In January 2021, Somaliland launched one of the most innovative and nationally owned public health reforms in its modern history: the creation of a dedicated National Mental Health Program financed entirely through a domestic revenue mechanism. This bold reform emerged from a landmark consensus between the Government and the country’s Khat Traders, who collectively supported the introduction of an additional 200 Somaliland Shillings on each bundle of imported khat.
The decision was not only unprecedented but visionary, because it placed Somaliland among the countries that use what economists call a “sin tax” – a targeted tax on goods or behaviors considered harmful to health or society, such as tobacco, alcohol, sugary drinks, or stimulants like khat. Sin taxes have dual benefits: they encourage healthier behavior while generating predictable revenue for essential public services. By applying this approach to khat, Somaliland aligned itself with global best practices in public health financing, adapting them to the country’s unique socioeconomic realities. Special appreciation is due to the Minister of Finance at that time, Dr. Saad Ali Shire, whose leadership ensured that this reform was effectively implemented. Without his stewardship, this breakthrough would not have been possible.
Before this initiative, the mental health system in Somaliland was exceptionally fragile as reported by the Ministry of Finance. Until 2021, the Ministry of Health Development (MOHD) – within which the Mental Health Department operates – had no formal mental health office, no dedicated staff, no national strategy, and no sustainable budget. Services existed in only two of the six regions and were deeply under-resourced. Patients were often subjected to chaining, overcrowding, and unsafe conditions due to limited infrastructure and lack of trained personnel. Staff morale was low, supervision was minimal, and stigma was widespread – even within the health sector. Unregulated Ilaaj centers (Cilaaj) dominated the landscape, and the system as a whole suffered from decades of chronic underinvestment and neglect.
A paradigm shift began in late 2020 when the Government approved the Mental Health Khat Tax as a dedicated form of sin tax. With an estimated 20 – 40 million kilograms of khat imported annually, the tax offered a reliable revenue stream. Collection began in January 2021, generating approximately USD 1.7 million per year – the first predictable domestic financing for mental health in Somaliland’s history. This success emerged from an alignment of political leadership, private-sector responsibility, and public acceptance, illustrating that sustainable development is strongest when built on local ownership.
The revenue generated through this mechanism became the backbone of a national mental health renewal. It enabled MOHD to support operational needs in all six regional mental hospitals, ensuring availability of essential medications, food, clothing, bedding, patient care, staff salaries, logistical support, and regular supervision. Consistent funds allowed mental health professionals – long deprived of training opportunities – to upgrade their skills and clinical capacity. Through strengthened outreach teams, equipped with minibuses in every region, the system expanded its reach to rural and remote communities. What had been a fragmented and under-resourced system evolved into a coordinated national service.
Infrastructure development was transformative. Somaliland constructed three new mental health hospitals in Laascaanood, Erigavo, and Berbera – regions previously without formal mental health facilities. Existing hospitals were rehabilitated, and new support infrastructure, such as the psychiatric kitchen at Hargeisa Group Hospital, was established. Services expanded into Sool and Sanaag for the first time, bringing care closer to underserved populations.
Governance reforms were equally significant. With steady funding, the Ministry established the Department of Mental Health as a structured entity within MOHD. Under the leadership of Dr. Yakoub Aden Abdi, MD, PhD, Senior Psychiatrist. Dr. Yakoub’s leadership in establishing governance frameworks, strengthening service delivery, and guiding national coordination has been central to transforming the sector. His stewardship ensured that the Khat Fund was managed transparently and strategically, with maximum benefit to patients nationwide.
The Department led the development of essential national frameworks: The Mental Health Policy, National Mental Health Strategy, Standard Operating Procedures, and the Mental Health Bill. Public awareness campaigns helped reduce stigma, while oversight of Ilaaj centers gradually improved their standards. Today, more than 40,000 patients receive mental health care annually – a figure unimaginable before 2021.
At the 2025 Somaliland Health Investment Conference, Dr. Yakoub presented a pressing challenge and issued a clear call to action, underscoring that despite extraordinary progress, the mental health system still faces critical vulnerabilities that must be addressed to protect its future. He warned that Somaliland’s mental health services remain heavily dependent on khat revenues -an inherently risky and unstable source of funding. He stressed that the Ministry of Health Development must also demonstrate institutional commitment by allocating at least 2% of its budget to mental health, noting that MOHD’s contribution is still missing.
Dr. Yakoub further highlighted that 42% of the current mental health budget is absorbed by staff salaries, leaving limited resources for medicines, infrastructure, and quality improvement. Additionally, he underscored the severe shortage of specialised professionals – psychiatrists, psychiatric nurses, psychologists, and social workers – warning that without urgent investment in workforce development, service quality and coverage cannot be maintained.
His message was not just a diagnosis of the challenges but a national call to action. He emphasized that mental health is everyone’s business, not the sole responsibility of MOHD. He urged international organizations to integrate mental health into their programs instead of treating it as a separate or optional component. He encouraged development partners to collaborate on projects where mental health needs are deeply intertwined—such as maternal health, youth development, disability services, and community resilience. Finally, he invited government institutions and partners to join the High-Level Mental Health Financing Initiative, a coordinated effort to diversify financing and safeguard the gains achieved since 2021.
Author: Abdirashid Ibrahim Abdirahman
