Financing Somalia’s Essential Package of Health Services: Budget Impact Analysis and the 2029 Financing Gap

Somalia’s Essential Package of Health Services (EPHS) is being implemented along an expanding coverage trajectory at a time when external health financing is contracting sharply. This study assesses the budget impact of implementing the EPHS from 2026 to 2030 and identifies when available financing becomes insufficient to sustain the planned coverage trajectory. A five-year, sector-level budget impact analysis was conducted from the health-sector payer perspective using undiscounted nominal US dollars. Two EPHS requirement scenarios were assessed: delivery through existing facilities and facility expansion to population norms. These were compared with three financing scenarios: financing frozen at 2026 levels, recovery of external financing to its 2025 level combined with federal budget growth, and recovery supplemented by proposed health-tax revenues.

The EPHS requires an estimated US$1.82 billion over 2026–2030 through existing facilities and US$2.27 billion with facility expansion. Under frozen financing, approximately US$1.14 billion, or 63% of the five-year requirement, remains unfunded. Recovery of external financing substantially reduces the cumulative gap to US$440.1 million, while recovery combined with proposed health-tax revenues reduces it further to US$266.1 million. However, both financing strategies face renewed and widening gaps from 2029 onward. Across all scenarios, 2029 emerges as the binding year, when the rising financing requirements associated with increased coverage exceed the resources available under the financing paths examined.

The findings indicate that Somalia’s EPHS is potentially financeable through 2028 under plausible financing recovery and domestic resource mobilisation, but sustaining the planned trajectory beyond 2028 will require additional resources or explicit re-phasing of coverage. The analysis therefore highlights 2028 as the critical decision year for addressing the 2029 financing gap, providing an actionable timeline for health-sector budgeting, resource mobilisation, and strategic prioritisation.