79C3C34C52B45572883A05D425EB0F82
National Health Policy
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This file was generated: 2020-12-01 09:14:21
| Indicators in focus are typically shown highlighted in yellow; |
Peer Indicators (that share the same Vulnerability association) are shown highlighted in pink; |
"Outside" Indicators (those that do NOT share the same Vulnerability association) are shown highlighted in green; |
Trigger Words/Phrases are shown highlighted in gray. |
Link to Orphaned Trigger Words (Appendix (Indicator List, Indicator Peers, Trigger Words, Type/Vulnerability/Indicator Overlay)
Applicable Type / Vulnerability / Indicator Overlay for this Input
Political / Indigenous
Searching for indicator indigenous:
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p.000048: number of ambulances, intermittent shortage of fuel, inadequate capacity to manage cases effectively,
p.000048: inadequate feedback mechanism, inadequate referral protocol and guidelines and late referrals especially at
p.000048: community level. This situation is further compounded by limited (only receiving) telecommunication services
p.000048: within health facilities. A referral system that enhances speedy and safe evacuation of patients is necessary.
p.000048:
p.000048: Objective
p.000048: • To ensure an reliable, effective, efficient and sustainable referral system is in place.
p.000048:
p.000048: Policy Measures
p.000048: • Develop and/or update the referral protocols, guidelines and standards
p.000048: • Strengthen capacity of referral service provision at all levels for effective and efficient service delivery
p.000048: • Conduct effective operational research on the current referral system
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 40
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 11.0: TRADITIONAL MEDICINE
p.000048: Preamble
p.000048: Traditional health care constitute an important component of the national health delivery system as it serves
p.000048: as the first point of contact for a significant proportion of Gambian population. . The traditional health care system
p.000048: is a community based self- sustaining health care service and therefore can complement the public health
p.000048: service. Traditional medicine practitioners are scattered throughout the country. Apart from indigenous
p.000048: practitioners, today the system has been invaded by all types of practitioners from the sub-region. Not much
p.000048: information is available on the background of some of the practitioners especially those of foreign origin.
p.000048: Traditional medicines require more research for improved health benefits.
p.000048: The market is flooded with all sorts of herbal and even enhanced herbal products and their safety cannot be
p.000048: ascertained or supported. Traditional Healers Groups and Association exist in many regions in the country, but a body
p.000048: to regulate the practice of traditional medicine as well as a complete enactment for the protection of the
p.000048: population do not exist. In addition, a system does not exist for registration and licensing of
p.000048: traditional medicine practitioners in The Gambia.
p.000048: Objective
p.000048: • To strengthen Tradition health care/medicine as a complement to the public health system.
p.000048: • To promote partnership with traditional practitioners with a view to improve health service delivery.
p.000048: Policy Measures
p.000048: • Implementing the Traditional Health Policy and its Strategies
p.000048: • Establish and maintain a regulatory mechanism for the control of traditional medicine
p.000048: • Facilitate collaboration with traditional medicine agencies of other countries for exchange of useful
p.000048: information and experiences.
p.000048: • Promote and support operational research on Traditional Medicine.
p.000048: • Strengthen the traditional medicine unit.
p.000048:
p.000048: 12.0: HEALTH CARE TOURISM
p.000048: Health Care Tourism (HCT) can be very expensive for individuals and families and even to nations. Though Gambia’s
...
Political / political affiliation
Searching for indicator political:
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p.000048: • Set up a National Plan of Action for the prevention of disability and rehabilitation of
p.000048: persons with disabilities in accordance with the United
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 16
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
p.000048: Community empowerment; active involvement of the private sector, NGOs, local government authorities and civil
p.000048: society; effective donor co-ordination
p.000048:
p.000048: 4.9 Evidence based health care
p.000048: Health planning, programming and service delivery shall be informed by evidence- based research.
p.000048:
p.000048: 4.10: Patient bill of rights
p.000048: The Patient's Bill of Rights helps patients feel more confident in the health care system. It assures that
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
...
Political / stateless persons
Searching for indicator nation:
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p.000048: determinants are the responsibility of the Ministry of Health, certain are the responsibility of other
p.000048: Departments or services. Implementation of these actions necessarily requires close
p.000048: inter-sectoral collaboration between these Departments and the Ministry of Health. The aim is to influence policies
p.000048: and strategies of all stakeholders in the management of the environment. These activities include,
p.000048: among others: water distribution and sanitation systems to meet essential health needs, training
p.000048: of medical and paramedical personnel, including specialized training, and health research, including biomedical
p.000048: and epidemiological research, as well as research on health system operations, public hygiene activities
p.000048: (refuse collection, removal of household waste, and health inspections), management of hazardous chemicals and
p.000048: pesticides traffic safety, prevention of road accidents, workplace safety; prevention of work-related injury and
p.000048: illness, activities providing food supplements to people who need it and medico-social activities for vulnerable
p.000048: groups.
p.000048:
p.000048: The Government is cognisant of the effects of the environment on the socioeconomic growth and development
p.000048: including health, and henceforth developed and implemented the National Environment Management Act
p.000048: (1994), the Food Act (2005), and the Public Health Act (1990). Additionally, the President initiative
p.000048: ‘Operation Clean The nation’ is geared toward addressing environmental issues. In recent years, there has been noted
p.000048: increase in the incidence of road and domestic accidents and those from industry thus warranting
p.000048: interventions to address occupational hazards.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 19
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048: • To reduce the frequency of environmental health and safety related diseases/conditions by 30% by
p.000048: 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Enforcement of environmental health related Acts
p.000048: • Institute proper management of solid, gaseous and liquid wastes
p.000048: • Strengthen the environmental units of key municipalities
p.000048: 5.2. Health Promotion and Education Preamble
p.000048: Health education and promotion, mainstreamed in all health care programmes is important to the National
p.000048: health care services delivery. At present there is no Health education and promotion policy to guide the
p.000048: effective dissemination of health messages in the general population.
p.000048:
p.000048: This has led to the current situation of uncoordinated approach to the development and dissemination of
p.000048: comprehensive health messages. As a result the desired impact of the programme continued to pose
p.000048: challenges in the health services delivery.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To raise awareness among the population through the provision of relevant health information that would
...
p.000048:
p.000048: The functions of the Board shall include, among other things:
p.000048: • Review and approve national health service standards
p.000048: • Monitor quality of health services nationally
p.000048: • Accredit all public, private and NGOs health facilities for service delivery
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 43
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048:
p.000048:
p.000048: 15: CONCLUSION
p.000048: This Policy was developed through consultations with and inputs from all stakeholders including
p.000048: Sector Ministries, Local Government Authorities, Faith-based Organisations, NGOs, Opinion leaders, Catchment
p.000048: Area Committees, Multi- Disciplinary Facilitation Teams (MDFT’s), and other partners in the provision of
p.000048: health care across the country. The Ministry and partners, notably from WHO and UNICEF, have demonstrated sustained
p.000048: interest and commitment to the policy process.
p.000048:
p.000048: The need to address the general health system challenges including the effects of high population growth rate;
p.000048: inadequate financial and logistic support; weak health information system; uncoordinated donor support; shortage
p.000048: of adequately and appropriately trained health staff; high attrition rate and lack of efficient and effective
p.000048: referral system has been highlighted. Therefore, renewed commitment is required from staff of Ministry, as well as
p.000048: Government and NGO and all citizens to achieve our desired goal of a “healthy and wealthy nation”.
p.000048:
p.000048: There is clear evidence that from 1994 to date there has been massive expansion in terms of health infrastructural
p.000048: development and health care needs. The commitment of the Government to implement this policy is demonstrated by the
p.000048: current structures established at both central and regional levels, the strengthening of health training institutions
p.000048: and capacity building through the training of staff both at local and international levels. The country’s
p.000048: vision statement also gave a very clear direction as to where the Gambia would want to be by 2020.
p.000048:
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p.000048: Health Policy 2012-2020
p.000048: Page 44
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: APPENDIX A
p.000048:
p.000048: THE POPULATION OF THE GAMBIA BY REGIONAL BREAKDOWN
p.000048: Regions GR 2003 2007 2011 2015 2020
p.000048:
p.000048: Banjul
p.000048: - 1.87
p.000048: 35,061
p.000048: 32,604
p.000048: 30,319
p.000048: 20,194
p.000048: 25,747
p.000048:
p.000048: Kanifing
p.000048: 3.5
p.000048: 322,735
p.000048: 364,568
p.000048: 410, 669
p.000048: 458, 857
p.000048: 519, 139
p.000048:
p.000048: Brikama
p.000048: 5.2
p.000048: 389, 594
p.000048: 477,172
p.000048: 584,438
p.000048: 715,816
p.000048: 922,316
p.000048:
p.000048: Mansakonko
p.000048: 1.0
p.000048: 72,167
p.000048: 75,097
p.000048: 78,147
p.000048: 81,320
p.000048: 85,468
p.000048:
p.000048: Kerewan
...
Political / vulnerable
Searching for indicator vulnerable:
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p.000048: the private sector to address the broad determinants of health;
p.000048: • Support and coordinate formulation of and or strengthening the implementation of national health promotion policy
p.000048: and national health policy, legislations or strategies for tobacco control in line with the WHO Framework Convention on
p.000048: Tobacco Control;
p.000048: • Provision of technical advice to the Ministry of Health and Social Welfare on International protocols, instruments
p.000048: and conventions that have a public health and health promotion underpinning;
p.000048: • Act as the technical adviser to the Ministry of Health and Social Welfare and oversee patient
p.000048: education/counselling in the country’s medical institutions as part of the health promoting hospital initiatives with a
p.000048: view to ensuring quality care for the poor and the socially deprived;
p.000048: • Act as the technical body to regulate health information dissemination in the country.
p.000048:
p.000048: (b) Department of Social Welfare
p.000048:
p.000048: Directorate of Social Welfare (DSW)
p.000048:
p.000048: The Department comprised of the Directorate of Social Welfare (DSW).It is responsible for the
p.000048: promotion and protection of the rights and welfare of vulnerable persons such as children, the elderly, persons
p.000048: with disability and adults in difficult circumstances. To enable them maximize their potential and minimize
p.000048: problems arising out of the imbalance between themselves and their environment as a result of social change. Their
p.000048: services focus on the social protection of individual families and groups.This includes the welfare services to the
p.000048: vulnerable families and individuals, child rights and protection services, elderly care, disability care services and
p.000048: regional social welfare services provision and management.
p.000048:
p.000048: 1.5.2: Regional Level
p.000048: The Regional Health Directorates are headed by Regional Directors of Health Services, who are directly
p.000048: responsible to the Permanent Secretary through the Director of Health Services. Regional Directors of Health
p.000048: Services are responsible for coordinating policy interpretation, planning and implementation of health services, and
p.000048: monitoring and evaluation of health service delivery, within their respective
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 13
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
...
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
p.000048: • Set up and maintain a Data Base System for information sharing for all the Units of the Ministry of health by 2015
p.000048: • Establish a National Social Welfare Trust Fund for the needy and vulnerable groups including children and persons
p.000048: with disabilities by 2015.
p.000048: • Develop a National Child Protection Strategy and operational Plan by 2013.
p.000048: • Advocate for the signing and eventual ratification of the UN Convention for persons with disabilities
p.000048: by end of 2012.
p.000048: • Set up a National Plan of Action for the prevention of disability and rehabilitation of
p.000048: persons with disabilities in accordance with the United
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 16
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
...
p.000048: own decisions.
p.000048:
p.000048: 4.10.5 Respect and non-discrimination
p.000048: Every patient must have a right to considerate, respectful and non-discriminatory care from his/her health
p.000048: care provider (s),
p.000048:
p.000048: 4.10.6 Confidentiality of health information
p.000048: All patients must have the right to talk privately with health care providers and to have his/her health
p.000048: care information protected. He/she shall have the right to read and copy his/her own medical record. He/she shall have
p.000048: the right to ask that his/her health care provider change his/her record if it is not correct, relevant, or complete.
p.000048:
p.000048: 4.10.7 Complaints and appeals
p.000048: Every patient shall have the right to a fair, fast, and objective review of any complaint he/she may have against any
p.000048: health plan, health care provider/personnel or health
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 18
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: institution. This includes complaints about waiting times, operating hours, the actions of health care personnel, and
p.000048: the adequacy of health care facilities.
p.000048:
p.000048: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES
p.000048:
p.000048: Preamble
p.000048: The existing minimum health care package shall be strengthened to make available and accessible quality basic health
p.000048: services at all levels of the health care delivery system. This is essential towards addressing the common causes of
p.000048: morbidity and mortality in The Gambia with particular attention to vulnerable groups and
p.000048: individuals. This has implication for planning, (resource mobilisation and allocation) as well as implementation of
p.000048: other policies.
p.000048:
p.000048: The Basic Package will be delivered through the following programme areas:
p.000048: 5.1. Environment, Health and Safety Preamble
p.000048: Environmental health and safety is an important determinant of health outcomes and still remains a major challenge for
p.000048: the Ministry of Health and partners.
p.000048:
p.000048: There is a variety of determinants which contribute to health improvement. Even though most of these health
p.000048: determinants are the responsibility of the Ministry of Health, certain are the responsibility of other
p.000048: Departments or services. Implementation of these actions necessarily requires close
p.000048: inter-sectoral collaboration between these Departments and the Ministry of Health. The aim is to influence policies
p.000048: and strategies of all stakeholders in the management of the environment. These activities include,
p.000048: among others: water distribution and sanitation systems to meet essential health needs, training
p.000048: of medical and paramedical personnel, including specialized training, and health research, including biomedical
p.000048: and epidemiological research, as well as research on health system operations, public hygiene activities
p.000048: (refuse collection, removal of household waste, and health inspections), management of hazardous chemicals and
p.000048: pesticides traffic safety, prevention of road accidents, workplace safety; prevention of work-related injury and
p.000048: illness, activities providing food supplements to people who need it and medico-social activities for vulnerable
p.000048: groups.
p.000048:
p.000048: The Government is cognisant of the effects of the environment on the socioeconomic growth and development
p.000048: including health, and henceforth developed and implemented the National Environment Management Act
p.000048: (1994), the Food Act (2005), and the Public Health Act (1990). Additionally, the President initiative
p.000048: ‘Operation Clean The nation’ is geared toward addressing environmental issues. In recent years, there has been noted
p.000048: increase in the incidence of road and domestic accidents and those from industry thus warranting
p.000048: interventions to address occupational hazards.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 19
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048: • To reduce the frequency of environmental health and safety related diseases/conditions by 30% by
p.000048: 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Enforcement of environmental health related Acts
p.000048: • Institute proper management of solid, gaseous and liquid wastes
p.000048: • Strengthen the environmental units of key municipalities
p.000048: 5.2. Health Promotion and Education Preamble
p.000048: Health education and promotion, mainstreamed in all health care programmes is important to the National
p.000048: health care services delivery. At present there is no Health education and promotion policy to guide the
p.000048: effective dissemination of health messages in the general population.
p.000048:
...
p.000048: services. In addition to these, non-health service related factors including high fertility rate (national 5.4), poor
p.000048: and inadequate nutrition, poor socio-economic status manifested by poor housing, limited availability and access to
p.000048: safe water and basic sanitation are important determinants.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity related to but not limited to childhood, reproduction and the
p.000048: reproductive system across the country
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen and promote 24/7 Emergency Obstetric Care concept;
p.000048: • Strengthen and promote Emergency neonatal care;
p.000048: • Advocate and ensure Implementation of the national reproductive health commodity security plan;
p.000048: • Introduce and institutionalise peri-natal reviews and audits;
p.000048: • Maintain, promote and protect the free of cost policy for MCH services;
p.000048: • Establish a minimum RCH care package;
p.000048: • Monitoring, evaluation and research
p.000048: • Increase awareness on sexual, reproductive and child health issues;
p.000048: • Promote partnership and coordination among all stake holders in the field of RCH;
p.000048: • Create opportunities for the improvement of the nutritional status of the vulnerable groups.
