Cherno Bah,
I wish to supplement your comment on the state of the Health sector in The
Gambia with the following observations, which are partial, at best. There
has been a general lack of appreciable improvement in this sector
particularly if the Alma Atta Declaration (Health for All by 2000) is the
basis for assessing the sector. But if you will recall, I argued somewhere
in one of my postings that the goals set then were unrealistic and, as far
as many health experts were concerned, unattainable. There are numerous
reasons for this including the health expenditure targets of between 15-20
percent over the period of 1978/79 and the year 2000 that were never met by
The Gambia and many African countries for that matter. Primary Health care
(PHC) was emphasised, as opposed to tertiary health. The Gambia did make
significant progress in the area of PHC, although most of the gains were
diminished due to high rate of population growth as seems to be the case in
most other sectors. With a population of a little over a million and an
annual growth rate of 4.2 percent, one of the highest in Africa, little
wonder that our health indicators are among the lowest in Africa. It may be
of interest to note that your physician to population ratio of one medical
doctor to over 35,000 Gambians in 1993 has dramatically improved to 12,000
persons per doctor which can only be attributed to the presence of Cuban
doctors. Unfortunately, most of the other health indicators that you
mentioned have not improved significantly over the years. Shortage of
qualified staff has been identified as one of the major constraints. More
health-care personnel such as the categories you mentioned i.e. community
health nurses, SENs, SRNs, traditional birth attendants etc must be trained
with attractive remuneration package to retain them. In the main, the
current Health Policy, in my opinion, is sound; it seeks to provide
universal health coverage, redistribute health resource in favour of under-
served rural population, improve the quality of the health care delivery
system and encourage greater community participation. Sound policies alone
are not enough however. Adequate budgetary allocation must accompany the
policy and efficient and prudent application of those very scarce resources
is an absolute necessity if the health status of the Gambian population is
to improve appreciably.
sidi sanneh
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