Beneficiaries of conflict: a qualitative study of people’s trust in the private health care system in Mogadishu, Somalia

Background: In 2005, the World Health Conference called for all nations to move toward
universal health coverage, which is defined as “access to adequate health care for all at an affordable price”. Despite this, an estimated 90% of Somalia’s largely impoverished population use
private health care. Therefore, considering that the private health care system is the dominant
health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people’s
trust in, the private sector is essential to help contribute an equitable and affordable health care
system in the country.
Methods: A qualitative study using unstructured interviews was conducted in Mogadishu
from August to November of 2016. A purposive sampling approach was used to recruit 23
participants, including seven medical doctors who own private health centers, eight patients,
five medical students and three senior officials who work for the Ministry of Health. Data were
analyzed using a thematic analysis.
Results: Our findings show that the private health care system in Mogadishu is not only
unregulated but also expensive, with the cost of health care often unaffordable for the majority
of the country’s citizens. There is evidence of prescription of inappropriate treatment, tendency
to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and
overcharging – including the widespread practice of further appointments for follow-up – which
inflates the costs. The study also found poor patient–provider relationship and widespread distrust
of the private health care system.
Conclusion: The study findings underline the need for the Somali government to develop
regulatory mechanisms and guidelines with the potential to guide the private health care sector
to provide equitable and affordable health care to people in Mogadishu. The doctor–patient
relationship has been – and remains – a keystone of care; thus, there is an urgent need for
guidelines for private health care providers to treat their patients with dignity and respect. The
education system, particularly the syllabus used by medical faculties, should be reviewed and
improved to provide medical students with necessary knowledge, skills and attitudes to maintain
patient dignity and rights