p.000048: • Operationalize operating theatres in all major health facilities.
p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
p.000048: and Childhood Illness (IMNCI) strategy in 1999 to address the high morbidity and mortality among children
p.000048: under five years. The IMNCI strategy combines improved case management of childhood illness in first-level health
p.000048: facilities with aspects of nutrition, immunization, disease prevention, and promotion of growth and
p.000048: development. There are three components of IMNCI which are: improving the skills of health workers; improving the
p.000048: health system, and improving household and community practices.
p.000048:
p.000048: The IMNCI strategy is a technically sound, comprehensive and evidence-based strategy focusing on the main
p.000048: threats to children’s health and focus mainly on the prevention and adequate treatment of malaria, diarrhoea,
p.000048: pneumonia, measles and malnutrition because they are responsible for about 70% of deaths among children
p.000048:
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p.000048:
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p.000048:
p.000048: under five years. It targets children under five years and focus on the five main causes of mortality in
...
p.000048:
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p.000048:
p.000048: In order to restore the functionality of all existing PHC villages, the Ministry of Health in collaboration with
p.000048: stakeholders and the community will review the present VDC system.
p.000048: The development of the VHS has been in isolation to the BHS. The latter possesses a wide range of resources to support
p.000048: the VHS. The policy calls for define linkages between the BHS and the VHS. A basic health facility will be linked to a
p.000048: number of trekking stations and PHC villages. This group of facilities and the population it serves
p.000048: (including non primary health care villages) will constitute a CATCHMENT AREA.
p.000048: The basic health facility will perform the first line supervision and provide support in the areas of training and
p.000048: supply of drugs to the VHS. Each catchment area will have a catchment area committee. The latter will be closely
p.000048: involved in the management, planning, monitoring and evaluation of services provided in the area under its
p.000048: jurisdiction.
p.000048: 6.1.1 Service Expansion
p.000048: At present, health services are provided by 546 health posts at the primary level. When PHC was introduced
p.000048: in 1979 some villages which did not qualify for reasons of numbers now qualify. The present policy of
p.000048: establishing PHC in villages with a population of 400 or more or where access is difficult will
p.000048: continue so as to accommodate new villages. In view of the numbers of villages to be involved, villages
p.000048: in vulnerable areas will be given first consideration, especially those in the north bank of CRR and URR as per the
p.000048: recent UNICEF MICS findings.
p.000048: To provide the required supervision and support, new key villages and circuits will be established simultaneously.
p.000048: NGO and Government partnership is essential and will be encouraged especially in the planning and inauguration of new
p.000048: PHC villages, so that NGO intervention and resources can be better maximised.
p.000048: Currently 21 NGO health facilities and 19 private clinics and 18 Community-owned/ managed Clinics complement
p.000048: government health services. In spite of the fact that this health policy calls for participation of the private
p.000048: sector and communities in the provision and management of health services delivery, the absence of
p.000048: clear guidelines and enabling policies and Acts has limited the capacity of the Ministry to control the unprecedented
p.000048: wave of expansion of services at these levels. New health mapping studies will be undertaken to determine
p.000048: health services expansion, especially in key growth centres and within the urban areas where population
p.000048: continue to grow at an alarming rate.
p.000048:
p.000048: Objective
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To ensure the functionality of all existing PHC villages
p.000048: Policy Measures
p.000048: • Strengthen/ build capacity at primary level
p.000048: • Regulate service delivery/expansion at primary levels
...
Health / Drug Usage
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p.000047: 47
p.000047: APPENDIX G
p.000047: 47
p.000047: APPENDIX H
p.000048: 48
p.000048: APPENDIX I
p.000048: 48
p.000048: APPENDIX J ERROR! BOOKMARK NOT DEFINED.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: ABBREVIATIONS
p.000048:
p.000048: ACSM - Advocacy Communication and Social Mobilisation AIDS - Acquired
p.000048: Immune Deficiency Syndrome
p.000048: ART - Anti – Retroviral Therapy
p.000048: BCC - Behavioural Change Communication
p.000048: BFCI - Baby Friendly Community Initiative
p.000048: BI - Bamako Initiative
p.000048: BTS - Blood Transfusion Services
p.000048: CBO - Community Based Organisation
p.000048: CP - Chief Pharmacist
p.000048: CSD - Central Statistics Department
p.000048: DFSQHE - Directorate of Food Security, Quality and Hygiene Enforcement DHS -
p.000048: Director of Health Services
p.000048: DNPHLS - Directorate of National Public Health Laboratory Services DOTS -
p.000048: Directly Observed Treatment Short course
p.000048: DPI - Directorate of Planning and Information
p.000048: DRF - Drug Revolving Fund
p.000048: EDC - Epidemiology and Disease Control
p.000048: EH - Environmental Health
p.000048: ENC - Emergency newborn care
p.000048: EOC - Emergency Obstetric Care
p.000048: EPI - Expanded Program on Immunization
p.000048: FP - Family Planning
p.000048: GAVI - Global Alliance for Vaccine Initiative
p.000048: HIV - Human Immunodeficiency Virus
p.000048: HMIS - Health Management Information System
p.000048: HRH - Human Resources for Health
p.000048: IEC - Information, Education and Communication
p.000048: IHR - International Health Regulations Illnesses
p.000048: IMNCI - Integrated Management of Neonatal & Childhood IPT - Intermittent
p.000048: Preventive Treatment
p.000048: ITN - Insecticide Treated Nets
p.000048: MDGs - Millennium Development Goals
p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
p.000048: PRSP - Poverty Reduction Strategy Programme
p.000048: RCH - Reproductive and Child Health
p.000048:
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p.000048:
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p.000048:
p.000048: RFH - Riders for Health
p.000048: RH - Reproductive Health
p.000048: RHD - Regional Health Directorate
p.000048: RHO - Regional Health Officer
p.000048: RHT - Regional Health Teams
p.000048: RTI - Respiratory Tract Infections
p.000048: STI - Sexually Transmitted Diseases
...
p.000048: • About 90.5% of adults (92.1% of men and 89% of women) never had their blood sugar tested
p.000048: • About 39.5% of the adult population (33.7% for men and 45.3%) are considered overweight with mean BMI >25kgM2
p.000048:
p.000048: Safe water is an essential pillar of sustainable health for the population. Access to safe water is 85.1% of the
p.000048: overall households; with 79.9% urban and 64.9% rural and access to proper sanitary facilities are not encouraging
p.000048: thus limiting to only 26% (PRSPII) for the entire country.
p.000048:
p.000048: The 2008 poverty assessment indicated that overall poverty to be at 55.5% with a poverty gap of 25.9% and poverty
p.000048: severity at 14.3%. However there are regional variation with rural poverty incident of 63% and an urban
p.000048: incident of 57%. See Appendix: D.
p.000048:
p.000048: Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in
p.000048: recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly
p.000048: Community Initiative and the Bamako Initiative.
p.000048:
p.000048: Also, relevant policy documents were developed including that of Nutrition, Drug , Malaria Reproductive and
p.000048: Child Health , Human Resource for Health , Maintenance , Mental Health , HIV/AIDS , Health Management Information
p.000048: System , National Blood Transfusion , Information Technology , and others such as Traditional Medicine,
p.000048: National Public Health Laboratory and the Health Research Policies at various stages of development.
p.000048:
p.000048:
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p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.3: Problem Statement
p.000048: • General health system challenges including the effects of previous high population growth
p.000048: rate; inadequate financial and logistic support; weak health information system; uncoordinated donor
p.000048: support; shortage of adequately and appropriately trained health staff; high attrition rate and lack of
p.000048: efficient and effective referral system. In addition, poverty, low awareness of health issues and poor attitude of
p.000048: service providers have led to inappropriate health seeking behaviours and contributed to ill health. These
p.000048: factors have seriously constrained efforts to reduce morbidity and mortality rates as desired and as a result health
p.000048: care delivery throughout the country has not lived up to expectation.
p.000048:
p.000048: • The frequent changes in top management positions at The Ministry of Health have been hampering
p.000048: continuity, institutional memory and policy flow. The need to have a clear direction to improve quality of health
p.000048: care and reduce the high morbidity and mortality rates requires a stable, supportive, organisational and
p.000048: management framework with a strong flexible and knowledgeable leadership, able and willing to take informed
p.000048: decisions.
p.000048:
p.000048: 1.4: Policy Orientation
p.000048: From the available statistics, it is important to enhance the delivery of quality health services in order to reduce
p.000048: the high prevailing morbidity and mortality rates.
p.000048: The need to review the current health policy framework has been influenced by the following factors:
p.000048: • The high disease burden (communicable and non-communicable diseases) needs intensification of efforts in
p.000048: our service delivery packages;
p.000048: • The disparity in the demand by the population and quality of services at different levels of health care;
p.000048: • Lessons learnt from the implementation of certain health projects/programmes like Primary Health Care,
p.000048: Bamako Initiative and Drug Revolving Fund to improve financing of health services;
p.000048: • The need for stronger partnership and coordination in the health sector with the donors, NGOs, private sector and
p.000048: the community in delivering health services to the population;
p.000048: • Formulation and implementation of other sector policies impacting on the health outcomes;
p.000048: • To keep pace with the Decentralisation and Local Government Reforms which emphasises an integrated
p.000048: management of government services, including health to the regions. The devolution of authority, responsibility
p.000048: and resources to the regions shall be directed by the policy framework;
p.000048: • The absence of a co-ordinated monitoring and evaluation system to measure performance and plan for
p.000048: improvements and ensure accountability; and
p.000048:
p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • The limited collaboration between the traditional healers and the formal health sector.
p.000048:
p.000048: 1.5: Health System
p.000048: The Ministry Of Health and Social Welfare (MOH&SW) is responsible for overall policy formulation,
p.000048: planning, organisation and coordination of the health sector at national, regional, district and community
p.000048: levels. In order to facilitate efficient and effective coordination of the sector, the following coordination
p.000048: structures have been established.
p.000048: 1.5.1 Central Level
p.000048: The MOH&SW Head Office in Banjul is responsible for overall formulation and direction of the national health
...
p.000048: autonomous National Health Research Council) to coordinate and set priorities of all research within the
p.000048: health sector is crucial.
p.000048:
p.000048: Health managers and policy makers need evidence-based information to promote rational decision-making in
p.000048: programmatic and policy matters. Such information has to come from sources that include health research
p.000048: findings. Research has led to tangible improvements. It has a key role to play in the ongoing health development
p.000048: process. The first priority is to set up a database of all research conducted in the country and a review of
p.000048: their findings. One of the reasons for this is the fact that the Directorate of Planning and Information (DPI)
p.000048: presently lacks material resources that will enable an effective and efficient running of the Health Systems
p.000048: Research and Documentation Unit.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To improve timely collection of health data and availability of reliable health information by 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Advocate, support and promote interest in research.
p.000048: • Establish monitoring and evaluation plan
p.000048: • Strengthen the existing health information system for effective utilization
p.000048: • Strengthen capacity towards health system research and documentation.
p.000048: • Promote and strengthen birth and death registration.
p.000048:
p.000048: 7.0: HEALTH FINANCING
p.000048: Preamble
p.000048: In 1988 a Cost Recovery Program was started as part of the national health development program. This
p.000048: established the Drug Revolving Fund and the introduction of user fees as a form of health financing. The
p.000048: Bamako Initiative (BI) was introduced in 1993 as a further development on the Cost Recovery Program. Although
p.000048: some successes were registered with both types of financing strategy, universal access and coverage still
p.000048: remains a major challenge.
p.000048:
p.000048: Healthcare service financing is a challenge the world over but more pronounced in developing countries where government
p.000048: budgetary allocation to the health sector is less than optimal and health insurance schemes have limited
p.000048: coverage or non- existent. There is need for health financing policy for the country. Government
p.000048: allocations to the health sector as a percentage of the total national budget continue
p.000048:
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p.000048:
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p.000048:
p.000048: to improve, ranging from 7% to 10% in the past five years1. This is still below the Abuja Declaration of 15% budgetary
p.000048: allocation to the health sector. Health care is provided almost free, especially for maternal and child health
p.000048: services since the introduction of the policy in 2007 by of President of the Republic.
p.000048:
p.000048: In 2007, the first National Health Accounts (NHA) for The Gambia was constructed covering the fiscal years 2002 – 2004.
p.000048: The results revealed marginal increase in total health expenditure (THE). As a percentage of GDP, the THE was 16.1%
p.000048: in 2002, 13.9% in 2003 and 14.9% in 2004. Per capita health expenditure was D895 in 2002, D1026 in 2003 and D1203 in
...
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p.000048:
p.000048: Government funding is supported by Global Alliance for Vaccine and Immunisation (GAVI) for the introduction of new
p.000048: vaccines, and UNICEF continues to support the vaccine procurement process. However, there is an urgent need for
p.000048: government to increase investment in the new vaccines on a sustainable basis.
p.000048:
p.000048: Availability of contraceptives is essential for promoting reproductive and child health outcomes and has always been a
p.000048: challenge as support provided by donors is limited thus, creating intermittent shortages.
p.000048:
p.000048: Lately the Logistic Management information System (LMIS) is being set up for strengthening the supply
p.000048: management chain. The system will be used for capturing, collecting and provision of data on medicines
p.000048: and other medical supplies consumption from health facilities which will be analysed and results used
p.000048: for informed decision making.
p.000048:
p.000048: Objective
p.000048: • To ensure available and affordable essential medicines that are safe, efficacious and of the
p.000048: required quality
p.000048: • To ensure availability of consumption data on medicines and other medical supplies
p.000048:
p.000048: Policy Measures
p.000048: • Transform the supply management system for essential medicines for the public sector into a semi
p.000048: autonomous institution
p.000048: • Advocate for increased government funding for pharmaceuticals
p.000048: • Improve the drug supply system and promote the rational use of medicines and supplies.
p.000048: • Strengthen the National Medicines Regulatory Authority and enact the necessary laws toward
p.000048: attaining quality products
p.000048: • Encourage greater private sector involvement in the provision of essential medicines especially for the
p.000048: rural community
p.000048: • Establish quality control testing of pharmaceuticals.
p.000048: • Strengthen and maintain the Logistics Management Information System (LMIS).
p.000048: 10.2: National Blood Transfusion Services Preamble
p.000048: Availability of safe blood for transfusion is an essential element in the delivery of health services
p.000048: particularly those related to maternal and child health services. Unreliable supply of blood interrupts
p.000048: general clinical care for example surgical operations and road traffic accidents. There is need for an
p.000048: uninterrupted supply of safe blood.
p.000048:
p.000048: Blood transfusion services in The Gambia were limited to RVTH and Bansang hospital for several years. Over
p.000048: the years transfusion services have been expanded to other tertiary hospitals (the Sulayman Junkung General
p.000048: Hospital in Bwiam, The Armed Forces Provisional Ruling Council Hospital in Farafenni) and some major
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: health centres. Although efforts have been made in the past through public campaign but expansion of
p.000048: services coupled with limited number of voluntary blood donor has created a gap between the need and availability of
...
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p.000048: causes of mortality within the population are: Malaria, Pneumonia, Anaemia, Diarrhoeal Diseases, road traffic
p.000048: accidents, pregnancy complications and Cardiovascular Diseases. Of increasing concern are the incidences of
p.000048: Tuberculosis and HIV/AIDS in the population.
p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
p.000048: • Set up and maintain a Data Base System for information sharing for all the Units of the Ministry of health by 2015
p.000048: • Establish a National Social Welfare Trust Fund for the needy and vulnerable groups including children and persons
p.000048: with disabilities by 2015.
p.000048: • Develop a National Child Protection Strategy and operational Plan by 2013.
p.000048: • Advocate for the signing and eventual ratification of the UN Convention for persons with disabilities
p.000048: by end of 2012.
p.000048: • Set up a National Plan of Action for the prevention of disability and rehabilitation of
p.000048: persons with disabilities in accordance with the United
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
...
