Integrating oral health into primary healthcare in Somaliland: A policy imperative

The aim of this letter is to address the critical neglect of oral health within Somaliland's primary healthcare (PHC) system. Despite the global recognition of oral diseases as major noncommunicable diseases (NCDs) that share common risk factors with systemic conditions, they remain marginalized in national health frameworks.¹

The design of this analysis involved a comprehensive review of current oral healthcare practices, workforce distribution, and national health policy documents in Somaliland. Our results indicate that the exclusion of oral health from the Essential Package of Health Services (EPHS) has institutionalized a crisis-intervention paradigm. Currently, the population relies on an unregulated private sector, creating significant financial and geographic barriers. Furthermore, the oral health workforce is heavily concentrated in urban centers, leaving rural and nomadic populations underserved.

A significant barrier is the meso-level educational silo. The absence of interprofessional education (IPE) at the undergraduate level institutionalizes professional isolation, leaving PHC practitioners specifically nurses and midwives without the competencies or clinical legitimacy to provide basic oral screening or hygiene promotion.² Consequently, dental and medical records remain technologically and clinically decoupled, preventing a holistic approach to patient care. This fragmentation is exacerbated by the lack of a unified health information system, which hinders evidence-based policymaking.³

We conclude that the current fragmentation between oral and general health systems perpetuates preventable disease burdens and widens health inequities. To achieve universal health coverage, Somaliland must transition toward an integrated Common Risk Factor approach.⁴ We propose a policy-driven framework centered on three pillars:

First, the formal inclusion of a “Basic Package of Oral Care” (BPOC) in the EPHS is essential to provide dedicated fiscal appropriation for essential dental consumables at the PHC level.⁵ Second, the mandatory colocation of dental suites within existing rural PHC centers should be incentivized to foster interprofessional collaboration and streamline referral pathways. Third, we advocate for the implementation of task-shifting strategies, where trained primary care providers are empowered to perform risk assessments and fluoride applications.

By leveraging existing Maternal and Child Health (MCH) infrastructure, Somaliland can embed oral screening into routine immunization and maternal health visits, mirroring successful models seen in other low-resource settings.⁶ These reforms are essential to transform oral health from a neglected specialty into a core component of the national health system. Moving the system away from vertical clinical silos toward an integrated, patient-centered model will not only improve oral health outcomes but also strengthen the overall resilience of the primary healthcare system in Somaliland.

Finally, to facilitate a rapid understanding of the core issues and proposed solutions, the key findings of this analysis are summarized in Table 1. This table highlights the transition from the current status quo to the recommended policy-driven framework for oral health integration.

Table 1.

Key points.

What is known on the topic	What this study contributes
Oral diseases are prevalent NCDs sharing common risk factors with systemic conditions.	It identifies specific systemic barriers to oral health integration in the Somaliland context.
PHC is the most effective setting for universal health coverage and preventive care.	It proposes a policy-driven framework for task-shifting and colocation of dental services in rural PHC centers.
Integration of oral health into PHC remains in a developmental phase in many low-resource settings.	It provides a roadmap for policy reform, including the inclusion of a “Basic Package of Oral Care” (BPOC) in the EPHS.

CRediT authorship contribution statement

AMA & AOA: Conceptualization, Design of the study, and Literature review. AMA: Writing the original draft. OS: Critical revision of the manuscript for important intellectual content: AHM Supervision and final draft editing. All authors have read and approved the final version of the manuscript.

Declarations

We declare that this work has not been submitted as a manuscript to any other journal.

Ethical considerations

This study is a perspective piece based on a review of existing literature and policy frameworks. It does not involve primary data collection from human or animal subjects; therefore, approval from an Institutional Review Board (IRB) was not required. The study adheres to the principles of the Declaration of Helsinki.

AI and AI-assisted technologies in writing

The authors declare that no artificial intelligence (AI) or AI-assisted technologies were employed in the writing, drafting, or content generation of this manuscript. All content was solely created and refined by the human authors, who take full responsibility for its accuracy and integrity.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

None.