Universal Health Coverage in Somalia: Charting the Path to Equitable Healthcare Financing and Governance

Somalia is a country facing numerous challenges in achieving universal health coverage (UHC) and ensuring adequate healthcare financing, This article explores the complexities and obstacles that Somalia must overcome in its pursuit of UHC, the paper begins by providing an overview of the current healthcare landscape in Somalia, highlighting the lack of infrastructure, political instability, and limited financial resources that hinder the establishment of a comprehensive and equitable healthcare system. It then examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while emphasizing the need for a more sustainable, domestically financed solution. Drawing on a range of data sources and case studies, the article proposes a multi-faceted approach to strengthen healthcare governance, improve resource allocation, and foster local capacity building, the study delves into the unique obstacles that Somalia faces, including a lack of infrastructure, political instability, and limited financial resources, which hinder the establishment of a comprehensive and equitable healthcare system. The paper also examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while highlighting the need for a more sustainable, domestically financed solution. The findings underscore the importance of political commitment, international cooperation, and innovative financing mechanisms in advancing towards UHC in Somalia, providing valuable insights for other low resource, conflict affected settings.

Facing ethical concerns in the age of precise gene therapy:Outlook on inherited arrhythmias

This editorial,comments on the article by Spartalis et al published in the recent issue of the World Journal of Cardiology.We here provide an outlook on potential ethical concerns related to the future application of gene therapy in the field of inherited arrhythmias.As monogenic diseases with no or few therapeutic options available through standard care,inherited arrhythmias are ideal candidates to gene therapy in their treatment.Patients with inherited arrhythmias typically have a poor quality of life,especially young people engaged in agonistic sports.While genome editing for treatment of inherited arrhythmias still has theoretical application,advances in CRISPR/Cas9 technology now allows the generation of knock-in animal models of the disease.However,clinical translation is somehow expected soon and this make consistent discussing about ethical concerns related to gene editing in inherited arrhythmias.Genomic off-target activity is a known technical issue,but its relationship with ethnical and individual genetical diversity raises concerns about an equitable accessibility.Meanwhile,the costeffectiveness may further limit an equal distribution of gene therapies.The economic burden of gene therapies on healthcare systems is is increasingly recognized as a pressing concern.A growing body of studies are reporting uncertainty in payback periods with intuitive short-term effects for insurance-based healthcare systems,but potential concerns for universal healthcare systems in the long term as well.Altogether,those aspects strongly indicate a need of regulatory entities to manage those issues.

Factors Influencing the Utilization of Postpartum Visits among Rural Women in China

Postpartum visits （PPVs） are still underutilized in rural China, and identification of factors that influence PPV use is important in ensuring the utilization of maternal health services and for well- being of women. A cross-section study was undertaken to collect related data from 347 rural women in- terviewed six weeks or more after delivery, and an ANOVA was performed to find whether there were significant differences in the number of PPVs among different rural areas in China. According to An- dersen＇s socio-behavioral model of health service use, factors were divided into equitable and inequita- ble ＂ones. Chi-squared test, univariate and multiple analyses were used to determine the equity of PPV use by identifying factors that were most strongly associated with the use of a PPV. The results showed that 20.2% of the respondents （n=70） did not receive any PPVs, and 62.5% （n=173） of those who had PPVs （n=277） did not receive standard PPVs （referring to at least 3 visits）. There was no significant difference among different rural areas in terms of the number of PPVs （F=1.514, P=-0.211）. Multiple re- gression analyses revealed that enabling factors such as compensation for delivery expense [OR （95% CI）=2.825 （1.331, 5.995）], village type [OR （95% CI）=1.802 （1.021, 3.182）] and service quality [OR （95% CI）=1.847 （1.074, 3.176）] were strongly associated with PPV use. Both enabling factors such as home visits [OR （95% CI）=1.855 （1.085, 3.174）], service quality [OR （95% CI）=1.993 （1.155, 3.439）] and need factors such as low birth weight [OR （95% CI）=4.424 （1.482, 13.203）] were significantly as- sociated with standard PPV use. Our results suggested that the equitable access to PPVs has been con- siderably improved in rural areas in China. The associations between inequitable factors and PPV use warrant further exploration, and policies aimed at improving quality and patterns of service supply are needed in order to ensure a full equitable access to maternal health services.