Emergency preparedness capacity and associated factors among health facilities in Somalia: evidence from the 2022–2023 national harmonized health facility assessment and implications for health-system strengthening

Background Emergency preparedness is essential for resilient health systems, particularly in fragile and conflict-affected settings where health facilities face recurrent outbreaks, conflicts, natural disasters, and other shocks. Methods A cross-sectional secondary analysis was conducted from 10 to 31 August 2026 using data from the 2022–2023 national Harmonized Health Facility Assessment (HHFA) to assess emergency preparedness capacity and associated factors among health facilities across Somalia. Emergency preparedness capacity was measured using a composite binary indicator based on key preparedness mechanisms, including emergency planning, response arrangements, emergency training/drills, and surge staffing strategies. Descriptive statistics and binary logistic regression were used to summarize preparedness indicators and identify associated factors. Results Among 1,214 facilities with available emergency preparedness information, 142 (11.7%) met the criteria for emergency preparedness capacity. Major gaps were observed in emergency planning, training and drills, surge staffing strategies, and other preparedness mechanisms. In multivariable analysis, state and facility type remained independently associated with preparedness capacity. Compared with health centers/primary health units/TB centers, hospital, referral, and specialty facilities had higher adjusted odds of preparedness capacity. Compared with Banadir, facilities in Galmudug and Puntland had lower adjusted odds, while Hirshabelle had higher adjusted odds. Conclusion Emergency preparedness capacity among health facilities in Somalia remains limited and unevenly distributed. Strengthening preparedness, particularly in primary health care facilities and underserved regions, through planning, workforce training, simulation exercises, supportive supervision, and routine monitoring is essential to improve health-system resilience.