Somaliland, a self-declared republic in the Horn of Africa, is quietly building a health system that rivals those of far better-known nations. I spoke with Dr Essa Abdi Jama, CEO of Better Health Somaliland, and what I discovered challenges common assumptions about healthcare in the region.

“Somaliland’s health system has been built from scratch since 1991,” Dr Jama explained. “Compared to other parts of Africa, we are trying our best, but we need support in human resources, medical services, and improving quality of care.”

Unlike much of the Horn of Africa, the major medical issues in Somaliland are no longer the infectious diseases often associated with the continent. “The number one causes of disease are non-communicable illnesses like diabetes and hypertension, similar to Western countries,” Dr Jama said. “We still have treatable infectious diseases, but they are not the leading cause of illness.”

He also highlighted the growing burden of cancer and the need for early detection programs, specialists and research funding. “We see people at late stages of cancer,” he said. “Capacity for oncology, cardiac surgery, and advanced treatments is urgently needed.”

The relative success of Somaliland’s healthcare system, Dr Jama says, is down to geography, climate and social organisation. “Sanitation is good, living conditions are stable, and air pollution is low,” he explained. “We have immunisation programmes and functioning vaccination systems, unlike many other African regions.”

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When compared with Somalia, which receives far more international aid, Somaliland’s healthcare infrastructure is markedly better. “Somaliland has built accessible, safe, and higher-quality systems despite not being recognised internationally,” Dr Jama noted. “If we had global recognition, this could become a five-star health system.”

The health system relies heavily on private initiatives, with doctors and communities investing their own resources to build hospitals and clinics. “The resilience of our people is remarkable,” Dr Jama said. “We have implemented public-private partnerships to strengthen the system, and it functions without reliance on external aid.”

International connections are already forming. Somaliland has ties with medical institutions in Israel, Australia and the UK, facilitating knowledge transfer and specialist training. Yet global recognition remains limited, constraining the potential of a system capable of competing with regional leaders like Kenya and Rwanda.

Dr Jama’s message to the world is clear: Somaliland is not a failed state, but a success story in waiting. “If donors and international medical associations invest here, the difference would be dramatic,” he said. “We are ready to show what a self-reliant, functioning democracy and healthcare system can achieve.”

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