Hospital logistics in Somalia: why health-specific supply chain expertise matters—an opinion

Hospital logistics determines whether care promised on paper can actually be delivered at the bedside. A hospital may have trained clinicians and functioning wards, yet treatment can still fail when oxygen interfaces, essential medicines, sterile supplies, laboratory reagents, blood-bank consumables, or device accessories are unavailable. In Somalia, this issue deserves greater policy attention because the health system operates under financial constraints, import dependence, insecurity, fragmented service delivery, and uneven institutional capacity. Somalia's Health Sector Strategic Plan 2022-2026 describes important pharmaceutical-sector challenges and a private pharmacy logistics network that, although rapid, operates largely through informal and trust-based processes without formal forecasting or contracting arrangements (1).In a WHO report on Somalia's 2020 pharmaceutical-sector assessment, stock-outs averaged 27.3 days per year in surveyed public health centres and warehouses (2). Although this finding should not be generalized to all Somali health facilities, it illustrates the operational vulnerabilities affecting pharmaceutical availability. Research examining Somalia's humanitarian health response has also documented recurrent procurement and transport-related shortages affecting medicines and other essential health commodities (3). Recent Somalia-focused health-systems commentary has additionally highlighted severe health-workforce scarcity, weak regulation, uneven deployment, and financing instability as threats to continuity and resilience of health services (4). These observations are not evidence that all Somali hospitals experience the same logistics weaknesses or that existing logistics personnel are ineffective. Rather, they expose a broader healthpolicy question: whether hospital logistics is best treated mainly as a generic administrative function or as a specialized health-system capability requiring competencies specific to medicines, medical devices, clinical demand, quality assurance, and patient safety. In this Opinion, health-specific supply-chain expertise refers to the combination of conventional supply-chain competencies with sufficient technical knowledge of medicines, medical devices, diagnostics, medical gases, storage and quality requirements, and the clinical consequences of procurement and inventory decisions.Generic supply-chain competence remains essential. Procurement planning, tendering, supplier management, inventory control, warehousing, transportation, budgeting, and contract management all matter. Health care, however, introduces technical requirements that substantially change the consequences of purchasing decisions. Ordering an unsuitable office product may create inconvenience; purchasing an incompatible ventilator circuit, an inappropriate oxygen regulator, a reagent without a compatible analyzer, a medicine with insufficient remaining shelf life, or equipment that cannot be maintained locally may interrupt treatment and waste scarce resources. Somalia's Essential Medicines List is intended to guide procurement, management, distribution, and regulation of medicines while supporting standardized medical care (5). Translating such guidance into hospital purchasing decisions requires more than comparing prices and delivery times. Supply-chain personnel must understand clinical consumption patterns, dosage forms and strengths, storage conditions, substitution risks, expiry management, cold-chain requirements, infection-prevention specifications, regulatory requirements, and the relationship between equipment and the consumables required to keep it functional.The international health-supply-chain literature increasingly recognizes the workforce itself as a core health-system resource. A recent professionalization framework emphasizes defined competencies, standardized job descriptions, education pathways, and career structures for health supply-chain personnel (6). Related work argues that reliable health supply chains depend on a competent, supported, and recognized workforce rather than ad hoc assignment of supply-chain responsibilities (7). Evidence from Ghana, Rwanda, and Uganda similarly demonstrates the importance of supply-chain competencies, dedicated roles, organizational support, and functional logistics information systems (8)(9)(10). Although these studies come from other settings, they provide a transferable framework for considering which competencies may be relevant to Somali hospitals; local adaptation and evaluation remain necessary.Health-specific supply-chain expertise does not require every logistician to become a physician, nurse, or pharmacist. Nor does it imply that already overburdened clinicians need to operate procurement departments and warehouses. A potentially appropriate model is a professional health supply-chain function that combines modern supply-chain expertise with sufficient understanding of health products and formal collaboration with clinical, pharmacy, laboratory, biomedical, finance, and infection-prevention teams.At minimum, hospital supply-chain personnel would benefit from the capability to translate service activity into quantification and forecasting; distinguish essential from discretionary products; verify technical specifications; evaluate suppliers beyond price; manage batch, expiry, temperature, and traceability requirements; calculate reorder levels and buffer stocks; identify single-source vulnerabilities; and use logistics data for management decisions. Purchases carrying substantial clinical or technical risk would warrant review by the relevant professional department.Medical equipment illustrates why this distinction matters. A systematic review of medical-device procurement in low-and middle-income countries found that equipment selection is better informed by