Trial version, Version d'essai, Versão de teste

Informação sanitária, investigação, evidências e conhecimentos

From AHO

Jump to: navigation, search

O conteúdo em Portugês estará disponível em breve.

Data are crucial in improving health.[1] The ultimate objective of collecting data is to inform health programme planning as well as policy-making and, ultimately, global health outcomes and equity. A well-functioning health information system empowers decision-makers to manage and lead more effectively by providing useful evidence at the lowest possible cost.

A health information system has been aptly described as "an integrated effort to collect, process, report and use health information and knowledge to influence policy-making, programme action and research". It consists of:

  • inputs (resources)
  • processes (selection of indicators and data sources; data collection and management)
  • outputs (information products and information dissemination and use).

The role of a health information system is to generate, analyse and disseminate sound data for public health decision-making in a timely manner. Data have no value in themselves. The ultimate objective of a health information system is to inform action in the health sector. Performance of such a system should therefore be measured not only on the basis of the quality of the data produced, but also on evidence of the continued use of these data for improving health systems' operations and health status.

The health information system[2]

The availability and use of information enables:

  • improved definition of a population
  • recognition of problems
  • setting of priorities in the research agenda
  • identification of effective and efficient interventions
  • determination of potential impact (prediction)
  • planning and resource allocation
  • monitoring of performance or progress
  • evaluation of outcomes after interventions
  • continuity in medical and health care
  • healthy behaviour in individuals and groups.

It also empowers citizens by enabling their participation in health care, policy and decision processes; and empowers countries and international partners by enabling better transparency and accountability through use of objective and verifiable processes.

Health knowledge gaps are where essential answers on how to improve the health of the people in Lesotho are missing. This is an issue related to the acquisition or generation of health information and research evidence. The “know-do gap” is the failure to apply all existing knowledge to improve people’s health. This is related to the issue of sharing and translation of health information, research evidence, or knowledge. Although there are major structural constraints, the key to narrowing the knowledge gap and sustaining health and development gains is a long-term commitment to strengthen national health information systems.

Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:

Contents

Analytical summary

O conteúdo em Portugês estará disponível em breve.

In the Gambia, the emergence and growth of information societies, together with the role of information and communications technologies, has led not only to rapid universal access and utilization of health information but also to enhanced effective monitoring of trends in health status of communities, especially towards achieving the health-related Millennium Development Goals by 2015, the Programme for Accelerated Growth and Employment,[3] and Vision 2020.

Generation of evidence and knowledge through research, including sharing and exchanging health information with many stakeholders across geographical boundaries through multiple channels including the Internet, libraries, seminars, conferences and workshops, and other information centres, is critical for making informed decisions at all levels.

The Government of the Gambia has created an enabling environment with the development of appropriate policies and strategies, supported by well-elaborated legal, institutional and regulatory frameworks, that optimize the uptake of information and communications technologies as well as health-related information and services geared towards reducing poverty, enhancing growth and promoting sustained development. Against this backdrop, sector programmes have been established with a series of projects implemented, including:

  • needs assessments
  • policy planning capacity enhancements
  • phased implementation of e-government strategies with that of e-health.

Strengths include establishing:

  • a national information and communications infrastructure;
  • a national health management information system;
  • an expanded access to both local area networks or wide area network at central and regional levels, including provision of the Internet to most health facilities with improved data management.

However, despite the availability and introduction of routine data collection and management tools into the health management information system, specific research data collection and management guidelines have not been developed. Lack of such tools poses a challenge not only for the management of research data but also for the systematic collection, management, effective utilization and dissemination of information generated from research. In addition to these challenges and weaknesses, little or no research capacity or structures exist in the Ministry of Health and Social Welfare and this is further compounded by limited access to research findings.

The link between policy-making and decision-making processes and research remains weak, largely owing to lack of a common national platform for the setting of health research agenda. Mechanisms for determining priorities in the area of health research are also not in place. Access to existing global health information has been facilitated through:

  • roll-out of the e-government strategy;
  • implementation of information and communications technology applications;
  • extension of Internet connectivity through government services, web presence and provision of services online.

Availability and use of health libraries and information centres are limited given resources constraints within the country.

Context

The United Nations General Assembly's adoption of Resolution 56/183 on 21 December 2001 marked the beginning of the holding of the World Summit on the Information Society. The fundamental aim of the World Summit is the creation of a global platform for dialogue among key stakeholders such as governments, United Nations agencies, the private sector and civil society with a view to:

  • developing a common vision and understanding of the information society;
  • adopting a declaration and a plan of action as well as an agenda for facilitating the effective growth of the information society;
  • helping bridge the digital divide for a people-centred, inclusive, development-oriented information society.[4].

This country profile on information, evidence and knowledge draws upon the many issues presented and discussed during different phases of the World Summit as it unfolded, first in Geneva from 10 to12 December 2003, and then in Tunis from 16 to 18 November 2005. It also makes reference to the preconference workshop on information and communication technology (ICT) and poverty reduction during the Accra regional preparatory conference for the World Summit, which was held on 29 January 2005, and to the Bamako 2002 Declaration, as well as to initiatives undertaken by the Government of the Gambia against these backgrounds.

Following these important developments, the Geneva phase adopted the World Summit's Declaration of Principles and Plan of Action, while the Tunis phase adopted the Tunis Commitment and the Tunis Agenda for the Information Society. At both locations, leaders from Africa and around the globe recognized the significant role of ICT as a catalyst to help achieve the Millennium Development Goals, and agreed to a set of specific targets, including ICT connectivity and applications goals, with 11 action lines with objectives to be achieved by 2015.

On the basis of these action lines, the United Nations Economic Commission for Africa sent a mission to the Gambia in November 2002 to carry out a preliminary assessment and discuss modalities for the design of an e-government strategy for the Gambia with a view to starting an e-government pilot project between the then Department of State for Finance and Economic Affairs and the Office of the Gambian President for the sharing of financial and economic management data and information. It is envisaged that after the successful implementation of the pilot project, all the relevant institutions and services across the country will be subsequently interconnected electronically.[5]

The outcome of the mission was a memorandum of understanding in which it was agreed that some of the fundamental prerequisites to achieve a well-planned and realistic e-government programme included:

  • conducting a baseline study to assess the situation in the country in relation to e-government related activities, available infrastructure and technical support;
  • developing an e-government policy and strategy.

In July 2003, a nationwide baseline survey was undertaken to assess the e-government situation in the country, including the available infrastructure and technical support (e-government readiness). The survey report was discussed and subsequently adopted at the validation workshop held in Banjul, the Gambia on 17 October 2003.

The African Information Society Initiative, which serves as a guiding framework for building the information and communication infrastructure in Africa, was launched by the United Nations Economic Commission for Africa in May 1996. According to the World Summit on the Information Society Plan of Action, "specific targets for the information society will be established as appropriate, at the national level in the framework of national e-strategies and in accordance with national development policies, taking into account the different national circumstances. Such targets can serve as useful benchmarks for action and for the evaluation of the progress made towards the attainment of the overall objectives of the information society”. Furthermore, the document stresses that national e-strategies should be encouraged by all countries by 2015, based on national priorities.

Implementing the African Information Society Initiative, African ministers of planning and economic development identified the use of ICT in central government and local administration as one of the priorities for the entry of Africa into the information era and as a means to support governments' administration and decentralization processes. This is also consistent with the Government of the Gambia's Vision 2020 development blueprint, which underlines the necessity for availability of an enhanced electronic information system in the country’s drive towards attaining a middle-income status.

Enabling environment

Policies and strategies to support the information society

National policies and strategies to support the information society are availability in the Gambia. Implementing the World Summit on the Information Society action lines in Africa: analysis of country reports[6] clearly indicates that the Gambia began the development of its National ICT Policy and e-Government Strategy in 2003 in advance of the World Summit on the Information Society process. The Gambia's National Information and Communications Infrastructure (NICI) Policies and Plans, supported by the United Nations Economic Commission for Africa, were finalized in December 2004.

Since the development and approval of the Gambia's national e-strategies, the country has registered significant progress toward their implementation. The World Summit on the Information Society Action Plan document[6] states that national e-strategies should be encouraged by all countries by 2015. The Gambia's ICT4D (NICI) Policy and Plans are premised on 10 key pillars:

  1. 1. Gender empowerment
  2. 2. Media
  3. 3. Agriculture
  4. 4. e-Government
  5. 5. Health
  6. 6. Education
  7. 7. Trade and commerce
  8. 8. Local governance
  9. 9. Regulatory issues
  10. 10. Infrastructure.

Within the Gambia's ICT4D National Policy framework, the e-Health Strategy has been well elaborated. This has enabled the country to develop programmes geared towards building health information systems and promoting medical training, education and research through the use of information and communications technology (ICT), including telemedicine initiatives. In addition, a functional disease surveillance system has been established in the Ministry of Health and Social Welfare as a common information system that alerts, monitors and controls the spread of communicable diseases.

With the recent introduction of virtual private network (VPN) and Internet connectivity to support the health management information system, ICT usage has increased tremendously at public health facilities in the six health regions across the country that generate data using computers as well as in the management of health records. A Health Management and Information System Policy and Strategy were developed by the Ministry of Health and Social Welfare and partners in 2003. There is a fair degree of coherence and consistency between the national ICT policies on one hand and the objectives set within the health management information system policy on the other.

e-Health policy or strategy

According to the Gambia's ICT4D National Policy, the specific objectives of the e-health sector strategy are to:

  • provide the Ministry of Health and Social Welfare with wireless area networks (WAN)
  • contribute to the substantial reduction of malnutrition among children
  • provide health information to all stakeholders via ICT
  • provide ICT training for all Ministry of Health and Social Welfare health personnel staff
  • create a documentation centre in each health region
  • provide Internet access to all health centres
  • provide health care through telemedicine
  • computerize record management of births and deaths
  • provide distance learning to health professionals through the use of ICT
  • provide centralized management for the provision of health information
  • provide effective management of ICT resources
  • provide consistent ICT standards and enforcement
  • provide an effective power supply for health facilities, regional health teams and central offices
  • provide effective maintenance of ICT equipment and support
  • provide an effective monitoring, evaluation, and auditing system for ICT
  • provide effective security and privacy of medical records
  • apply ICT for capacity development and empowerment of young men and women.

