The APRC dictatorship has find time to distract and cause
havoc when important issues are raised on the L. This is
no surprise that you continue to engage Gambian citizens in prevaricative analyses of situations that can be easily interpreted as plots in avoiding questions posted to you.
On the healthcare debate, your illegal
government's apparent lack of strategy opened
a medical school in The Gambia without endorsement from
The Gambia Medical Association. The illegal government of
the day did not see it fit that a medical school cannot
be founded without a state of the earth hospital for the
graduates to facilitate their knowledge. Who wants to be
operated on by an intern or a Gambian Medical School graduate
who has not even touched a needle to inject a patient? Do
we have assurance that The Gambian Medical Association will
give accredation to the school? Is the school accredited
by any major educational system in West Africa?
Finally, it will be appropriate if you can quote from your
source rather than plagiarizing.
Naphiyo,
Comrade ML Jassey-Conteh,MBA
Greensboro NC/Kombo East Constituency
Original Message:
-----------------
From: TOMBONG SAIDY [log in to unmask]
Date: Mon, 2 Jul 2001 22:09:13 -0500
To: [log in to unmask]
Subject: HEALTH FOR ALL
<html><DIV>
<P>SITUATION OF THE GAMBIA’S HEALTH SERVICES <BR> FROM JULY 22ND 1994 TO DATE<BR> with a special section on AIDS/HIV. </P>
<P><BR>Clicking any of the scrolling pictures to the left opens a short write-up about that picture.</P>
<P>Developments FROM 1994 TO 2001<BR>(A Brief Background to Gambian Health Services follows at the end of this report)</P>
<P>Since the coming into power of the AFPRC on July 22nd 1994 and the subsequent<BR>voting of the APRC party into power in October 1996, significant strides have been<BR>made in the health sector and a continuous upgrading of the Gambian Health<BR>Services is ongoing. Four new major health facilities have been built as shown<BR>below (see Table 1)</P>
<P>Table 1: Major Health Facilities Constructed Since 1994 to Date</P>
<P> NAME OF HEALTH FACILITY LOCATION</P>
<P><BR> 1. AFPRC General Hospital Farafenni, Upper Badibu, North Bank Division</P>
<P><BR> 2. Soma Major Health Centre Soma, Jarra West Lower River Division</P>
<P><BR> 3. Bwiam Hospital Bwiam, Foni, Western Division </P>
<P><BR> 4. Bundung Major Health Centre Bundung, Kanifing Municipality</P>
<P> </P>
<P>In addition to these, the tender documents for a third hospital, the Serrekunda<BR>Hospital, is already publicised and the award of contract for the civil works is<BR>expected to be done in August 2001. Also, many village dispensaries/clinics<BR>throughout the country are currently being run by experienced Cuban medical<BR>personnel with the support of the Gambian staff. </P>
<P>It is to be noted that before 1994, the only significant presence of medical doctors<BR>was in four locations in Farafenni, Kaur, Bansang and at the Royal Victoria Hospital<BR>in Banjul.</P>
<P>However, through the untiring and dynamic efforts of H.E. The President, Alhaji Dr.<BR>Yahya A.J.J. Jammeh, medical doctors are not only available in all government<BR>dispensaries, minor and major health centres but also in many remote villages<BR>throughout the country. For the first time in the history of this country, villages<BR>enjoy the services of a Doctor very close to their localities. No more will villagers<BR>have to travel as far as 50 kilometres to see a Medical Doctor. This development<BR>has brought increased confidence in the medical and health services nationally and<BR>within the sub-region to the extent that within the last few years, thousands of<BR>people from the neighbouring countries have come to The Gambia for quality<BR>health care. </P>
<P>Another attribute of the APRC Government under President Jammeh has been the<BR>continuous provision of a universal free health care service for all Gambian citizens.<BR>No Gambian citizen pays for medical services rendered by State personel<BR>regardless of the extent or degree of the medical care provided. </P>
<P>What this means is that after an initial one-time registration fee of 5 Dalasis, a<BR>Gambian admitted to have a complex surgical procedure performed and a Gambian<BR>reporting to hospital with a mild flu are both managed and treated completely at<BR>the expense of the government. In addition, a foreigner in the Gambia gets the<BR>same free medical treatment save for a higher registration fee. This has been one<BR>of the motivating factors bringing thousands of other nationals into the Gambia for<BR>medical treatment.</P>
