Public-Private Partnerships in tuberculosis service delivery in Somalia: a qualitative analysis

Tuberculosis remains a major public health challenge in Somalia, where a fragile health system and reliance on private providers complicate care. Although Public-Private Partnerships are globally recognized for strengthening TB services, their role and implementation in Somalia's conflict-affected context are not well understood. This study aimed to explore the role, challenges, and opportunities of Public-Private Partnerships in delivering TB services in Somalia, generating evidence to inform policy and practice.

A qualitative exploratory study was conducted in urban and peri-urban areas of Somalia, using in-depth interviews (18) and focus group discussions (4) with purposively selected stakeholders, including Ministry of Health officials, private providers, NGO representatives, and TB patients. Data were transcribed, coded, and analyzed thematically using NVivo software.

Partnerships in Somali TB care are largely informal and shaped by local relationships, NGOs, and donor initiatives, with weak governance, insecurity, limited infrastructure, and inconsistent monitoring posing major barriers. Despite these challenges, leveraging the private sector, mobile diagnostics, community health workers, and digital tools offers opportunities to improve case detection, treatment adherence, and data quality. Patients often face complex and costly care pathways, with perceived partnership effectiveness tied to accessibility, continuity, and reduced financial burden.

Public-Private Partnerships in Somali TB care are fragmented and informal, providing some benefits but falling short of addressing the national TB burden. Establishing a national framework, clear guidelines, and robust data-sharing mechanisms is essential to develop context-specific PPP models that can strengthen TB service delivery in fragile and conflict-affected settings.