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Directorate of Health Services


Heath Services

The public health service delivery system is three tier based on the primary health care strategy. Presently services are provided by 3 hospitals, 36 health facilities at the secondary level and 492 health posts at the primary level. There is also one hospital under construction and another planned for construction in 2001. The public health system is complemented by 34 private and Non-Governmental Organization clinics. The public sector has 1477 beds, 211 doctors and dentists, 8 Pharmacists, 261 Registered nurses, 250 Enrolled nurses, 144 community nurses, 122 public health officials and 8 laboratory technologists.

The Gambia has an Infant Mortality Rate of 84/1000 live births, 60% of which is attributable to malaria, diarrheal diseases and acute respiratory tract infections. The main causes of mortality in infants (0-12 months) are neonatal sepsis, premature deliveries, malaria, respiratory infections, diarrheal diseases and malnutrition. For child mortality, main causes are: malaria, pneumonia, malnutrition, and diarrheal diseases. The Maternal Mortality Ratio is estimated at 10.5/1000 live births, with regional variation of 9/1000 in the urban areas and 16/1000 live births in the rural areas, the majority of which are due to sepsis, hemorrhage and eclampsia.

40% of total outpatient consultation in 1999 was due to malaria, while diarrheal diseases and acute respiratory tract infections constitute about 25%`.

The HIV prevalence rate is 2.2% (1.7% HIVI and 0.5% HIVII) in the general population and 1.7 % in antenatal clinic attendance (1991). A sentinel surveillance study result in one of the sites shows that the prevalence of HIV1 has significantly increased from 0.6% in 1995 to 0.9% in 2000.

There has been a decline in national coverage for fully immunized children to a present level of 68.6% for under 1 year and 76.0% for the under 2 year in 2000. (See Appendix A)

Malnutrition continues to be a major public health problem in The Gambia. A 1998 national anthropometrics study of children under five conducted in the dry season indicated 16.8% stunting, 6.8% wasting and 17.1% underweight. Diabetes Mellitus is estimated to affect about 1% of the population while a study found that about 16% of urban women are obese compare to only 1% of rural women.

Safe water is an essential pillar of sustainable health for rural and urban population. Access to safe water (1996 MICS) is 69% of the overall households; with 79.9% urban and 64.9% rural and access to proper sanitary facilities are not encouraging thus limiting to only 37% (1998) for the entire country. This percentage is unevenly distributed between urban areas (83%) and rural areas (17%).

In 1998, the Household Poverty Study indicated that the proportion of the extremely poor population has increased significantly from 15% to 51% (See Appendix B)

Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly Community Initiative and the Bamako Initiative. Also, relevant policy documents were developed including: Nutrition Policy, Drug Policy, and many others at various stages of development.

As we highlight the progress made in health, it is worth mentioning the significant support and contributions made to the health sector by the NGOs and by both Bilateral and Multilateral partners.

Although considerable progress has been made, a lot more remains to be done. The implementation of the Health Action Plan 1999-2003 is constrained by several factors including:

All the major health centres are not fully functional; the main supporting units of the major health centres, i.e. laboratory, radiological services and operating theatres are still not equipped and staffed.

 Acute shortage of medical, nursing and other health staff at all health facilities.

Inadequate staffing of all Divisional Health Management Teams

Poor conditions of services including inadequate staff houses have made it extremely difficult to retain staff particularly in rural areas.


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