<P>The most significant impact of the widespread availability of medical personnel in<BR>the short term, has been the improvement in the quality of service, better clinical<BR>diagnosis, reduced referrals, better service delivery in the hospitals and major<BR>health centres and the convenience of the patient in getting medical attention<BR>within a short travel distance. In the long term, the increase in qualified medical<BR>personnel will bring about reduced mortality and disability from disease, which will<BR>lead to a healthier population and a longer life expectancy.</P>
<P>The period 1994 to date has also seen the building of proper Schools of Public<BR>Health and of Nursing and Midwifery. Also of great significance, was the<BR>establishment, by the APRC Government, of the School of Medicine of the<BR>University of The Gambia. Like in many other things, the School of Medicine is the<BR>first in the country and for the first time Gambians are being trained in The Gambia<BR>to become doctors. </P>
<P>The medical school is an important strategy in achieving VISION 2020 " a healthy<BR>and wealthy Nation". Less than 10% of the medical doctors in the government are<BR>Gambians. There are currently 250 Cuban medical personnel, 50 medical personnel<BR>from Nigeria and 14 from Egypt who are serving in The Gambia together with the<BR>few Gambian Doctors. The School of Medicine will in the next few years, reduce the<BR>health services’ over reliance in foreign doctors.</P>
<P>From the foregoing, it is clear that under the leadership of the Yahya Jammeh led<BR>APRC Government, Health Care Development in the Gambia has leaped and<BR>bounded in a positive direction. The re-election of the APRC and President Jammeh<BR>in October 2001 will definitely result in an even greater development of the Health<BR>Sector in The Gambia.</P>
<P>HIV/AIDS CONTROL PROGRAMME</P>
<P>Without a doubt, the APRC Government has made the fight against AIDS one of it's<BR>primary Health Care Agendas.</P>
<P>The multi-sectoral National AIDS Committee was reconstituted in 1995 to ensure a<BR>more focussed intervention to control the spread of HIV/AIDS. The National AIDS<BR>Control Programme carries out activities to sensitise the public and prevent the<BR>spread of HIV/AIDS.</P>
<P>A sentinel surveillance system is currently in place to measure HIV prevalence rates<BR>among pregnant women in 4 major health facilities in the countries. Result available<BR>from the first sentinel site located in the urban area indicated that between<BR>1995-2000 the prevalence of HIV1 has increased from 0.6% to 0.93%. It also<BR>show that HIV2 decline from 1.12% to 0.6% is less pathogenic compared to HIV1.</P>
<P>Clinical data on HIV1 and HIV2 infections among patients also show a similar<BR>picture. It shows a stable number of cases infected with HIV2 and exponential<BR>increase in the cases infected with HIV1.</P>
<P>Earlier, the Department of State for Health and Social Welfare and the Medical<BR>Research Council (MRC) with support from WHO conducted a study on HIV<BR>prevalence and its consequences on pregnant women and their children in<BR>1993/95. The study of 29,670 women conducted nationwide showed that 168<BR>(0.6%) were positive for HIV1, 336 (1.1%) were positive for HIV2 and 16 (0.1%)<BR>were dually reactive (i.e. infected with both HIV1 and HIV2).</P>
<P>Although the rate of HIV/AIDS infection in The Gambia is still quite low, the rate of<BR>increase in HIV 1 on the other side, is alarming. This provides an early warning of<BR>what "could happen" if steps were not taken immediately. The Department of<BR>State for Health and Social Welfare was able to quickly enlist strong political<BR>commitment from the highest level for HIV/AIDS control. A National AIDS Forum<BR>was organised and was addressed by H.E. The President. </P>
<P>The President stated in his address that "The Gambia is not only small but it is<BR>endowed with very little natural resources. All we have is our human<BR>resources. We cannot afford to allow HIV/AIDS to spread like it did in some<BR>other countries. We should act now!" The clarion call by H.E The President<BR>motivated the Officials of the Department of State for Health and Social Welfare in<BR>conjunction with the Department of State for Finance and Economic Affairs to<BR>negotiate the HIV/AIDS Rapid Response Project known as HARRP. </P>
