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