Factors associated with health insurance coverage among ever-married women in Somalia using 2020 health and demographic survey data

Achieving universal health coverage (UHC) requires effective financial risk protection mechanisms, with health insurance being a cornerstone. In Somalia’s fragile and under-researched context, the factors influencing health insurance adoption remain poorly understood. This study aims to identify socio-demographic determinants of personal health insurance coverage among ever-married women in Somalia, utilizing the first comprehensive national health and demographic data available for the country. This demographic is crucial as they often serve as primary caregivers, and their financial protection is vital for household well-being. We analyzed data from the 2020 Somali Health and Demographic Survey (SHDS) for 1,626 ever-married women. A multivariable logistic regression model was used to identify factors associated with personal health insurance coverage. The prevalence of personal health insurance coverage among ever-married women was notably low at 2.28% (95% CI: 1.55%, 3.01%). Multivariable logistic regression revealed significant associations between borrowing status, place of residence, region of residence, and personal health insurance coverage. Specifically, ever-married women in households that reported borrowing money demonstrated significantly elevated odds of possessing health insurance (AOR = 5.35, 95% CI: 2.52, 11.35), indicating the importance of access to credit and potential awareness of financial protection tools. Conversely, ever-married women residing in nomadic areas exhibited reduced odds of health insurance coverage relative to those in urban areas (AOR = 0.15, 95% CI: 0.03, 0.67). Ever-married women in the Bari region were less likely to have health coverage than those in the Awdal region (AOR = 0.095, 95% CI: 0.01–0.89), while women in the Bari region were less likely to have coverage, highlighting regional disparities linked to socio-economic and infrastructural challenges. With health insurance coverage for ever-married women in Somalia at just 2.28%, progress toward UHC is stalled. This study identifies borrowing status, nomadic lifestyle, and geographic location as the most significant factors. These findings present an urgent policy roadmap: promote financial inclusion by linking insurance to credit, develop culturally-sensitive schemes for mobile populations, and actively reduce regional disparities. These targeted interventions are critical for increasing insurance uptake and ensuring equitable healthcare access in Somalia.