infrastructure, end-user capability, maintenance requirements, and life-cycle costs rather than acquisition price alone (11). WHO health-technology-management guidance similarly places procurement within a continuum extending through incoming inspection, inventory, user training, maintenance, performance monitoring, and eventual decommissioning (12). For Somali hospitals, purchasing a monitor, ventilator, anesthesia machine, oxygen system, or laboratory analyzer would therefore benefit from assessment of electricity requirements, compatibility, spare parts, consumables, end-user training, preventive maintenance, technical support, and replacement planning. Hospitals can begin this transition without creating a large new bureaucracy. First, hospitals could define a health supply-chain competency profile for personnel responsible for procurement, stores, inventory, and internal distribution.Recruitment and promotion could assess these competencies, while existing staff could be offered structured professional development through short courses, postgraduate education, certification, mentorship, and continuing professional development. Although addressing disaster and emergencycare education rather than supply-chain management specifically, recent Somali commentary has similarly emphasized profession-specific competencies, explicit learning objectives, interprofessional coordination, and adaptation of training to resource-constrained environments (13). These principles may be relevant to building a competent hospital supply-chain workforce in Somalia.Second, hospitals could establish multidisciplinary procurement and supply oversight with clear thresholds for technical review. Routine low-risk commodities can remain administratively streamlined, whereas medicines, medical gases, high-risk consumables, diagnostics, and medical devices could undergo pharmacy, clinical, laboratory, biomedical, infection-prevention, or other relevant technical review as appropriate. Such an approach preserves the essential role of logistics and finance personnel while reducing the probability of technically unsuitable purchases.Third, logistics-management information can function as a management instrument rather than merely a record-keeping requirement. A minimum hospital supply-chain performance set could be grouped into four domains: availability (stock-out days, order fill rate, and emergency purchases); efficiency (forecast accuracy, supplier lead time, and inventory turnover); quality and safety (expiry and wastage, traceability, and equipment downtime); and resilience (qualified alternative suppliers and critical-item contingency plans). Persistent logistics failures can then be reviewed alongside clinical quality and patient-safety indicators because commodity shortages may directly undermine care.For emergency preparedness, structured stockpiling may also strengthen continuity. The 5P Strategic Medical Stockpile model integrates stockpile planning within the emergency-management cycle and offers a conceptual reference for emergency buffers, alternative supply arrangements, and replenishment planning, although adaptation to the Somali context would be required (14).Fourth, procurement decisions could place greater emphasis on total value rather than unit price alone. For medicines and consumables, value includes quality, shelf life, regulatory compliance, storage requirements, and delivery reliability. For medical devices, it includes installation, compatibility, consumables, spare parts, warranties, training, maintenance, and expected useful life. In resourceconstrained hospitals, the lowest-priced item may ultimately be the most expensive if it cannot be safely used or kept functional.Finally, hospitals, universities, and health authorities could increasingly recognize health supplychain management as a legitimate professional and educational pathway. Somalia needs personnel who understand both supply-chain science and the health-service consequences of logistics decisions. Specialized postgraduate education, competency-based in-service programs, and multidisciplinary training involving logisticians, pharmacists, nurses, physicians, biomedical professionals, finance teams, and hospital managers could help build this capability. The objective is professionalization, not professional displacement.Strengthening hospital logistics in Somalia is not principally about changing job titles. It is about improving the governance of decisions that determine whether essential inputs reach patients in the correct form, quality, quantity, condition, and time. Generic logistics expertise remains indispensable, but hospitals manage products for which procurement and supply errors can cause immediate clinical harm, service interruption, financial waste, or unusable technology. This additional risk justifies healthspecific competency standards and multidisciplinary technical oversight.The policy direction is therefore practical rather than prescriptive. Somali hospitals could recognize health supply-chain management as a specialized clinical-support function, define competency-based roles, integrate technical review into high-risk procurement, use logistics data in executive decisionmaking, and develop formal education and career pathways. National health authorities, universities, hospitals, professional organizations, and development partners can facilitate this transition by aligning curricula, job descriptions, procurement standards, and performance indicators. Somalia does not need to replace existing logistics systems or personnel to pursue this agenda. It can strengthen them by ensuring that supply-chain decisions incorporate the technical realities of healthcare delivery. In a health system where every scarce resource must generate maximum patient benefit, professionalizing hospital supply chains can be viewed as an investment in safer, more reliable, and more resilient health services.