NSHIA’s mandate is to act as Somalia’s national pooled fund manager and strategic purchaser of health services. Its purpose is to help shift the country from a fragmented, high out-of-pocket financing environment toward a more coherent national model based on pooled resources, defined benefits, enforceable contracts, and stronger accountability.
The Authority is responsible for managing transparent, ring-fenced financial windows suited to Somalia’s fiscal and administrative context. These may include subsidized pools for poor and vulnerable populations, contributory windows for formal and organized groups, and aligned financing arrangements for priority health services.
Strategic purchasing is a central instrument of reform. NSHIA is expected to contract eligible providers under standardized rules for service delivery, quality assurance, reporting, referral compliance, client protection, and payment performance. Through contracting, the Authority can improve value for money while promoting more consistent service standards.
NSHIA is responsible for defining and progressively expanding a benefits package anchored in the Essential Package of Health Services. The package is expected to begin with high-impact essential services and expand in line with fiscal space, service readiness, and operational performance.
The Authority is expected to support adaptable enrollment systems, including mobile registration, community verification, digital credentialing, and protocols that make benefits portable across districts and Federal Member States.
NSHIA’s mandate includes claims administration, payment reconciliation, verification, and fraud control systems that balance administrative simplicity with strong accountability safeguards. Integrity is a core function, not a back-office afterthought.
The Authority is expected to establish complaint, appeal, and grievance mechanisms that protect users, clarify entitlements, and help resolve disputes related to billing, service access, provider conduct, or claims decisions.
NSHIA is also mandated to support dashboards, financial reporting, audits, and routine performance monitoring. This includes tracking coverage, payment timeliness, service use, equity, complaint resolution, and other indicators needed for public accountability and adaptive learning.