Evaluation of Sweden’s support to health systems in Somalia through PHAS, SPIDER and WHO

This evaluation, commissioned by the Embassy of Sweden in Nairobi, assesses Sweden’s contribution to strengthening the Somali health system through three interventions: the Public Health Agency of Sweden (PHAS), SPIDER’s HADDA project, and WHO’s support in Somalia. It aims to determine the relevance, effectiveness, coherence, and sustainability of these interventions and to generate lessons for future programming in fragile settings. The interventions made significant progress in strengthening Somalia’s health system, particularly in public health functions, digital health innovation, and disease surveillance. However, sustainability is challenged by political instability, infrastructure deficits, and reliance on external funding. The evaluation highlights the need for legal and financial anchoring of institutional gains and greater engagement with private health actors. Key recommendations include enhancing coordination among interventions, embedding sustainability mechanisms, improving digital health infrastructure, and ensuring legal and financial support for health institutions. Future efforts should focus on integrating private sector actors and maintaining flexibility to adapt to the volatile Somali context.