Medical products, vaccines, infrastructures and equipment
A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost effectiveness, and their scientifically sound and cost-effective use.
To achieve these objectives, the following are required:
- national policies, standards, guidelines and regulations that support policy;
- information on prices, international trade agreements and capacity to set and negotiate prices;
- reliable manufacturing practices and quality assessment of priority products;
- procurement, supply, storage and distribution systems that minimize leakage and other waste;
- support for rational use of essential medicines, commodities and equipment, through guidelines, strategies to assure adherence, reduce resistance, maximize patient safety and training.
Major components of the medicines market are shown in the figure.
This section of the health system profile is structured as follows:
Management of medical supplies in the Gambia is under the National Pharmaceutical Services and covers essential medicine supply, legislation and regulation, quality control services, and planning and management. A Medicines Board, chaired by the Director of Health Services, is responsible for reviewing import as well as the distribution and sale of pharmaceuticals in the country.
Quality regulation is carried out by the quality control department, which is minimally functional due to human and material resource constraints. Procurement of medicines for the public sector is centralized and is mainly from WHO-certified companies. The lack of manufacturing companies in the Gambia sometimes results in delays in receipt of orders. Therefore the need to utilize medicine judiciously is recognized by the National Pharmaceutical Services, which regularly conducts in-service training on the rational use of drugs.
Vaccines procurement and storage are controlled and coordinated centrally with regular distribution to the regions from where further distribution to the health facilities is carried out. Most of the facilities have solar power that runs the refrigerators for vaccine storage. There are few challenges, especially where generators are used due to inadequate fuel supply. The use of robust solar panels seems to be the more sustainable option for the health sector.
Standard operating procedures, quality control of tests and training of laboratory personnel on blood safety are in place. Whole blood for transfusion is tested for HIV, syphilis and hepatitis B virus, but not hepatitis C virus. The supply of blood nationwide is not well coordinated due to the absence of a proper blood transfusion service. There is no quality control manager in the laboratory/blood transfusion services. It is expected that with continued strengthening of the National Public Health Laboratories, the required human resource will be recruited to maintain internationally accepted standards for blood transfusion services.
Medical equipment and other devices are either purchased by the department or come as donations from philanthropists and development partners. A Biomedical Engineering Unit has recently been established at the National Public Health Laboratories to support basic repairs and maintenance. Collaboration with the Medical Research Council of Gambia is another avenue for maintenance support.
One issue with donations is a lack of operational manuals, making the equipment of little or no use. A donation policy needs to be articulated and strictly adhered to so that the health sector does not inadvertently become a dumping ground for used equipment.
Infrastructures and equipment
Priorities and ways forward
Endnotes: sources, methods, abbreviations, etc.
- ↑ Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action (pdf 843.33kb). Geneva, World Health Organization, 2007
- ↑ The world medicines situation (pdf 1.03Mb). Geneva, World Health Organization, 2004
- ↑ The Gambia National Drug Policy. Banjul: Government of the Gambia, Ministry of Health and Social Welfare; 2007