significant portion of the reported workers were listed under a general "other" category, which made it difficult to know exactly what skills those individuals possessed.
Where these workers were located told a story of uneven distribution. The capital region and the Southwest State reported the highest numbers of staff, while other areas had fewer. However, the researchers were careful to explain that these differences might not just be about where people chose to work. The data also showed that the system used to collect this information was far from perfect. Out of every 100 health facilities that were expected to send in their workforce reports, only about 58 actually did so. In some areas, the reporting rate was very high, but in others, it was shockingly low. For instance, in one region, only about one in ten facilities submitted their data. This means that the numbers for those areas are likely incomplete, and the true shortage of workers there could be even worse than the report suggests.
When the researchers looked at whether the facilities that did report had enough staff to meet the country's minimum requirements, the picture was mixed. Among the facilities that provided data, fewer than half met the standard for having enough workers to function properly. The situation varied wildly from one region to another. In the capital, most reporting facilities had enough staff, but in other regions, only about a quarter of the facilities met the minimum. Crucially, the study pointed out that for the many facilities that did not report at all, their staffing status was simply unknown. It is impossible to say if they are empty or full, which makes planning difficult.
The authors concluded that Somalia faces a real shortage of health workers, but the full scale of the problem is hidden by gaps in the reporting system itself. The country has a workforce that is heavily focused on nursing and community care, with fewer specialists, and this workforce is spread unevenly across the land. To move forward, the study suggests that the country needs to do two things at once: train and hire more health workers, and fix the system that tracks them. Without better data, it will be hard to know if new workers are being placed where they are needed most or if the goal of providing basic health care to everyone is being met. The numbers tell a story of effort and progress, but they also reveal that the map of Somalia's health workforce is still being drawn.
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