# Challenges and opportunities in controlling and eradicating neglected tropical diseases: Public and private health operators in Somalia 2025

## TL;DR

This study explores challenges and opportunities for controlling neglected tropical diseases in Somalia, focusing on the perspectives of public and private health workers in Mogadishu.

## Contribution

The paper provides new insights into NTD control in Somalia by combining quantitative and qualitative data from health workers and stakeholders.

## Key findings

- Major barriers to NTD control include lack of funding, limited infrastructure, and low public awareness.
- Opportunities include improved infrastructure, health education, and public-private partnerships.
- Stigma, access barriers in conflict-affected areas, and underused PPP channels were highlighted through qualitative insights.

## Abstract

Globally, neglected tropical diseases (NTDs) affect > 1.7 billion people and remain a major cause of morbidity in fragile, resource-limited settings. Somalia, the 44th largest country worldwide, is situated in Africa and ranks among the top 20 countries with the highest number of zero-dose children. Protracted conflict, climate shocks, and displacement hinder effective surveillance and service delivery, exacerbating the prevalence of infectious diseases and active outbreaks. We assessed frontline perspectives on barriers and opportunities for neglected tropical diseases (NTDs) control and eradication in Mogadishu.

We conducted a mixed-methods, facility-based cross-sectional study (January–June 2025) across seven hospitals (2 public, 5 private). A structured questionnaire captured sociodemographic and perceptions from 535 health workers (specialists, general practitioners, nurses, pharmacists, midwives, laboratory staff). Qualitative data comprised 15 key informant interviews (KIIs) and 6 focus group discussions (FGDs; 60 participants) with clinicians, CHWs, and managers. Quantitative data were analyzed with descriptive statistics and bivariate tests; qualitative data underwent thematic analysis.

Of 535 participants, 341/535 (63.7%) were female most had 1–5 years of experience and bachelor’s degrees. Training on NTDs was moderate (58.1%). Priority barriers were lack of funding (61.5%), limited infrastructure (17.4%) and low public awareness (14.2%). Perceived opportunities included improved infrastructure (38.5%; n = 206), health education (37.8%) vaccination campaigns (32.7%) joint CHW–provider training (46.0%), and mHealth for surveillance/reporting (32.9%) PPPs were viewed as essential/important (89.9%). KIIs/FGDs triangulated these findings, adding themes of stigma (especially leprosy), access barriers in IDP/conflict-affected areas, and underused PPP channels.

NTD progress in Somalia is constrained by financing, capacity, and coordination gaps, but integrated, feasible interventions exist: multi-year financing tied to performance; competency-based upskilling for clinicians/CHWs; standardized CHW–facility referral feedback and digitized reporting within IDSR/DHIS2; formalized PPPs for commodities/reporting/supervision; and climate-aware vector control with WASH messaging prioritized for IDP-dense, flood-prone districts.