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Analytical summary - Health financing system

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Over 66% of the total health funding in the Gambia comes from international health development partners, raising issues of sustainability and predictability of funding to the sector.[1] Between 2010 and 2011, about 10–11%[2] of the Government's budget was allocated to the health sector, basically for recurrent and development costs, which is still below the Abuja target of 15%.[3]

The cost of providing health care continues to rise owing to increasing demand, changes in diagnostic and therapeutic technologies, inflation and currency fluctuations.[4] This requires that current funding levels be increased to enable the Ministry of Health and Social Welfare to deliver quality services to the population. There is a need to advocate for the funding of the health sector to be increased to at least the 15% Abuja target.

The Ministry of Health and Social Welfare spends the bulk of its budget on capacity-building for health care workers, purchase of equipment, logistics and supplies, and medications and vaccines. Evidence indicates a decline in household’s direct out-of-pocket payment contribution to total health expenditure, which has fallen from 12% in 2002, to 11% in 2003 and 9% in 2004.[5]

At present, the Government of the Gambia uses many channels for the pooling of resources for health financing. These include the prepayment system, where funds collected through taxes, levies, special funds and insurance contributions are used to protect citizen by reducing out-of-pocket spending. The issue of introducing health insurance for public services is currently in progress. The Personnel Management Office is currently working on an insurance scheme for the public service. However, this will only cover a small percentage of the population and ways of further protecting the rest of the population are needed.

The Gambia Public Procurement Authority is responsible for ensuring efficient, effective and transparent procurement procedures. The health sector is sometimes constrained in that emergency purchases are inadvertently delayed due to the need to follow such procedures.

The private sector finances health services through a parallel system that is used mainly by those who can afford to pay the fees, which are higher than the Government charges.


  1. National health accounts 2002, 2003, 2004 (789.53kb). Banjul, Government of the Gambia, Department of State for Health and Social Welfare, 2007
  2. Ministry of Health and Social Welfare estimates 1998─2011 (Government local funds only). Banjul, Government of the Gambia, Directorate of Planning and Information, Health Financing Unit, 2010
  3. Health Financing Policy, 2009. Banjul, Government of the Gambia, Ministry of Health and Social Welfare, 2009
  4. World health report 2007. A safer future. Global public health security in the 21st century (pdf 3.96Mb). Geneva, World Health Organization, 2007
  5. Estimates of revenue and expenditure, 2002─2007. Banjul, Government of the Gambia, Department of State for Finance and Economic Affairs