Dr Abdulrazaq Yusuf Ahmed

Insurance models that rely primarily on payroll deductions struggle where formal employment is limited.
Tax-based systems struggle where revenue collection capacity is weak.
Community-based schemes struggle without scale.
The challenge is not choosing a model.
It is engineering a hybrid architecture

08.02.2026 18:14 — 👍 0    🔁 0    💬 0    📌 0

it is imitation.
Insurance models that rely primarily on payroll deductions struggle where formal employment is limited.
Tax-based systems struggle where revenue collection capacity is weak.
Community-based schemes struggle without scale.
The challenge is not choosing a model.

08.02.2026 18:14 — 👍 0    🔁 0    💬 1    📌 0

In Somalia, three structural constraints matter:
A large informal economy
Heavy donor dependence
Limited risk pooling mechanisms
Designing UHC without acknowledging these realities is not reform —

08.02.2026 18:14 — 👍 0    🔁 0    💬 1    📌 0

High-income systems evolved over decades of:
• Broad tax bases
• Formal labor markets
• Strong regulatory institutions
• High levels of social trust
Fragile states operate under very different political and economic realities.
Replication without adaptation produces fragmentation.

08.02.2026 18:14 — 👍 0    🔁 0    💬 1    📌 0

Somalia’s path to Universal Health Coverage will not mirror high-income models — and it shouldn’t.
UHC is not a template.
It is a financing architecture shaped by context.
🧵👇

08.02.2026 18:14 — 👍 0    🔁 0    💬 1    📌 0

Somalia’s path to UHC will not mirror high-income models and it shouldn’t.

Importing insurance frameworks without importing tax bases, regulatory capacity, and social trust is policy theater.

It needs structural innovation.
Systems, not slogans.

08.02.2026 18:09 — 👍 0    🔁 0    💬 0    📌 0

Health reform in fragile states does not fail because of lack of goodwill. It fails because we avoid structural truths. Universal Health Coverage is not a slogan. It is a financing model. It is a governance contract. It is an accountability system. If we continue treating UHC as a project instead of an architecture, we will continue recycling inequity. Somalia — and similar contexts — deserve systems, not short-term interventions. Evidence over rhetoric. Systems over slogans. Equity over optics. Dr. Abdulrazaq Yusuf Ahmed Healthcare Economist | Tropical Medicine & Public Health Specialist Health Systems Expert | Senior Executive Director Advancing Universal Health Coverage in Fragile States ORCID: 0000-0002-6985-1087

08.02.2026 18:05 — 👍 1    🔁 0    💬 0    📌 0