In order to achieve these policy objectives, the Government of the Gambia has embarked upon:

  • networking of health care centres and hospitals in rural areas via ICT with the nearest equivalent institution in urban areas to promote cooperation and collaboration between institutions;
  • supporting the use of audio and video transmission systems to broaden the geographic reach using scarce resources;
  • enhancing the quality of information specific to different fields of medicine and clinical treatment in the health sector through content development, databases and metasearch engines in order to reduce inconsistencies in data sharing and medical terminologies.

Similarly, provision has been made for a web-based portal for dissemination of existing clinical and medical information and epidemiological information on the prevention of diseases such as sexually transmitted infections, HIV/AIDS, tuberculosis and malaria. This has enabled the facilitation of research through the use of ICT to explore ways of disseminating genetic information within existing clinical systems to help diagnosis, treatment and development of cost-effective drugs, and to promote closer health sector collaboration with private entrepreneurs and regional initiatives. A budget line has been established within the Government budget estimates since 2000 as a mechanism to sustain ICT initiatives in health.

Procurement policies or strategies

Procurement policies include the Gambia Public Procurement Authority Regulations 2003, Instructions on Public Procurements by Procuring Organisations 2003 and Gambia Public Procurement Authority bidder registration forms. There is high political commitment to advance the e-strategy implementation process within national development and socioeconomic plans such as the Poverty Reduction Strategy Paper, the Programme for Accelerated Growth and Development (PAGE) 2012-2015, the Millennium Development Goals and Vision 2020. This includes the allocation of public funds to ICT programmes.

Availability of public funding and private funding

The successful implementation of the strategic objectives and priorities of the e-government programme in the Gambia requires the mobilization of additional resources. The additional resources required to meet the funding gaps identified in priority areas in the e-strategy, include:

  • institutional capacity-building and provision of ICT equipment;
  • establishment of a premier technical university for higher ICT education and training through formal and non-formal educational (open and distance) modes;
  • partnership development activities in the region through the United Nations Economic Commission for Africa and other regional institutions.

These priority activities were largely funded through public sector financial resources such as government local funding, with contributions from private entities. Public–private partnership initiatives to implement such ICT-related policies have been developed. Multi-stakeholder partnership at the international level to mobilize human, financial and technical resources in order to bridge major gaps in ICT infrastructure is crucial. However, there are many actors and partners involved in ICT for development in the Gambia, including the African Information Society Initiative, Commonwealth Telecommunications Organisation, Economic Community of West African States, Japan International Cooperation Agency, Regional African Satellite Communication, United Nations Development Programme, United Nations Economic Commission for Africa, United Nations Volunteers, and the governments of Egypt, Finland, India and Taiwan.

E-health standards

In spite of numerous developments that characterize the e-government project and programmes, there is a lack of specific e-health standards within the Ministry of Health and Social Welfare. In 1996, with African Development Bank financing, the then Department of State of Health contracted out Health Sector Requirements Studies, which among other things estimated the cost of rehabilitating and equipping selected facilities and proposed strategies for rehabilitating existing maintenance system that form the basis of elaborating health standards.

Consequently, as part of its Participatory Health Population and Nutrition Project (PHPNP) preparations, the Department of State of Health and the International Development Association reviewed outputs of the Health Sector Requirements Studies and agreed to commission additional analyses in order to:

  • conduct a comprehensive assessment of needs
  • finalise the civil works component of the PHPNP project in the context of that assessment
  • prepare a national maintenance strategy in close coordination with the African Development Bank.

Within the scope of the assessment is a minimum package of activities, covering the range of services being delivered at various levels of the health care delivery system as well as complementary resources for delivery of health services. These norms and standards essentially cover a wide range of issues such as staffing, civil works and equipment. Review of the equipment list section versus the schedule of requirements indicates that the goods covered by the contract are grouped together in the following six lots according to the function they will fulfil:

  • Lot 1: Current furniture
  • Lot 2: Medical and hospital furniture and trolleys
  • Lot 3: Standard medical equipment and instruments
  • Lot 4: Medical and surgical equipment
  • Lot 5: Laboratory equipment
  • Lot 6: Imaging equipment and accessories
  • Lot 7: Hospital, logistics and computer equipment.

However, this schedule falls short of expectations for provision for elaboration of e-health standards as there is a complete absence of Internet connection facilities or a plan for a computerized system for health facilities. In spite of inadequacies in terms of e-health standards, there have been remarkable improvements over the years with regards to a set of new health indicators being selected for the Ministry of Health and Social Welfare in 2000, and introduction of a new computer system and HMIS Policy in 2003.

Introduction of the Gambia ICT4D National Policy in 2006 played a pivotal role in reshaping and providing for the needed ICT infrastructure by providing health information to all stakeholders via ICT. The health systems strengthening project of the HIV Round 8 Global Fund project, in addition to the provisions by the Ministry of Health and Social Welfare from 2008 to date, supported the networking of health centres and hospitals in rural areas via ICT with the nearest equivalent institution in urban areas to promote cooperation and collaboration between institutions and supporting the use of audio and video transmission systems to broaden the geographic reach of scarce resources.

In 2010, the Ministry of Health and Social Welfare introduced the District Health Information System (DHIS) version 2 database for the management of the health information through the University of Oslo, Norway.This system is supported by a global network of developers and researchers based at Oslo University.

Citizen protection, equity, and the promotion of multilingualism and cultural diversity

The enactment of ICT Act 2009 serves a legal, regulatory and institutional framework that provides citizen protection, equity, and the promotion of multilingualism and cultural diversity. This legal instrument, which takes into account good governance in ICT among other things, probes into the substance and issues of licensing, access and interconnection, spectrum management and numbering, universal access/services, end-user interests and rights and personal data privacy and protection.

Similarly, another provision in the Act contains information society issues such as computer misuse and cyber crime, electronic signatures and transactions and elements of e-government and broadcasting. In terms of ensuring regulatory effectiveness, the critical role of the Public Utilities Regulatory Authority, established in 2004 by the Public Utilities Regulatory Authority Act to regulate public utilities and enterprises in the electricity, telecommunications, broadcasting, water and transportations sectors, cannot be overlooked.

The Public Utilities Regulatory Authority Act, as umbrella legislation, gives the Authority its regulatory mandate over utility companies and sectors responsible for the provision of water, electricity, postal, sewage, telecommunications, global system for mobile communications (GSM) and other similar services within the country.

Infrastructure

Access to ICT infrastructure

The World Summit for the Information Society Plan of Action emphasized the need for putting in place, by country, infrastructure that is key “to achieving the goal of digital inclusion, enabling universal, sustainable, ubiquitous and affordable access to information and communications technology (ICT) by all, taking in to account relevant solutions already in place in developing countries and countries with economies in transition, to provide sustainable connectivity and access to remote and marginalized areas at national and regional level".

Communication is one of the essential tools for the enhancement of economic, social and cultural development of the people. Development in the telecommunication sector not only supports growth in the economy but also helps boost productivity and accelerates industrial activities, transportation efficiency and social equity.

The Gambia is striving for the improvement of the telecommunications sector, especially with regard to ICT. An enabling environment, created for investment by the Government of the Gambia and harnessed by the private sector over the past years, has led to tremendous improvements in the ICT sector under the Ministry of Communication, Information and Information Technology. The development of the National Information and Infrastructure Policy with its plans and strategies resulted in actions such as e-government as well as other e-strategies. Their inclusion into the Information and Communication (IC) Act has been an important milestones for the Ministry.

As regards the telecommunication infrastructure, the National Post Office is now a semi-autonomous agency; the post office has been modernized with a view to improving postal services for the population.

According to the 2010 Millennium Development Goals assessment report for the Gambia, the Ministry of Communication, Information and Information Technology instituted measures that were aimed at the attainment of socioeconomic development of the Gambia in general, and specifically for the development of the ICT subsector. The following policy directions were implemented:

On the issue of creating an enabling environment and using an appropriate legal framework for the service providers and operators in ICT services, the country undertook the following:

  • developing a telecommunication policy that promoted universal access and continuing to develop the infrastructure;
  • developing a policy on e-government and other electronic intervention areas;
  • setting up the Universal Service Fund, the Frequency Allocation Advisory Committee and Licensing Framework.

Significant progress has been registered since 2008 with mainstreaming into the public service delivery system of selected ongoing programmes of the Ministry of Communications, Information and Information Technology. Achievement are shown in Table 1.

Table 1. Summary of programme achievements in the Ministry of Communications, Information and Information Technology. Adapted from the Millennium Development Goals status report, 2010, the Gambia[7]

The main telephone service provider licensed in the Gambia is the Gambia Telecommunication Company Limited (Gamtel). After it became operational in 1984, Gamtel’s subscribers increased from 2400 to 43 454 in 2009. It has also improved its national coverage from 70% in the 1980s to 100% in 2009. Currently, Gamtel has a fibre network of 534 km (see Figure 1). In 2006, there were 3225 telecentres registered by Gamtel. There were 2275 prepaid and 4047 post-paid subscribers giving a total of 6312 telecentres in 2009. The number of these centres has declined recently due to an increase in the Gamtel tariff and the proliferation of new cellular phone services in the country.

Figure 1. Topology of telecommunication links. Adapted from the Scan-ICT country final report 2007[8]

Telephone lines per 100 population

The number of telephone lines per 100 population has increased from 22% in 2006 to 54.5% and 76% in 2007 and 2008, respectively.

Cellular subscribers per 100 population

In view of the Government’s commitment to ensuring universal access to telephone services, an environment was created for the establishment of Africel, Comium and Qcell cellular phone services. The operation of these three additional cellular phone services in the country has increased competition in the sector, hence the rapid increase in cellular phone lines. Consequently, cellular phone lines increased from 2.89 per 100 population in 2005 to 3.93 per 100 population in 2007. NB: Data on cellular subscribers per 1000 population are available from 2005 to 2007. With the coming of Qcell into operation, the proportion of cellular subscribers per 100 population is expected to increase.