<P>Underscoring the importance assigned to the fight against AIDS by President<BR>Jammeh, a National AIDS Control and National AIDS Secretariat were set up as an<BR>entity directly under the Office of The President to oversee the activities<BR>programmed for the HARRP. The HIV/AIDS and other Sexually Transmitted<BR>Infections Unit of the Department of State for Health and Social Welfare will<BR>continue to provide care, management and counseling services to those affected<BR>by those infections. The HARRP is US$15 Project which is to be implemented for an<BR>initial period of three years. The activities under HARRP, which are mainly<BR>sensitisation and prevention, treatment and care of those affected by the disease,<BR>are generally implemented at the level of the communities.<BR>Click here to open in a new window, the June 26th Address by <BR>H.E. Njie-Saidy to the United Nations Special Session on AIDS</P>
<P>Because of the widespread publicity and high level of importance given to the fight<BR>against AIDS by the Gambian Leadership, many members of the Gambian public<BR>have been motivated to join the government in its' fight against AIDS. Today,<BR>throughout the Gambia, there are several private individuals and organisations who<BR>are involved in running anti-AIDS campaigns, maintaining pressure groups,<BR>educational groups and social groups, all of whom are working hand in hand with<BR>the Gambian Government in the collective national fight against AIDS and the HIV<BR>virus. The just concluded 2001National Youth Conference picked The Anti-HIV/AIDS<BR>fight as one of its' leading themes.<BR>Click here to listen to an anti-AIDS Single released by one of<BR>The Gambia's leading musical group, The Dancehall Masters© </P>
<P>Health and Social Welfare Policies</P>
<P>The first National Health Policy was formulated in 1995 to cover the period 1995 to<BR>2000 and currently the second National Health Policy is under preparation and<BR>should be available by end July 2001. Other policies that impact on the health and<BR>social welfare of the public have also been or are being formulated. These include<BR>the Population Policy, the Reproductive Health Policy, the Nutrition Policy, the Drug<BR>Policy, the National Policy on Blood Transfusion, the Social Welfare Policy, the Policy<BR>for the Elderly and the Child Protection Policy are currently. The primary goal of the<BR>various policies is to provide direction to the Department of State for Health and<BR>Social Welfare in the execution of its mandate.</P>
<P>HEALTH PROJECTS AND PROGRAMMES</P>
<P>Government was also able to successfully negotiate a financial assistance package<BR>with the Republic of China for the Health sector. The financial assistance of the<BR>ROC, which is to the tune of US$500,000 annually, goes towards the upkeep of<BR>the Medical Technical Assistants working in the Public Health Sector. The<BR>Department of State for Health and Social Welfare also obtained an IDA credit for<BR>US$20 m for a Participatory Health, Population and Nutrition Programme. The<BR>Participatory Health Population and Nutrition Project, PHPNP, is a five-year project,<BR>which started in 1998, to improve family health in The Gambia. The Project is<BR>designed to enhance the quality and facilitate access to, health services, in<BR>particular reproductive health, child health and nutrition and the management of<BR>such services. The Department of State for Health and Social Welfare assumes<BR>supervisory responsibility for the Project while the Project Manager and the various<BR>component heads carry out the implementation of the Project. The Project has<BR>four components:</P>
<P> Reproductive Health services. <BR> Integrated Management of Childhood Illness. <BR> Nutrition Policy and Service for Women of reproductive age and children.<BR> Management and Implementation of a Family programme. </P>
<P>All four components address monitoring and evaluation, operations research<BR>extensive training activities and IEC. These cross-cutting activities are coordinated<BR>by the Project Management Unit, the Project Coordination Committee and the<BR>specific technical coordinators. As part of the Government’s commitment to<BR>implement a successful project, a set of performance indicators for the Project<BR>Monitoring and Evaluation has been agreed to. These key indicators provide the<BR>basic framework and reference point in considering what actions are to be taken in<BR>fulfillment of PHPNP activities. Please see table 3.</P>
