Operationalizing public health emergency operations centers in Somalia: a scoping review of challenges and strategies

Abstract

BACKGROUND: Public Health Emergency Operations Centers (PHEOCs) are central to national health security systems, enabling coordinated preparedness, surveillance, and response to public health emergencies. However, their operationalization remains particularly challenging in fragile and conflict-affected settings such as Somalia, where systemic constraints, governance fragmentation, and limited resources undermine emergency coordination capacity. This study aimed to systematically map the existing evidence on the challenges and strategies for operationalizing PHEOCs in Somalia and comparable fragile settings, and to identify priority areas for strengthening emergency preparedness and response systems. METHODS: This scoping review was conducted in accordance with PRISMA-ScR guidelines to systematically map the evidence on challenges and strategies related to PHEOC operationalization in Somalia and comparable settings. A structured search of peer-reviewed and grey literature was conducted in PubMed, Scopus, and Google Scholar, as well as in institutional repositories, covering publications from January 2010 to March 2025. A total of 43 documents met the inclusion criteria. Data were charted using a standardized framework and synthesized using an inductive thematic approach. RESULTS: The reviewed literature consistently identifies five interrelated domains of challenges affecting PHEOC operationalization: (1) operational and infrastructure constraints, including weak legal frameworks and inadequate facilities; (2) financing and sustainability challenges, characterized by heavy reliance on donor funding and absence of dedicated domestic financing; (3) human resources and system capacity gaps, including workforce shortages, training limitations, and weak laboratory and surveillance systems; (4) political and security barriers, including limited political prioritization, fragmented federal governance, and insecurity; and (5) information systems and digital constraints, including fragmented and non-interoperable data systems and limited operationalization of One Health approaches. These challenges are systemic and mutually reinforcing, significantly constraining effective emergency coordination. A detailed mapping of included studies and extracted findings is provided in Supplementary Table S1. CONCLUSION: Strengthening PHEOC systems in Somalia requires comprehensive, multisectoral interventions addressing governance, financing, workforce, infrastructure, and digital systems. Institutionalizing legal frameworks, enhancing sustainable financing, investing in workforce development, improving data interoperability, and integrating One Health approaches are critical for building resilient emergency preparedness and response systems in fragile settings.