Facility-level determinants of infection prevention and control monitoring in Somalia: evidence from the 2024 Harmonized Health Facility Assessment

Somalia lacks empirical data on routine infection prevention and control (IPC) monitoring at the health-facility level, despite ongoing gaps in IPC worldwide. Reducing healthcare-associated infections, preventing antibiotic resistance, and safeguarding healthcare personnel, especially in fragile health systems, all depend on effective IPC systems. This study examines IPC monitoring practices and associated facility-level determinants in Somalia using nationally representative data from the 2024 Harmonized Health Facility Assessment (HHFA).

1,219 health facilities were evaluated using a cross-sectional analytical approach. Data were collected using the standardized WHO. Harmonized Health Facility Assessment (HHFA) instrument, including facility-reported evaluations of standard IPC monitoring procedures using structured questionnaire items. The data were verified using field supervision and digital quality standards. To investigate relationships between IPC monitoring and facility characteristics, descriptive statistics and chi-square tests were applied, with a significance level of p < 0.05.

Routine IPC monitoring based on standardized monitoring approaches in the preceding six months was reported in only 6.6% of facilities. While there was no significant variation by the state level, monitoring varied considerably by managing authority (p = 0.047) and facility type (p < 0.001). Primary health units, private clinics, TB centers, and privately run facilities demonstrated the lowest levels of monitoring performance, whereas higher-level facilities and those run by the government or non-governmental organizations showed higher monitoring levels. There was no significant correlation found between facility ownership and IPC monitoring.

The IPC system in Somalia is still limited by managerial, structural, and capacity-related issues. It is crucial to prioritize resources for lower-tier and privately run facilities, strengthen governance, and standardize audit-feedback systems. To lower healthcare-associated infections and support antimicrobial resistance control, these findings provide practical evidence for national IPC scale-up, targeted oversight, and policy. Building capacity in privately run, primary-level facilities needs to be a top priority for the national IPC scale-up.

Not applicable.