However, the number of cellular phone lines in use in the country has been difficult to establish because there are no centralized data available to capture their distribution at the Ministry of Communications, Information and Information Technology. The cellular telephone service providers issue SIM cards to customers without keeping records of customer details. This is the major problem recognized by the Ministry as a constraint in keeping track of the number of cellular phone lines issued by service providers.

Internet service providers

Internet use has been on the increase in the Gambia. This has been manifested by the large number of cyber cafes and Internet providers in the country. Initially, Gamtel was the sole provider of Internet services but recently other private providers have started providing the service.

Currently, the Internet service providers operational in the country are Connexion Solutions, Gamtel, Netpage, QuantumNet and Unique Solutions.

Access to radio

Radio is the most important source of information for most of the populace in Sub-Saharan Africa. It provides information on a range of issues related to improved health, education and livelihoods, and serves as a channel for the communication of opinions. Households’ access to the radio is near universal in the Gambia, with almost every household with at least one member owning a radio. The radio is the most popular source of information and entertainment in the Gambia, particularly in rural areas. The 2003 Census figures showed that 95.09% of the population had access to a radio. Recent survey reveals that over 80% of the population get news for the first time through radio.

Newspaper companies and access to newspapers

There are eight newspaper companies, which are a source of information to the general public. These newspaper companies are: The Observer, Point, The Gambia Info, Foroya, The Gambia News and Report Magazine, Today, The Daily News and The Standard. Among these newspaper companies, three have gone online with wider coverage and accessibility. There are also online news sites that do not have an equivalent printed version, for example the Gambia News, Wow, etc.

The 2003 Census report on access to the media shows that 19.05% of the population had access to newspapers. It is important to note that an individual reading a newspaper is largely influenced by his or her literacy and poverty status. This probably explains why the proportion of the population with access to newspapers is higher in urban than in rural areas (30.46% and 6.86%, respectively) since literacy rates are higher in urban areas and urban dwellers tend to have the lowest rates of poverty.

Television stations and access to television

The Gambia depended on television signals from Senegal and foreign stations until 1994–1995 when the Gambia Radio and Television Services was established during the Second Republic. Some private channels also operate in the country namely: Premium TV Network, GAM TV and Gambia Electrical. These networks usually charge subscription fees either on a monthly, quarterly, biannual or annual basis. According to the 2003 Census figures on households access to the media, 70.86% of the population have access to television, with the proportion being higher in urban (88.79%) than in rural areas (51.69%).

Availability of a national ICT in health development plan

The current National Health Policy and Strategic Plan 2011-2020, the theme of which is “health is wealth” envisages ensuring acceleration of quality health services and universal coverage. This important vision cannot be realized in the absence of a good health management information system (HMIS) and the necessary ICT support services.

Within the health policy framework, the objective is to improve the timely collection of health data and availability of reliable health information by 2015. In the context of improving ICT within the national health development plan, an HMIS Policy was elaborated in 2003. The goal is to ensure sufficient IT resources are in place to support the HMIS infrastructure on a sustainable basis with these objectives:

  • to identify resource requirements
  • to improve management of IT resources
  • to increase IT capacity.

The Gambia health system strengthening component of the Global Fund Round 8 HIV/AIDS grant in 2008 as one of the intervention areas aims to ensure a timely availability of relevant, reliable health information for effective planning. In order to strengthening the data collection and management system of HMIS, a virtual private network (VPN) has been established with server database, with 14 computers with improvements in Internet connectivity.

Policy on affordability of infrastructure

The Scan-ICT country final report September, 2007 Status of ICT access, usage and exploitation in the Gambia clearly unveils issues and linkages between promoting the ideals of universal access to ICT and affordability of ICT.

Aware of the need to popularize and increase access to ICT, the Government has put in place enabling policies to make the purchase of ICT equipment and the price of accessing the Internet more affordable, for example by introducing a zero-tariff on computers. As the purchase of computer equipment is still far beyond the reach of the average citizen, implementation of such a policy will ensure increase in mass IT literacy among the population. In addition, the Information and Communication Act 2009, Part VIII[9] has made provisions for tariffs and quality of service. Guidelines have also been provided in terms of price caps for the general structure of tariff regulation mechanism.

Prices have remained comparatively low since the liberalization of Gamtel and effective administration of the Universal Service Fund by PURA and this has had a positive impact on both service providers and consumers in terms of cost reduction.

The major problem for the Ministry of Communications, Information and Information Technology in executing their projects has been funding. However, over time the Ministry has been successful in improving its base on radio and telephone service coverage within and outside the country. These facilities have provided alternatives in communication at relatively lower costs. This achievement has been a big boost in the sector’s contribution towards poverty alleviation in the country.

Other challenges the Gambia faces to achieve Millennium Development Goal 8 are:

  • limited resources – in particular aid resources have been declining over the years;
  • continuous heavy debt burden;
  • narrow market for service delivery;
  • regular and sustainable grid-line electricity supply;
  • timely data availability and access;
  • limited financial support to the agricultural sector when compared with the education and health sectors, despite being considered as the backbone of the economy and the engine for poverty alleviation through rural employment creation and the production of food in support of the strive for attainment of food security in the Gambia.

Cultural and linguistic diversity and cultural identity

In the Gambia, women’s access to and control of information and communications technology (ICT) has featured prominently in both the theory and practice of the gender digital divide. Women’s access to and control of ICT is dependent on factors such as gender discrimination in jobs and education, social class, illiteracy and geographic location, which means that the great majority of Gambian women have no access to ICT.

Despite the emphasis of the information society on getting women connected, civil society actors have argued that the issues of access and control are more complex than just connectivity. The high cost of computers and connectivity keep ICT services far beyond the reach of most women. ICT infrastructure is largely urban centred. Internet content is overwhelmingly in English. Insufficient attention is paid to content in local languages and the use of the Internet for women with low levels of literacy and gender roles and other cultural factors translates to the fact that women have less time to make use of ICT.

Existence of multilingual projects, translation and cultural adaptation

With consultations on the existence of multilingual projects, and translation and cultural adaptations, there appears to be no documentary evidence of such support for the creation of software in local languages in the Gambia. However, within the context of a guiding framework of the pillars or priority areas of the National Information and Communications Infrastructure (NICI) Policies and Plans, the Government of the Gambia seeks to discourage the inappropriate use of information and communications technology that is detrimental to the country’s cultural values, ethics, norms and traditional values.

Content

The World Summit on the Information Society Declaration of Principles states that “the ability for all to access and contribute information, ideas and knowledge is essential in an inclusive information society”. The sharing of and access to information and knowledge have become instantaneous due to rapid advances in information and communications technology. Information and knowledge can be shared by removing barriers to equitable access and by strengthening the public domain through public institutions such as libraries, documentation centres, museums, archives and other community-based access points. In addition, information on different software models, such as free and open-source software, can help users to develop solutions that best meet their local information and knowledge access needs.

The Gambia has policies or guidelines for the development and promotion of public domain information to promote public access to such information. One way of generating information and knowledge is by promoting scientific and technological research and development. There exist strategies to foster innovation, science and technology and research. The Information and Communications Act 2009 serves as a mechanism for respecting intellectual property rights while encouraging the use of information and sharing of knowledge. Several initiatives have been undertaken to promote awareness among all stakeholders of the possibilities offered by different software models.

Capacity

The World Summit on the Information Society Plan of Action states that “everyone should have the necessary skills to benefit fully from the information society. Therefore, capacity-building and information and communications technology (ICT) literacy are essential. ICT can contribute to achieving universal education worldwide, through delivery of education and training of teachers, and offering improved conditions for lifelong learning, encompassing people that are outside the formal education process and improving professional skills”.

The Gambia has made significant strides in improving the literacy rate, which now stands at 65%. The country is on course to meet its national target of a 50% reduction in illiteracy rates by 2015. Current trends indicate that the Gambia will attain primary school enrolment targets, although completion rates need to be increased. Primary enrolment increased from 60% in 2001–2002 to 77% in 2008–2009. The reasons for increases in enrolment, especially for girls, include full scholarships, interventions by nongovernmental organizations, and the fact that over 200 schools have been built around the country over the past 10 years.

There were significant increases in enrolment at the Gambia College, Management Development Institute, Gambia Technical Training Institute and the University of the Gambia. The number of academic graduates in the university is increasing, especially for teachers. The Ministry of Basic and Secondary Education continues to be preoccupied with the execution of its mandate to deliver quality education in the areas of early childhood development, basic education, adult and nonformal education, and secondary education.

The specific objectives of the education sector strategy include:

  • extending cost-effective ICT facilities to rural areas to provide Internet access to all schools, as well as adult education and computer literacy classes;
  • utilizing ICT to provide distance and open learning and equitable access to limited resources, especially in remote areas;
  • introducing compulsory ICT training for all professional education staff and students by 2011;
  • maintaining consistent national standards in the ICT education curriculum;
  • creating comprehensive research facilities by linking them locally and internationally with schools, libraries and resource centres, as part of continuing education and e-learning.

Structural organization of health information

Organization and management

Management of health information resources for health care, human, financial and material, still remains a central function of the Directorate of Planning and Information. The Directorate leads the process of setting the health management information system (HMIS) policy and strategic development through multisectoral engagement and active participation of stakeholders. The planning functions for the health system are within the purview of the Directorate. These functions include but are not limited to:

  • budget preparation
  • public expenditure review
  • policy analysis, reviews and strategic planning
  • human resource planning
  • HMIS
  • health systems strengthening
  • health systems research
  • epidemiology, and disease surveillance
  • information and communications technology and applications to the health system
  • quality control and standards
  • maintenance policy monitoring
  • monitoring and evaluation of health sector performance
  • coordination of partners and stakeholders.

In order to perform these planning functions, the Directorate of Planning and Information must correlate financial, health and essential resource information from a variety of sources. The Health Statistics Unit was established in 1976. The Epidemiology Unit was created in 1979 and merged with the Health Statistics Unit to form the Epidemiology and Statistics Unit.