<P>Table 2: Government Projects in The Health Sector since 1994 to date</P>
<P> NAME OF<BR> PROJECT FUNDING AGENCY UNIT RESPONSIBLE<BR> 1. Participatory Health </P>
<P>Population & Nutrition Project IDA of World Bank Project Implementation Unit </P>
<P><BR> 2. Health Services <BR> Development Project<BR> (Health II) ADF of The ADB Project Implementation Unit</P>
<P><BR> 3. Support to the<BR> Development of PHC<BR> in North Bank<BR> Division Italian Government – Cooperation Project Implementation Unit</P>
<P><BR> 4. Family Health<BR> Project United Nations Fund for Population<BR> Activities Maternal & Child<BR> Health/Family Planning Unit</P>
<P><BR> 5. HIV/AIDS Rapid<BR> Response Project<BR> (HARRP) United Nations Development<BR> Programme <BR> (UNDP/UNICEF/WHO/UNAIDS) National AIDS Control<BR> Secretariat</P>
<P><BR> 6. Urban Eye Care<BR> Project Sight Savers International & Jersey<BR> Overseas Aid Programme - UK National Eye Care<BR> Programme<BR> 7. Gambian German<BR> Family Planning <BR> Project German Technical Co-operation<BR> Maternal & Child Health/Family Planning Unit</P>
<P><BR> 8. Rehabilitation<BR> Project Netherlands Foundation Department of Social<BR> Welfare</P>
<P><BR> 9. Tuberculosis and<BR> Leprosy Control Netherlands Leprosy/TB Unit</P>
<P><BR> </P>
<P>DISEASE SURVEILLANCE</P>
<P>A sharp surveillance system provides the scientific basis for identifying major public<BR>health problems in an area and helps provide overtime, long term disease trends<BR>and epidemiological patterns. Thus Department of State for Health and Social<BR>Welfare maintain a continuous surveillance of communicable diseases of epidemic<BR>potential so that prompt action can be taken to confine any outbreak to a limited<BR>area within the shortest possible time. This system has made it possible for the<BR>Health Team to contain the yearly meningitis outbreaks to a manageable level.</P>
<P>EPI COVERAGE </P>
<P>The EPI Programme- Gambia’s Expanded Programme for Immunization is one of<BR>the most successful child health interventions in the sub-region. The programme<BR>provides for the following antigens that are being given to children; Diphtheria,<BR>Pertusis, Tetanus, Measles, Yellow Fever, Haemophilus Influenza type B (HiB),<BR>Pneumonia and Meningitis.</P>
<P>Levels of immunisation coverage in The Gambia have increased markedly in recent<BR>years and by 1995 over 85% of children under 1 year were fully vaccinated. This<BR>has been accompanied by a dramatic reduction in the number of vaccine<BR>preventable diseases and indeed polio eradication is now within sight. Currently<BR>about 79% of children under 1 are fully vaccinated.</P>
<P>THE HEALTH SERVICE DEVELOPMENT PROJECT</P>
<P>In line with Government’s commitment to the health sector, a D95 M ADB Project<BR>for further development of the health service is also being implemented. The<BR>project supports health services delivery, strengthens laboratory and support<BR>services as well as constructs and equips the Central Medical Store and 5 Health<BR>Centres in the provinces.</P>
<P>THE ITALIAN PROJECT – SUPPORT TO THE DEVELOPMENT OF PHC</P>
<P>In September 2000, a bilateral agreement between the Governments of Italy and<BR>The Gambia was signed to support the development of Primary Health Care in The<BR>Gambia. The North Bank Division, which was deemed to be under served,<BR>commanded high priority in terms of access to resources was chosen as the<BR>project area.</P>
<P>Under the project, 10 new health posts will be built and equipped and 5<BR>dispensaries will be rehabilitated in the North Bank Division. The project will also<BR>provide equipment and materials to the newly trained traditional birth attendants. It<BR>will also support the Nutrition Surveillance programme in the North Bank Division.</P>
<P>MALARIA CONTROL PROGRAMME</P>
<P>Malaria continues to be the disease that is most commonly reported and is still the<BR>leading cause of childhood deaths in the under fives. It is also the leading cause of<BR>workdays lost due to illness. WHO estimates that controlling the malaria endemic<BR>could raise GDP in some parts of Africa by 20% within a 15-year period.</P>
