Maternal and Neonatal Mortality in Somalia: A Persistent Women's Health Crisis Requiring Primary Health Care and Community Health System Reform.

This policy-oriented commentary aims to interpret the drivers of maternal and neonatal mortality in Somalia through the Three Delays Model and the World Health Organization health-system building-block framework and to propose a Somalia-specific policy framework for strengthening the continuum of care. It draws on purposively selected peer-reviewed literature, national and international reports, and health-system evidence. Its distinctive contribution is to frame maternal and neonatal mortality as both a women's health and reproductive-health equity crisis and a priority for health-system reform. The commentary argues that preventable deaths result from interconnected failures across households, communities, referral pathways, primary health care, hospitals, financing, governance, and accountability, and that isolated facility-based projects and short-term humanitarian responses are insufficient. Progress requires an accountable continuum of care linking community health workers, primary health-care facilities, emergency transport, referral hospitals, public and private providers, health-information systems, and sustainable financing. Priority actions include strengthening district referral networks, round-the-clock emergency obstetric and newborn care, workforce capacity and equitable deployment, financial and transport protection, government-led partner coordination, regulation of public and private providers, and maternal and perinatal death surveillance and response. Implementation should be monitored through disaggregated indicators, routine performance and accountability reviews, clearly assigned responsibilities, time-bound corrective actions, and implementation research.