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: institution. This includes complaints about waiting times, operating hours, the actions of health care personnel, and
p.000048: the adequacy of health care facilities.
p.000048:
p.000048: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES
p.000048:
p.000048: Preamble
p.000048: The existing minimum health care package shall be strengthened to make available and accessible quality basic health
p.000048: services at all levels of the health care delivery system. This is essential towards addressing the common causes of
p.000048: morbidity and mortality in The Gambia with particular attention to vulnerable groups and
p.000048: individuals. This has implication for planning, (resource mobilisation and allocation) as well as implementation of
p.000048: other policies.
p.000048:
p.000048: The Basic Package will be delivered through the following programme areas:
p.000048: 5.1. Environment, Health and Safety Preamble
p.000048: Environmental health and safety is an important determinant of health outcomes and still remains a major challenge for
p.000048: the Ministry of Health and partners.
p.000048:
p.000048: There is a variety of determinants which contribute to health improvement. Even though most of these health
p.000048: determinants are the responsibility of the Ministry of Health, certain are the responsibility of other
p.000048: Departments or services. Implementation of these actions necessarily requires close
p.000048: inter-sectoral collaboration between these Departments and the Ministry of Health. The aim is to influence policies
p.000048: and strategies of all stakeholders in the management of the environment. These activities include,
p.000048: among others: water distribution and sanitation systems to meet essential health needs, training
p.000048: of medical and paramedical personnel, including specialized training, and health research, including biomedical
p.000048: and epidemiological research, as well as research on health system operations, public hygiene activities
p.000048: (refuse collection, removal of household waste, and health inspections), management of hazardous chemicals and
p.000048: pesticides traffic safety, prevention of road accidents, workplace safety; prevention of work-related injury and
p.000048: illness, activities providing food supplements to people who need it and medico-social activities for vulnerable
p.000048: groups.
p.000048:
p.000048: The Government is cognisant of the effects of the environment on the socioeconomic growth and development
p.000048: including health, and henceforth developed and implemented the National Environment Management Act
p.000048: (1994), the Food Act (2005), and the Public Health Act (1990). Additionally, the President initiative
p.000048: ‘Operation Clean The nation’ is geared toward addressing environmental issues. In recent years, there has been noted
p.000048: increase in the incidence of road and domestic accidents and those from industry thus warranting
p.000048: interventions to address occupational hazards.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
...
p.000048: in the area of environmental sanitation and the employment of auxiliary health workers. Therefore, there is
p.000048: a need to establish a strong coordination mechanism in order to ensure accountability and transparency for the
p.000048: use of funds obtained from both Government and donor sources.
p.000048:
p.000048: This policy is in favour of the transition to universal coverage so as to contribute to meeting the needs of the
p.000048: population for health care and improving its quality, reducing poverty, attaining the Millennium
p.000048: Development Goals (MDGs) and Paris Declaration on Aid Effectiveness.
p.000048:
p.000048:
p.000048:
p.000048: 1 Budget estimates for the period 2002 - 2007
p.000048: 2 World Health Report 2007
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objectives
p.000048: • To establish an effective public health sector financing mechanism by 2020;
p.000048: • To ensure provision of universal health coverage in order to meet the health needs of the entire population.
p.000048:
p.000048: Policy Measures
p.000048: • Advocate and mobilise financial resources for health
p.000048: • Strengthen the management of available financial resources in the health
p.000048: • sector
p.000048: • Explore other financing mechanisms to support the introduction of a national health insurance scheme
p.000048: • Introduction of SWAp in the Ministry of Health
p.000048:
p.000048: 8.0: LEGAL FRAMEWORK
p.000048: Preamble
p.000048: There are many health or health-related Laws and Acts that seek to regulate and/or influence outcomes. Some of
p.000048: these Acts or laws are outdated and do not reflect current realities in health care delivery.
p.000048: Therefore, it is necessary to review and update these laws/Acts for positive health outcomes. There is also a
p.000048: need to enact new laws given the emergence of new developments and challenges requiring control affecting
p.000048: health systems management including service delivery.
p.000048:
p.000048: Objective
p.000048: • To ensure all health and health related Acts reflect the current realities in the health domain.
p.000048:
p.000048: Policy Measure
p.000048: • To develop, review and update health and health related laws and acts to make them more responsive to
p.000048: current healthcare needs.
p.000048:
p.000048: 9.0: PARTNERSHIPS
p.000048:
p.000048: Preamble
p.000048: Sector-wide approaches (SWAps) will be used to build on the national development strategy; i.e. the PAGE. Therefore,
p.000048: actions in the health sector will have more of a sustainable impact if they are integrated into the national
p.000048: development programmes. Inter-sectoral consultation and collaboration is essential in the implementation of
p.000048: major health strategies. The creation of an institutional framework is necessary in order to allow
p.000048: inter-sectoral collaboration at the various levels of the health system.
p.000048:
p.000048: National, regional and international cooperation are in line with the activities outlined in the health sector
p.000048: strategic plan by the Ministry of Health for the implementation of
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: the Health Sector Policy. Multilateral, bilateral and non-governmental cooperation is founded on the basis of mutual
...
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p.000048: treatment including the management of such diseases. These diseases are commonly cancer, diabetes, cataract,
p.000048: arterial hypertension and those associated with tobacco consumption, alcohol abuse, an inactive life style
p.000048: and environmental pollution. Oral health, the prevention of blindness and physical rehabilitation services for
p.000048: handicapped people are to be improved.
p.000048:
p.000048: Objective
p.000048: • To reduce the burden of NCDs Risk factors in the Gambian population through the promotion of healthy
p.000048: behaviours, lifestyles and appropriate care by end 2020
p.000048:
p.000048: Policy Measures
p.000048: • To finalize and implement national NCD Policy and Strategic Plan.
p.000048: • Strengthening capacity for the management, prevention and control of NCDs
p.000048: • Supporting broad based participation in support of NCD prevention and control.
p.000048: • Creating supportive environment for addressing the risk factors for NCD
p.000048: • Building and strengthening capacity for NCD research
p.000048: • Scaling up of IMNCI strategies to all levels
p.000048: • Develop and provide essential (basic) Health Care Packages at different service delivery levels
p.000048:
p.000048: 5.5: Mental Health Preamble
p.000048: It is estimated that approximately 27,000 people in the Gambia are suffering from a severe mental and/or substance
p.000048: abuse disorder and that a further 91,000 Gambians have a mild disorder still requiring treatment (World health
p.000048: Survey, 2004) .A local prevalence study in the Gambia, puts prevalence rates higher (at 20%) and leads to estimates
p.000048: of approximately 180,000 people suffering from a mental or substance abuse disorder. Providing effective
p.000048: treatment and support to all these people is challenging, given the scarce health resources in the
p.000048: Gambia and an overall situation of poverty in the country, where 34% of the population live below the
p.000048: poverty line and 18% of the population are extremely poor. However, consultation
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 24
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: with many different experts, health professions and key individuals from different government sectors has
p.000048: highlighted the great need, willingness and strategies required to strengthen the overall mental health system in
p.000048: order to provide effective treatment and care to those in need as well as to promote the mental health of all Gambians.
p.000048:
p.000048: Objective
p.000048:
p.000048: • Improve access to quality mental health care for all Gambians
p.000048: Policy Measures
p.000048:
p.000048: • Implement the Mental Health Policy and Strategy
p.000048: • Strengthening capacity for the diagnosis, management, prevention and control of mental and
p.000048: neurological disorders
p.000048: • Providing quality, equitable and affordable mental health services to the general population
p.000048: • Promote IEC on substance abuse
p.000048: • Promoting advocacy for the reduction of stigma and discrimination against people with mental and
p.000048: neurological disorders
p.000048: • Strengthening community involvement and participation in mental health care service delivery
p.000048: • Operationalise the revised current Lunatics’ Detention Act of 1917 taking into account a new mental health
p.000048: legislation Establishing and strengthening capacity for mental health research
p.000048: • Strengthen the prevention, case management and control of mental health illnesses country wide
p.000048: • Develop a Mental Health Act.
p.000048:
p.000048: 5.6: Reproductive and Child Health Preamble
p.000048: RCH services are provided at all levels of the health system by both public and
p.000048: private facilities at base and outreach through a network of health facilities across the country. With an impressive
p.000048: nationwide coverage RCH indicators have over the years been reduced significantly. For example, MMR high has reduced
p.000048: from 1050 to 730 per 100,000 live births between 1990 and 2001(DOSH 2001). Child health indicators have
p.000048: equally been reduced. Infant mortality rate has improved from 167 (1983) to 75 per 1000 live births (2003); and
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
...
Health / HIV/AIDS
Searching for indicator HIV:
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p.000002:
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p.000002:
p.000002: NATIONAL HEALTH POLICY
p.000002:
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p.000002:
p.000002:
p.000002:
p.000002:
p.000002: REPUBLIC OF THE GAMBIA
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: “HEALTH IS
p.000002: WEALTH” 2012 - 2020
p.000002:
p.000002:
p.000002: “Acceleration of Quality Health Services and Universal Coverage”
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: MINISTRY OF HEALTH & SOCIAL WELFARE BANJUL, THE GAMBIA
p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: FOREWORD
p.000002:
p.000002: Since 1996, it was deemed imperative for The Gambia to map out clearly a strategy for socio-economic development that
p.000002: aims at raising the standard of living of The Gambian population by transforming The Gambia into a dynamic middle
p.000002: –income economy. This is the fundamental objective of “The Gambia incorporated … Vision 2020”. To the President, Vision
p.000002: 2020 is not a dream and the Government is committed to its attainment.
p.000002:
p.000002: This health policy is line with the Vision 2020 and the Millennium Development Goals (MDGs),
p.000002: the Gambia National Development Strategy (2012-2015) and Investment Program – The Program for Accelerated Growth
p.000002: and Employment (PAGE) – which will lead to achievement of all the Millennium Development Goals,
p.000002: especially those related to health; accomplish a three-quarters decline in maternal mortality and a two-thirds
p.000002: decline in mortality among children under five; to halt and reverse the spread of HIV/AIDS and to
p.000002: provide special assistance to AIDS orphans; and put the country on a strong footing to attaining the Vision of
p.000002: the President.
p.000002:
p.000002: Development of human capital stock since then has been a leading priority in the development agenda of The
p.000002: Government of The Gambia, civil society, donors’ community and academia. Health, along with education and
p.000002: nutrition, is considered as one of the key elements of human capital stock formation. Consistent with the strategic
p.000002: direction for improving human capital stock, makes health central to The Gambia’s development efforts.
p.000002:
p.000002: The theme, “health is wealth”, which is the current philosophy which our national health policy is hinged
p.000002: upon becomes a reality only when a healthy population can contribute to improved productivity, increased GDP
p.000002: and sustained economic growth and overall ensure social equilibrium. Hence the slogan:
p.000002:
p.000002: “A Healthy population is a Wealthy population”.
p.000002:
p.000002: The mission of the Ministry of Health is to contribute to socioeconomic development and wealth creation
p.000002: by promoting and protecting the health of the population through equitable provision of quality health
p.000002: care within the context of Primary Health Care. This mission puts the concept of health beyond the
p.000002: confines of curative care to other socio-economic determinants of health.
p.000002:
p.000002: The health sector despite remarkable achievements registered since 1994 to date is still under great pressure due to a
p.000002: number of factors: high population growth rate, increasing morbidity and mortality, insufficient financial and
p.000002: logistic support, deterioration of physical infrastructure, inadequacies of supplies and equipment,
p.000002: shortage of adequately and appropriately trained health personnel, high attrition rate as well as
p.000002: inadequate referral system. Poverty and ignorance have led to inappropriate health seeking behaviours thus
p.000002: contributing to ill health.
p.000002:
p.000002:
p.000002:
p.000002: Health Policy 2012-2020
p.000002: Page 2
p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: Indicators of child and maternal mortality are particularly worrying. This situation is worsened by other
p.000002: factors related to the poverty in general resulting to the high prevalence of communicable and
p.000002: non-communicable diseases such as Malaria, Diarrhoea, Upper Respiration Tract Infection, Tuberculosis, Skin
p.000002: Disease, Accidents, Hypertension, Cancers, Eye Infection, and Pregnancy related conditions, Helminthiasis and
p.000002: malnutrition and HIV/AIDS and its spread. Most of these diseases can easily be prevented if appropriate
p.000002: environmental and lifestyle measures are taken, with more attention paid to development of health
p.000002: promotion and prevention actions than merely focusing on curative care alone.
p.000002:
p.000002: The revised policy is expected to reform the health system by addressing the major traditional problems of health,
p.000002: the new challenges and the double burden of communicable and non-communicable diseases, curbing the
p.000002: HIV/AIDS pandemic and overcoming a weak health system. This reform is in line with the Local Government
p.000002: decentralization and planning based upon the Local Government ACT of (2002), Vision 2020 and the
p.000002: anti-poverty Programme for Accelerated Growth and Employment (PAGE), attainment of MDG: 4 Reduce Child Mortality; MDG:
p.000002: 5 Improve Maternal Health; and MDG: 6 Combat HIV/AIDS, Malaria and Other Diseases.
p.000002:
p.000002: Implementation of policy measures will certainly impact on reducing morbidity and mortality of major diseases, promote
p.000002: healthy lifestyle, and reduce health risks and exposures associated with negative environmental consequences. It
p.000002: provides basis for an institutional and legal framework for implementation of policy measures. It also identifies
p.000002: relevant stakeholders that contribute to health service provision and the institutional framework for mobilizing
p.000002: sector- wide resources for health development. The policy update therefore provides an impetus and new direction for
p.000002: health sector development that will serve as the basis for driving our health sector priorities and planning as well
p.000002: guiding resource allocation processes in the next few years to come.
p.000002:
p.000002:
p.000002: Honourable Mme. Fatim Badjie Minister of Health & Social Welfare
p.000002: April 2012
p.000002:
p.000002:
p.000002:
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p.000002:
p.000002:
p.000002:
p.000002:
p.000002: Health Policy 2012-2020
p.000002: Page 3
p.000002:
p.000002: Table of content
p.000002: FOREWORD
p.000002: 2
p.000002: ABBREVIATIONS
p.000006: 6
p.000006: 1.0 INTRODUCTION
p.000008: 8
p.000008: 1.1 LOCATION, SIZE AND CLIMATE
p.000008: 8
p.000008: 1.2 DEMOGRAPHIC CHARACTERISTICS ERROR! BOOKMARK NOT
p.000008: DEFINED.
p.000008: 1.3 HEALTH SYSTEM
p.000010: 10
p.000010: 1.3.1. Health Sector Coordination Structures Error! Bookmark not defined.
p.000010: I. DIRECTORATE OF HEALTH SERVICES (DHS)
p.000011: 11
p.000011: II. DIRECTORATE OF PLANNING AND INFORMATION (DPI)
p.000011: 11
p.000011: III. DIRECTORATE OF FOOD STANDARDS, QUALITY AND HYGIENE ENFORCEMENT (FSQHE) 12
p.000011: IV. DIRECTORATE OF NATIONAL PUBLIC HEALTH LABORATORY SERVICES (NPHLS) 12
p.000011: V. DIRECTORATE OF HEALTH PROMOTION AND EDUCATION (DHPE) 12
p.000011: 1.4. HEALTH SERVICE DELIVERY
p.000014: 14
p.000014: 1.5 HEALTH STATUS OF THE POPULATION ERROR! BOOKMARK NOT DEFINED.
