Transitioning from Donor-Financed to Publicly Financed Health Systems: Key Insights from the Puntland Health Financing Conference 2025

Fragile and conflict-affected settings often rely heavily on external assistance to maintain health systems, leaving them vulnerable to geopolitical shifts and donor fatigue. Puntland State of Somalia exemplifies this challenge, with over 90% of its health sector historically funded by international donors. In response to growing concerns over aid reductions and the sustainability of health services, the Puntland Health Financing Conference 2025 convened a broad array of stakeholders, including government officials, international donors, diaspora representatives, private sector actors, and community members, to discuss pathways toward sustainable, publicly financed health systems. This commentary summarises the conference discussions, highlighting the current financing landscape, the roles of key actors, and strategies proposed to reduce donor dependence. Recommendations emphasised expanding domestic revenue mobilisation, leveraging diaspora contributions, strengthening public-private partnerships, and formalising community-based health financing mechanisms. The commentary also explores political feasibility, implementation challenges, and potential timeframes, drawing lessons from comparable fragile states. Insights from the conference underscore the importance of integrated, locally led financing frameworks in enhancing health system resilience, equity, and sustainability in Puntland and similar contexts.