Somalia expands Digital Public Infrastructure to improve child immunization in Mogadishu

A digital lifeline for Somalia’s children: Inside Mogadishu’s experiment with an electronic immunization register

On a bright morning in Kahda, a district on the southern edge of Mogadishu, a young mother stands at the immunization desk without the small, creased card that once governed her child’s medical future. For years, that paper card—easily misplaced during eviction, flood or displacement—was the only proof a child had been vaccinated. When it disappeared, health workers guessed which doses had been given, repeated injections, or marked children as “zero-dose” because there was no way to know.

Now, nurse Naima Muse turns from a crying toddler, taps a number into a desktop computer and retrieves the child’s record within seconds. “Before, if a mother lost the card, we had nothing,” she says. “Now, we just search.”

The system is the Electronic Immunization Register, or EIR, a digital platform piloted in 14 health facilities across Somalia’s Banadir region in 2025. It assigns each vaccinated child a unique identification number, stores dose histories and sends SMS reminders to caregivers. Health officials at district, state and federal levels can see aggregated data in near real time. The Ministry of Health says it plans to expand the system to more than 80 facilities nationwide by 2026.

At first glance, it is a story of digitizing a registry. But in Somalia—where paper records have long substituted for institutional continuity—the shift represents something larger: an experiment in digital public infrastructure, the idea that interoperable systems such as ID-linked health registries can function as public goods. The question is not simply whether the software works. It is whether such infrastructure can change how power, accountability and trust move through a fragile state.

Until recently, immunization at Kahda Health Center followed a routine familiar across the country. A mother arrived with a vaccination card. A nurse flipped through thick registers to find the child’s name. If the card was missing, staff relied on memory or started the schedule again. In busy periods, paperwork spilled into hours after patients left. “Previously it took time for follow-up,” Naima says. “There were campaigns and more worries regarding duplicate or zero-dose child.”

“Zero-dose” refers to children who have not received even a first routine vaccine—a group unusually large in Somalia. Conflict, drought, displacement and weak infrastructure have left roughly 60% of children without a single routine immunization dose in recent years, according to international estimates. Outbreaks of measles and diphtheria recur with regularity; in the first 11 months of 2025, Somalia recorded more than 3,000 suspected diphtheria cases and over 130 deaths.

In such conditions, paper systems are not merely inconvenient; they are structurally fragile. Registers can be damaged or lost. Data cannot be easily consolidated across districts. Children who move—and many do—effectively start over. Kahda itself has become an overstretched hub for families fleeing conflict and climate shocks from the Lower and Middle Shabelle regions. Overcrowded camps such as Biyo iyo Caano, Horseed and Danyar shelter thousands of people facing shortages of food, water and sanitation.

“We saw that many mothers did not remember how many vaccines their child had received or which doses were still due,” Naima says. During a recent visit, she administered an oral vaccine to a toddler whose mother had come without documentation. The woman looked anxious when asked for her card. Naima turned the monitor toward her and pulled up the record electronically. The mother relaxed. “This is one benefit,” Naima says. “The mother should not worry.”

The EIR runs on DHIS2, a widely used open-source health information platform. It includes a mobile app for frontline workers, dashboards for managers and automated text reminders for caregivers. Supported technically by the World Health Organization and HISP Tanzania, the system is owned and operated by the Somali government.

Officials describe it as part of a broader move toward digital public infrastructure: secure, interoperable and inclusive systems that reduce duplication, create shared standards and enable real-time oversight. In practice, DPI is not just about efficiency. It reorganizes who sees information and who controls it.

“When a child is vaccinated, the data that the user has entered can be seen at the district, regional, state and national levels,” says Abdirahman Mohamed Mohamud, data manager for the Expanded Program on Immunization at the Federal Ministry of Health. “For example, child X—his age, his dose and his vaccination level—is known.” Under the old model, upward reporting was slow and incomplete. Now, federal officials can monitor facility-level trends as they occur, potentially identifying “zero-dose” pockets and defaulters faster.

