Lessons from establishing a national public health institute in Somalia

National Public Health Institutes are critical for health security, yet their development is inconsistent in fragile and conflict-affected settings due to state legitimacy challenges and structural trust deficits.

To document the establishment of the Somalia National Institute of Health from 2013 to 2023 and how post-conflict dynamics shaped its path across 4 operating periods.

Between September and November 2023, we conducted key informant interviews with 22 stakeholders who had direct, high-level operational or governance experience in the establishment of the Somalia National Institute of Health. We reviewed published literature on national public health development in low-income and fragile settings and reviewed the National Institute of Health annual reports, strategic plans, meeting minutes, and partner assessment reports for 2013 to 2023.

The Somalia National Institute of Health evolved through 4 phases: foundational establishment (2012-2013), global integration (2014-2016), structural consolidation (2017-2019), and operational maturity (2020-2023). Key accomplishments include nationalisation of the integrated disease surveillance and response system, training of 123 epidemiologists and establishment of a distributed polymerase chain reaction laboratory network. Operational progress was challenged by contested federalism and low domestic funding (1.3%). The key informant interviews highlighted the role of technical platforms in mitigating regional trust deficits.

Building a functional national public health institute in fragile settings is operationally feasible by leveraging crisis leadership, global networks and informal technical platforms to navigate political volatility.