Strengthening Somalia's health system: pathways to achieving International Health Regulations core capacities at points of entry by 2025.

INTRODUCTION: The International Health Regulations (2005) (IHR) mandate global health security through core capacities, yet Somalia's 48 Points of Entry (PoEs), including airports, seaports, 12 domestic airports, 6 international airports, and land borders, lack essential infrastructure, staffing, and surveillance. Somalia allocates only 1.3% of the government budget to health, far below the Abuja Declaration target of 15%, with 75% of domestic airports lacking medical staff. The study aimed to enhance Somalia's PoEs control by analyzing existing systems, identifying gaps, and comparing countries and pathway resilience strategies. METHODS: Following the Preferred Reporting Items for Narrative Reviews by SANRA guidelines, this Narrative review analyzed 118 data. The data for this study were collected from multiple sources: peer-reviewed articles, government reports, and datasets. Searches across PubMed, Scopus, and Google Scholar used terms including (International OR regulation* OR "international health regulation*") AND ("point* of entry*" OR surveillance) AND (response OR Somalia OR "horn of Africa" OR "core capacity*"). Data were coded in NVivo 12 using a hybrid approach of deductive coding mapped to WHO IHR (2005) PoE domains, and data were thematically analyzed across five domains. RESULTS: For health system gaps, Somalia's IHR compliance score (31 out of 100) reflects weak surveillance, workforce shortages (4.45 health workers per 1000 people), and fragmented governance. For PoEs deficiencies, 63% of sea ports lack screening measures; only 50% of international airports meet basic health security standards. For regional comparisons, Somalia trails Kenya (80% IHR capacity), Ethiopia (75% surveillance), and Rwanda (72% lab capacity) in preparedness. For key challenges, political instability disrupts coordination, CONCLUSION: Somalia's progress in meeting IHR core capacities at Points of Entry (PoEs) by 2025 is critical for enhancing national resilience, global health security, and major challenges. Addressing these challenges requires significant investments in PoEs to achieve measurable outcomes.