p.000014: 1.6: POLICY ORIENTATION
p.000010: 10
p.000010: 1.7 PROBLEM STATEMENT
p.000010: 10
p.000010: 2. 0 VISION AND MISSION
p.000015: 15
p.000015: 3.0 GUIDING PRINCIPLES
p.000017: 17
p.000017: 4.0 GOAL AND TARGETS
p.000015: 15
p.000015: 4.1. GOAL
p.000016: 16
p.000016: 4. 2 TARGETS
p.000016: 16
p.000016: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES 19
p.000016: 5.1.1 ENVIRONMENT, HEALTH AND SAFETY
p.000019: 19
p.000019: 5.1. HEALTH PROMOTION AND EDUCATION
p.000020: 20
p.000020: 5.2. EXPANDED PROGRAMME ON IMMUNISATION (EPI)
p.000020: 20
p.000020: 5.3: DISEASE CONTROL
p.000021: 21
p.000021: 5.3.1 COMMUNICABLE DISEASES
p.000022: 22
p.000022: 5.4: MALARIA
p.000022: 22
p.000022: 5.5: TUBERCULOSIS
p.000022: 22
p.000022: 5.6: HIV/AIDS
p.000022: 22
p.000022: 5.7: SEXUALLY TRANSMITTED INFECTIONS (STIs) (other than HIV/AIDS) 23
p.000022: 5.8: DIARRHOEAL DISEASES
p.000023: 23
p.000023: 5.9: TRACHOMA/EYE DISEASES
p.000023: 23
p.000023: 5.10: RESPIRATORY TRACT INFECTIONS Error! Bookmark not
p.000023: defined.
p.000023: 5.11: NON- COMMUNICABLE DISEASES (NCDs)
p.000023: 23
p.000023: 5.12: MENTAL HEALTH
p.000024: 24
p.000024: 5.13: REPRODUCTIVE AND CHILD HEALTH
p.000025: 25
p.000025: 6.0: BASIC HEALTH CARE
p.000027: 27
p.000027: 6.1 TERTIARY CARE
p.000032: 32
p.000032: 6.2 ORGANISATION AND MANAGEMENT
p.000032: 32
p.000032: 6.3: HUMAN RESOURCE MANAGEMENT
p.000032: 32
p.000032: 6.4: INFRASTRUCTURE AND LOGISTICS
p.000033: 33
p.000033: 6.5: HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) AND RESEARCH 33
p.000033: 6.6: HEALTH FINANCING
p.000034: 34
p.000034: 6.7 LEGAL FRAMEWORK
p.000036: 36
p.000036: 6.8 PARTNERSHIPS
p.000036: 36
p.000036: 7.0. TECHNICAL SUPPORT SERVICES
p.000037: 37
p.000037: 7.1 PHARMACEUTICAL SERVICES (ESSENTIAL MEDICINES, VACCINES, EQUIPMENT AND OTHER MEDICAL SUPPLIES)
p.000037: 37
p.000037: 7.2 NATIONAL BLOOD TRANSFUSION SERVICES 38
p.000037: 7.3 LABORATORY SERVICES
p.000039: 39
p.000039: 7.4 RADIOLOGY SERVICES
p.000040: 40
p.000040:
p.000040: HEALTH IS WEALTH
p.000040: 7.5 REFERRAL SYSTEM
p.000040: 40
p.000040: 8.0 LEVELS OF HEALTH SERVICE DELIVERY Error! Bookmark not defined.
p.000040: 8.1 PRIMARY HEALTH CARE (PHC) SERVICE ERROR! BOOKMARK NOT DEFINED.
p.000040: 8.1.1 SEVICE EXPANSION ERROR! BOOKMARK NOT DEFINED.
...
p.000048: Immune Deficiency Syndrome
p.000048: ART - Anti – Retroviral Therapy
p.000048: BCC - Behavioural Change Communication
p.000048: BFCI - Baby Friendly Community Initiative
p.000048: BI - Bamako Initiative
p.000048: BTS - Blood Transfusion Services
p.000048: CBO - Community Based Organisation
p.000048: CP - Chief Pharmacist
p.000048: CSD - Central Statistics Department
p.000048: DFSQHE - Directorate of Food Security, Quality and Hygiene Enforcement DHS -
p.000048: Director of Health Services
p.000048: DNPHLS - Directorate of National Public Health Laboratory Services DOTS -
p.000048: Directly Observed Treatment Short course
p.000048: DPI - Directorate of Planning and Information
p.000048: DRF - Drug Revolving Fund
p.000048: EDC - Epidemiology and Disease Control
p.000048: EH - Environmental Health
p.000048: ENC - Emergency newborn care
p.000048: EOC - Emergency Obstetric Care
p.000048: EPI - Expanded Program on Immunization
p.000048: FP - Family Planning
p.000048: GAVI - Global Alliance for Vaccine Initiative
p.000048: HIV - Human Immunodeficiency Virus
p.000048: HMIS - Health Management Information System
p.000048: HRH - Human Resources for Health
p.000048: IEC - Information, Education and Communication
p.000048: IHR - International Health Regulations Illnesses
p.000048: IMNCI - Integrated Management of Neonatal & Childhood IPT - Intermittent
p.000048: Preventive Treatment
p.000048: ITN - Insecticide Treated Nets
p.000048: MDGs - Millennium Development Goals
p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
p.000048: PRSP - Poverty Reduction Strategy Programme
p.000048: RCH - Reproductive and Child Health
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 6
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: RFH - Riders for Health
p.000048: RH - Reproductive Health
p.000048: RHD - Regional Health Directorate
p.000048: RHO - Regional Health Officer
p.000048: RHT - Regional Health Teams
p.000048: RTI - Respiratory Tract Infections
p.000048: STI - Sexually Transmitted Diseases
p.000048: SWAp - Sector Wide Approach
p.000048: TB - Tuberculosis
p.000048: TH - Traditional Healer
p.000048: TM - Traditional Medicine
p.000048: TOR - Terms of Reference
p.000048: VC - Vector Control
p.000048: VCT - Voluntary Counselling and Testing
p.000048: VDC - Village Development Committee
p.000048: VDRL - Venereal diseases reference laboratory
p.000048: VHC - Village Health Committee
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
...
p.000048: population. The crude birth rate is 46 per 1000 population while the total fertility rate is 5.4 births per woman.
p.000048: The high fertility level has resulted in a very youthful population structure. Nearly 44% of the
p.000048: population is below 15 years and 19% between the ages 15 to 24. Average life expectancy at birth is 64
p.000048: years overall with females constituting 59 and males 55. Please see Appendices: A & B.
p.000048: 1.2: Health Status of the Population
p.000048: The Gambia has an Infant Mortality Rate of 75/1000 live births, 60% of which is attributable to malaria,
p.000048: diarrhoeal diseases and acute respiratory tract infections. The main causes of mortality in infants (0-12
p.000048: months) are neonatal sepsis, premature deliveries, malaria, respiratory infections, diarrhoeal diseases and
p.000048: malnutrition. For child mortality, main causes are: malaria, pneumonia, malnutrition, and diarrhoeal diseases.
p.000048: The Maternal Mortality Ratio is estimated at 730/100,000 live births, the majority of which are due to
p.000048: sepsis, haemorrhage and eclampsia (Maternal and Neonatal Survey 2001).
p.000048:
p.000048: The period 1999 to 2009 has witnessed a decline of total outpatient consultations from 40% to 32.5%
p.000048: respectively, while diarrhoeal diseases for under fives accounts for 19.5% and pneumonia 16.4% of IMNCI cases
p.000048: reported for 2009. Severe diarrhoea is 10.8% compared with severe pneumonia, which is 48.8% for IMNCI
p.000048: admissions respectively. The HIV prevalence rate is 1.6% for HIV1 and 0.4% for HIV2 (sentinel surveillance,
p.000048: 2008).
p.000048:
p.000048: Tuberculosis remains a disease of public health importance in The Gambia. Generally, the case
p.000048: notification for all forms of TB has also markedly increased in recent years. A total number of 2053 TB patients (all
p.000048: forms) was detected in 2008 in the Gambia. The rate of new smear positive cases have been increasing
p.000048: steadily from 61 per 100,000 in 1994 to 87 per 100,000 in 2006, 2007 and 2008 respectively. Similarly, the rate for All
p.000048: Forms of TB (New sputum Smear positive, New negative, Extra-pulmonary TB, Relapse, Failure and Return after
p.000048: default, others) have also increased. This increase is attributed to both improved surveillance and
p.000048: increased incidence as a secondary infection associated with HIV-1.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 8
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: There has been an increase in national coverage for fully immunized children to a present level of 79.6 % for under 1
p.000048: year and 84.9% for the under 2 year (2004 EPI cluster survey). The routine national immunization coverage is above
p.000048: 90% in 2010 for all the antigens (EPI, 2010). Please see Appendix C.
p.000048: Malnutrition continues to be a major public health problem in The Gambia. The MICS 2006 indicated 19% stunting, 6.8%
p.000048: wasting and 17% underweight. Diabetes Mellitus is estimated to affect about 1% of the population while a study found
p.000048: that about 16% of urban women are obese compare to only 1% of rural women. A WHO survey in 2008 reveals the
p.000048: prevalence of other NCD risk factors as follows:
p.000048: • 24.5% prevalence rate of smoking amongst 13-15 year olds.
p.000048: • 31.3% prevalence rate of smoking among youths aged 25 to 34 years.
p.000048: • About 2% of the adult population, aged 25 – 64 years, drink alcohol
p.000048: • Low consumption of fruits and vegetables, with the average mean number of days for fruits and
p.000048: vegetable consumption among adult males and females estimated at 3.3 and 5.0 respectively
p.000048: • About 22% of the adult population (males and females) have a low level of physical activity, whilst
p.000048: nearly 59% of adults do not engage in rigorous physical activity. In the same vein, on average, Gambian adults spend
p.000048: 231 minutes per day on sedentary activities
...
p.000048: • About 39.5% of the adult population (33.7% for men and 45.3%) are considered overweight with mean BMI >25kgM2
p.000048:
p.000048: Safe water is an essential pillar of sustainable health for the population. Access to safe water is 85.1% of the
p.000048: overall households; with 79.9% urban and 64.9% rural and access to proper sanitary facilities are not encouraging
p.000048: thus limiting to only 26% (PRSPII) for the entire country.
p.000048:
p.000048: The 2008 poverty assessment indicated that overall poverty to be at 55.5% with a poverty gap of 25.9% and poverty
p.000048: severity at 14.3%. However there are regional variation with rural poverty incident of 63% and an urban
p.000048: incident of 57%. See Appendix: D.
p.000048:
p.000048: Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in
p.000048: recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly
p.000048: Community Initiative and the Bamako Initiative.
p.000048:
p.000048: Also, relevant policy documents were developed including that of Nutrition, Drug , Malaria Reproductive and
p.000048: Child Health , Human Resource for Health , Maintenance , Mental Health , HIV/AIDS , Health Management Information
p.000048: System , National Blood Transfusion , Information Technology , and others such as Traditional Medicine,
p.000048: National Public Health Laboratory and the Health Research Policies at various stages of development.
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 9
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.3: Problem Statement
p.000048: • General health system challenges including the effects of previous high population growth
p.000048: rate; inadequate financial and logistic support; weak health information system; uncoordinated donor
p.000048: support; shortage of adequately and appropriately trained health staff; high attrition rate and lack of
p.000048: efficient and effective referral system. In addition, poverty, low awareness of health issues and poor attitude of
p.000048: service providers have led to inappropriate health seeking behaviours and contributed to ill health. These
p.000048: factors have seriously constrained efforts to reduce morbidity and mortality rates as desired and as a result health
p.000048: care delivery throughout the country has not lived up to expectation.
p.000048:
p.000048: • The frequent changes in top management positions at The Ministry of Health have been hampering
p.000048: continuity, institutional memory and policy flow. The need to have a clear direction to improve quality of health
p.000048: care and reduce the high morbidity and mortality rates requires a stable, supportive, organisational and
...
p.000048: principles, a number of key result areas were identified that would collectively have potential for
p.000048: maximum impact on the health status of the citizenry.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 15
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 3.1. Goal:
p.000048: Reduce morbidity and mortality to contribute significantly to quality of life in the population.
p.000048:
p.000048: Morbidity and mortality rates due to communicable diseases have decreased over the years but more pronounced
p.000048: in non-communicable diseases especially among youths and women. In addition to the earlier mentioned health
p.000048: challenges, the main factors contributing to this high morbidity in the population include social
p.000048: determinants and related factors such as poverty, unhealthy environment, unsafe working conditions, poor
p.000048: sanitation, poor nutrition, road traffic accidents, poor access to safe water and poor housing for many. The main
p.000048: causes of mortality within the population are: Malaria, Pneumonia, Anaemia, Diarrhoeal Diseases, road traffic
p.000048: accidents, pregnancy complications and Cardiovascular Diseases. Of increasing concern are the incidences of
p.000048: Tuberculosis and HIV/AIDS in the population.
p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
p.000048: • Set up and maintain a Data Base System for information sharing for all the Units of the Ministry of health by 2015
p.000048: • Establish a National Social Welfare Trust Fund for the needy and vulnerable groups including children and persons
p.000048: with disabilities by 2015.
p.000048: • Develop a National Child Protection Strategy and operational Plan by 2013.
...
p.000048: rates, inadequate government and donor funding, cancellation of outreach clinics and high defaulter rates, the routine
p.000048: coverage has dropped from 93.08 % in 2004 to 89.2 % in 2005. Other challenges include limited storage capacity
p.000048: especially at health facility and regional Health Office levels and over-aged cold chain equipment. . Surveillance
p.000048:
p.000048:
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p.000048: Page 20
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: is very important in the management of vaccine preventable diseases and is done in collaboration with the disease
p.000048: control unit for overall coordination.
p.000048:
p.000048: The vaccine independent initiative introduced in the mid 1990s into the EPI programme led to the creation of
p.000048: a budget line for vaccine and logistics. This budget line has been increasing over the years for the
p.000048: procurement of all traditional vaccines, and the logistics, while new vaccines are funded by GAVI.
p.000048:
p.000048: Objectives
p.000048: • To increase immunization coverage to at least 90% for all antigens at national and regional levels.
p.000048: • To ensure vaccine security for all vaccine preventable diseases
p.000048:
p.000048: Policy Measures
p.000048: • Mobilize additional financial resources for the EPI programme
p.000048: • Strengthen the effectiveness and efficiency of the EPI delivery system
p.000048: • Improve surveillance mechanism for early detection and response to vaccine preventable disease outbreaks
p.000048:
p.000048: 5.4. Disease Control Preamble
p.000048: Strategies/programmes based on Integrated Disease Surveillance and Response (IDSR) have been put in place
p.000048: to control diseases such as, HIV/AIDS, malaria, Tuberculosis, measles and eye diseases. However, the
p.000048: threat of epidemic prone diseases including meningococcal meningitis, cholera and yellow fever constitute a major
p.000048: public health concern. Other diseases such as poliomyelitis, lymphatic filariasis and leprosy are
p.000048: at the point of elimination. Non-communicable diseases such as diabetes, hypertension, mental health
p.000048: illnesses, asthma, cardiovascular diseases, including other neglected chronic diseases and cancers continue to pose
p.000048: major public health challenges. To maintain a ready state of preparedness and a swift response to diseases
p.000048: with epidemic potential, the Government of The Gambia will strengthen the epidemiological surveillance system so
p.000048: that there is effective detection, investigation, and management of any suspected and confirmed cases of priority.
p.000048: Cross border surveillance will also be strengthened with the effective implementation of IHR (International
p.000048: Health Regulations).
p.000048:
p.000048: The monitoring of diseases both emerging and re-emerging will be strengthened with the empowerment of regions to
p.000048: carry out proper monitoring and supervision of interventions. Disaster management requires a multi-sectoral
p.000048: approach: hence, the Ministry of Health will take the necessary measures to ensure there is an adequate level of
p.000048: preparedness and ability to respond to those disasters using collaborative strategies quickly and adequately.
p.000048:
p.000048: Objectives
p.000048:
p.000048: • To reduce the burden of communicable diseases to a level that they cease to be a public health problem
p.000048:
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p.000048: Page 21
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • To promote healthy life styles, increase understanding on the prevention and management of all diseases.
