People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.
The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:
- The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
- The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
- The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.
This section of the health system profile is structured as follows:
In the Gambia, the mission of the health sector as stated in the National Health Policy 2012–2020 is to "promote and protect the health of the population through the equitable provision of quality health care". The private sector, nongovernment organizations and faith-based organizations also play a vital role in the delivery of health services with a view to complementing the Government of the Gambia's effort in this direction. These joint efforts result in increased access to health services in nearly every community in the country.
The health and health-related laws and acts are designed to regulate or influence outcomes in service delivery. Enforcement of these regulations often poses a challenge due to lack of delineation of functions between the Ministry of Health and Social Welfare and the various professional councils.
Currently, the Upper River Region and the Lower River Region do not have hospitals and thus have to refer patients over quite long distances. However, the major health centre in the Upper River Region could serve as a hospital if the human and material resources were available, as the infrastructure is adequate to serve that purpose.
The Government is committed to universal coverage as evidenced by the opening of new outreach stations within the health regions in order to expand target population coverage, particularly of pregnant women and children. Expansions of health facilities and structures financed mainly under the World Bank's Participatory Health Population and Nutrition Project have enabled the Government to widen the scope of services to new areas. Financing of these ventures is mainly through support from international and local partners as well as through private sector engagement.
Although there is no government health insurance scheme, medical care is largely affordable. Emergency services are usually managed, even if the patient is unable to pay at presentation. Diseases of public health importance are financed by the Government in collaboration with international partners. However, despite the good intentions for the health of the population, rising cost of health commodities is a challenge for the Government in financing health care.
Collaborative efforts such as the Health for Peace Initiative, involving West African countries, increase access to comprehensive eye care at all levels of the health system. Other areas of collaboration in this Initiative are in:
- disease surveillance
- epidemic management and complex emergencies
- the Roll Back Malaria Partnership
- HIV/AIDS and sexually transmitted infections.