<P>It is estimated that over 20% of all attendance at public health facilities in The<BR>Gambia are as a result of malaria. Malaria also accounts for a large proportion of<BR>paediatric admissions. During the period 1993-95, 39% of paediatric admissions in<BR>Royal Victoria Hospital were related to malaria. Most of these admissions were due<BR>to cerebral malaria, which has a high case fatality rate of 18%.</P>
<P>The Malaria Control Unit therefore carries out constant sensitisation activities<BR>throughout the country to educate people on environmental sanitation and the<BR>benefits of sleeping under bed nets impregnated with insecticide. In addition, the<BR>Programme ensures the availability of the insecticide pemethrin in sufficient<BR>quantities in collaboration with UNICEF/WHO and UNDP. Through the Malaria<BR>Control Programme impregnated bed nets are distributed to all health facilities<BR>including the Hospitals for the protection of the in-patients.</P>
<P> A FURTHER BACKGROUND TO THE CURRENT HEALTHCARE SYSTEM </P>
<P>The Government of The Gambia has overall responsibility for the provision of<BR>health services to all Gambians and non-Gambians resident in the country. The<BR>Department of State for Health and Social Welfare through its various structures<BR>assures an effective public health delivery system that addresses in particular the<BR>needs of the under privileged and under served communities in the country.<BR>Government’s health care delivery system is organised into three directorates:<BR>Directorate of Health Services, Directorate of Planning and Information and<BR>Directorate of Support Services.</P>
<P>The Directorate of Health Services has overall responsibility for the provision of<BR>health services. The Director of Health Services with a Deputy Director of Health<BR>Services and three Assistant Directors of Health head the Directorate. The three<BR>Assistant Directors are responsible for the three technical divisions of the<BR>Directorate i.e. Family Health, Disease Control and Health Promotion and<BR>Protection. </P>
<P>All the programme units fall within one of the three technical divisions. The Maternal<BR>and Child Health and Family Planning Unit and the Expanded Programme on<BR>Immunization Unit are under the Family Health Division; Malaria Control, Control of<BR>Diarrhoeal Diseases, Acute Respiratory Illnesses, HIV/AIDS, STDs and other<BR>communicable and non communicable diseases fall under Disease Control while the<BR>Health Education Unit, Mental Health and Environmental Health are under Health<BR>Promotion and Protection. </P>
<P>The primary and secondary level health services i.e. health posts, dispensaries and<BR>centres are under the Directorate of Health Services while the third level health<BR>services i.e. the hospitals are managed by semi-autonomous management boards<BR>with the Department of State for Health assuming oversight responsibility for the<BR>Hospitals. The administration and management of the primary and secondary level<BR>health services have been decentralised into 6 Divisional Health Teams to<BR>adequately cover the health divisions in the country.</P>
<P>The Gambia adopted the Primary Health Care (PHC) concept, which emanated<BR>from the Alma Ata Declaration of September 1978. It is stated in the Declaration<BR>that PHC "is an essential health care system based on scientifically sound and<BR>socially acceptable methods and technology, universally accessible to individuals<BR>and families in the community and that the country and its people can afford at<BR>every stage of their development in the spirit of self reliance and self<BR>determination." </P>
<P>Primary health care is provided at both village levels by Village Health Service (VHS)<BR>and at the secondary level at Minor and Major Health Centres. The VHS are<BR>provided in villages with a population of 400 or more and are situated away from<BR>locations with health facilities. However in a bid to provide for the under-served,<BR>smaller and remotely located villages with fewer than 400 inhabitants have been<BR>made eligible for PHC and in some cases small villages close together have been<BR>made into one PHC cluster. All PHC villages or cluster of villages have a Village<BR>Health Worker and/or a trained Traditional Birth Attendant. These cadres of<BR>community health workers are volunteers selected by their respective communities<BR>after a process of sensitisation and are trained by the Department of State for<BR>Health. PHC villages are organized into groups called circuits, which usually<BR>comprise between 5 to 9 PHC villages. A Community Health Nurse trained and<BR>appointed by Government supervises each circuit.</P>
