Hordhac
Siyaasaddan cusub ee daboolidda qarashaadka adeegyada caafimaadka oo dhawaan golaha wasiirada Puntland ay ansixiyeen waxay ku soo aadday iyadoo ay hoos u dhacday taageeradii deeq-bixiyeyaasha iyo wada shaqayntii dowladda dhexe labaduba sida ku xusan qodobbada siyaasadda ee 8.2, 8.3, Iyo Meela Kale (IMK), siyaasadda waxaa loogu talaggalay xoojinta adeegga caafimaadka taasoo himila ahaan wanaagsan.
Siyaasaddu waxay dul istaagaysaa dhibaatada taagan, iyo baahida loo qabo nidaam dhaqaale oo gudaha ka yimaada (Qod, 1.2, qod, 2.2, Imk). Waxaa kaloo lagu sheegay in laga duulayo qorshaha horumarinta Soomaaliya, tubta, habraacyada caafimaadka iyo himilooyinka caalamiga ah sida caafimaad dadka wada gaara (Universal Health Coverage) iyo hiigsiyada horumarin waarta (SDGs) (qodobka 1.4).
Siyaasaddu waxay diiradda saaraysaa in xarumaha caafimaadku dib u soo ceshadaan qayb ka mid ah kharashaadka adeegyada iyagoo adeegsanaya waxa afka qalaad loo yaqaan user fees (Khidmad yar oo dib laga go’aamin doono tiradeed) iyadoo la ilaalinayo dadka nugul oo loo marayo ka-dhaafis (Qod, 1.2 & IMK). Meelaha qaar siyaasaddu waxay tilmaamaysaa in adeegyada aasaasiga ah sida tallaalka umulinta, daryeelka dhalmada, qorsheynta qoyska iwm, sii ahaanayaan bilaash (Meelahaan waa inta deeqbixiyayaashu taageeraan), halka adeegyada heerka labaad (Secondary health) iyo saddexaad ( Tertiary) lagu soo rogi doono khidmad la sharciyeeyey (Qod, 5.2 & IMK), balse marka lala aqriyo qodobka 1.3, xilliga ay kusoo aaddey, war saxaafadeedka wasaaradda iyo adeegyadii ka bixi jiray xarumaha Bari ee la tibaaxey, waxay u muuqataa in lagu dabaqi doono heerarka oo dhan.
Si guud, inkastoo xal uraadinta qarashaadka caafimaadka iyo jaangoynta khidmadaha xarumuhu muhiim yihiin; haddana marka si dhug leh loo eego, waxaa ka muuqda siyaasadda goldaloolooyin waaweyn oo saameyn kara u sinnaanta caafimaadka, caddaaladda iyo hirgalintinta siyaasaddaba.
Goldaloolooyinka ka muuqda siyaasadda
- Iska-hor-imaad: Siyaasaddu waxay isku dayaysaa in ay isku larto laba aragtiyood oo si dabiici ah isku khilaafsan oo kala ah: helitaan caafimaad aan culays dhaqaale lahayn (Universal health coverage) iyo kordhinta lacagaha tooska ah ee bukaanku bixiyo.
Daraasado badan ayaa muujinaya in khidmadda bukaanku bixiyo (user fees) si toos ah u yareeyo doonashada adeegyada caafimaadka, gaar ahaan dadka saboolka ah (Dehnavi et.al, 2025, Ahmed, et.al 2023, Khalif, et.al 2026). Sidaa darteed, lacagaynta adeegu wuxuu horseedi karaa in dadka saboolka ah ay imaan waayaan, kuwa dhaqaalaha haystana isbitaallada gaarka loo leyahay aadaan.
