Coordination without commitment in aid alignment and the use of country systems in the health sector of Somalia from 2014 to 2026
Despite continuous institutional coordination and the adoption of seven aid-alignment instruments between 2014 and 2026, Somalia's health sector failed to achieve meaningful fiduciary alignment or binding commitments, leaving the vast majority of external financing off-budget due to unresolved collective-action and credibility challenges.
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
In the world of international aid, there is a long-standing hope that when wealthy nations give money to help poorer countries build hospitals or train doctors, that money should flow through the recipient country's own government. This idea is called "using country systems." The logic is simple: if aid bypasses the local government and goes straight to foreign agencies or non-governmental organizations, the local government never gets the chance to learn how to manage its own health budget. It remains dependent, and the systems meant to serve its people stay weak. For decades, global agreements have promised that donors would gradually shift their money into these local channels. However, in places torn by conflict or instability, this shift has been incredibly difficult to achieve. The central question for researchers has always been whether the problem is a lack of planning or a lack of trust.
A new study by Khalid Mohamed Mohamud, a health financing specialist in Somalia, examines this exact struggle over a twelve-year period, from 2014 to 2026. Somalia presents a unique case because it has been a laboratory for these aid experiments. The country has seen a continuous stream of official documents, roadmaps, and agreements where the government and its international partners promised to align their efforts. The study does not look at whether the health system improved in a general sense; instead, it performs a detailed audit of the promises themselves. It asks a very specific question: did the documents that were signed actually change where the money went? The researcher gathered every major agreement made during this time, read them word-for-word to see what rules they created, and then compared those rules against the actual flow of money recorded in government databases.
The findings reveal a stark contrast between the paperwork and the reality. Over the years, the coordination between Somalia's Ministry of Health and its international partners became remarkably sophisticated. They built a permanent structure of committees, held regular joint reviews, and created a government-run system to track every dollar spent. This "architecture" of cooperation deepened continuously. However, the way the money actually moved did not follow the same path. Despite all the planning and the new committees, the vast majority of external health funding continued to flow outside the government's budget, treasury, and accounting systems. In the period from 2022 to 2026, the study found that out of nearly 1.24 billion dollars in registered project value, more than 82 percent remained entirely off-budget. This means the money was never recorded in the national budget, never approved by parliament, and never passed through the government's central bank account.
The study explains that this happened because the agreements signed over the years were designed to coordinate, but not to commit. The documents created plans for discussion and reporting, but they lacked any binding rules that forced donors to put their money into the government system. There were no consequences written into the text for partners who chose to keep their funds separate, and no published reports holding specific donors accountable for their choices. The researcher suggests that this created a situation where everyone was good at talking and planning together, but no single donor felt compelled to take the risk of moving their money into the local system first. The few instances where money did flow through the government came almost entirely from one specific group of donors who already had their own strict internal rules for trusting government systems, rather than from a collective change in behavior driven by the new agreements.
The situation became even more complex as the study period ended. In 2025 and 2026, the total amount of committed external funding dropped sharply, with humanitarian aid falling by more than 80 percent from its peak. In response, the Somali government increased its own health budget significantly, but the overall pool of money shrank. The study notes that when the total amount of money decreases, the percentage of money flowing through the government can mathematically rise even if no donor actually changes their behavior. This is a crucial distinction: the data showed a rise in on-budget spending, but the researcher could not prove that this was due to a successful policy change rather than just a change in the mix of donors. The study explicitly rules out the idea that the problem was solved by the existing roadmaps, noting that the documents themselves contained no mechanism to force the change.
Looking ahead, the study points to a new proposal for a pooled fund, a single mechanism where multiple donors would contribute money under a shared set of rules. This proposal, drafted in 2026, is the first time the documents have included specific conditions for entry, rules for how the money is managed, and plans for what happens if a donor leaves. The researcher describes this as a live policy test. It is an attempt to move from a system of voluntary coordination to one of binding commitment. The study concludes that while Somalia has successfully built the infrastructure to manage aid, the next step requires changing the rules of the game to ensure that the money actually follows the plan. Until donors agree to be bound by these new rules, the gap between the promise of alignment and the reality of off-budget spending is likely to remain.
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