<P>The secondary level has three different types of basic health facilities, viz. major<BR>health centres, minor health centres and dispensaries. The services common to all<BR>three of them include out-patient services, maternal and child health/ family<BR>planning services, immunisation services, environmental health services and<BR>registration of births and deaths. Some minor health centres have in-patient<BR>facilities in addition to the aforementioned services. The major health centres have<BR>theatre and laboratory facilities to handle minor operations and obstetric<BR>emergencies. Any case that cannot be handled by the VHS is referred to the<BR>nearest Health Centre.</P>
<P>The third level is made of the three hospitals that are currently fully functional i.e.<BR>Royal Victoria, Bansang and AFPRC General hospitals. </P>
<P>SOCIAL WELFARE</P>
<P>The Department of Social Welfare is responsible for the following</P>
<P> care of the blind <BR> care of children and young persons <BR> charitable collections from friendly societies and distribution to the needy<BR> juvenile delinquents <BR> prisoners after care <BR> probation <BR> social welfare service to the destitute <BR> collaboration with voluntary organisations and other welfare societies </P>
<P>In the area of disability and rehabilitation, the Department of Social Welfare<BR>provides wheel chairs, clutches and other related materials to the disabled. It also<BR>provides oversight supervision of the organisations of the disabled such as the<BR>Organisation of the Visually Impaired and the Association of the Disabled persons.</P>
<P>The Department cares for the aged and the destitute and is currently putting up a<BR>home for the elderly and the infirm persons with Government and World Bank<BR>financing.</P>
<P>The Department spearheads the development of the policy for Social Welfare,<BR>Policy on the elderly. The Department works very closely with UNICEF in the<BR>implementation of programmes aimed at child protection and development. It also<BR>coordinates the child protection alliance which brings together representatives from<BR>a wide range of organisations with the common goal of promoting the protection<BR>of children and young people from abuse.</P>
<P>The alliance is founded on principles that can be found in the UN Convention on the<BR>Right of the Child, the African Charter on the Rights and Welfare of the Child, the<BR>International Labour Organisation Convention 138 and 182 all of which have been<BR>ratified by the Government of The Gambia.</P>
<P> </P>
<P>HEALTH INDICATORS </P>
<P>Table 3</P>
<P>Life Expectancy at birth:<BR>Males: 56.0 (1999 Estimate)<BR>Females: 58.9 (1999 Estimate)</P>
<P>Total Fertility Rate: 5.1 (1999 Estimate)</P>
<P>Under 5 Mortality Rate: 82 (1998 Estimate)</P>
<P>Infant Mortality Rate (Under 1) 64 (1998 Estimate)</P>
<P>Maternal Mortality Ratio: 105 (1990 Maternal Mortality Study)</P>
<P>Exclusively Breastfed (0-3 months (2000 Anthropometric Exit Survey)</P>
<P>Percentage of under fives suffering from:<BR>(a) Stunting: 9.0% (2000 Anthropometric Exit Survey)<BR>(b) Wasting: 10.1% (2000 Anthropometric Exit Survey)<BR>(c) Underweight: 15.9% (2000 Anthropometric Exit Survey)</P>
<P>Percentage of Fully Immunized Children <BR>78.6% (1999 EPI Coverage Evaluation Survey)</P>
<P>Percentage of Pregnant Women<BR>Receiving Tetanus Toxoid: 70.6% (1999 EPI Coverage Evaluation Survey)</P>
<P>Percentage of Contraceptive Prevalence: 12% (1990)</P>
<P> *********FILED JUNE 28TH 2001********<BR> <BR> Copyright 2001 Jammeh/APRC Campaign Team</P>
<P>For more information go to: <A href="http://www.jammeh2001.org/">www.jammeh2001.org/</A>healthaids/index.html<BR></P>
<P>Please note that the previous Government did not build a single hospital or high school even though it was in power for more than 30 years.<BR><BR>PEACE </P>
<P>Tombong</P></DIV>
<DIV></DIV>
<DIV></DIV><br clear=all><hr>Get Your Private, Free E-mail from MSN Hotmail at <a href="http://www.hotmail.com">http://www.hotmail.com</a>.<br></p></html>
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