Strengthening malaria control in Somalia: lessons from Uganda’s One Health model for community-based service delivery and health-system resilience
Résumé
Background Progress in malaria control in Somalia is constrained by structural fragmentation of the health system. Despite global efforts to reduce malaria burden, the transition from predominantly humanitarian and donor-supported service delivery toward sustainable, nationally led systems remains incomplete. Objectives To synthesize evidence on community health worker (CHW) implementation and identify context-sensitive strategies for strengthening government-led malaria control and health-system resilience in Somalia. Methods Following the PRISMA-ScR guidelines, we searched Scopus and Web of Science for sources published from 2000 through the final search date in 2026. A total of 54 sources of evidence were included using a framework focused on governance, financing, community-based service delivery, health-system integration, and One Health considerations in fragile settings. Results Evidence from Uganda’s formalized integrated community case management (iCCM) model indicates that CHW effectiveness depends not only on community-level service delivery but also on systemic integration, including reliable supply chains, standardized supervision, sustainable financing, and functional referral and surveillance systems. In contrast, Somalia remains characterized by fragmented and predominantly donor-supported interventions, contributing to persistent coverage and continuity gaps, particularly in rural, remote, and displaced populations. Conclusion Sustainable malaria control in Somalia requires a transition from project-based outreach toward a nationally integrated primary healthcare workforce. We propose a One Health-informed strategy that links human health services with malaria vector and environmental surveillance, while prioritizing government-led digital surveillance, sustainable CHW financing and supervision, and formalization of female health workers (FHWs) within the national primary healthcare system.
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