Gambia Health Profile 2012

HEALTH & DEVELOPMENT
The government is the major provider of health services. The public health care system has three tiers, based on the primary health care strategy. Presently, services are provided by four hospitals at the tertiary level, 38 health centers at the secondary level and 492 health posts at the primary level. The system is complemented by 34 private and nongovernmental organization (NGO) clinics. For most communities,the first point of contact with health care services is the informal sector through traditional healers. The burden of communicable and noncommunicable diseases is high. Malaria and tuberculosis are leading causes of morbidity and mortality. Other causes of morbidity that drive the demand for public health services in children are acute respiratory infections, diarrhoeal diseases, helminthic infections and skin disorders. Cardiovascular diseases including hypertension, diabetes, cancers and trauma are the common diseases/conditions in adults. These health conditions are responsible for over 75% of the outpatient and inpatient care delivered through the government’s health care system.
The maternal mortality ratio (MMR) of 730 per 100 000 live births in 2001 is unacceptably high. Institutional delivery is estimated at 52% of all births (2001 MMR survey). The main causes of maternal mortality are haemorrhages, eclampsia, anaemia, malaria in pregnancy and postpartum sepsis. Poor maternal nutrition contributes to complications during pregnancy and delivery, and shortage of skilled birth attendants further exacerbates the problem. One of the major obstacles facing the health sector is the shortage of health personnel at all levels of the healthcare delivery system. The major health challenge is the slow progress towards achieving the health Millennium Development Goals (MDGs) and constitutes a concern for the country as well as the international community.

Health care has become increasingly accessible thanks to the rapid expansion of health services to the communities as well as the staffing of village clinics in hard-to-reach rural areas. Antenatal care coverage is almost universal with more than 96% of Gambian women making at least one antenatal-care visit during pregnancy. The Gambia attained higher than 90% immunisation coverage for all antigens for children under one year of age. Malaria remains a public-health challenge. Access to effective anti-malarial drugs by the general population has increased to 63%. In 2009, insecticide treated nets coverage for children under five years of age and pregnant women stood at 54% and 63% respectively. The uptake of sulphadoxine-pyrimethamine for intermittent preventive treatment in pregnancy increased from 33% in 2008 to 47% in 2009. Routine tuberculosis (TB) data show that at least 70% of the estimated TB cases in The Gambia have been detected. The case detection rate has risen from 64% in 2006 to 78% in 2008, the cure rate rose from 67% in 2003 to 78% in 2008, while the treatment success rate rose to 84% in 2008. The share of population aged 15 to 49 living with HIV/AIDS remained relatively low at 0.9% in 2007.

One of the main challenges that the government faces in the health sector is the difficulty of keeping health workers within the public sector. The government lost up to half of its trained health workers per year in recent years to the private sector or to jobs abroad because of low salaries, a lack of career-development opportunities, difficult working conditions and lack of equipment.

OPPORTUNITIES

• The national 5 year MDG Based 2nd Poverty Reduction Strategy Paper (PRSP II 2007-2011) has identified health as a priority area of focus for reducing inequality and enhancing economic development;
• A number of policies are in place to steer health sector reform for better health service delivery and outcomes;
• Implementation of a Sector Wide Approach (SWAp) based on the National Health Policy (2007-2020) and Health Strategic Plan;
• Enhanced Highly Indebted Poor Country (HIPC) initiative completion point reached at the end of 2007 and the debt relief is targeted for use in the social sectors including health;
• Government has identified health as one of 3 priority sectors (along with education and agriculture) for development.

CHALLENGES

• Reduction of the high maternal mortality ratio and child mortality through the scale–up of priority interventions;
• Health systems strengthening and capacity building – through organization and management of health care services, human resources development, infrastructure and logistics, health information, health financing and partnerships;
• Weak technical support services including the referral system, essential drugs supply chain, vaccines and other medical supplies, blood transfusion services and radiology services;
• Community participation and mainstreaming traditional medicine into the public health service delivery;
• Inadequate health financing and therefore development and implementation of an appropriate and effective Health Financing Policy
• Establishment of an effective system to cope with natural disasters and other emergencies that poses serious threat to health.