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Analytical summary - Health system outcomes

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The overall health system status in the Gambia has improved in various areas, including the availability of trained personnel, infrastructure and coordination. This is evidenced by the construction of new heath facilities through African Development Bank funding; increased staff being trained at the University of the Gambia as well as postgraduate training for health personnel through bilateral cooperation with some countries.

The major achievement of the sector is the high immunization coverage rate of 97%, which has led to a decline in childhood diseases.

The Government of the Gambia allocates about 12.7% of its national budget to health.[1] All citizens of the Gambia pay a token sum of approximately US$ 0.6 per consultation and US$ 5 for major surgery, irrespective of location. In 2007, a presidential pronouncement was made exempting all pregnant women and children aged under 5 years from all fees. Patients with diseases of public health importance, such as tuberculosis and HIV/AIDS, are also exempted from all fees, irrespective of nationality.

Resources in the health sector are unevenly distributed. Thus, qualified staff are reluctant to go to the remote areas for various reasons. Funds generated at the facility level are collated into central accounts, which are not easily accessible to health facilities for minor maintenance. However, the Ministry of Health and Social Welfare has secured funding for payment of hardship allowances to staff posted to remote areas. It will be necessary to monitor the effects of these allowances on staff retention and also to seek more innovative means of staff motivation, such as further training opportunities.

Before 1995 when there was no medical school, care was delivered by nurses and a limited number of doctors. However, with the availability of home-trained doctors, the Royal Victoria Teaching Hospital is now better served. The burning issue is the lack of any clear policy on the distribution of doctors after their training.

The Ministry of Health and Social Welfare has identified the delivery of quality care as a challenge that it seeks to address. The high attrition rate and occasional shortages of medical and surgical supplies are the major factors contributing to inadequate quality of care.

As health does not only arise from the health sector, the role of other government agents is recognized by the health sector, which works closely with other key sectors such as the National Environment Agency, National Nutrition Agency and the Ministries of Agriculture, Education, Fisheries and Water Resources and Community Development. Representatives from the health sector sit on technical committees of these agencies.

The priorities for the health system are to continue to reduce maternal and child mortality and disease burden, and improve quality of care. This will be done through strengthening of the health system through capacity-building, staff retention and equitable distribution of resources.

One of the major challenges in the health sector is the rapid turnover of staff, which leads to lack of institutional memory and expertise. The presence of nongovernmental organizations in the health sector could be further harnessed to yield positive results on the health of the people.


  1. The Gambia Government budget estimate 2011/12. Banjul, Government of the Gambia, Ministry of Finance and Economic Affairs, December 2011