Several reviews of the health statistics system were carried out by donors and partners. The British Overseas Administration conducted a desktop review to assess the system in 1987 through technical assistance. The review looked at the data collection tools and some variables/indicators that were measured. In 1990, the United Nations Population Fund provided technical assistance to improve data collection and analysis for the Family Health Programme of the then Maternal and Child Health Programme Unit. The Centre for Applied Research on Population and Development was subcontracted to develop a computerized database that will facilitate data entry and simple analysis. Dbase clipper software called the Gambia software was produced by the Centre for Applied Research on Population and Development in 1990–1991.

In 1995 and 1998, the WHO Regional Office for Africa provided technical assistance to review the overall performance of the Epidemiology and Statistics Unit in data collection, management, analysis and use. A key recommendation in the report emphasized the need to move the statistics component to the Directorate of Planning and Information and to provide enough resources to facilitate computerization.

In 2000, the Participatory Health, Population and Nutrition Project provided funds to assess and put in place an integrated, computerized and functional health information system. The assessment focused on five areas: data collection tools, database, indicators, personnel and infrastructure. A 5-day indicators selection workshop was carried out at Tendaba Camp and involved all stakeholders, including partners, donors, and private and nongovernmental organizations. Although, the reviews contributed to some improvements in strengthening the health information system, there still exists a fragmented and vertical health information system operating within the Department of State for Health and Social Welfare. This is mostly due to lack of consensus on ownership, leadership and coordination.

The Health Metrics Network (HMN) project and framework is meant to establish norms, standards and principles for health information system development based on the two pillars: the normative and the roadmap. The Gambia was among the low and lower-middle income countries invited to the Nairobi HMN intercountry workshop on 2–4 August 2005. It was at this workshop that the HMN framework, monitoring and needs assessment tool was first introduced to participants.

The presentations were followed by a country proposal development exercise. The country was represented at this meeting by the manager, Health Management Information System, Directorate of Health Planning and Information, and a principal statistician from the Gambia Bureau of Statistics.

In November 2005, the Gambia completed and submitted to HMN a proposal to support strengthening Gambia’s health information system development. The independent review committee approved the country’s proposal for the sum of US$ 70 000 to conduct three main activities:

  • health information system needs assessment
  • a comprehensive HIS Strategic Plan
  • capacity-building from 1 May 2006 to 30 April 2007.

HIS institution, human resources and financing

The Gambia Health Information System (HIS) Unit is housed in the Directorate of Health Planning and Information, Department for State for Health and Social Welfare. The Unit has appointed data entry clerks at all the six divisional health offices and all major government health centres. There are also HIS focal persons in all the government hospitals and programme units at the Department of State for Health and Social Welfare.

At the central level there is only one trained health information officer who is the health management information systems manager. Other staff include a senior health planner, a statistician (on the job training), an information and communications technology (ICT) officer and a data entry clerk.

At the subnational level there is no trained health information officer but there are plans to create such positions in the national budget estimate in the near future. This will be followed by the recruitment. Currently, the Government takes care of the salaries of all HIS Unit staff on a yearly basis. The Unit is faced with the problem of high attrition in both the information and IT sections, owing to low wages, poor working environment and lack of motivation. The funds for financing the HIS Unit other than staff salaries are mainly provided by donors and partners, mostly loans through projects such as the then Participatory Health, Population and Nutrition Project. Although there are budget line items provided for in the annual government budget estimates, the Unit has had problems in accessing them.

ICT equipment, including computers, Internet services, servers and accessories, were bought by the then Participatory Health, Population and Nutrition Project. Currently the Unit is faced with the problems of paying annual Internet subscription fees and bills, and the maintenance and replacement of equipment. In the area of software development, there is limited capacity in-house to take care of it and this is usually subcontracted to other computer firms. The Unit uses Microsoft Excel for data entry and management. There is a need to develop user-friendly software for data management and analysis. The capacity of IT staff needs to be developed equally to enable them to handle the issue.

The HIS Unit has an office space provided at the central level with some infrastructure at the subnational level. In 2005, a local area network was established, connecting almost all programme units to Internet services through a server. There is a need to provide electric power back-up to provide continuous supply of power to aid data entry, processing and management. Fuel supply should be provided on a regular basis to keep stand-by generators running.

The Gambia had one of the first computerized health information systems in Africa, based on the use of custom database software developed by the Centre for Applied Research on Population and Development. The system enabled the Ministry of Health and Social Welfare to produce annual statistical reports that summarized output.

Overview of the flows of information

The selected health indicators include measures of demographics, health status, health and the environment, reproductive health, inpatient and outpatient services, and overall service delivery. A system of reporting exists, defining reporting responsibility, the frequency of reporting and what each level should expect from the others. The ultimate responsibility for ensuring the quality and accuracy of the data rests with the officer in charge at each level. The organizational diagram below depicts structural flow of information within the system.

Organogram of the Health Information System under the Directorate of Health Planning and Information

Organogram of HIS under the Directorate of Health Planning & Information gambia.png

(HMIS, health management information system; HMN, Health Metrics Network; IDSR, Integrated Disease Surveillance and Response; NGO, nongovernmental organization; NPS, National Population Secretariat; UNFPA, United Nations Population Fund; UNICEF, United Nations Children's Fund; WHO, World Health Organization)

Specific regulatory framework

The legal and regulatory context within which health information is generated and used is an important element, since it enables the establishment of mechanisms to ensure data availability, exchange, quality and sharing. Legislation and regulation are of particular significance in relation to the ability of the health information system to draw upon information from both private and public health services, and from non-health sectors.

Furthermore, the existence of a legal and policy framework consistent with international standards enhances confidence in the integrity of the results. Quality information is essential for guiding policy-makers in the evidence-based decision-making necessitated by budgetary constraints. When used effectively, information can maximize the use of limited resources, support policy formulation, and facilitate priority-setting, planning and programme monitoring. Investment in improving the quality of available information will be returned with optimized resource management.

However, the development of a health information legal framework to ensure mandatory and timely reporting by all health institutions to the health information system is essential, as this helps ensure that all health and health-related acts conform to the health policy. It is to be noted that no legal framework for mandatory reporting of health information exists in the Gambia. A Health Information System Policy is available but is not yet fully implemented.

Data sources and generation

Since 1998 to date there has been a lack of a unified monitoring and evaluation plan in the Ministry of Health and Social Welfare. This situation has resulted in a separation between data sources and the elaboration of a logical framework with types of data sources and their generation. Owing to this situation, most programme units have developed monitoring and evaluation systems and plans that may sometimes run against the national health system in the Gambia.

The Health Management Information System Unit has put in place data management guidelines with descriptions of data collection sources, primarily from health facility registers. On the other hand, data for the indicators in the monitoring and evaluation plans of specific intervention programme units such as HIV/AIDS, tuberculosis and malaria come from routine programme activity monitoring, surveys and other special studies.

These data sources provide information that facilitates understanding of programme performance and guide strengthening of programme implementation. A number of existing data collection and reporting tools have been revised and new ones introduced, among other things to include gender disaggregated data set in 2010, supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations Children's Fund in order to capture data on all the indicators in the monitoring and evaluation framework.

The main sources of health data are censuses and surveys, vital registration and hospital/administrative records. While censuses are conducted every 10 years, periodic surveys are carried out to meet intercensal demands for health data. The content of health and health-related data collected in these surveys is adequate for health-planning purposes.

On the other hand, registration of births and deaths is a routine activity done at the Directorate of Health Services, while marriages and divorce are registered at the Department of State for Justice. Though the content of the vital registration system may be adequate, the coverage is generally not adequate. Hospital records are mainly on major communicable and noncommunicable diseases and clinical data. These records are not sent to the Health Management Information System Unit. An assessment report in 2006 indicated the status of the aforementioned data collection methods was inadequate and required adjustment (see table).

Health management information system data sources. Adapted from The Gambia health information system 2006: review and assessment.[10]

Despite the lack of an monitoring and evaluation plan and logical frameworks for the Ministry of Health and Social Welfare, core types of data sources have been relied upon based on identified national and internal health indicators under the programmes:

  • national censuses
  • civil registration and vital statistics, such as births and deaths
  • health facility surveys
  • the Gambia Demographic and Health Survey.
  • surveillance systems based on Integrated Disease Surveillance and Response strategy, including additional information obtained from sentinel sites for HIV/AIDS, malaria and other disease and health system research.

The frequency and timeframe for these data sources differ but they have been carefully selected to meet the various reporting requirements.

Censuses

A wide range of health indicators are covered by the Gambia Bureau of Statistics in Population and Housing Censuses and in ad hoc surveys jointly conducted by the Ministry of Health and Social Welfare and other stakeholders.

Indicators covered in Population and Housing Censuses include life expectancy at birth and at various ages, infant and under-five mortality rates and crude and age-specific death rates. Population and Housing Censuses are conducted every 10 years, with the last having been carried out in 2003.

From the analysis of the 2003 data, life expectancy for the population has increased to 64 years with sex differentials of 62 years for males and 65 years for females. The 2003 census also shows a reduction in the mortality rates among infants and children aged under 5 years. The infant mortality rate declined to 75 per 1000 live births (79/1000 among males and 70/1000 among females) whereas the under-five mortality rate declined to 99 per 1000 live births (103/1000 among males and 94/1000 among females). Intercensal estimates of these indicators are usually done to facilitate population projections.

Censuses and surveys are principally conducted by the Gambia Bureau of Statistics in collaboration with other stakeholders. However, the capacity of the Gambia Bureau of Statistics is limited in terms of human, material and financial resources to adequately conduct censuses and surveys without delay. For example, a post-enumeration survey was planned for the 2003 census but owing to inadequate human and material resources this could not take place.

Civil registration and vital statistics systems

The registration of births and deaths with government authority commenced around the 1880s in the Gambia. At that time it was meant for British colonial masters and few of their subjects. It was then centred in Bathurst and MacCarthy Islands. After independence in 1965, it became the responsibility of the Head of State to determine the scope and extent of births and death registrations in the country.

