Healthcare facility accreditation status and associated factors in Somalia: evidence from the 2022–2023 harmonized health facility assessment

Healthcare facility accreditation, licensing, and quality assurance are critical mechanisms for improving patient safety and service quality. In fragile and conflict-affected settings such as Somalia, these regulatory and quality assurance systems remain weak and poorly institutionalized. This study assessed the status of facility accreditation and associated factors using data from the 2022–2023 Harmonized Health Facility Assessment (HHFA). This study was a secondary analysis of cross-sectional data from the Somalia HHFA 2022–2023, including 1,219 healthcare facilities across Five Federal Member States and Banadir Region. Descriptive statistics summarized facility characteristics and accreditation-related indicators. Bivariate and multivariable logistic regression analyses were conducted using Stata version 17 to identify factors associated with facility accreditation status. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and p < 0.05 was considered statistically significant. Overall, only 18.46% (95% CI: 16.28%–20.64%) of healthcare facilities reported having undergone any accreditation. In the adjusted analysis, accreditation was significantly associated with state and facility type, and with certification and licensing status. Facilities certified for specific services (AOR = 8.49; 95% CI: 3.78–19.07) or licensed/registered facility-wide (AOR = 4.79; 95% CI: 2.03–11.34) had higher odds of accreditation. Facilities with a routine quality assurance process were also more likely to be accredited (AOR = 2.34; 95% CI: 1.51–3.64). Facility accreditation in Somalia remains extremely limited, reflecting major gaps in regulatory oversight and quality assurance. Certification and licensing indicators and the presence of routine quality improvement processes were key factors associated with accreditation. Strengthening national accreditation frameworks and supporting routine quality improvement including context-appropriate accreditation pathways for complex referral facilities are vital to improve healthcare quality and safety in Somalia.