Critical Gaps in Infection Prevention and Control in Somalia: Insights from the 2024 Nationwide Harmonized Health Facility Assessment Data

Background: Preventing outbreaks, antibiotic resistance, and healthcare-associated infections (HAIs), infection prevention and control (IPC) is the cornerstone of safe, robust health systems. There is little data on IPC readiness across the country in Somalia due to its weak health system. The study aims to evaluate the preparedness of IPC systems in Somali healthcare facilities by looking at policies, fundamental procedures, and essential resources; to find gaps that guide focused interventions to improve patient safety and the resilience of the health system. Methods: We carried out a cross-sectional secondary analysis of the 2024 Harmonized Health Facility Assessment (HHFA), which included 1,219 healthcare facilities of various categories spread over six states. Data were collected through structured interviews, observations, and facility record reviews. IPC indicators were presented using descriptive and inferential statistics. STATA Version 16 was used for the analyses, and a significance level of p < 0.05 was used. Results: All Somali facilities have inadequate IPC readiness. Just 24% and 18%, respectively, have rules for standard precautions and healthcare waste management; 21% reported waste management training for workers. Hand hygiene supplies (39%), sterilizing equipment (26%), gloves (87%), masks (61%), and protective gowns (61%) were among the critical resources that differed in availability. There were significant regional differences (p < 0.001), with Benadir frequently having better resources than Southwest, Jubaland, Puntland, Galmudug, and Hirshabelle. Conclusion: This study identifies significant gaps in the infection prevention and control (IPC) systems of Somali healthcare facilities, such as a lack of resources, procedures, and regulations that are critical to patient safety. Geographical disparities were apparent. These results underline the necessity of targeted, system-wide interventions to raise IPC readiness, increase resource accessibility, and guarantee uniform policy integration and training, all of which will contribute to the development of a more secure and robust healthcare system in Somalia. Keywords: personal protective equipment, waste management, healthcare facilities, harmonized health facility assessments, Somalia, infection prevention and control