However, the Ministry of Health and Social Welfare does not have the capacity to computerize the vital registration system and have statistical focal persons at regional level and a health data analyst at national level. In addition, there is only one hospital that uses the International Classification of Diseases (ICD-10) and that is the Royal Victoria Teaching Hospital.

Health surveys

Numerous household surveys with health modules are carried out between censuses by the Gambia Bureau of Statistics in collaboration with the Ministry of Health and Social Welfare and other stakeholders to meet the demand for health data at both national and international levels. Health and health-related indicators covered in these ad hoc studies include maternal mortality, immunization coverage, delivery assistance and malnutrition.

According to the results of the last maternal mortality study, the Maternal Mortality Survey 2001, the maternal mortality rate is currently estimated at 730 per 100 000 live births. Given the importance of maternal mortality for health planning and for monitoring the empowerment of women, some institutions and individuals are requesting that the Gambia Bureau of Statistics should attempt to collect the data in the Population and Housing Census. Although these requests were tabled before stakeholders for the 2013 census, it should be noted that addressing maternal mortality in a Population and Housing Census would be costly and time consuming. Consequently, a Demographic and Health Survey aimed at collecting indicators on maternal mortality ratio and other health indicators has been carried out in 2013.

Immunization coverage among children and skilled attendant at birth for pregnant women are important health indicators that are collected on a periodic basis, for example in the maternal mortality survey and the Multiple Indicator Cluster Survey. Results of the Multiple Indicator Cluster Survey 2010 show that immunization coverage among children aged 12–23 months was xx% while skilled attendant at birth was 56.6%.

The health status of the population, and particularly of pregnant women, lactating mothers and children, to a large extent depends on their level of nutrition. The Ministry of Health and Social Welfare in collaboration with the National Nutrition Agency regularly collects anthropometric data to determine the extent of malnutrition among infants and children aged under 5 years. On the other hand, the Multiple Indicator Cluster Survey sponsored by the United Nations Children's Fund and executed by the Gambia Bureau of Statistics and the Ministry of Health and Social Welfare is carried out every 5 years. The frequency of Multiple Indicator Cluster Surveys has now been reduced to 3 years.

The Government of the Gambia's commitment to containing the spread of HIV/AIDS and other sexually transmitted infections is high. Funds have been made available to the National Aids Secretariat and the National AIDS Control Programme. The National Aids Secretariat conducts sentinel surveillance at eight sites, data from which are used to monitor the impact of their activities on the population. In addition, with the Global Fund to Fight AIDS, Tuberculosis and Malaria project under Round 8, behavioural surveillance survey studies have been conducted, especially for the most-at-risk groups.

The National Malaria Control Programme, in collaboration with partners, has instituted routine Malaria Indicator Surveys at both health facility and community levels through the Global Fund malaria consolidated grant, yielding extremely useful information. In addition, the recent setting up of a malaria sentinel surveillance system is useful for providing a programme-level source of health data on the trend of malaria in the country.

With regards to tuberculosis (TB) control, the overall goal of the National Leprosy and Tuberculosis Strategic Plan 2008–2012[11] is to reduce transmission, morbidity and mortality of TB so that it is no longer a public health problem in the Gambia. The impact indicators identified include TB prevalence rate, and HIV prevalence in TB patients. The last TB prevalence survey in the Gambia dates back to the 1960s. Since then the true prevalence of TB remains questionable as it has been generally recommended by WHO that periodicity of such a data collection be 5–7 years. However, with the approval of the Global Fund Round 9 TB grant in 2009, the National Leprosy and Tuberculosis Control Programme and the Medical Research Council will be implementing another TB prevalence survey in 2011.

Routine surveillance of HIV prevalence in TB patients obtained from voluntary counselling and testing registers has been ongoing since 2007 under the Round 5 TB grant culminating in annual reporting of prevalence data. Operational research and behavioural surveillance has also been undertaken by the Medical Research Council. It should be noted that special programme assessments such as periodical reviews have been undertaken with support of WHO.

Surveillance systems

In the Gambia, routine disease surveillance is conducted by health care system workers at all levels of health care and coordinated at the regional level by regional health teams. Overall responsibility for the processing and analysis of the data is in the purview of the Government of the Gambia's Epidemiology and Disease Control Unit within the Directorate of Planning and Information. However, a review of the health information system has highlighted a number of weaknesses, including the poor quality of data being generated, the incomplete nature of these data and their poor dissemination.[12] This has led to a proposal developed for overhauling the system.

Issues considered for resolving the challenges faced by the Health Management Information System Unit include:

  • reformulating guidelines and data collection forms for disease notification and health service statistics
  • ensuring that data collection is regular and of high quality
  • increasing the capacity of regional health team staff and health facility staff to analyse their own data
  • ensuring that information is disseminated widely and rapidly
  • ensuring nongovernmental organizations and private practitioners also participate in the system.

In addition, owing to limitations of service-based data, it was proposed that a sentinel surveillance system be established.

A technical guideline for Integrated Disease Surveillance and Response in the Gambia has been developed by the Ministry of Health and Social Welfare with support from WHO and partners, and has been in use since 2008. Capacities of regional health team staff and health facility staff have been improved through trainings conducted by the Health Management Information System Unit and the Epidemiology and Disease Control Unit on the application of Integrated Disease Surveillance and Response tools, as well as on establishment and operation of sentinel surveillance of malaria.

Systematic documentation of contextual and qualitative data

Census and survey data are available in publications. With the advancement of the e-government strategy and establishment of official websites by all ministries, data from the 2003 Housing and Population Census and the 2006 Multiple Indicator Cluster Survey up to the 2010 Multiple Indicator Cluster Survey can be downloaded from the Gambia Bureau of Statistics website.

With regard to hospital/administrative records, annual service reports are produced but these do not adequately cover all aspects of health service delivery (e.g. drug information, staffing by cadre) and they do not provide an in-depth analysis of the data they contain. A general health database was created and installed at the Ministry of Health and Social Welfare, which is regularly updated.

Health research

The growth of any national health service must be responsive to research innovations of all types. While there is an abundance of research on the biomedical services there is a paucity of research on health systems in the Gambia, and local capacity for such research is limited.

In view of the strategy to provide basic health care and to fulfil the requirements of primary health care, the overriding need is for studies to assess health delivery systems, the impact of services and the nature of prevailing health problems, especially in the underserved rural areas.

The National Health Research Policy 2010–2014 has been finalized.[13] The establishment of a national body (functional autonomous National Health Research Council) to coordinate and set priorities of all research within the health sector was highlighted. The first priority is to set up a database of all research conducted in the country and a review of their findings. One of the reasons for this is the fact that the Government of the Gambia's Directorate of Planning and Information presently lacks material resources that will enable an effective and efficient running of the Health Systems Research and Documentation Unit.

Formal structures exist to facilitate, regulate and monitor health research activities with the health sector. These include an Ethics Committee at the Royal Victoria Teaching Hospital, the only teaching hospital, and a Research and Publications Committee at the University of the Gambia's School of Medicine and Allied Health Sciences. The Medical Research Council's Scientific Coordinating Committee was set up to coordinate research activities. It consists of Medical Research Council staff members and three representatives of the Government of the Gambia, including a member from the Ministry of Health and Social Welfare.

The mandate of the scientific and ethics committees at the Royal Victoria Teaching Hospital, University of the Gambia, Royal Victoria Teaching Hospital and the Medical Research Council is to review research proposals for scientific rigour. This involves:

  • critically discussing and determining the scientific merits of projects proposals
  • providing technical advice to investigators
  • assessing staffing and budgetary planning needs of projects and providing technical advice when needed to researchers.

However, the oversight role of these committees is limited. A significant number of research activities, mainly operational research studies, qualitative studies and programme reviews relevant to the health sector, are conducted without prior review by the scientific committees of the University of the Gambia, Royal Victoria Teaching Hospital or Medical Research Council. Furthermore, there is no legal framework to guide the functioning of committees in either the public or nongovernmental sectors.

Ethical review of research proposals is conducted by three committees:

  • the Ethics Committee at the Royal Victoria Hospital reviews research proposals to be conducted in the Royal Victoria Teaching Hospital;
  • the Research and Publications Committee of the University reviews research proposals submitted by staff of the University of the Gambia and partners;
  • the Government of the Gambia/Medical Research Council Joint Ethics Committee was set up to ensure that research activities are conducted in line with established international ethical principles and standards.

The role of the Government/Medical Research Council Joint Ethics Committee has evolved since its establishment. The membership consists of representatives of the Medical Research Council, the Government and lay persons in conformity with international standards. The Committee, which meets monthly, is responsible for the ethical review of proposed research projects submitted to the Medical Research Council Scientific Committee and the University Research and Publications Committee. This includes:

  • ensuring that study protocols conform to bioethics of research; evaluating health and safety provisions made in the proposal, assessing any potential risks involved;
  • protecting the interest of study participants and seeking expert opinion, where necessary to inform the ethical review process.

The functioning of the Committee is limited as it has no legal mandate to enforce its decisions.

Data management

The Gambia's Health Management Information System Policy[14] has outlined clear strategies for the management of information/database management. In addition, The Gambia health information system assessment review and assessment has identified the need to develop guidelines for data management in the Ministry of Health and Social Welfare . The same study[15] intimated that management of statistical and health data require a suitable working environment with the requisite hard and soft ware needs to be in place as well as the professional skills in information technology. Some of the problems with information/database management within the current structure as per the assessment were:

  • inadequate resources and trained staff at all levels
  • inappropriate access to and use of information
  • duplication of information
  • inconsistency of information.

In 2010, with the support of WHO and partners, data collection and management guidelines were developed specifying:

  • reporting responsibilities
  • routine data collection
  • instructions for completing monthly and quarterly returns, organizing and keeping track of data with the total exclusion of other data sources such as administrative records, studies and/or research-based information.

Data collection

The Health Management Information Policy[16] sets the strategic direction as a basis for health research in the identification of research topics. Conversely, information obtained through research is expected to feed into the health management information system.