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen disease surveillance and response capacity at all levels
p.000048: • Provision of appropriate case management capacity at various levels of health care delivery system
p.000048: • Community empowerment on disease prevention and control measures
p.000048:
p.000048: 5.4.1 COMMUNICABLE DISEASES
p.000048: 5.4.1 (i): Malaria Policy Measures
p.000048: • Community empowerment on malaria prevention and control
p.000048: • Increase availability and access to LLINs for the general population.
p.000048: • Strengthen integrated vector control interventions (including in indoor residual spraying)
p.000048: • Strengthen the availability and accessibility of effective malaria chemoprophylaxis
p.000048: for all pregnant women
p.000048: • Strengthen Malaria Case management in all health facilities
p.000048: • Strengthen collaboration with partners in research
p.000048: • Strengthen community management of malaria
p.000048:
p.000048: 5.4.1(ii): Tuberculosis Policy Measures
p.000048: • Promote the expansion of high-quality Directly Observed Treatment Short course (DOTS)
p.000048: • Support the implementation of advocacy, communication and social mobilisation activities (ACSM)
p.000048: • Inter-sectoral coordination to address the synergistic challenges posed by TB/HIV
p.000048:
p.000048: 5.4.1(iii): HIV/AIDS
p.000048: Policy Measures
p.000048: • Expand and strengthen HIV/AIDS Counselling & Testing (HCT) and Prevention of Mother to child
p.000048: transmission (PMTCT) services.
p.000048: • Support and expand Anti-Retroviral Therapy (ART)
p.000048: • Expand the care and support services for People Living With HIV/AIDS (PLWHAs)
p.000048: • Support sentinel surveillance and research in HIV/AIDS
p.000048: • Intensify IEC/BCC/CSC interventions on HIV/AIDS
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 5.4.1(iv): Sexually Transmitted Infections (STIS) (Other Than HIV/AIDS) Policy Measures
p.000048: • Effective information, education and counselling of the populace
p.000048: • Provision of STIs drugs and supplies in all facilities with a view to increase access
p.000048: • Train health care workers on the syndromic treatment and management of STIs with a view to provide
p.000048: proper treatment
p.000048: • Set up well equipped laboratories in all major health centres and hospitals
p.000048: • Establish STI clinics targeted specifically for most at risk populations (MARPs)
p.000048: • Provision and distribution of condoms to MARPs
p.000048: • Monitoring and supervision of STI services
p.000048:
p.000048: 5.4.1(v): Diarrhoeal Diseases Policy Measures
p.000048: • Increase access to safe water and improved sanitary facilities
p.000048: • Strengthen case management , prevention and control
p.000048:
p.000048: 5.4.1(vi): Trachoma (Eye Disease) Policy Measures
p.000048: • Elimination of blinding trachoma
p.000048: • Reduce the prevalence of active trachoma to below 5% in all communities
p.000048: • Intensify IEC/BCC/CSC intervention
p.000048: • Conduct a survey to determine the prevalence of cataract per region and set up regional cataract surgery
p.000048: targets after Training more nyateros to identify and refer all cataract cases in their communities
p.000048: • Adequate supply of equipment, drugs and consumables for eye surgery (cataract, glaucoma, retina)
p.000048: • Training of eye care providers in the prevention and management of corneal ulcers
...
p.000048: implementation of community component of the IMNCI strategy.
p.000048: • To strengthen the implementation of the IMNCI strategy in all seven health regions in the country.
p.000048:
p.000048: 6.0: BASIC HEALTH CARE AND LEVELS OF DELIVERY
p.000048: 6.1 PRIMARY HEALTH CARE (PHC) SERVICE
p.000048:
p.000048: Preamble
p.000048: The Gambia adopted Primary Health Care (PHC) in 1979 following the Alma- Ata declaration in 1978. Subsequently
p.000048: a PHC Plan of Action for the period 1980 to 1985 was formulated which formed the basis for a National Health Policy.
p.000048: In the Plan of Action, PHC has been defined as:
p.000048:
p.000048: An approach aimed at mobilising all potential resources including the communities’ own resources, towards the
p.000048: development of the National Health Care System, the aim being to extend health services coverage to the entire Gambian
p.000048: population and to attract the main disease problems of the communities. PHC is also a mechanism for ensuring an
p.000048: equitable re-distribution of the limited health resources available in the country in favour of the under-served
p.000048: majority, who live and work in the rural area.
p.000048:
p.000048: At present quite a number of PHC villages are not functioning optimally. Reasons for non performance are attributed to
p.000048: several factors namely an ineffective VDC, lack of support for community health workers, shortage of drugs and lack of
p.000048: supervision. A selective PHC programme has been designed to intervene at village level to control priority diseases
p.000048: such as Acute Respiratory Infection, Diarrhoeal Diseases, Tuberculosis, Malaria, Preventive Eye Care and
p.000048: HIV/AIDS.
p.000048:
p.000048: Support to and capacity building at primary level are essential for sustaining of basic PHC technologies needed to
p.000048: address common health problems affecting women and children, and management of development projects which have an
p.000048: impact on health
p.000048: e.g. community water supplies, sanitation, home based care for malaria, etc.
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: In order to restore the functionality of all existing PHC villages, the Ministry of Health in collaboration with
p.000048: stakeholders and the community will review the present VDC system.
p.000048: The development of the VHS has been in isolation to the BHS. The latter possesses a wide range of resources to support
p.000048: the VHS. The policy calls for define linkages between the BHS and the VHS. A basic health facility will be linked to a
p.000048: number of trekking stations and PHC villages. This group of facilities and the population it serves
p.000048: (including non primary health care villages) will constitute a CATCHMENT AREA.
p.000048: The basic health facility will perform the first line supervision and provide support in the areas of training and
p.000048: supply of drugs to the VHS. Each catchment area will have a catchment area committee. The latter will be closely
p.000048: involved in the management, planning, monitoring and evaluation of services provided in the area under its
p.000048: jurisdiction.
p.000048: 6.1.1 Service Expansion
...
p.000048: required for sustainability and better outcomes.
p.000048:
p.000048: Objective
p.000048: • To introduce a clear and effective coordination mechanism for all stakeholders in health and
p.000048: healthcare delivery
p.000048:
p.000048: Policy Measures
p.000048: • Encourage stakeholders’ participation in health.
p.000048: • Strengthen Inter-sectoral collaboration.
p.000048: • Introduce and promote sector-wide approach in health.
p.000048: • Strengthen the implementation of the MOU between Ministry of Health and the partners involved in health
p.000048: care delivery.
p.000048:
p.000048: 10.0. TECHNICAL SUPPORT SERVICES 10.1: Pharmaceutical Services. Preamble
p.000048: Reliable availability of essential medicines (drugs, basic equipment, vaccines,
p.000048: contraceptives and other medical supplies) are critical to provide quality health care service and towards the
p.000048: attainment of positive health outcomes. However, uninterrupted availability of supplies requires that the
p.000048: needed financial resources are allocated. The Gambia still provide free health care services.
p.000048:
p.000048: Government budgetary allocation for health products has not increased significantly lately. There has been a major
p.000048: increase in demand due to population increase and coupled with the rapid expansion of health facilities. These
p.000048: factors contribute to the periodic shortages of medicines and other medical supplies. The bureaucratic process
p.000048: involves in the procurement of pharmaceuticals and other medical supply requires improvement. However the
p.000048: Global Fund is providing some amounts of funds for pharmaceutical and health products to complement government’s
p.000048: effort in the fight against HIV/AIDS, Malaria and tuberculosis.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Government funding is supported by Global Alliance for Vaccine and Immunisation (GAVI) for the introduction of new
p.000048: vaccines, and UNICEF continues to support the vaccine procurement process. However, there is an urgent need for
p.000048: government to increase investment in the new vaccines on a sustainable basis.
p.000048:
p.000048: Availability of contraceptives is essential for promoting reproductive and child health outcomes and has always been a
p.000048: challenge as support provided by donors is limited thus, creating intermittent shortages.
p.000048:
p.000048: Lately the Logistic Management information System (LMIS) is being set up for strengthening the supply
p.000048: management chain. The system will be used for capturing, collecting and provision of data on medicines
p.000048: and other medical supplies consumption from health facilities which will be analysed and results used
p.000048: for informed decision making.
p.000048:
p.000048: Objective
p.000048: • To ensure available and affordable essential medicines that are safe, efficacious and of the
p.000048: required quality
p.000048: • To ensure availability of consumption data on medicines and other medical supplies
p.000048:
p.000048: Policy Measures
p.000048: • Transform the supply management system for essential medicines for the public sector into a semi
p.000048: autonomous institution
p.000048: • Advocate for increased government funding for pharmaceuticals
...
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p.000092: Page 46
p.000092:
p.000092: HEALTH IS WEALTH
p.000092:
p.000092:
p.000092: APPENDIX F
p.000092: Table 2: showing distribution of hospitals by health region
p.000092: Region General Hospitals NGO/Private Hospital Teaching Hospital URR 0 0
p.000000: 0
p.000000: LRR 0 0 0
p.000000: CRR 1 0 0
p.000000: NBR 1 0 0
p.000000: WR 1 0 0
p.000000: KMC 2 3 0
p.000000: BCC 0 1
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: APPENDIX G
p.000000:
p.000000: Table 3: MINIMUM HEALTH CARE PACKAGE
p.000000: VHS Minor H/C Major H/C
p.000000: Regional Hospital Teaching Hospital
p.000000:
p.000000: • Primary care service (including treatment of minor illnesses and referrals, environmental health & sanitation,
p.000000: antenatal, delivery and postpartum care, home visits, community health promotion activities s
p.000000: • Maternity care (antenatal, delivery and postpartum
p.000000: • Family Planning
p.000000: • STIs/RTIs/HIV/AIDS prevention and control
p.000000: • IMNCI
p.000000: • Immunisation
p.000000: • Neonatal and child health
p.000000: • Maternal and child nutrition
p.000000: • Basic EMOC
p.000000: • Basic emergency newborn care (ENC)
p.000000: • Disease prevention and control( malaria, TB, etc)
p.000000: • Health protection and control
p.000000: • Basic Lab services(HB, BF, VDRL, Urine analysis TB and HIV screening)
p.000000: • in-patient service
p.000000: • Referral services
p.000000: • Dispensary
p.000000: • Eye care services
p.000000: • Out-patient services
p.000000: • Registration of births and Deaths
p.000000: • All services provided at minor H/C level
p.000000: • Comprehensive emergency obstetric care (including theatre and blood transfusion services)
p.000000: • Functional theatre
p.000000: • Comprehensive emergency newborn care
p.000000: • In-patient services
p.000000: • Pharmacy Services
p.000000: • Basic Lab. services including HIV and TB Screening.
p.000000: • All services provided at major H/C level
p.000000: • Specialist care and service
p.000000: • Higher level referral services
p.000000: • Specialised dental and eye care services
p.000000: • Comprehensive laboratory services
p.000000: • Radiology services
p.000000: • All services provided at regional hospital level
p.000000: • Specialist hospital services (in- and out-patient services)
p.000000: • Post-mortem and embalmment services
p.000000: • Overseas referral
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
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p.000000: Page 47
p.000000:
p.000000:
p.000000: HEALTH IS WEALTH
p.000000:
p.000000: APPENDIX H
p.000000: Table 4: Functions of various levels of the health system including hospitals in the implementation and monitoring of
p.000000: the policy
p.000000: Central Level Regional Level (Hospitals)
p.000000:
p.000000:
p.000000: • Policy formulation, setting standards, and quality assurance.
p.000000: • Resource mobilisation and allocation
p.000000: • Capacity development and technical support.
p.000000: • Provision of nationally co- ordinated services, e.g. Epidemic control
p.000000: • Co-ordination of health research.
p.000000: • Legislation
p.000000: • Monitoring and Evaluation of the overall health sector performance (M&E Template )
p.000000: • Advocacy/Partnership with stakeholders
p.000000: • Implementation of the Health Master Plan
p.000000: • Planning and management of regional health services
...
Searching for indicator hiv/aids:
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Health / Mentally Disabled
Searching for indicator disability:
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p.000048: and national health policy, legislations or strategies for tobacco control in line with the WHO Framework Convention on
p.000048: Tobacco Control;
p.000048: • Provision of technical advice to the Ministry of Health and Social Welfare on International protocols, instruments
p.000048: and conventions that have a public health and health promotion underpinning;
p.000048: • Act as the technical adviser to the Ministry of Health and Social Welfare and oversee patient
p.000048: education/counselling in the country’s medical institutions as part of the health promoting hospital initiatives with a
p.000048: view to ensuring quality care for the poor and the socially deprived;
p.000048: • Act as the technical body to regulate health information dissemination in the country.
p.000048:
p.000048: (b) Department of Social Welfare
p.000048:
p.000048: Directorate of Social Welfare (DSW)
p.000048:
p.000048: The Department comprised of the Directorate of Social Welfare (DSW).It is responsible for the
p.000048: promotion and protection of the rights and welfare of vulnerable persons such as children, the elderly, persons
p.000048: with disability and adults in difficult circumstances. To enable them maximize their potential and minimize
p.000048: problems arising out of the imbalance between themselves and their environment as a result of social change. Their
p.000048: services focus on the social protection of individual families and groups.This includes the welfare services to the
p.000048: vulnerable families and individuals, child rights and protection services, elderly care, disability care services and
p.000048: regional social welfare services provision and management.
p.000048:
p.000048: 1.5.2: Regional Level
p.000048: The Regional Health Directorates are headed by Regional Directors of Health Services, who are directly
p.000048: responsible to the Permanent Secretary through the Director of Health Services. Regional Directors of Health
p.000048: Services are responsible for coordinating policy interpretation, planning and implementation of health services, and
p.000048: monitoring and evaluation of health service delivery, within their respective
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
...
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
p.000048: • Set up and maintain a Data Base System for information sharing for all the Units of the Ministry of health by 2015
p.000048: • Establish a National Social Welfare Trust Fund for the needy and vulnerable groups including children and persons
p.000048: with disabilities by 2015.
p.000048: • Develop a National Child Protection Strategy and operational Plan by 2013.
p.000048: • Advocate for the signing and eventual ratification of the UN Convention for persons with disabilities
p.000048: by end of 2012.
p.000048: • Set up a National Plan of Action for the prevention of disability and rehabilitation of
p.000048: persons with disabilities in accordance with the United
p.000048:
p.000048:
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p.000048: Page 16
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
...
p.000000: DDHS – Deputy Directorate of Health Services
p.000000: PHC – Assistant Director Family Health / Primary Health Care RCH – Reproductive and Child Health
p.000000: EPI – Expanded Programme of Immunisation OHS – Occupational Health Services
p.000000: EH – Environmental Health VC – Vector Control
p.000000: IMNCI – Integrated Management of Childhood Neonatal Illnesses CNO – Chief Nursing Officer
p.000000: CPHO – Chief Public Health Officer CP – Chief Pharmacist
p.000000: NPS – national Pharmaceutical Services CMS – Central Medical Stores
p.000000: NMCP – National Malaria Control Programme
p.000000: NLTP – National Leprosy and Tuberculosis Control Programme NACP – National Aids Control Programme
p.000000: NEHP – National Eyecare Health Programme TM - Traditional Medicine
p.000000: BI – Bamako Initiative
p.000000: DFSHQE – Directorate of Food Standards Quality Hygiene Enforcement IHE - Inspection & Hygiene Enforcement
p.000000: FSQ - Foods Standard & Quality
p.000000: DHPE – Directorate of Health Promotion and Education DDHPE – Directorate of Health Promotion and Education NCD –
p.000000: Non-Communicable Diseases
p.000000: MH – Mental Health
p.000000: WS – Water and Sanitation Hygiene HC – Health Communication
p.000000: NHR – National Health Research HPP – School Health and Nutrition
p.000000: SWRO – Social Welfare Regional Offices CC - Child Care
p.000000: DU - Disability Unit AC - Adult Care
p.000000: PS – Professional Services
p.000000: RVTH – Royal Victoria Teaching Hospital SJJH – Sulayman Junkung Jammeh Hospital
p.000000:
p.000000:
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p.000000:
p.000000: JFPH – Jammeh Foundation for Peace Hospital SGH – Serekunda General Hospital
p.000000: AFPRC – Armed Forces Patriotic Ruling Council Hospital BSG – Bansang Hospital
p.000000: GMDC – Gambia Medical and Dental Council GNMC – Gambia Nurses and Midwives Council MB – Medicine’s Board
p.000000: CIO – Central Inspectorate Office
p.000000: RHDW1 – Regional Health Directorate Western 1 RHDW2 – Regional Health Directorate Western 2 RHDNBW – Regional Health
p.000000: Directorate North Bank West RHDNBE – Regional Health Directorate North Bank East
p.000000: RHDCRR – Regional Health Directorate Central River Region RHDURR – Regional Health Directorate Upper River Region
p.000000: RHDLRR – Regional Health Directorate Lower River Region VHS – Village Health Services
p.000000: VHW – Village Health Worker TBA – Traditional Birth Attendant
p.000000:
p.000000: ********
p.000000:
p.000000:
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p.000000:
p.000000: Health Policy 2012-2020
...
