Keeping care alive in 2025-26 humanitarian Somalia: routine digital data and frontline and managerial perspectives on integrated services

In conflict-affected settings facing polycrisis and a contraction in humanitarian funding, service integration helps sustain care with fewer resources, yet lacks a simple measure. We examine how the Caafimaad+ consortium's vaccination, nutrition, and mental health services functioned under pressure in Somalia in 2025-2026. Using the Levesque conceptual framework with a sequential mixed-methods approach, we organised participatory workshops with 21 frontline workers, then nine managers, from nine structures around Mogadishu area in November-December 2025. We built an integration indicator from routine data for six structures (April 2025-March 2026). Workers described continuous pressure worsened by US funding cuts and ranked supply availability as most critical dimension. Facilities kept running through constant adaptations and informal mechanisms, especially smaller facilities. Vaccination-to-nutrition integration rate declined significantly, reflecting a dilution effect. The nutrition-to-vaccination rate showed a similar trend but non-significant. The fall in nutrition contacts matched supply shortage reports. This low-cost, reproducible approach refine service-volume monitoring where data collection is risky. Finally, our study identified a second, overlooked group: the frontline workers themselves. They sustain services through their informal efforts, but at the expense of their own well-being.