There is no established mechanism for the systematic collection of non-routine data regarding health research. The National Health Research Policy and Strategic Plan 2010–2014 has been developed; however, it does not clearly define how data generated from sources such as surveys will be systematically collected.

The situation is totally different with well-established research institutions such as the Medical Research Council UK/the Gambia who, for obvious reasons, have put in place systems and processes to deal with data generated from biomedical research. Data collection and management guidelines for the National Health Management Information System Unit have existed since 2010. It is interesting to note that no specific mention has been made of data collection relating to health research. There is therefore an urgent need to develop data collection and management guidelines that cater for health research.

Data compilation, storage, management

The issue of data compilation, storage and management is critical for any national health system. In the Gambia there are gross inadequacies in terms of managerial capacity and appropriate resources, which has led to research data being compiled, stored and managed at different levels as well as with different institutions and individuals within the health care delivery system. Serious consideration should be made for integration of this issue into specific research data collection and management guidelines.

Data sharing and access

The Ministry of Health and Social Welfare has conducted many studies in the Gambia; however, it has not effectively used information from these studies and from routine health statistics to identify research topics. Inadequate use of research results is due to several factors:

  • lack of communication and collaboration between researchers and potential users of research results;
  • lack of access to research data in the public sector;
  • data ownership is narrow and is mainly placed with individual researchers and their institutions.

Sharing and access to research data has significantly improved, given the fact that numerous platforms such as libraries, Internet access, exchange forums and academia serve as important sources. The Medical Research Council disseminates research findings in peer-reviewed journals, the local press and during technical and public meetings.

The National Health Research Policy[17] states that “avenues for the dissemination and utilization of research findings to the public will include the setting up of regular public forum, policy briefs for decision-makers and policy-makers and the distribution of copies of published article”.

Several health research studies whose findings could be used to improve health have been conducted in the Gambia. Individual institutions have established systems and mechanisms for disseminating their health research results by:

  • publications in international, peer-reviewed journals
  • annual research retreat meeting
  • annual institution reports
  • community meetings such as open days, etc.
  • open seminars and workshops
  • internal reports
  • websites.

However, the health sector has underutilized the research findings due to:

  • lack of awareness of their existence
  • inaccessibility of the research reports
  • failure to appreciate the value of the finding for policy formulation and programme implementation.

There is a need to integrate the various sources of information into a national information system and to make information and communication technologies accessible to all sources and potential users of information. Inadequate use of research results due to lack of communication and collaboration between institutions, researchers, other stakeholders and potential users of research findings is a persistent problem.

Limitations to data sharing and access in the Gambia are also triggered by increasing concerns about biopiracy related to potential benefits that can be patented from research studies or related activities conducted. The sheer lack of a specific legal framework to protect intellectual property rights derived from research activities is a major hindrance. As indicated earlier, guidelines and protocols must be established for this purpose.

Data quality and analysis

In the Gambia, the public sector lacks set procedures to track, coordinate and monitor health research in relation to research topic, objectives, location, timing and reporting. There is an absence of a coordinating structure to collate findings emanating from research studies, and inadequate human resources within the public sector to analyse and interpret findings to inform the development of policies and the revision of programmes.

The Medical Research Council has established mechanisms to monitor the safety of research subjects in clinical trials of new interventions. Emphasis on development guidelines and protocols, especially within the public health sector, cannot be overstated.

Estimation methods

In the Gambia, the Ministry of Health and Social Welfare has set up formal structures to facilitate, regulate and monitor health research activities with the health sector. These include:

  • an Ethics Committee at the Royal Victoria Teaching Hospital, the only teaching hospital
  • the University of the Gambia has established a Research and Publications Committee in its School of Medicine and Allied Health Sciences.

The Medical Research Council Scientific Coordinating Committee was initiated by the Council to coordinate research activities. It consists of Council staff members and three representatives of the Government of the Gambia.

The mandate of the scientific and ethics committees at the Royal Victoria Teaching Hospital, University of the Gambia and the Medical Research Council is to review research proposals for scientific rigour. This involves:

  • critically discussing and determining the scientific merits of projects proposals;
  • providing technical advice to investigators;
  • assessing staffing and budgetary planning needs of projects and providing technical advice when needed to researchers.

The Government of the Gambia/Medical Research Council Joint Ethics Committee review of proposed research projects is submitted to the Medical Research Council Scientific Committee and the University Research and Publications Committee. Study protocols are assessed to:

  • conform to bioethics of research;
  • evaluate health and safety provisions made in the proposal, and potential risks involved;
  • protect the interest of study participants and seek expert opinion, where necessary, to inform the ethical review process.

The Gambia Bureau of Statistics is the statistical arm of the Government which provides guidance in drawing up estimation methods for many research activities conducted by the Ministry of Health and Social Welfare, especially large-scale surveys.

The seven elements of data quality[18]

The Gambia health information system review and assessment 2006 shows the analysis of the quality of the various data collection methods such as census, vital statistics, population-based surveys, health and disease records (including disease surveillance systems), health service records and administrative records. With the exception of timeliness and disaggregation, all the other elements assessed were found to be available but not adequate (see figure).

Statistics

Since its establishment in 1976, the Health Statistics Unit has been charged with the responsibility to collect, compile and provide health information on all health and disease indicators. From that time on, the Unit, which is now an integral part of the Health Management Information System Unit within the Government of the Gambia's Directorate of Planning and Information, continues to publish annual health statistical reports. It also provides for a number of indicators that will enable progress towards increasing access to quality health care for the poor to be measured.

Introduction of a computerized system was first set up in 1986, with support from the British Overseas Development Assistance. In 1990, the new Centre for Applied Research on Population and Development developed new computer software for data entry of health indicators and with further development a new set of health indicators and a new computer system was introduced in 2000.

In 2010, a statistical software and database called DHIS2, an open-source and free software, was launched and this has enhanced the capability and production of statistical reports.

Access to existing global health information, evidence and knowledge

As part of the roll-out of the e-government strategy and implementation of information and communications technology applications in the Gambia, government services have extended Internet connectivity, web presence and provision of services online. In 2004, the Ministry of Health and Social Welfare, the then Ministry of Health, launched its website, thereby creating access to global health networks through established external links. Recently, a new website has been developed through support from the Ministry of Communications, Information and Information Technology and is powered by NetPage, which is an independent service provider within the private sector.

The initial setting up of the website had limited connectivity confined to central level administration of the Ministry. Gateways and external links to health information now include: ActionAid - the Gambia, Bill & Melinda Gates Foundation, Catholic Relief Services, the Gambia, ChildFund, GAVI Alliance, United Nations Children's Fund, United Nations Educational, Scientific and Cultural Organization, West African Health Organisation, World Bank, World Health Organization and other international research and development agencies. Apart from these, the generation of information and knowledge by promoting scientific and technological research and development has been the cornerstone of government policies.

Availability and use of indexes of local, non-English, and unpublished

In the Gambia, initiatives that support the creation of software in local languages have neither been fully developed and/or explored. The nonformal education services are well established and, apart from the use of English language in the formal schools system, the use of Arabic has been widely applied in nonformal settings including the madrassas. French language continues to gain prominence and forms an important part of the school curriculum. These opportunities have not been fully harnessed in the country. However, faith-based nongovernmental organizations and other civil society organizations explore the use of local languages in their developmental literature. These materials need to be appropriately sourced, indexed and published.

Availability and use of search engines, networking platforms

The e-resources of the University of the Gambia library guide provide at least five search engines for scholarly publications: Citeseerx; Scholar, Scirus, Social Science Research Network and TechXtra.

There are also three metasearch engines, which search many search engines at once: IxQuick, Clusty and DogPile.

Availability and use of open access journals

Greater available and use open-source electronic journals has been put at the disposal of the University of the Gambia. Listings of 16 websites were completed as part of the comprehensive library guide. Among the sites that offer free and open access are:

The University of the Gambia library subscribes to many useful online databases such as:

and many more.

The University of the Gambia library electronic resources guide lists good-quality and evaluated subject gateways, electronic journal databases and other web resources.

Access to copyrighted publications

The University of the Gambia library has an e-resources guide that creates access to a multiplicity of electronic resources, including journal databases, electronic books, subject gateways and many other useful web resources. The guide, which is fairly comprehensive, enables staff and students to find relevant information to support their teaching, learning and research.

It is possible to access 16 databases for electronic journals, including the famous Health InterNetwork Access to Research Initiative (HINARI). Login as a registered user to search the database is ensured through provision of a username and password. Other databases are open access journals and provide links to other online open access journals of interest published by renowned research foundations, including medical research.

Regarding electronic books and publications, the guide lists 10 websites that provide access to free electronic books. On purchase, these have been incorporated within the guide.

In addition, the guide contains contains 13 websites for information gateways, two websites for electronic working papers, three websites for online dictionaries and encyclopaedias, two websites for Internet tutorials, two websites for news search, and one website for referencing tools.

Regulatory frameworks on intellectual property

With the enactment of the Information and Communications Act 2009, mechanisms have been put in place in the Gambia for respecting intellectual property rights, while encouraging the use of information and sharing of knowledge.

Storage and diffusion of information, evidence and knowledge

There is no systematic storage and diffusion of information in the Gambia. No written policy exists that clearly states for how long source documents need to be retained. Data management guidelines exist; however, there is no data dissemination plan. The Gambia health information system review and assessment 2006 attempts to define how health information is transmitted through the system with a conceptual framework (see figure).

Ministry of Health and Social Welfare conceptual framework health management information flow diagram. Adapted from the Gambia health information system review and assessment 2006[19]

Availability and use of health libraries and information centres

Health libraries and information centres follow the establishment of health institutions within the Gambia. There are four health training institutions:

  • the School of Nursing and Midwifery (State Registered Nurses) in Banjul
  • the School of Public Health in Brikama
  • the School for State Enrolled Nurses in Bansang
  • the School for Community Health Nurses in Mansakonko.

These four schools have health libraries open to resident students and staff.

