Cherno Bah, I wish to supplement your comment on the state of the Health sector in The Gambia with the following observations, which are partial, at best. There has been a general lack of appreciable improvement in this sector particularly if the Alma Atta Declaration (Health for All by 2000) is the basis for assessing the sector. But if you will recall, I argued somewhere in one of my postings that the goals set then were unrealistic and, as far as many health experts were concerned, unattainable. There are numerous reasons for this including the health expenditure targets of between 15-20 percent over the period of 1978/79 and the year 2000 that were never met by The Gambia and many African countries for that matter. Primary Health care (PHC) was emphasised, as opposed to tertiary health. The Gambia did make significant progress in the area of PHC, although most of the gains were diminished due to high rate of population growth as seems to be the case in most other sectors. With a population of a little over a million and an annual growth rate of 4.2 percent, one of the highest in Africa, little wonder that our health indicators are among the lowest in Africa. It may be of interest to note that your physician to population ratio of one medical doctor to over 35,000 Gambians in 1993 has dramatically improved to 12,000 persons per doctor which can only be attributed to the presence of Cuban doctors. Unfortunately, most of the other health indicators that you mentioned have not improved significantly over the years. Shortage of qualified staff has been identified as one of the major constraints. More health-care personnel such as the categories you mentioned i.e. community health nurses, SENs, SRNs, traditional birth attendants etc must be trained with attractive remuneration package to retain them. In the main, the current Health Policy, in my opinion, is sound; it seeks to provide universal health coverage, redistribute health resource in favour of under- served rural population, improve the quality of the health care delivery system and encourage greater community participation. Sound policies alone are not enough however. Adequate budgetary allocation must accompany the policy and efficient and prudent application of those very scarce resources is an absolute necessity if the health status of the Gambian population is to improve appreciably. sidi sanneh ---------------------------------------------------------------------------- To unsubscribe/subscribe or view archives of postings, go to the Gambia-L Web interface at: http://maelstrom.stjohns.edu/archives/gambia-l.html ----------------------------------------------------------------------------