The Gambia’s health sector is currently handicapped due to acute shortage of skilled health personnel like doctors and nurses as well as laboratory technicians and scientists coupled with staff attrition and redeployment, this paper can reveal.
|Fatim Badjie, Gambia's Minister of Health and Social Welfare|
In this vein, maternal mortality rate is considered to be still high in the country, and neonatal mortality rate, estimated at 54 per 1000 live birth, is also high.
A document of the Ministry of Health and Social Welfare says the key challenges hindering the country’s
health sector also include inadequate budgetary allocation as the annual budget of the ministry is lower than the Abuja target, which states that 15% of the national budget should be allocated to the health sector.
Presented during the resource mobilization and investment forum for the Programme for Accelerated Growth and Employment (PAGE) held in early July, the document also indicates that there is inadequate staff accommodation in hospitals and other health facilities across the country, aggravated by lack of adequate information within the health sector due to weak health management information system.
“Lack of funds to conduct the annual sentinel surveillance,” is also mentioned in the document as being among the key challenges of the ministry.
The latest sentinel surveillance in The Gambia was done in 2008. There is also lack of fund to conduct nationwide survey on HIV, and to do an assessment and refurbishment of pharmaceutical stores of the health facilities across the country. There is also lack of electricity and water supply in health facilities, the document states.
The health sector has been experiencing increasing pressure due to a number of problems such as high population growth rate, high morbidity and mortality rates associated with communicable and non-communicable diseases, ageing health infrastructure and limited medical equipment and supplies, lack of efficient referral system, and health-related statistics.
The Gambia at risk of not achieving MDGs 4 and 5
Due to the high rate of maternal mortality and child mortality, The Gambia is at risk of not achieving Millennium Development Goal 4, which is a target to reduce by two-thirds the under-five mortality rate, and Goal 5 a target to reduce by three-quarters the maternal mortality ratio and universal access to reproductive health. According to the global timeline, both goals should be achieved between 1990 and 2015.
The document also states that there is “urgent need to reduce the unacceptably high morbidity and mortality rates, especially among women, children and other vulnerable groups”.
“Achieving the health MDGs represents one of the greatest challenges in our drive towards national health development,” it says. “Improving health outcomes will not be possible without major improvements in health delivery systems, which in turn depends on changes in public sector management, new forms of engagement with the private sector, as well as interventions well beyond the health sector itself.”
The Ministry of Health says improvement in health is essential if progress is to be made with the other MDGs, including reduction of absolute poverty.
However, in the document, the ministry has outlined that the main strategies to overcome the challenges is to strengthen maternal, infant and child health services; strengthen surveillance, prevention, control and management of communicable and non-communicable diseases; improve knowledge and skills of healthcare providers at all levels; and improve health infrastructure at primary, secondary and tertiary health care levels.
As a way forward, the health ministry has recommended increment of budgetary allocation for the health sector in conformity with the Abuja target, and strengthening the health system to address operational challenges at all levels of service delivery.
Also recommended is to mobilize adequate resources to consolidate current gains in malaria control, tuberculosis, HIV, and other programmes. It is also recommended for the government to develop a viable health financing policy, and create budgetary space for improved production, retention and performance of health professionals.
Not all is doom
Despite the challenges, the country has registered some significant achievements in the health sector, notably among them is antenatal care coverage which is almost universal with over 97% of Gambian women making at least one antenatal care visit during pregnancy. Also 32 health facilities offer prevention of Mother-to-Child-Transmission services of HIV and AIDS.
The Gambia is the second country in Africa to introduce Pneumococcal Conjugate Vaccine (PVC7) in its routine immunization services, according to the document. The introduction of this vaccine will help to reduce both morbidity and mortality due to pneumococcal diseases as they are presently among the leading causes of morbidity and mortality among children in the country.
In addition, the country has registered marked success in the fight against malaria incidences, as hospital admissions due to malaria and deaths attributable to malaria has reduced by 74% and 90% respectively.