By Dr. Liban Cigaal
“No society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means.” —Aneurin Bevan, UK Minister of Health, 1948.
Kenya’s Bold Step Towards Universal Health Coverage
Early this week, Kenya provided the region something rare hope backed by action. Health Cabinet Secretary Hon. Aden Duale announced that primary health care (PHC) services across all public Level 2–4 health facilities in Kenya are now entirely free for all citizens.
This transformative policy covers essential services such as clinical consultations, diagnosis and treatment, prescribed laboratory tests, basic radiological services like X-rays and ultrasound, and the dispensing of prescribed medications. It also includes comprehensive reproductive, maternal (antenatal and postnatal), and child health services, routine immunizations under the KEPI schedule, and health education, wellness promotion, and counseling.
Additionally, the policy ensures that Kenyans have free access to care for acute and chronic conditions, management of non-communicable diseases (NCDs) and enteric infections, as well as diagnosis and treatment of sexually transmitted infections (STIs), HIV/AIDS, and mental health services including education, counselling, and psychosocial support. Screening for common illnesses and minor outpatient procedures done under local anesthesia are also provided at no cost.
With this bold move, Kenya steps firmly into the ranks of countries making Universal Health Coverage (UHC) a lived reality, not just a promise on paper.
A Personal Journey Towards Health Equity
As a Somali Doctor and a public health professional, I have spent years thinking deeply about how to advocate effectively for healthcare and how we can achieve free health coverage. It has always been a personal dream to see UHC become a reality in our region, and this aspiration led me to write a book dedicated to exploring universal health coverage.
Throughout my career as a medical student, practicing doctor, and public health advocate—I have witnessed firsthand the critical impact of accessible healthcare. My studies for a Master of Public Health (MPH) at the University of Birmingham in the UK further reinforced my understanding of health equity. There, learning from renowned experts like Professor Sir Michael Marmot, whose influential work “Fair Society, Healthy Lives” framed health as an issue of justice rather than charity, deeply influenced my thinking.
Back then, I often pondered if countries facing profound security challenges, such as Somalia, could realistically achieve UHC. It felt distant, almost impossible. Today, witnessing a Somali-Kenyan minister lead this transformative initiative in Kenya fills me with renewed optimism. As an East African nation, if Kenya can successfully implement UHC today, Somalia can certainly achieve it tomorrow. Furthermore, the minister responsible for this achievement is of Somali origin, a fact that we as Somali people should celebrate. Additionally, regions such as Puntland face relatively fewer security issues, making it a practical and promising location to pilot its UHC initiatives.
The Global Imperative of Universal Health Coverage
The concept of UHC is not new. Its roots stretch back to the 1978 Alma-Ata Declaration, where countries including Somalia acknowledged primary healthcare as a fundamental right rather than a privilege. Fast forward to the present, and UHC is prominently featured in the Sustainable Development Goals (SDGs) as a global target for 2030. Yet, for millions globally, the urgency remains pressing, and every advancement matters. Kenya’s recent step is a critical one.
Countries committed to UHC demonstrate tangible outcomes: longer, healthier lives, protection from crippling medical debt, enhanced trust in health systems, and increased community productivity and equality. Examples of successful UHC implementations abound. Rwanda’s affordable health insurance model, initially launched at just $3 per person in a single village, scaled rapidly, achieving over 90% national coverage within a decade. Similar successes are visible in Ghana, Tunisia, and now Kenya. UHC works not because it is flawless, but because it prioritizes people.
A Self-Sufficient Path for Somalia
Somalia confronts significant challenges, including fragile institutions, political instability, and insecurity. Yet, a strong government is not a prerequisite for dignity or progress. I firmly believe that Somalia can achieve UHC independently, without relying on traditional foreign aid. Inspired by economist Dr. Dambisa Moyo’s powerful critique of aid dependency, which highlights how extensive aid has failed to foster sustainable development in Africa, I advocate a self-sufficient healthcare model.
In my book, I propose a practical and achievable strategy: if every Somali contributes just $5 annually to a healthcare fund, Somalia could establish a viable, sustainable UHC system. I am confident this approach could succeed, and I plan to pilot this model soon, starting in Puntland and Mogadishu or elsewhere in Somalia.
Somalia possesses powerful assets, including strong community solidarity, a skilled global diaspora, technological innovations, regions with stable governance like Puntland and Somaliland, and opportunities for public-private partnerships in Mogadishu. With collective commitment and modest individual contributions, Somalia could realistically implement a UHC pilot within a few years.
A Beacon of Hope for the Horn of Africa
Minister Duale, your actions go beyond policy announcements. You’ve lit the first candle of UHC in the Horn of Africa a flame not easily extinguished. Your success is more than Kenya’s victory; it’s a beacon for all of us in Somalia and the rest of the region, who believe that access to health should never depend on one’s wealth or birthplace.
Lastly, I am concluding my book written in Somali, “Waarimaysidee War Ha Kaa Haro: Himilo Caafimaad iyo Hirgelinta UHC ee Soomaaliya” (also known as “Himilo Caafimaad 2030 ee Somalia”), focused on health equity and how we can implement UHC using a community model. This significant moment will be featured prominently, proving we are neither too broken nor too distant from achieving health justice.
Dr. Liban Cigaal, BMS, MBBS, MPH & Global Health Diplomacy
Twitter: https://x.com/lebanegaal
Email: raydab@hotmail.co.uk