- Iskutiirin xad dhaafa ee khidmada bukaanku bixiyo: Siyaasaddu waxay u aragtaa khidmadda bukaanka xal dhaqaale oo lagu maarmi karo, balse tani suuragal ma ahan, khidmaddaan waxaa loo sameeyaa caadiyaan in ku noqnoqashada adeegga iyo ka faa’iidaysiga xad-dhaafkaa lagu yareeyo ee maaha il dhaqaale oo qarash weyn lagu baxsho. Hadday dhacdo in lagu tiirsanaado khidmadda bukaanka (User fee), qarashka bukaanku baxsho kuma fillaan doono adeegyada caafimaadka haddii ay ka jabnaadaan isbitaallada kale, waxay kaloo noqon kartaa culays dhaqaale oo shacabku dareemo haddii la qaaliyeeyo. Dhanka kale, waxaa muuqata inaan xisaabta lagu darin canshuurtii dadweynaha ee kabi lahayd caafimaadka.
- Ka dhaafid aan caddeyn: Siyaasaddu waxay tilmaameysaa ka-dhaafisyo si loo ilaaliyo dadka saboolka ah, balse lama qeexin hab cad oo lagu kala saarayo qofka saboolkaa iyo kaan ahayn.
Arrintani waxay keeni kartaa in dadkii u baahnaa lacag laga qaado, halka kuwa aan u baahnayn ay ka faa’iidaystaan, qarashaadkana laga dhigto la jiifiyaana banaan.
- Goldaloollo la xariirta xaq-soorka xarumaha dagmooyinka yaryar iyo kuwa magaalooyinka waaweyn: Inkastoo siyaasaddu aqoonsantahay kala duwanaanshaha magaalooyinka waaweyn iyo magaalooyinka yaryar, ma bixinayso habraac loogu caddaalad falo; madaama xarumaha ku yaalla magaalooyinka waaweyn ay heli karaan dakhli aysan heli karin kuwa magaalooyinka yaryar.
- Goldaloolooyin dhanka hirgalinta la xariira: Siyaasaddu waxay u badantahay tilmaama guud, kumana cadda khidmadaha, habraaca khidmadaha iyo habraaca hirgalinta toona; taasoo keeni karta fasiraaado kala duwan.
- Iino dhanka Maamul wanaagga la xariira: Inkastoo la tilmaamey hufnaan, haddana siyaasaddu tilmaami mayso waddadii iyo qaab-dhismeedkii lagu hirgalin lahaa, kuma cadda habraac, cabasho bukaan iyo dabagal toona.
- Caddayn iyo xog yaraan: Siyaasaddu kuma salaysna cilmi-baaris ku filan oo deegaanka ku saabsan, sida saameynta khidmadahu ku yeeshaan tagista isbitaallada iyo qiyaasta dakhliga laga filan karo inuu soo xaroodo.
- Ismoodsiis (assumption): Siyaasaddu waxay mala awaaleysaa inay dadku lacagta bixin doonaan haddii adeeggu hagaago; balse taas si ka duwan dadka saboolka ah qiimaha iyo awoodda dhaqaalaa uga muhiimsan tayada adeegga.
- Maqnaanshaha habab kale oo caafimaadka loo kabo sida caymis bulsho, caymis shaqa-bixiye, canshuurta badeecadaha xun, miisaaniyad dowladeed iwm.
- Arrimaha kale ee maqan waxaa kamid ah siyaasaddu ma caddayn, mana reebin cidda qarashka qaadaysaa inay noqon karto dowladda keliya si aan loo siyaasadeyn nadaamka caafimaadka.
- Arrinta halista leh ee ugu danbeysa, siyaasaddu waxay ogolaanaysaa in caafimaadka lagu wareejin karo shirkadaha gaarka loo leeyahay (PPP) oo hadda bulshadu ku dhibban tahay. Waxaana ka dhalan karta in si qaldan looga faaideysto hantida dadweynaha iyo taageerada deeq-bixiyayaasha.
Caadiyan waa dhacdaa in adeegyada qaar isbitaalla gaar loo leeyahay loo dhiibo ama loo wakiisho dhismaha iwm; balse ma dhacdo dunida in isbitaallada dowladeed lagu wareejiyo gabi ahaan.
