Operationalizing the WHO Blueprint for Fungal Disease and Antifungal Resistance in Fragile Health Systems: Insights from Somalia.

The World Health Organization (WHO) Blueprint for Strengthening Responses to Fungal Disease and Antifungal Resistance provides a global framework for improving national responses to fungal diseases and antifungal resistance. However, translating these recommendations into routine practice remains challenging in fragile and resource-constrained health systems, where weak governance, limited laboratory capacity, workforce shortages, constrained financing, and fragile supply chains may hinder implementation. Using Somalia as an illustrative context, this narrative policy commentary examines how such health-system constraints may affect operationalization of the WHO Blueprint. Somalia specific evidence on fungal disease burden and antifungal resistance remains limited; therefore, the country is used as an implementation context rather than as an evaluated fungal disease program. Drawing on the WHO Blueprint, established health-system strengthening concepts, and implementation constraints relevant to fragile settings, we propose a phased approach built around five interconnected priorities: strengthening governance and coordination, expanding laboratory and surveillance capacity, ensuring sustainable access to essential antifungal medicines, developing the health workforce, and integrating fungal disease services within existing health-system platforms. Rather than establishing new vertical programs, fragile health systems should leverage existing antimicrobial-resistance initiatives, laboratory networks, procurement mechanisms, and clinical training structures to improve feasibility and sustainability. Although derived from the Somalia context, these considerations may also be relevant to other settings facing similar resource and system constraints. The success of the WHO Blueprint will ultimately depend on the ability of health systems to adapt global recommendations into feasible and sustainable national action.