The system generates a unique ID when a child receives a first vaccine. If the mother travels to another participating facility, staff can retrieve the record using that ID. Duplicate entries, Abdirahman says, are reduced. Still, he and frontline workers acknowledge gaps. “Sometimes we record on paper and upload later,” says nurse Hani Ali. Electricity cuts, weak connectivity and staffing shortages persist. The digital layer overlays older constraints rather than eliminating them.

That hybrid reality mirrors experience in neighboring Kenya and Tanzania, where digital immunization systems have rarely displaced paper overnight. Maintenance costs, unreliable internet, system downtime and parallel reporting structures have limited impact. In some cases, data fragmentation persisted despite digitization.

Somalia faces similar risks. The EIR currently operates in just 14 public facilities in the capital. Mogadishu alone has hundreds—if not thousands—of health points when private and informal clinics are counted. Scaling beyond the capital will require stable connectivity, trained personnel and sustained funding. Digital tools succeed not because they exist, but because they are embedded in daily workflows and governed with clarity.

If paper records were fragile, digital records raise different concerns. “The data belongs to the government,” Abdirahman says. Access is tiered: federal, state, regional and district managers view information according to role. “Not everyone can enter,” he adds. “There are different layers to protect the data.” At the facility level, individual users are issued credentials.

Yet Somalia does not have a comprehensive, widely enforced data protection framework comparable to those in other countries experimenting with DPI. Key questions linger: Who audits access logs? How long is child-level data retained? What happens if a device is stolen? In insecure or contested areas, could records be misused? Consent, officials say, is obtained at registration. Mothers receive brief explanations before their child’s information is recorded and SMS reminders are activated.

For caregivers like Halimo Adan, 25, a mother of four, the first text reminder came as a surprise. “Firstly, I thought I need to pay the center for message,” she says. “Later they told me it is a new system to help children.” She signed a consent form at the clinic. “We need this message to remind us of the time because we usually move place to another and we lost the card.” Maryan Ahmed, 34, who has three children, was also asked to consent. “They found my son’s record immediately,” she says. “Before, I had to explain everything again.” Still, she hesitates. “I don’t know who else can see his information.”

Officials attribute early improvements in follow-up rates partly to digital alerts. SMS reminders reduce reliance on radio announcements and manual phone calls. “It is a 100% follow-up,” Abdirahman says—describing the system’s design, not its current reality. At Kahda, nurses report fewer missed appointments among mothers who receive messages. Operationally, some changes are already visible: staff spend less time calling parents, duplicate entries decline where IDs are used consistently, and managers can compare facilities’ performance without waiting for monthly paper submissions.

But the pilot’s scale limits measurable conclusions. Fourteen facilities cannot shift national immunization rates. Many children still receive vaccines in clinics without digital registration. And during connectivity outages, staff revert to paper and upload later—prolonging double work, a familiar pitfall in other countries. Even as the Ministry explores solar-powered cold-chain systems and insulated ARKTEK storage boxes to keep vaccines viable in remote areas, the EIR’s success will hinge on a more mundane mix: training, electricity, airtime data, and a help desk that answers quickly.

Expanding from 14 facilities to more than 80 will test more than server capacity. Somalia’s federal system divides authority between the central government and member states. Political disagreements have, at times, slowed cooperation on health initiatives. Long-term sustainability will require domestic budget lines for software maintenance, hardware replacement, upgrades and refresher training. Kenya and Tanzania’s experiences suggest that without consistent funding, systems stagnate—or slide back into partial paper use.

Trust will be cumulative. It will depend on whether data remains secure, consent is meaningful and expansion is equitable, reaching the private and informal clinics where many Somali families seek care. It will also depend on transparency—clear rules on who can see what, for how long, and under what safeguards.

Back at her desk in Kahda, Naima keeps a stack of paper forms close by. The toddler on his mother’s lap is crying; the vaccine stings briefly before he quiets. The computer hums beside her. The system is still being tested. Sometimes, she admits, the data goes in later.

The real measure will not be whether a dashboard updates instantly. It will be whether the system remains funded, governed and trusted—and whether children who once disappeared between ledgers become, finally, visible.

By Ali Musa
Axadle Times international–Monitoring.