Gunaanad
Guud ahaan, in siyaasad laga dajiyo qarashaadka xarumaha caafimaadka ee dowliga waa arrin wanaagsan, balse waxa ka muuqda cillada saameyn kara helidda adeeg caafimaad oo loo simanyahay. Ku-tiirinta adeegga caafimaadka keliya khidmad iyo baaqiga deeqaha, waa halis kale waliba dadka saboolka ah oo bulshada inta ugu badan ah. Haddii aan laga digtoonaan, waxaa jirta halis ah in siyaasaddan kordhiso culayska dhaqaale ee bukaanka la saaro, dhaliso sinaan la’aan caafimaad, yarayso helitaanka adeegyada caafimaadka, sidoo kalana hoos u dhigto kalsoonida bulshada, isweydiinna geliso waxa dowladdu ku toorran tahay madaama adeegyadii oo dhan lacag laga dhigay.
Intaan la hirgalin siyaasaddaan waxaan ku talinayaa
- In la ballaariyo la tashiyada si loo helo aragti dheellitiran.
- In laga fakaro habab kale oo loo kabi karo caafimaadka sida kordhinta miisaaniyadda caafimaadka
- In canshuur gaar ah caafimaadka loo saaro badeecadda halista caafimaad leh (Sin tax); sida Qaadka, Sigaarka, Tubaakada iyo dawooyinka laysku caddeeyo.
- In la hirgaliyo caymiska bulshada iyadoo khidmad yar laga qaadayo qoysaska si ay u helaan caafimaad lacag la’aan ah.
- Wasaaraddu waxay ku soo dhaqmaysay siyaasadda ballaarinta xarumaha, taa baddalkeeda waxaa haboon in la yareeyo xarumaha balse la tayeeyo adeegga meela kooban, awooddana la saaro baabuurta gargaarka degdegga ah, iyadoo meelaha aan dadka badan joogin lagu soo koobayo gargaarka degdega iyo ambulance-ta.
- In shirkadaha ganacsiga iyo xarumaha kale ee loo shaqeeyo lagu qasbo inay caymis caafimaad galiyaan shaqaalahooda.
- In qaaraan yar loo saaro caafimaadka is-waydaarsiga lacagaha danabaysan sida 0.01 ama ila 0.05 boqolkiiba.
- Inaan loo arag khidmadda bukaanka xal buuxa, iyo in la caddeeyo shuruudaha qofka loogu tixgalinayo sabool, lana sameeyo xafiis dabagal iyo cabasho oo isha ku haya sida loola dhaqmayo bukaannada qarash ahaan iyo daaweyn ahaanba.
Ugu danbeyntii, waa u mahadcelinayaa dhamaan dadkii ka soo shaqeeyey siyaasadda, waxaana muhiim ah in laysu dheellitiro dawga muwaadinku u leeyahay inuu helo adeeg caafimaad oo aan culays ku ahayn iyo socodsiinta hawlaha caafimaadka.
Raadraac
- Ministry of Health Puntland State of Somalia. (2025). Cost recovery policy for equitable and sustainable healthcare services in Puntland. Unpublished doc.
- Dehnavi, H., Nematollahi, M.S., Daneshkohan, A. et al. From fees to free: impacts of user fee removal on child health outcomes – a systematic review. Int J Equity Health 25, 12 (2026). https://doi.org/10.1186/s12939-025-02730-w
- Hodan, A., et al. (2023). Constraints to maternal healthcare access among pastoral communities in the Darussalam area of Mudug region, Somalia: A qualitative study. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1210401
- Khalif. M., Warei, S. Y., & Abubakr, A. H. A. (2026). Burden or benefit? Unveiling the impact of out-of-pocket health expenditures in Somalia’s healthcare system. Health Economics Review, 16(5). https://doi.org/10.1186/s13561-025-00703-
Qoraaga