Information centres have also been set up in three regional health team offices prior to 1993, when the decentralization of the health system began. Currently with six health regions country wide, all regional health offices have resources such as books and other hard publications serving as general-purpose health reference materials. However, management of these resource centres is unsatisfactory and the lack of capacity of record keepers has diminished the usefulness of their presence. Their literature is either outdated or irrelevant to new and emerging realities of health systems development.

The health training intuitions also face a similar crisis, which has adversely affected the utility of most reference materials on their book shelves.

Availability and use of publications in appropriate formats and languages

In the Gambia, most available publications are in English, with appropriately designed formats. Other languages such as French and Spanish will require translations.

Consolidating and publishing existing evidence for policy and decision

The long absence of consolidation and dissemination of existing evidence in the Gambia was mainly due to the lack of access to research data in the public sector. Generation of evidence, which is often conducted mostly outside the public sector domain, narrows data ownership and restricts sharing and open access.

Lack of a coordinating structure to collate findings emanating from research studies is coupled with insufficient skilled health personnel within the public sector to analyse and interpret findings to inform the development of policies and the revision of programmes.

Mapping and sharing experiential knowledge, including best practices

The concept of mapping and knowledge migration is not a new phenomenon in the Gambia. This could be in the form of constructing scientific concept maps, principles, theories, nature of scientific thinking, value of visual representation, basic types of knowledge, and meaningful and mindful learning. Whether in academic, managerial and research circles, sharing of experiential knowledge can be regarded as a continuous process.

The Personnel Management Office/United Nations Development Programme project, Public Service Reform and Institutional Capacity Development, provides capacity-building training in strategic management and strategy formulation. Strategy mapping for key government institutions in the Gambia was a classic example of this approach in 2009 in a strategy formulation process for sectoral lines ministries, generating strategies using a strengths, weakness, opportunities and threats (SWOT) matrix, strategic mapping was utilized for knowledge sharing.

However, it is important to stress that knowledge integration is difficult but essential, and availability and access to such common literature is rare. Different technical experts also use analytical frameworks to transmit experience and share knowledge in this form.

Indexing of local publications in international indexes

The Health Management Information System Policy[20] states that it “will make research findings readily available to the Ministry of Health and Social Welfare and its stakeholders for more informed decision-making”. A key strategy is to incorporate an index of health research studies within the Health Management Information System Unit.

The National Health Research Policy 2010–2014[21] calls for "strengthening of the Health Systems Research Unit to conduct and co-ordinate health research activities in the Ministry of Health and Social Welfare and be involved in maintaining a database of on-going research in the country”. There therefore appears to be a duplication of roles between the Health Management Information System Unit on the one hand and the Health Systems Research Unit on the other.

However, in practice there is no evidence of the availability of any local publications in international indexes despite the vast wealth of literature available in almost all the main local languages used in the Gambia. The Ministry of Basic and Secondary Education, through the then Directorate of Non-Formal Education Services, introduced teaching and learning materials on a wide range of subjects in their literacy programmes, some of which cover health issues. A Curriculum and Research Unit has also been established under this Directorate. The human, infrastructure (including finance) and logistical inadequacies of the Health Management Information Unit and poor intersectoral collaboration and networking with relevant partners are obvious reasons.

The Medical Research Council in the Gambia was established in the Gambia in 1947 and is the UK’s single largest investment in medical research in a developing country. The Unit’s research focuses on infectious diseases of immediate concern to the Gambia and the African continent, with the aim of reducing the burden of illness and death in the country and the developing world as a whole.

The Bacterial Diseases Programme is composed of two divisions: acute respiratory infections and tuberculosis (TB). The Programme is engaged in a wide range of projects dealing with clinical, epidemiological and laboratory science, often preparatory to small-scale (phase I and II) and large-scale clinical intervention (phase III and IV) trials. The trials are undertaken in collaboration with the Government of the Gambia and entire communities are often involved in programme activities. In addition, the Programme provides laboratory diagnostic services for the Medical Research Council hospital and reference culture and drug susceptibility services for the Government's National TB Control Programme.

The WHO Regional Office for Africa designated the Medical Research Council's microbiology laboratory as a subregional reference laboratory for surveillance and response for epidemic pathogens in February 2004, and the Bacterial Disease Programme's bacteriology laboratory has been recently accorded a WHO subregional pneumococcal reference centre.

Up to 37 publications from the Bacterial Disease Programme appeared in peer-reviewed journals between 2005 and 2006 alone. In spite of these opportunities, the Ministry of Health and Social Welfare is yet to use these to its advantage, i.e. ensuring the indexing of research findings. This also excludes studies conducted by the different health programmes within the Ministry itself.

Research

The Gambia stands out among many developing countries that have engaged in research from a wide range of disciplines. There are well-established research organizations such as the Medical Research Council which is a leader in biomedical research. Other research intuitions include the International Trypanotolerance Centre established in 1970s that specializes in veterinary medicine and recently the National Agricultural Research Institute. Independent researchers of national and international origin generate information, evidence and knowledge that inform policies and decision-making of the Government of the Gambia and partner agencies.

Stewardship

A fundamental objective of the National Health Research Policy[22] is to establish structures for health research governance. An autonomous National Health Research Council will be set up to provide leadership in national health research. Its key functions are to:

  • set standards;
  • arbitrate on ethical issues;
  • develop mechanisms for tracking, coordinating and monitoring health research;
  • provide advice to the Government of the Gambia and international bodies on research issues;
  • initiate the setting of the national research agenda.

In addition, the Council will facilitate health research priority-setting and the coordination and monitoring and evaluation of health research, including clinical, biomedical, health systems, operational, behavioural, health economics and epidemiological research. The Council will also exercise oversight control over institutional scientific committees in academia, public, nongovernmental organization and private sectors.

In terms of mechanisms for dissemination and utilization of health research findings, the Council will oversee the development of a communication and utilization strategy that identifies the setting up of regular public forums, policy briefs for decision-makers and policy-makers, and the distribution of copies of published articles as an open access to primary data and published findings of research results.

Financing

Currently, the bulk of scientific research in the Gambia, consisting largely of basic science studies and clinical trials, is conducted, managed and financed by the Medical Research Council. Funding by national authorities and institutions still remains relatively low. National health research funding from the private sector is nonexistent. The high potential of this source remains untapped.

The Gambia, like other countries in the WHO African Region, faces the challenge of how to allocate adequate resources from the health budget to health research. Declining health budgets and competing interests have contributed to the deprioritization of research activities.

Creating and sustaining resources

Institutional capacity to conduct research varies in the Gambia. The nongovernmental sector is more developed, with the Medical Research Council being the research institution that is building most capacity in the country. The Ministry of Health and Social Welfare's institutional capacity for health research still remains generally weak.

The Directorate of Planning and Information, which is responsible for overseeing research activities, has neither the number nor the mix of staff to facilitate, regulate, carry out and monitor health research activities within the public sector.

Research output

Until recently, outputs of research in the Gambia were not subject to any systematic reviews and meta-analyses of evidence, etc. within the public sector. In 2010, the Ministry of Health and Social Welfare launched a public forum that attracted research findings from individual researchers and research institutions.

Use of information, evidence and knowledge

According to the Gambia health information system review and assessment 2006,[6] analysis of results on the indicators regarding information dissemination and use showed gross inadequacies in the use of information for policy and advocacy, planning and priority-setting, resource allocation and action.

Analysis of results on indicators regarding information dissemination and use[6]

Formatting and packaging of evidence for policy and decision making

Lack of analytical skills among information producers and managers in data analysis, interpretation and reporting (including presentation) is a key factor for inappropriate formatting of evidence for policy-making and decision-making in the Gambia.

The table and figure summarize The Gambia health information system review and assessment[6] and policy implications

Health information system components, Source: The Gambia health information system review and assessment[6]
Resources 45%
Indicators 66%
Data sources 40%
Data management 37%
Information products 60%
Dissemination & use 48%
Components of health management information system (HMIS) needs. Source: The Gambia health information system review and assessment[6]
Components of HMIS Needs gambia.png


Indicators scored the highest at 66%, followed by information products at 60%.

Sharing and reapplying information and experiential knowledge

In the Gambia, tools and techniques using information and communications technology are used to disseminate information to audiences in schools through lectures, formal public presentations, and scientific and research meetings.

Availability of literature on this issue is hard to come by at the national level .

Policy and decision makers' articulation of their need for evidence

It is quite evident that policy-makers and decision-makers in the Gambia more or less rely on evidence from research findings. However, owing to the paucity of information, practices have indicated that poor decisions and inappropriate policies may be promoted. There is a need to conduct more research into this issue, as it is difficult to deduce evidence from existing literature.

Policy and decision makers' participation in the research agenda setting process

The National Health Research Policy[23] highlights the lack of mechanisms for articulating, prioritizing and updating a national health research agenda in the Gambia. It stresses that individual health research institutions should have their priority research agendas and procedures. The implications of this are that the Ministry of Health and Social Welfare and stakeholders will have difficulty determining the priority health research needs and effectively coordinating the health research activities that address the health needs of the country.

As far as anecdotal evidence is concerned, participation of policy-makers and decision-makers in the research agenda setting process is often considered a mostly technocratic exercise. This elaborate and meticulous time-consuming exercise may not appeal to time-constrained senior government executives. Their lack of participation may have far-reaching implications, not only for the research agenda setting exercise, but also in that the process brings forth the realistic views and perspectives of important decision-makers who during their day-to-day work are faced with difficult, unanswered or unresolved health problems of utmost priority.

A National Health Research Council is being established that will take account of a wide range of stakeholders, including policy-makers, and develop guidelines and tools to support the consultative process on emerging concerns to be considered within a research portfolio.

Policy and decision makers' capacity to access and apply evidence

Although no studies have been carried out in the Gambia to formally assess the capacity of policy-makers and decision-makers on how they access and apply evidence from routine and nonroutine sources, anecdotal evidence suggests that in the public health sector this is a serious constraint and challenge.

Problems include:

  • lack of knowledge on computer usage;
  • poor Internet connectivity;
  • lack of access to search engines, databases of national and international relevance, and literature on published research findings, and low awareness of their existence;
  • inaccessibility of research reports,
  • lack of appreciation of the value of findings that could be relevant for policy-making, planning and decision-making;.
  • the culture of sharing information/data is seen as a hindrance.

