A Theoretical Framework for Health System Preparedness in Managing Female Genital Mutilation/Cutting Complications: An Analysis for Somalia and Somaliland (2021–2026)

This theoretical article addresses a critical gap in structured health system preparedness for managing the acute and chronic complications of female genital mutilation/cutting (FGM/C) in Somalia and Somaliland, where prevalence remains near-universal. It contends that the predominant focus on prevention, whilst vital, must be integrated with robust, trauma-informed clinical care pathways within overstretched health systems. Employing a critical synthesis methodology, it analyses recent evidence (2021–2026), including WHO guidelines, national health policies, and regional health system analyses, to construct an integrated theoretical model. The framework proposes that effective preparedness relies on four interdependent pillars: (1) enhancing frontline health workers’ clinical competency in FGM/C-related obstetric, urological, and psychological care; (2) securing consistent availability of essential medical commodities; (3) developing ethical, context-specific data surveillance to inform service delivery; and (4) fostering community-health system linkages to overcome stigma and encourage timely care-seeking. The analysis demonstrates that without such integration, health systems risk perpetuating harm by failing to manage the very complications prevention efforts seek to avert. Consequently, this work provides a rigorous model for policymakers, advocating a dual-track approach that synchronises urgent clinical response with long-term prevention within the broader public health agenda.