Regulation of health professions education and the growth of schools in Somalia

Abstract
Background Health professions education, encompassing training programs for medicine and surgery, nursing,
midwifery, medical laboratory sciences,, and public health, along with their regulations, are pivotal to achieving
universal health coverage and Sustainable Development Goals, contributing significantly to health outcomes and
public trust in the healthcare workforce. However, low- and middle-income countries, especially in sub-Saharan
Africa, face challenges, such as inadequate resources, outdated curricula, and weak governance. Somalia in particular
grapples with a fragmented health system and a critical shortage of skilled health professionals, exacerbated by
decades of civil war and political instability.
Methods This study employed a mixed-method approach that incorporated both qualitative and quantitative data
collection and analysis. A comprehensive literature review was conducted along with semi-structured interviews with
44 key informants, including representatives from professional health schools and officials from the Ministry of Health.
Additionally, five focus group discussions were held with young professionals and an online survey was administered
to students enrolled in professional health courses. The data analysis employed descriptive for quantitative data, and
thematic analysis for qualitative data, guided by the human resources for health (HRH) maturity model framework.
Results This study identified 112 health professions schools across Somalia, with a significant concentration in
urban areas, particularly in Benadir. The health workforce analysis revealed a pronounced urban-rural disparity and a
density of health professionals below the WHO’s recommended threshold. The focus group discussions and surveys
highlighted the employment challenges faced by young physicians and students’ perceptions of their training and
future employment opportunities.
Conclusion The proliferation of health professions schools without adequate quality control, the critical shortage
and maldistribution of skilled health professionals, and the absence of a comprehensive regulatory framework are
significant challenges facing Somalia’s healthcare system. The establishment of the National Health Professionals’
Council (NHPC) Act in 2020 marks a step towards addressing these issues. This study emphasizes the need for
accreditation of health professions schools, capacity building of HRH teams, and collaboration among stakeholders
to improve healthcare workforce development and regulation. Addressing urban-rural disparities and combating