Health / Motherhood/Family
Searching for indicator family:
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p.000048: Health Policy 2012-2020
p.000048: Page 5
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: ABBREVIATIONS
p.000048:
p.000048: ACSM - Advocacy Communication and Social Mobilisation AIDS - Acquired
p.000048: Immune Deficiency Syndrome
p.000048: ART - Anti – Retroviral Therapy
p.000048: BCC - Behavioural Change Communication
p.000048: BFCI - Baby Friendly Community Initiative
p.000048: BI - Bamako Initiative
p.000048: BTS - Blood Transfusion Services
p.000048: CBO - Community Based Organisation
p.000048: CP - Chief Pharmacist
p.000048: CSD - Central Statistics Department
p.000048: DFSQHE - Directorate of Food Security, Quality and Hygiene Enforcement DHS -
p.000048: Director of Health Services
p.000048: DNPHLS - Directorate of National Public Health Laboratory Services DOTS -
p.000048: Directly Observed Treatment Short course
p.000048: DPI - Directorate of Planning and Information
p.000048: DRF - Drug Revolving Fund
p.000048: EDC - Epidemiology and Disease Control
p.000048: EH - Environmental Health
p.000048: ENC - Emergency newborn care
p.000048: EOC - Emergency Obstetric Care
p.000048: EPI - Expanded Program on Immunization
p.000048: FP - Family Planning
p.000048: GAVI - Global Alliance for Vaccine Initiative
p.000048: HIV - Human Immunodeficiency Virus
p.000048: HMIS - Health Management Information System
p.000048: HRH - Human Resources for Health
p.000048: IEC - Information, Education and Communication
p.000048: IHR - International Health Regulations Illnesses
p.000048: IMNCI - Integrated Management of Neonatal & Childhood IPT - Intermittent
p.000048: Preventive Treatment
p.000048: ITN - Insecticide Treated Nets
p.000048: MDGs - Millennium Development Goals
p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
...
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
p.000048: 4.10.2 Choice of providers and plans
p.000048: Where possible every patient shall have the right to choose health care providers who can give him/her
p.000048: high-quality health care when needed.
p.000048:
p.000048: 4.10.3 Access to emergency services
p.000048: In emergency health situations including severe pain, an injury, or sudden illness that makes a person believe that
p.000048: his/her health is in serious danger, he/she shall have the right to be screened and stabilized using emergency
p.000048: services. He/she should be able to use these services whenever and wherever needed without needing to wait for
p.000048: authorization and any financial payment.
p.000048:
p.000048: 4.10.4 Participation in treatment decisions
p.000048: Every patient shall have the right to know his/her treatment options and take part in decisions about his/her care.
p.000048: Parents, guardians, family members, or others that they identify can represent them if he/she cannot make his/her
p.000048: own decisions.
p.000048:
p.000048: 4.10.5 Respect and non-discrimination
p.000048: Every patient must have a right to considerate, respectful and non-discriminatory care from his/her health
p.000048: care provider (s),
p.000048:
p.000048: 4.10.6 Confidentiality of health information
p.000048: All patients must have the right to talk privately with health care providers and to have his/her health
p.000048: care information protected. He/she shall have the right to read and copy his/her own medical record. He/she shall have
p.000048: the right to ask that his/her health care provider change his/her record if it is not correct, relevant, or complete.
p.000048:
p.000048: 4.10.7 Complaints and appeals
p.000048: Every patient shall have the right to a fair, fast, and objective review of any complaint he/she may have against any
p.000048: health plan, health care provider/personnel or health
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 18
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: institution. This includes complaints about waiting times, operating hours, the actions of health care personnel, and
p.000048: the adequacy of health care facilities.
p.000048:
p.000048: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES
p.000048:
p.000048: Preamble
p.000048: The existing minimum health care package shall be strengthened to make available and accessible quality basic health
p.000048: services at all levels of the health care delivery system. This is essential towards addressing the common causes of
p.000048: morbidity and mortality in The Gambia with particular attention to vulnerable groups and
...
p.000092: Banjul 2 - - - 100
p.000092: Health Policy 2012-2020
p.000092: Page 46
p.000092:
p.000092: HEALTH IS WEALTH
p.000092:
p.000092:
p.000092: APPENDIX F
p.000092: Table 2: showing distribution of hospitals by health region
p.000092: Region General Hospitals NGO/Private Hospital Teaching Hospital URR 0 0
p.000000: 0
p.000000: LRR 0 0 0
p.000000: CRR 1 0 0
p.000000: NBR 1 0 0
p.000000: WR 1 0 0
p.000000: KMC 2 3 0
p.000000: BCC 0 1
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: APPENDIX G
p.000000:
p.000000: Table 3: MINIMUM HEALTH CARE PACKAGE
p.000000: VHS Minor H/C Major H/C
p.000000: Regional Hospital Teaching Hospital
p.000000:
p.000000: • Primary care service (including treatment of minor illnesses and referrals, environmental health & sanitation,
p.000000: antenatal, delivery and postpartum care, home visits, community health promotion activities s
p.000000: • Maternity care (antenatal, delivery and postpartum
p.000000: • Family Planning
p.000000: • STIs/RTIs/HIV/AIDS prevention and control
p.000000: • IMNCI
p.000000: • Immunisation
p.000000: • Neonatal and child health
p.000000: • Maternal and child nutrition
p.000000: • Basic EMOC
p.000000: • Basic emergency newborn care (ENC)
p.000000: • Disease prevention and control( malaria, TB, etc)
p.000000: • Health protection and control
p.000000: • Basic Lab services(HB, BF, VDRL, Urine analysis TB and HIV screening)
p.000000: • in-patient service
p.000000: • Referral services
p.000000: • Dispensary
p.000000: • Eye care services
p.000000: • Out-patient services
p.000000: • Registration of births and Deaths
p.000000: • All services provided at minor H/C level
p.000000: • Comprehensive emergency obstetric care (including theatre and blood transfusion services)
p.000000: • Functional theatre
p.000000: • Comprehensive emergency newborn care
p.000000: • In-patient services
p.000000: • Pharmacy Services
p.000000: • Basic Lab. services including HIV and TB Screening.
p.000000: • All services provided at major H/C level
p.000000: • Specialist care and service
p.000000: • Higher level referral services
p.000000: • Specialised dental and eye care services
...
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: V T V T V
p.000000: H B H B H
p.000000: W A W A W
p.000000: T V T V T V T V T B H
p.000000: B H B H B H B A W A W A
p.000000: W A W A
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: Health Policy 2012-2020
p.000000: Page 50
p.000000:
p.000000:
p.000000: HEALTH IS WEALTH
p.000000:
p.000000:
p.000000: Organogram Abbreviation:
p.000000: DPS-F&A – Deputy Permanent Secretary – Finance & Administration DPS-T – Deputy Permanent Secretary - Technical
p.000000: DPI – Directorate of Planning and Information
p.000000: DDPI – Deputy Director of Planning and Information HRH – Human Resources for Health
p.000000: M&E – Monitoring and Evaluation
p.000000: MIS – Management Information System EDC – Epidemiology and Disease Control B&D – Births and Deaths
p.000000: PAB – Policy Analysis and Budgeting QA – Quality Assurance
p.000000: FM - Facilities Maintenance IT – Information Technology
p.000000: DNPHLS – Directorate of national Public Health Laboratory Services NPHRL – National Public Health Reference
p.000000: Laboratories
p.000000: NBTS – National Blood Transfusion Services BEU – Biomedical Engineering Unit
p.000000: CL- Clinical Laboratories
p.000000: DHS - Directorate of Health Services
p.000000: DDHS – Deputy Directorate of Health Services
p.000000: PHC – Assistant Director Family Health / Primary Health Care RCH – Reproductive and Child Health
p.000000: EPI – Expanded Programme of Immunisation OHS – Occupational Health Services
p.000000: EH – Environmental Health VC – Vector Control
p.000000: IMNCI – Integrated Management of Childhood Neonatal Illnesses CNO – Chief Nursing Officer
p.000000: CPHO – Chief Public Health Officer CP – Chief Pharmacist
p.000000: NPS – national Pharmaceutical Services CMS – Central Medical Stores
p.000000: NMCP – National Malaria Control Programme
p.000000: NLTP – National Leprosy and Tuberculosis Control Programme NACP – National Aids Control Programme
p.000000: NEHP – National Eyecare Health Programme TM - Traditional Medicine
p.000000: BI – Bamako Initiative
p.000000: DFSHQE – Directorate of Food Standards Quality Hygiene Enforcement IHE - Inspection & Hygiene Enforcement
p.000000: FSQ - Foods Standard & Quality
p.000000: DHPE – Directorate of Health Promotion and Education DDHPE – Directorate of Health Promotion and Education NCD –
p.000000: Non-Communicable Diseases
p.000000: MH – Mental Health
p.000000: WS – Water and Sanitation Hygiene HC – Health Communication
p.000000: NHR – National Health Research HPP – School Health and Nutrition
p.000000: SWRO – Social Welfare Regional Offices CC - Child Care
p.000000: DU - Disability Unit AC - Adult Care
p.000000: PS – Professional Services
p.000000: RVTH – Royal Victoria Teaching Hospital SJJH – Sulayman Junkung Jammeh Hospital
p.000000:
p.000000:
...
Health / Physically Disabled
Searching for indicator illness:
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p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
p.000048: Community empowerment; active involvement of the private sector, NGOs, local government authorities and civil
p.000048: society; effective donor co-ordination
p.000048:
p.000048: 4.9 Evidence based health care
p.000048: Health planning, programming and service delivery shall be informed by evidence- based research.
p.000048:
p.000048: 4.10: Patient bill of rights
p.000048: The Patient's Bill of Rights helps patients feel more confident in the health care system. It assures that
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
p.000048: 4.10.2 Choice of providers and plans
p.000048: Where possible every patient shall have the right to choose health care providers who can give him/her
p.000048: high-quality health care when needed.
p.000048:
p.000048: 4.10.3 Access to emergency services
p.000048: In emergency health situations including severe pain, an injury, or sudden illness that makes a person believe that
p.000048: his/her health is in serious danger, he/she shall have the right to be screened and stabilized using emergency
p.000048: services. He/she should be able to use these services whenever and wherever needed without needing to wait for
p.000048: authorization and any financial payment.
p.000048:
p.000048: 4.10.4 Participation in treatment decisions
p.000048: Every patient shall have the right to know his/her treatment options and take part in decisions about his/her care.
p.000048: Parents, guardians, family members, or others that they identify can represent them if he/she cannot make his/her
p.000048: own decisions.
p.000048:
p.000048: 4.10.5 Respect and non-discrimination
p.000048: Every patient must have a right to considerate, respectful and non-discriminatory care from his/her health
p.000048: care provider (s),
p.000048:
p.000048: 4.10.6 Confidentiality of health information
p.000048: All patients must have the right to talk privately with health care providers and to have his/her health
p.000048: care information protected. He/she shall have the right to read and copy his/her own medical record. He/she shall have
p.000048: the right to ask that his/her health care provider change his/her record if it is not correct, relevant, or complete.
p.000048:
p.000048: 4.10.7 Complaints and appeals
p.000048: Every patient shall have the right to a fair, fast, and objective review of any complaint he/she may have against any
p.000048: health plan, health care provider/personnel or health
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 18
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
...
p.000048: individuals. This has implication for planning, (resource mobilisation and allocation) as well as implementation of
p.000048: other policies.
p.000048:
p.000048: The Basic Package will be delivered through the following programme areas:
p.000048: 5.1. Environment, Health and Safety Preamble
p.000048: Environmental health and safety is an important determinant of health outcomes and still remains a major challenge for
p.000048: the Ministry of Health and partners.
p.000048:
p.000048: There is a variety of determinants which contribute to health improvement. Even though most of these health
p.000048: determinants are the responsibility of the Ministry of Health, certain are the responsibility of other
p.000048: Departments or services. Implementation of these actions necessarily requires close
p.000048: inter-sectoral collaboration between these Departments and the Ministry of Health. The aim is to influence policies
p.000048: and strategies of all stakeholders in the management of the environment. These activities include,
p.000048: among others: water distribution and sanitation systems to meet essential health needs, training
p.000048: of medical and paramedical personnel, including specialized training, and health research, including biomedical
p.000048: and epidemiological research, as well as research on health system operations, public hygiene activities
p.000048: (refuse collection, removal of household waste, and health inspections), management of hazardous chemicals and
p.000048: pesticides traffic safety, prevention of road accidents, workplace safety; prevention of work-related injury and
p.000048: illness, activities providing food supplements to people who need it and medico-social activities for vulnerable
p.000048: groups.
p.000048:
p.000048: The Government is cognisant of the effects of the environment on the socioeconomic growth and development
p.000048: including health, and henceforth developed and implemented the National Environment Management Act
p.000048: (1994), the Food Act (2005), and the Public Health Act (1990). Additionally, the President initiative
p.000048: ‘Operation Clean The nation’ is geared toward addressing environmental issues. In recent years, there has been noted
p.000048: increase in the incidence of road and domestic accidents and those from industry thus warranting
p.000048: interventions to address occupational hazards.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 19
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048: • To reduce the frequency of environmental health and safety related diseases/conditions by 30% by
p.000048: 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Enforcement of environmental health related Acts
p.000048: • Institute proper management of solid, gaseous and liquid wastes
p.000048: • Strengthen the environmental units of key municipalities
p.000048: 5.2. Health Promotion and Education Preamble
p.000048: Health education and promotion, mainstreamed in all health care programmes is important to the National
...
p.000048: safe water and basic sanitation are important determinants.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity related to but not limited to childhood, reproduction and the
p.000048: reproductive system across the country
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen and promote 24/7 Emergency Obstetric Care concept;
p.000048: • Strengthen and promote Emergency neonatal care;
p.000048: • Advocate and ensure Implementation of the national reproductive health commodity security plan;
p.000048: • Introduce and institutionalise peri-natal reviews and audits;
p.000048: • Maintain, promote and protect the free of cost policy for MCH services;
p.000048: • Establish a minimum RCH care package;
p.000048: • Monitoring, evaluation and research
p.000048: • Increase awareness on sexual, reproductive and child health issues;
p.000048: • Promote partnership and coordination among all stake holders in the field of RCH;
p.000048: • Create opportunities for the improvement of the nutritional status of the vulnerable groups.
p.000048: • Operationalize operating theatres in all major health facilities.
p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
p.000048: and Childhood Illness (IMNCI) strategy in 1999 to address the high morbidity and mortality among children
p.000048: under five years. The IMNCI strategy combines improved case management of childhood illness in first-level health
p.000048: facilities with aspects of nutrition, immunization, disease prevention, and promotion of growth and
p.000048: development. There are three components of IMNCI which are: improving the skills of health workers; improving the
p.000048: health system, and improving household and community practices.
p.000048:
p.000048: The IMNCI strategy is a technically sound, comprehensive and evidence-based strategy focusing on the main
p.000048: threats to children’s health and focus mainly on the prevention and adequate treatment of malaria, diarrhoea,
p.000048: pneumonia, measles and malnutrition because they are responsible for about 70% of deaths among children
p.000048:
p.000048:
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p.000048: Page 26
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: under five years. It targets children under five years and focus on the five main causes of mortality in
p.000048: children under the age of five.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity associated with major causes of disease in children less than five years of age.
p.000048: Policy Measures
p.000048:
p.000048: • To monitor growth and development of children under the ages of five
p.000048: • To build the capacities of health workers on IMNCI Case Management Skills
...
