Introduction

It is generally agreed that the level of economic, social and political involvement and performance of a nation depends largely on the health status of the people.

The saying: ‘a healthy nation is a wealthy nation’ is, therefore, very appropriate in this context.

For example, the economic loss to the nation resulting from the effects of Malaria and HIV/AIDS (that is, in terms of man-hours for the active labour force or student’s school days lost) must be colossal.

It is no coincidence, therefore, that the government has placed the provision of quality, affordable and accessible health care very high on the national agenda.

Infrastructural Development

Since 1994, the government has demonstrated a commitment to improving the health of the general population, especially that of women and children.

In the past ten years, the public health sector has seen unprecedented rapid expansion.

Two new hospitals (the AFPRC hospital in Farafenni and Sulayman Junkung Jammeh hospital in Bwiam) have been built and are operational, with another new hospital under construction in Serrekunda.

In addition, a number of health centres and clinics have been built and others rehabilitated and upgraded.

These developments represent a real milestone and serve as significant landmarks in the history of the country’s health system, considering that in 30 years the previous government did not build a single hospital.

Logistical Support

In addition to building, rehabilitating and upgrading health facilities nation-wide, the government works to ensure the availability and adequate supply of drugs, medical supplies, equipment, transport and other logistics.

For example, the continuous replacement of the old fleet of ambulances with new ones has greatly improved the referral system, and contributed significantly to the advancement of maternal and child health, and thus a reduction of the national maternal and under-five mortality rates.

Public health financing

There has been an annual increase in the allocation given to health from the national coffers, meaning that there has been a steady increase in public health expenditures over the years.

For example, expenditure rose from D43 million in 1991/92 to D192 million in 2001.

"Since 1999, recurrent health expenditures have averaged more that 13 per cent while the average share of recurrent public resources (excluding debt services) devoted to health in the period 1990/91 to 2001 was 10.0%.

"Public health expenditure as a share of GDP averaged 2.6% between 1998 and 2001" (DoSH PER, 2001).

This represents a significant increase in both monetary and growth terms and, consequently, a gradual rise in real per capita health expenditure.

In 1991/92 real per capita health expenditure was D41.3 rising to D85.1 in 2000. Measured in US dollars, public health expenditures were close to $6 per capita in 2000 (DoSH PER, 2001).

Human resources for health

In the area of human resource development, significant improvements have been registered. The establishment of the Faculty of Medicine and Allied Health Sciences of the University of The Gambia means, for the first time in the history of The Gambia, the country could train its own medical doctors.

Nursing and public health officers are also being trained up to BSc level.

Health human resource saw significant improvements over the past ten years. During the period under review, the public health sector witnessed an increase in the number of doctors and other health professionals. Through bilateral cooperation with other governments, especially in Taiwan, Nigeria and Egypt, the government was able to strengthen the technical assistance programme with these and other countries.

Because of the increase in the number of doctors, minor health centers and dispensaries and, for the first time ever, some villages, now have resident doctors.

An increase in the number of intakes and graduates from the health training institutions such as the School of Nursing and Midwifery and School of Public Heath under the Gambia College, the State Enrolled Nurse School in Bansang and the Community Heath Nurse School in Mansakonko also helps in meeting the human resource requirements of the health sector.

Health promotion and service delivery

The public health sector has been more strategic in its approach. For example, the creation of the National Population Commission (NPC), National Nutrition Agency (NaN) and National AIDS Secretariat (NAS) are measures taken to ensure the smooth running and implementation of programmes and activities.

Since their creation, positive results have been registered. A major contribution of the NPC is the increase in public awareness of the implications of an increasing population. Improvements in the nutritional status of Gambian women and children, and the relatively low HIV/AIDS prevalence rate in the country are to a large extent attributable to the good work of NaNA and NAS.

Operation Clean the Nation

The national cleansing exercise (Operation Clean the Nation (OCN), the brainchild of the President, will significantly help in the fight against Malaria. With the strengthening of OCN, especially during the rainy season, the country is set to attain the number one spot in Africa as the country with the best national malaria control programme in the region.

Constraints and challenges

Not-with-standing the numerous achievements registered by the government in the past ten years, there are areas that need improving.

Perhaps, most important of all, is human resources development. The acute shortage of staff in the public health facilities, the high attrition rate of health workers, especially nurses and the high dependency on expatriate doctors are areas that require urgent attention.

However, these issues and concerns are being addressed through the HRH policy and strategic plan (2004-2008). All that remains is for the government to approve and support their implementation.

There is also a need to improve the quality of health care services. This requires the adequate and timely supply of drugs, medical supplies and other consumables.

What this requires is a further increase in the national health budget. A boost in public health expenditure would improve service delivery.

Conclusion

The public health sector has registered tremendous achievements in the past 10 years. It is important that we consolidate on these gains, while working to address the challenges faced in view of the increasing demand for quality health services by the general public.  (For a more detailed Report on the Health Sector, please click here!)