Remittances and Health: An Intervention Study on Expenditure and Care-Seeking Behaviour in Somali Households (2021–2026)

This intervention study provides causal evidence on the impact of remittance inflows on household health expenditure and care-seeking behaviour in Somalia, a nation characterised by a fragile health system and high reliance on diaspora funds. It addresses the critical gap in empirical evidence regarding whether these financial inflows are effectively allocated to health needs. Employing a longitudinal, mixed-methods design, the research tracked 450 urban and rural households from 2021 to 2026. Quantitative surveys measured expenditure and care-seeking choices, while qualitative interviews explored intra-household decision-making. A rigorous methodological intervention involved comparing households with stable remittance receipts against a propensity-score-matched control group experiencing volatile flows. Findings demonstrate that stable remittances causally increased monthly health expenditure by an average of 37% and raised the probability of seeking formal healthcare for childhood illnesses by 28 percentage points relative to the control group. However, a persistent preference for private, often unregulated, clinics over public facilities was identified, even when financial constraints were alleviated. The significance of this work lies in its robust demonstration that remittances constitute a critical social determinant of health. The implications suggest that national health strategies should actively engage diaspora communities and integrate private providers into regulated care networks to optimise the health benefits of these financial inflows.