Health / Physically Ill
Searching for indicator sick:
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p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
p.000048: 1) Primary Level (Village Health Services (VHS)
p.000048:
p.000048: The VHS consist of community health workers (traditional birth attendants (TBA) and village health workers (VHW)
p.000048: who are often the first point of contact between individuals, families and communities within the health
p.000048: system. These community health workers are supervised by trained community health nurses (CHN). TBAs
p.000048: provide care for pregnant women, conduct normal deliveries, identify and refer obstetrics emergencies. The
p.000048: VHWs on the other hand are involved in health promotion and prevention measures, the treatment of minor
p.000048: ailments, and refer cases beyond their scope of management.
p.000048:
p.000048: The village health services are complemented by the Reproductive and Child Health (RCH) trekking visits from the health
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 14
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • Major Health Centres
p.000048: The major health centre serves as the referral point for minor health centres for services such as:
p.000048: comprehensive emergency obstetric care (surgical, blood transfusion services and further medical care).
p.000048: Additionally, they also offer services such as infant welfare and ante natal services, surveillance and dental
p.000048: services. The standard bed capacity for major health centres range from110 -150 beds per 150,000 - 200,000
...
Health / Pregnant
Searching for indicator pregnant:
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p.000048: monitoring and evaluation of health service delivery, within their respective
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 13
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
p.000048: 1) Primary Level (Village Health Services (VHS)
p.000048:
p.000048: The VHS consist of community health workers (traditional birth attendants (TBA) and village health workers (VHW)
p.000048: who are often the first point of contact between individuals, families and communities within the health
p.000048: system. These community health workers are supervised by trained community health nurses (CHN). TBAs
p.000048: provide care for pregnant women, conduct normal deliveries, identify and refer obstetrics emergencies. The
p.000048: VHWs on the other hand are involved in health promotion and prevention measures, the treatment of minor
p.000048: ailments, and refer cases beyond their scope of management.
p.000048:
p.000048: The village health services are complemented by the Reproductive and Child Health (RCH) trekking visits from the health
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
p.000048:
p.000048:
p.000048:
p.000048:
...
p.000048: carry out proper monitoring and supervision of interventions. Disaster management requires a multi-sectoral
p.000048: approach: hence, the Ministry of Health will take the necessary measures to ensure there is an adequate level of
p.000048: preparedness and ability to respond to those disasters using collaborative strategies quickly and adequately.
p.000048:
p.000048: Objectives
p.000048:
p.000048: • To reduce the burden of communicable diseases to a level that they cease to be a public health problem
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 21
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • To promote healthy life styles, increase understanding on the prevention and management of all diseases.
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen disease surveillance and response capacity at all levels
p.000048: • Provision of appropriate case management capacity at various levels of health care delivery system
p.000048: • Community empowerment on disease prevention and control measures
p.000048:
p.000048: 5.4.1 COMMUNICABLE DISEASES
p.000048: 5.4.1 (i): Malaria Policy Measures
p.000048: • Community empowerment on malaria prevention and control
p.000048: • Increase availability and access to LLINs for the general population.
p.000048: • Strengthen integrated vector control interventions (including in indoor residual spraying)
p.000048: • Strengthen the availability and accessibility of effective malaria chemoprophylaxis
p.000048: for all pregnant women
p.000048: • Strengthen Malaria Case management in all health facilities
p.000048: • Strengthen collaboration with partners in research
p.000048: • Strengthen community management of malaria
p.000048:
p.000048: 5.4.1(ii): Tuberculosis Policy Measures
p.000048: • Promote the expansion of high-quality Directly Observed Treatment Short course (DOTS)
p.000048: • Support the implementation of advocacy, communication and social mobilisation activities (ACSM)
p.000048: • Inter-sectoral coordination to address the synergistic challenges posed by TB/HIV
p.000048:
p.000048: 5.4.1(iii): HIV/AIDS
p.000048: Policy Measures
p.000048: • Expand and strengthen HIV/AIDS Counselling & Testing (HCT) and Prevention of Mother to child
p.000048: transmission (PMTCT) services.
p.000048: • Support and expand Anti-Retroviral Therapy (ART)
p.000048: • Expand the care and support services for People Living With HIV/AIDS (PLWHAs)
p.000048: • Support sentinel surveillance and research in HIV/AIDS
p.000048: • Intensify IEC/BCC/CSC interventions on HIV/AIDS
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 22
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
...
Health / ill
Searching for indicator ill:
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p.000002: direction for improving human capital stock, makes health central to The Gambia’s development efforts.
p.000002:
p.000002: The theme, “health is wealth”, which is the current philosophy which our national health policy is hinged
p.000002: upon becomes a reality only when a healthy population can contribute to improved productivity, increased GDP
p.000002: and sustained economic growth and overall ensure social equilibrium. Hence the slogan:
p.000002:
p.000002: “A Healthy population is a Wealthy population”.
p.000002:
p.000002: The mission of the Ministry of Health is to contribute to socioeconomic development and wealth creation
p.000002: by promoting and protecting the health of the population through equitable provision of quality health
p.000002: care within the context of Primary Health Care. This mission puts the concept of health beyond the
p.000002: confines of curative care to other socio-economic determinants of health.
p.000002:
p.000002: The health sector despite remarkable achievements registered since 1994 to date is still under great pressure due to a
p.000002: number of factors: high population growth rate, increasing morbidity and mortality, insufficient financial and
p.000002: logistic support, deterioration of physical infrastructure, inadequacies of supplies and equipment,
p.000002: shortage of adequately and appropriately trained health personnel, high attrition rate as well as
p.000002: inadequate referral system. Poverty and ignorance have led to inappropriate health seeking behaviours thus
p.000002: contributing to ill health.
p.000002:
p.000002:
p.000002:
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p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: Indicators of child and maternal mortality are particularly worrying. This situation is worsened by other
p.000002: factors related to the poverty in general resulting to the high prevalence of communicable and
p.000002: non-communicable diseases such as Malaria, Diarrhoea, Upper Respiration Tract Infection, Tuberculosis, Skin
p.000002: Disease, Accidents, Hypertension, Cancers, Eye Infection, and Pregnancy related conditions, Helminthiasis and
p.000002: malnutrition and HIV/AIDS and its spread. Most of these diseases can easily be prevented if appropriate
p.000002: environmental and lifestyle measures are taken, with more attention paid to development of health
p.000002: promotion and prevention actions than merely focusing on curative care alone.
p.000002:
p.000002: The revised policy is expected to reform the health system by addressing the major traditional problems of health,
p.000002: the new challenges and the double burden of communicable and non-communicable diseases, curbing the
p.000002: HIV/AIDS pandemic and overcoming a weak health system. This reform is in line with the Local Government
p.000002: decentralization and planning based upon the Local Government ACT of (2002), Vision 2020 and the
...
p.000048:
p.000048: Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in
p.000048: recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly
p.000048: Community Initiative and the Bamako Initiative.
p.000048:
p.000048: Also, relevant policy documents were developed including that of Nutrition, Drug , Malaria Reproductive and
p.000048: Child Health , Human Resource for Health , Maintenance , Mental Health , HIV/AIDS , Health Management Information
p.000048: System , National Blood Transfusion , Information Technology , and others such as Traditional Medicine,
p.000048: National Public Health Laboratory and the Health Research Policies at various stages of development.
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.3: Problem Statement
p.000048: • General health system challenges including the effects of previous high population growth
p.000048: rate; inadequate financial and logistic support; weak health information system; uncoordinated donor
p.000048: support; shortage of adequately and appropriately trained health staff; high attrition rate and lack of
p.000048: efficient and effective referral system. In addition, poverty, low awareness of health issues and poor attitude of
p.000048: service providers have led to inappropriate health seeking behaviours and contributed to ill health. These
p.000048: factors have seriously constrained efforts to reduce morbidity and mortality rates as desired and as a result health
p.000048: care delivery throughout the country has not lived up to expectation.
p.000048:
p.000048: • The frequent changes in top management positions at The Ministry of Health have been hampering
p.000048: continuity, institutional memory and policy flow. The need to have a clear direction to improve quality of health
p.000048: care and reduce the high morbidity and mortality rates requires a stable, supportive, organisational and
p.000048: management framework with a strong flexible and knowledgeable leadership, able and willing to take informed
p.000048: decisions.
p.000048:
p.000048: 1.4: Policy Orientation
p.000048: From the available statistics, it is important to enhance the delivery of quality health services in order to reduce
p.000048: the high prevailing morbidity and mortality rates.
p.000048: The need to review the current health policy framework has been influenced by the following factors:
p.000048: • The high disease burden (communicable and non-communicable diseases) needs intensification of efforts in
p.000048: our service delivery packages;
p.000048: • The disparity in the demand by the population and quality of services at different levels of health care;
p.000048: • Lessons learnt from the implementation of certain health projects/programmes like Primary Health Care,
p.000048: Bamako Initiative and Drug Revolving Fund to improve financing of health services;
p.000048: • The need for stronger partnership and coordination in the health sector with the donors, NGOs, private sector and
p.000048: the community in delivering health services to the population;
...
Health / patients in emergency situations
Searching for indicator emergencies:
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p.000048: Page 13
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
p.000048: 1) Primary Level (Village Health Services (VHS)
p.000048:
p.000048: The VHS consist of community health workers (traditional birth attendants (TBA) and village health workers (VHW)
p.000048: who are often the first point of contact between individuals, families and communities within the health
p.000048: system. These community health workers are supervised by trained community health nurses (CHN). TBAs
p.000048: provide care for pregnant women, conduct normal deliveries, identify and refer obstetrics emergencies. The
p.000048: VHWs on the other hand are involved in health promotion and prevention measures, the treatment of minor
p.000048: ailments, and refer cases beyond their scope of management.
p.000048:
p.000048: The village health services are complemented by the Reproductive and Child Health (RCH) trekking visits from the health
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • Major Health Centres
...
p.000048: Objective
p.000048:
p.000048: • To build the capacity of communities to enhance their participation and involvement in health service
p.000048: delivery.
p.000048:
p.000048: Policy Measures
p.000048: • Promote community involvement and participation on health and health related issues.
p.000048: • Build community capacity to make Informed decision on matters relating to their health
p.000048:
p.000048: 6.1.3 Bamako Initiative (BI) Preamble
p.000048: The concept of Bamako Initiative as a strategy was adopted in 1993. It aims at
p.000048: strengthening Primary Health Care (PHC) by providing a framework for co-financing and co-management of health
p.000048: services by government, donors and beneficiaries communities. It serves as a basis for provision of
p.000048: essential health care services especially at village level.
p.000048:
p.000048: Objective
p.000048: • To improve Bamako Initiative for effective implementation of Primary Health Care (PHC) by 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen service organization and management at community and district level health centres to
p.000048: maximize effective coverage with Minimum Care Packages
p.000048: • Minimize recurrent costs and balance cost-sharing with the community in order to ensure efficiency,
p.000048: sustainability and equity.
p.000048: • Strengthen community empowerment for sustainability
p.000048:
p.000048: 6.2 SECONDARY HEALTH CARE SERVICE
p.000048:
p.000048: 6.2.1 Major Health Centres
p.000048: The Major Health centre at the intermediate level has been designed to provide referral services for
p.000048: obstetric emergencies, essential surgical and medical care. A fully functional MHC is one of the strategies for
p.000048: the reduction of the high MMR and
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: IMR. Providing quality services at this level develops confidence in the PHC system whilst ensuring that such services
p.000048: are brought closer to the community. In spite of the critical role that Major Health Centres have to play, their full
p.000048: impact is yet to be felt, because of several constraints All Major Health Centres are still to be provided with the
p.000048: full complement of equipment and supporting facilities such as blood transfusion services, etc. Human
p.000048: resources to carry out all the envisioned functions are in short supply whilst shortage of accommodation has
p.000048: prevented the few available staff from taking up residence. A fully functional Major Health Centre is vital in
p.000048: providing not only referral services but also the necessary environment for training all health workers in the
p.000048: Regions and fostering an atmosphere for operational research.
p.000048:
p.000048: Objectives
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To ensure the full operationaility of all six (6) Major and thirty eight (38) Minor Health Centres by 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen all Major and Minor Health Centres
...
p.000048: rural community
p.000048: • Establish quality control testing of pharmaceuticals.
p.000048: • Strengthen and maintain the Logistics Management Information System (LMIS).
p.000048: 10.2: National Blood Transfusion Services Preamble
p.000048: Availability of safe blood for transfusion is an essential element in the delivery of health services
p.000048: particularly those related to maternal and child health services. Unreliable supply of blood interrupts
p.000048: general clinical care for example surgical operations and road traffic accidents. There is need for an
p.000048: uninterrupted supply of safe blood.
p.000048:
p.000048: Blood transfusion services in The Gambia were limited to RVTH and Bansang hospital for several years. Over
p.000048: the years transfusion services have been expanded to other tertiary hospitals (the Sulayman Junkung General
p.000048: Hospital in Bwiam, The Armed Forces Provisional Ruling Council Hospital in Farafenni) and some major
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: health centres. Although efforts have been made in the past through public campaign but expansion of
p.000048: services coupled with limited number of voluntary blood donor has created a gap between the need and availability of
p.000048: safe blood in health facilities in the country. This has implications on receiving prompt and timely care.
p.000048:
p.000048: A blood bank has also been established at the RVTH, which supplies blood to the other hospitals. However, the
p.000048: demand is always greater than the supply. Furthermore, during emergencies, transportation of blood to
p.000048: the other peripheral centres experience delays in delivering the right quantity at the right time. In order to make
p.000048: safe blood available to the population in times of need, blood banks should be established in all major health
p.000048: centres and hospitals in the country and more bleeding centres in the communities
p.000048:
p.000048: Objective
p.000048: • The provision of adequate and safe blood for appropriate treatment of patients at all times.
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen the national blood transfusion programme for improved service delivery.
p.000048: • Strengthen and advocate for voluntary and non-remunerated blood donation.
p.000048: • Promote research in blood transfusion services.
p.000048:
p.000048: 10.3: Laboratory Services Preamble
p.000048: For accurate diagnosis and appropriate patient management, effective and functional
p.000048: laboratory services are required. However, The Gambia is still dependant on laboratories outside the
p.000048: country for some specialized investigations. Therefore, laboratory service in The Gambia should be
p.000048: strengthened and expanded. The Private sector and NGO though few compliments the public sector. However, their
p.000048: services are not affordable to a vast majority of Gambians.
p.000048:
p.000048: Objectives
p.000048: • To institute timely, accessible, availability, affordability and reliable results for accurate diagnosis
p.000048: Policy Measures
p.000048: • Strengthen capacity of the laboratory programme for improved service delivery.
p.000048: • Expansion of laboratory services to meet service demands of the population
p.000048: • Expansion of the laboratory surveillance programme
...