Availability and use of networks and CoPs for better use of evidence for policy and decision

A major objective of the national health research strategic plan[24] is to make research publications available annually to stakeholders. In pursuit of this noble objective, the Ministry of Health and Social Welfare conducted the first national health research conference‏ at Jerma Beach Hotel, 19–20 October 2010. Conference participants were drawn from both indigenous and external researchers and institutions within the subregion. Prior to the conference, calls for abstracts were made which were presented at the conference.

A scientific research conference organized by the West African Health Organisation was held in Burkina Faso in November 2010, where the delegation from the Ministry of Health and Social Welfare presented findings of the incentive study funded by the West African Health Organisation. The conference of parties suggested the creation of research networks as a platform for the sharing and exchange of research information relevant for policy-making and decision-making.

Both conferences were well attended by senior government policy-makers; academics; researchers in health, agriculture and the food industry; laboratory scientists; senior health professionals (including physicians of teaching hospitals); research students; and the media.

Leverage information and communication technologies

The Health Management Information System Unit has office space at the central level, with some infrastructure at the subnational level. In 2005, a local area network was established connecting almost all programme units to Internet services through a server.

Significant progress has been registered by the Information and Communications Technology Unit and Health Management Information System Unit through the establishment of a DHIS2 database and new Ministry of Health and Social Welfare website. Capacities of both Health Management Information System Unit staff (including data entry clerks) and information technology support technicians was enhanced. Data collection tools were revised and introduced into DHIS2.

With the provision of virtual private network (VPN) by the health systems strengthening component of Round 8 of the HIV/AIDS Global Fund to fight AIDS, Tuberculosis and Malaria grant, connectivity was extended to cover the entire six health regions and referral hospitals. Similarly, the malaria consolidated grant will soon set up its own VPN within the system to give it a boost.

What remains is the need to integrate the various sources of information into the Health Management Information System Unit and make information and communications technology accessible to all sources and potential users of information.

Level of access to IT infrastructure

Infrastructure is central in bridging the digital divide, providing universal access to information and communications technology (ICT). The Gambia has made towards implementation of the National Information and Communication Infrastructure Policy and e-government strategy. These, together with other issues relating to access, have been discussed in other sections of this profile. Within the health system, there has been expanded access to ICT through provision of hundreds of computers, setting up of local area networks and creating Internet connectivity. Other parts of this profile have described and analysed the situation at the level of the health sector. Access to ICT infrastructure nationally is shown in the table below.

Profile of national ICT infrastructure. Source: Ministry of Information and Communication Infrastructure website
Country code top-level domain name .gm
Government web portal site
Inception of the Internet in the Gambia 1998
Fixed line provider Gambia Telecommunication Company (Gamtel)
National transmission backbone 534 km of fibreoptic cable
Total yearly voice subscribers[6] 2009 = 1 409 732
2008 = 1 215 004
Annual fixed telephone penetration rate[6] 2005 = 3.05
2006 = 4.72
2007 = 3.08
2008 = 3.05
2009 = 3.03
Annual mobile penetration rate[6] 2005 = 15.4
2006 = 16.9
2007 = 51.4
2008 = 72.9
2009 = 85.1
Mobile GSM operators
  • Africell
  • Comium
  • Gamcel
  • Qcell
Internet service providers
  • Gamtel
  • QuantumNet/QCell
  • Netpage
  • Lanix Limited
  • Connexion Solution
  • Unique Solutions
Type of Internet access
  • Dial-up, asymmetric digital subscriber line (ADSL), leased line, fibreoptic cable, wireless connection (code division multiple access [CDMA], third generation (3G) and other types of broadband services offered by the providers)
Estimated percentage of the population with computer[25] Urban - 7.71%
Rural - 1.06%
Estimated percentage of the population with access to Internet[25] Urban - 5.01%
Rural - 0.24%
Cost of Internet access (average) Sample of tariff profile can be found at Gamtel
Number of TV stations One - government-owned Gambia Radio & Television Service (GRTS) with satellite TV connected through Intelsat 901
Satellite and cable TV providers DSTv/Premium Network, GamTV
Number of operational radio stations (as of January 2011)
  • FM radio stations – 12
  • Community radio stations - 7
Number of newspaper and their daily circulation
  • The Observer - daily
  • The Point - daily
  • Today - daily
  • Foroyaa - 3 times a week
  • News and Report - weekly
  • The Gambia Info - twice a week
Percentage of household with electricity[25]
  • Banjul & Kanifing - 71.54%
  • Brikama Urban & Kombo North - 21.07%
  • Other urban - 9.38%
  • Other rural - 1.37%
Gambia government websites All government ministries and some department agencies have their own website. Links can be found at www.gambia.gov.gm.

Availability of IT solutions

The private sector in the Gambia has now taken the lead in providing IT solutions, especially the interoperability, scalable and finding sustainable solutions. The table in Section 3.5.10.2 is indicative of in country capacity that addresses both national and local needs.

Extent of integration of the HIS

Health information system (HIS) development is still in its infancy in the Gambia. The key challenges faced are:

  • data warehouse, which is limited to only servicing existing statistics, both at national and divisional level;
  • inadequate data management procedures and limited capacity at all levels;
  • hospital records not captured in the HIS processes;
  • baseline data on HIV/AIDS among high-risk groups is limited to sex workers;
  • health parameters do not include accidents (road and other forms of accidents);
  • no information is collected on smoking and alcohol consumption;
  • HIS reports are not regularly produced;
  • HIS reports are not made available to policy-makers/politicians outside the health sector;
  • access to HIS data collected by public institutions is strictly controlled;
  • HIS reports are not user friendly to policy-makers, as they are usually presented in table and graph form with limited, simplified interpretation.

Recently, the Medical Research Council adopted an electronic medical record system, which is both functional and useful. Within the Directorate of Planning and Information, a proposal for the development and introduction of an open medical record system is currently underway. Advances in technology will enable:

  • conversion of paper-based recording system to electronic software with a high level of efficiency for patient-based HIV care;
  • a system for aggregated data management;
  • a central data warehouse for data integration and management.

It should be noted that the Ministry of Health and Social Welfare introduced the DHIS2 database for the management of the HIS through support provided by the University of Oslo. The DHIS2 software has already been deployed to all the six health regions and programme units within the Ministry. DHIS 2 can integrate with other software such as the integrated human resource information system, geographic information system (GIS) for mapping, and the medical record information system.

In 2010, the Ministry in collaboration with International Health Partners introduced a 6-month "sms for health" pilot project in all the public health facilities. The project has so far trained 100 health workers (officers in charge, dispensing assistants, regional public health officers, registered public health nurses, data entry clerks, regional store managers) on the use of sms for health.

There has been an agreement with International Health Partners and the Ministry of Health and Social Welfare to introduction e-community health patient records in 2012, using smart phones. This would revolutionize the ability of health workers to track and manage patients – especially in maternal/child care and areas such as tuberculosis.

Finally, plans will be implemented soon for the Ministry to collect global positioning system (GPS) coordinates of all villages with primary health centres, health facilities (public, private, nongovernmental organization and community owned) to establish a GIS.

Endnotes: sources, methods, abbreviations, etc.

References

  1. Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action (pdf 843.33kb). Geneva, World Health Organization, 2007
  2. Framework and standards for country health information systems, 2nd ed. (pdf 1.87Mb). Geneva, World Health Organization, 2008
  3. Program for Accelerated Growth and Employment (PAGE) 2012–2015 (pdf 3.96Mb). Banjul, Government of he Gambia, Ministry of Finance and Economic Affairs
  4. Implementing the World Summit on the Information Society action lines in Africa: analysis of country reports. Addis Ababa: United Nations Economic Commission for Africa; 2009
  5. E-Government Strategy for the Gambia. Addis Ababa: United Nations Economic Commission for Africa; 2003
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 Implementing the World Summit on the Information Society action lines in Africa: analysis of country reports. Addis Ababa: United Nations Economic Commission for Africa; 2009
  7. Level of achievement of the Millennium Development Goals (MDGs). The Gambia MDG status report, 2009 (pdf 1.24Mb). Banjul: Government of the Gambia, National Planning Commission; 2010
  8. [Status of ICT access, usage and exploitation in the Gambia. Banjul: Government of the Gambia, UNECA SCAN-ICT country report; 2007
  9. Information and Communications Act 2009. Banjul: Government of the Gambia; 2009
  10. The Gambia health information system 2006: review and assessment (pdf). Tendaba, Government of the Gambia, 2006
  11. National Leprosy and Tuberculosis Control Programme Strategic Plan 2008–2012. Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2008
  12. Report. Banjul: Government of the Gambia, Department of State and World Health Organization;1996
  13. National Health Research Policy 2010–2014. Banjul: Government of the Gambia, Ministry of Health and Social Welfare
  14. Health Management Information System Policy. Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2003
  15. The Gambia health information system review and assessment, Tendaba, the Gambia, 2006 (pdf). Banjul: Government of the Gambia, Department of State for Health and Social Welfare and Bureau of Statistics; 2006
  16. Health Management Information System Policy. Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2003
  17. National Health Research Policy (2010–2014). Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2010
  18. The Gambia health information system review and assessment, Tendaba, the Gambia, 2006 (pdf). Banjul: Government of the Gambia, Department of State for Health and Social Welfare and Bureau of Statistics; 2006
  19. The Gambia health information system review and assessment, Tendaba, the Gambia, 2006 (pdf). Banjul: Government of the Gambia, Department of State for Health and Social Welfare and Bureau of Statistics; 2006
  20. Health Management Information System Policy. Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2003
  21. National Health Research Policy (2010–2014). Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2010
  22. National Health Research Policy (2010–2014). Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2010
  23. National Health Research Policy (2010–2014). Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2010
  24. Ministry of Health and Social Welfare Strategic Plan 2010-2014. Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2010
  25. 25.0 25.1 25.2 ICT report.Banjul, Government of the Gambia, 2007