Data-Informed Health Leadership in Somalia: A Narrative Policy Review of Digital Health Systems, Analytics Capacity and Subnational Decision-Making

Digital health systems can strengthen planning, surveillance, resource allocation and service improvement, but technology creates value only when healthcare leaders demand evidence, trust the data, have authority to act and are accountable for implementation. This narrative policy review examines how leadership conditions shape the use of routine and digital health information for subnational decision-making in Somalia. Targeted searches of peer-reviewed literature, Somali policy documents and institutional reports were organized using WHO SCORE, the WHO Global Strategy on Digital Health, the Performance of Routine Information System Management (PRISM) framework and its action-oriented refinement (PRISM-Act) and health leadership evidence. Somalia has established important foundations, including District Health Information Software 2 (DHIS2)-based reporting, Integrated Disease Surveillance and Response (IDSR) integration, an electronic immunization registry and emerging electronic medical record systems and a national facility registry. Nevertheless, evidence consistently shows a gap between data submission and managerial action. Major constraints include weak leadership demand for evidence, limited district analytical and managerial capability, insufficient decision authority, variable data quality, fragmented digital governance, weak feedback loops, under-integrated private-sector and community reporting, and limited accountability for completing data-informed actions. The review proposes a data-to-action leadership framework centered on six functions: setting direction and demanding evidence; building analytical and managerial capability; delegating decision authority; coordinating programs, partners and providers; governing data quality and interoperability; and tracking decisions, implementation and learning. Somalia should treat digital health reform as a leadership and governance transformation supported by technology. Priority actions are to institutionalize review-to-action meetings, develop district leadership teams, link authority with resources, strengthen feedback and data stewardship, and use dashboards to document decisions and implementation. These measures can help convert expanding digital infrastructure into more responsive, equitable and accountable health services.