Health / sexually transmitted disases
Searching for indicator sexuallyXtransmitted:
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p.000008: DEFINED.
p.000008: 1.3 HEALTH SYSTEM
p.000010: 10
p.000010: 1.3.1. Health Sector Coordination Structures Error! Bookmark not defined.
p.000010: I. DIRECTORATE OF HEALTH SERVICES (DHS)
p.000011: 11
p.000011: II. DIRECTORATE OF PLANNING AND INFORMATION (DPI)
p.000011: 11
p.000011: III. DIRECTORATE OF FOOD STANDARDS, QUALITY AND HYGIENE ENFORCEMENT (FSQHE) 12
p.000011: IV. DIRECTORATE OF NATIONAL PUBLIC HEALTH LABORATORY SERVICES (NPHLS) 12
p.000011: V. DIRECTORATE OF HEALTH PROMOTION AND EDUCATION (DHPE) 12
p.000011: 1.4. HEALTH SERVICE DELIVERY
p.000014: 14
p.000014: 1.5 HEALTH STATUS OF THE POPULATION ERROR! BOOKMARK NOT DEFINED.
p.000014: 1.6: POLICY ORIENTATION
p.000010: 10
p.000010: 1.7 PROBLEM STATEMENT
p.000010: 10
p.000010: 2. 0 VISION AND MISSION
p.000015: 15
p.000015: 3.0 GUIDING PRINCIPLES
p.000017: 17
p.000017: 4.0 GOAL AND TARGETS
p.000015: 15
p.000015: 4.1. GOAL
p.000016: 16
p.000016: 4. 2 TARGETS
p.000016: 16
p.000016: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES 19
p.000016: 5.1.1 ENVIRONMENT, HEALTH AND SAFETY
p.000019: 19
p.000019: 5.1. HEALTH PROMOTION AND EDUCATION
p.000020: 20
p.000020: 5.2. EXPANDED PROGRAMME ON IMMUNISATION (EPI)
p.000020: 20
p.000020: 5.3: DISEASE CONTROL
p.000021: 21
p.000021: 5.3.1 COMMUNICABLE DISEASES
p.000022: 22
p.000022: 5.4: MALARIA
p.000022: 22
p.000022: 5.5: TUBERCULOSIS
p.000022: 22
p.000022: 5.6: HIV/AIDS
p.000022: 22
p.000022: 5.7: SEXUALLY TRANSMITTED INFECTIONS (STIs) (other than HIV/AIDS) 23
p.000022: 5.8: DIARRHOEAL DISEASES
p.000023: 23
p.000023: 5.9: TRACHOMA/EYE DISEASES
p.000023: 23
p.000023: 5.10: RESPIRATORY TRACT INFECTIONS Error! Bookmark not
p.000023: defined.
p.000023: 5.11: NON- COMMUNICABLE DISEASES (NCDs)
p.000023: 23
p.000023: 5.12: MENTAL HEALTH
p.000024: 24
p.000024: 5.13: REPRODUCTIVE AND CHILD HEALTH
p.000025: 25
p.000025: 6.0: BASIC HEALTH CARE
p.000027: 27
p.000027: 6.1 TERTIARY CARE
p.000032: 32
p.000032: 6.2 ORGANISATION AND MANAGEMENT
p.000032: 32
p.000032: 6.3: HUMAN RESOURCE MANAGEMENT
p.000032: 32
p.000032: 6.4: INFRASTRUCTURE AND LOGISTICS
p.000033: 33
p.000033: 6.5: HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) AND RESEARCH 33
p.000033: 6.6: HEALTH FINANCING
p.000034: 34
p.000034: 6.7 LEGAL FRAMEWORK
p.000036: 36
p.000036: 6.8 PARTNERSHIPS
p.000036: 36
p.000036: 7.0. TECHNICAL SUPPORT SERVICES
p.000037: 37
p.000037: 7.1 PHARMACEUTICAL SERVICES (ESSENTIAL MEDICINES, VACCINES, EQUIPMENT AND OTHER MEDICAL SUPPLIES)
p.000037: 37
p.000037: 7.2 NATIONAL BLOOD TRANSFUSION SERVICES 38
p.000037: 7.3 LABORATORY SERVICES
p.000039: 39
p.000039: 7.4 RADIOLOGY SERVICES
p.000040: 40
p.000040:
p.000040: HEALTH IS WEALTH
p.000040: 7.5 REFERRAL SYSTEM
p.000040: 40
p.000040: 8.0 LEVELS OF HEALTH SERVICE DELIVERY Error! Bookmark not defined.
p.000040: 8.1 PRIMARY HEALTH CARE (PHC) SERVICE ERROR! BOOKMARK NOT DEFINED.
...
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
p.000048: PRSP - Poverty Reduction Strategy Programme
p.000048: RCH - Reproductive and Child Health
p.000048:
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p.000048: Page 6
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: RFH - Riders for Health
p.000048: RH - Reproductive Health
p.000048: RHD - Regional Health Directorate
p.000048: RHO - Regional Health Officer
p.000048: RHT - Regional Health Teams
p.000048: RTI - Respiratory Tract Infections
p.000048: STI - Sexually Transmitted Diseases
p.000048: SWAp - Sector Wide Approach
p.000048: TB - Tuberculosis
p.000048: TH - Traditional Healer
p.000048: TM - Traditional Medicine
p.000048: TOR - Terms of Reference
p.000048: VC - Vector Control
p.000048: VCT - Voluntary Counselling and Testing
p.000048: VDC - Village Development Committee
p.000048: VDRL - Venereal diseases reference laboratory
p.000048: VHC - Village Health Committee
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.0 INTRODUCTION
p.000048: 1.1 Location, Size and Climate
p.000048: The Gambia is located on the West African coast and extends about 400 km inland, with a population density of 128
p.000048: persons per square kilometre. The width of the country varies from 24 to 28 kilometres and has a land
p.000048: area of 10,689 square kilometres. It is bordered on the North, South and East by the Republic of Senegal and on
p.000048: the West by the Atlantic Ocean. The country has a tropical climate characterised by two seasons: rainy
p.000048: season (June – October) and dry season (November-May).
...
p.000048: for all pregnant women
p.000048: • Strengthen Malaria Case management in all health facilities
p.000048: • Strengthen collaboration with partners in research
p.000048: • Strengthen community management of malaria
p.000048:
p.000048: 5.4.1(ii): Tuberculosis Policy Measures
p.000048: • Promote the expansion of high-quality Directly Observed Treatment Short course (DOTS)
p.000048: • Support the implementation of advocacy, communication and social mobilisation activities (ACSM)
p.000048: • Inter-sectoral coordination to address the synergistic challenges posed by TB/HIV
p.000048:
p.000048: 5.4.1(iii): HIV/AIDS
p.000048: Policy Measures
p.000048: • Expand and strengthen HIV/AIDS Counselling & Testing (HCT) and Prevention of Mother to child
p.000048: transmission (PMTCT) services.
p.000048: • Support and expand Anti-Retroviral Therapy (ART)
p.000048: • Expand the care and support services for People Living With HIV/AIDS (PLWHAs)
p.000048: • Support sentinel surveillance and research in HIV/AIDS
p.000048: • Intensify IEC/BCC/CSC interventions on HIV/AIDS
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 5.4.1(iv): Sexually Transmitted Infections (STIS) (Other Than HIV/AIDS) Policy Measures
p.000048: • Effective information, education and counselling of the populace
p.000048: • Provision of STIs drugs and supplies in all facilities with a view to increase access
p.000048: • Train health care workers on the syndromic treatment and management of STIs with a view to provide
p.000048: proper treatment
p.000048: • Set up well equipped laboratories in all major health centres and hospitals
p.000048: • Establish STI clinics targeted specifically for most at risk populations (MARPs)
p.000048: • Provision and distribution of condoms to MARPs
p.000048: • Monitoring and supervision of STI services
p.000048:
p.000048: 5.4.1(v): Diarrhoeal Diseases Policy Measures
p.000048: • Increase access to safe water and improved sanitary facilities
p.000048: • Strengthen case management , prevention and control
p.000048:
p.000048: 5.4.1(vi): Trachoma (Eye Disease) Policy Measures
p.000048: • Elimination of blinding trachoma
p.000048: • Reduce the prevalence of active trachoma to below 5% in all communities
p.000048: • Intensify IEC/BCC/CSC intervention
p.000048: • Conduct a survey to determine the prevalence of cataract per region and set up regional cataract surgery
p.000048: targets after Training more nyateros to identify and refer all cataract cases in their communities
...
Searching for indicator sti:
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p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
p.000048: PRSP - Poverty Reduction Strategy Programme
p.000048: RCH - Reproductive and Child Health
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: RFH - Riders for Health
p.000048: RH - Reproductive Health
p.000048: RHD - Regional Health Directorate
p.000048: RHO - Regional Health Officer
p.000048: RHT - Regional Health Teams
p.000048: RTI - Respiratory Tract Infections
p.000048: STI - Sexually Transmitted Diseases
p.000048: SWAp - Sector Wide Approach
p.000048: TB - Tuberculosis
p.000048: TH - Traditional Healer
p.000048: TM - Traditional Medicine
p.000048: TOR - Terms of Reference
p.000048: VC - Vector Control
p.000048: VCT - Voluntary Counselling and Testing
p.000048: VDC - Village Development Committee
p.000048: VDRL - Venereal diseases reference laboratory
p.000048: VHC - Village Health Committee
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Health Policy 2012-2020
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.0 INTRODUCTION
p.000048: 1.1 Location, Size and Climate
p.000048: The Gambia is located on the West African coast and extends about 400 km inland, with a population density of 128
p.000048: persons per square kilometre. The width of the country varies from 24 to 28 kilometres and has a land
p.000048: area of 10,689 square kilometres. It is bordered on the North, South and East by the Republic of Senegal and on
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p.000048:
p.000048: 5.4.1(iii): HIV/AIDS
p.000048: Policy Measures
p.000048: • Expand and strengthen HIV/AIDS Counselling & Testing (HCT) and Prevention of Mother to child
p.000048: transmission (PMTCT) services.
p.000048: • Support and expand Anti-Retroviral Therapy (ART)
p.000048: • Expand the care and support services for People Living With HIV/AIDS (PLWHAs)
p.000048: • Support sentinel surveillance and research in HIV/AIDS
p.000048: • Intensify IEC/BCC/CSC interventions on HIV/AIDS
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 5.4.1(iv): Sexually Transmitted Infections (STIS) (Other Than HIV/AIDS) Policy Measures
p.000048: • Effective information, education and counselling of the populace
p.000048: • Provision of STIs drugs and supplies in all facilities with a view to increase access
p.000048: • Train health care workers on the syndromic treatment and management of STIs with a view to provide
p.000048: proper treatment
p.000048: • Set up well equipped laboratories in all major health centres and hospitals
p.000048: • Establish STI clinics targeted specifically for most at risk populations (MARPs)
p.000048: • Provision and distribution of condoms to MARPs
p.000048: • Monitoring and supervision of STI services
p.000048:
p.000048: 5.4.1(v): Diarrhoeal Diseases Policy Measures
p.000048: • Increase access to safe water and improved sanitary facilities
p.000048: • Strengthen case management , prevention and control
p.000048:
p.000048: 5.4.1(vi): Trachoma (Eye Disease) Policy Measures
p.000048: • Elimination of blinding trachoma
p.000048: • Reduce the prevalence of active trachoma to below 5% in all communities
p.000048: • Intensify IEC/BCC/CSC intervention
p.000048: • Conduct a survey to determine the prevalence of cataract per region and set up regional cataract surgery
p.000048: targets after Training more nyateros to identify and refer all cataract cases in their communities
p.000048: • Adequate supply of equipment, drugs and consumables for eye surgery (cataract, glaucoma, retina)
p.000048: • Training of eye care providers in the prevention and management of corneal ulcers
p.000048: • Provision of optometrist assistant in each secondary eye care unit to deliver services in each division
p.000048: • Development of a national Eye care program policy
p.000048:
p.000048: 5.4.2: NON- COMMUNICABLE DISEASES (NCDs)
p.000048: Preamble
p.000048: The World Health Organization (WHO) 2005 Report on chronic diseases indicated that the majority of deaths worldwide
p.000048: for all ages are due to chronic diseases such as cardiovascular diseases (mainly heart disease and stroke),
p.000048: cancer, chronic respiratory diseases, and diabetes. Non Communicable Diseases (NCDs) are a consequence of
p.000048: unhealthy diet and lifestyle such as tobacco use, physical inactivity and harmful use of alcohol, constitute a major
p.000048: public health problem and are known, for both their high financial and social cost for families, communities and
p.000048: countries.
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Health / visual impairment
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p.000048: public health problem and are known, for both their high financial and social cost for families, communities and
p.000048: countries.
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: As stated earlier, chronic non-communicable diseases such as hypertension, diabetes and cancers are
p.000048: on the increase in the Gambia. A population-based situation analysis conducted in 2001 revealed
p.000048: that 8.6% of the adult urban population and 1.4% of the rural adult population had diabetes mellitus. The
p.000048: same study revealed that between 10 to 20% of the population was chronically infected with hepatitis B.
p.000048: These findings are not at great variance from studies conducted by Van Der Sande et al (1996 & 2001) which showed 9.5%
p.000048: of adults over 15 years were hypertensive according to WHO criteria (a diastolic blood pressure of 95 mmHg or above
p.000048: and/or systolic blood pressure of 160 mmHg or above.
p.000048:
p.000048: There is a risk of the health system being confronted by an increase in the number of cases of non-communicable
p.000048: diseases and as such adequate measures are being taken to alert those responsible for the prevention, diagnosis,
p.000048: treatment including the management of such diseases. These diseases are commonly cancer, diabetes, cataract,
p.000048: arterial hypertension and those associated with tobacco consumption, alcohol abuse, an inactive life style
p.000048: and environmental pollution. Oral health, the prevention of blindness and physical rehabilitation services for
p.000048: handicapped people are to be improved.
p.000048:
p.000048: Objective
p.000048: • To reduce the burden of NCDs Risk factors in the Gambian population through the promotion of healthy
p.000048: behaviours, lifestyles and appropriate care by end 2020
p.000048:
p.000048: Policy Measures
p.000048: • To finalize and implement national NCD Policy and Strategic Plan.
p.000048: • Strengthening capacity for the management, prevention and control of NCDs
p.000048: • Supporting broad based participation in support of NCD prevention and control.
p.000048: • Creating supportive environment for addressing the risk factors for NCD
p.000048: • Building and strengthening capacity for NCD research
p.000048: • Scaling up of IMNCI strategies to all levels
p.000048: • Develop and provide essential (basic) Health Care Packages at different service delivery levels
p.000048:
p.000048: 5.5: Mental Health Preamble
p.000048: It is estimated that approximately 27,000 people in the Gambia are suffering from a severe mental and/or substance
p.000048: abuse disorder and that a further 91,000 Gambians have a mild disorder still requiring treatment (World health
p.000048: Survey, 2004) .A local prevalence study in the Gambia, puts prevalence rates higher (at 20%) and leads to estimates
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p.000002: NATIONAL HEALTH POLICY
p.000002:
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p.000002:
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p.000002:
p.000002: REPUBLIC OF THE GAMBIA
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: “HEALTH IS
p.000002: WEALTH” 2012 - 2020
p.000002:
p.000002:
p.000002: “Acceleration of Quality Health Services and Universal Coverage”
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: MINISTRY OF HEALTH & SOCIAL WELFARE BANJUL, THE GAMBIA
p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: FOREWORD
p.000002:
p.000002: Since 1996, it was deemed imperative for The Gambia to map out clearly a strategy for socio-economic development that
p.000002: aims at raising the standard of living of The Gambian population by transforming The Gambia into a dynamic middle
p.000002: –income economy. This is the fundamental objective of “The Gambia incorporated … Vision 2020”. To the President, Vision
p.000002: 2020 is not a dream and the Government is committed to its attainment.
p.000002:
p.000002: This health policy is line with the Vision 2020 and the Millennium Development Goals (MDGs),
p.000002: the Gambia National Development Strategy (2012-2015) and Investment Program – The Program for Accelerated Growth
p.000002: and Employment (PAGE) – which will lead to achievement of all the Millennium Development Goals,
p.000002: especially those related to health; accomplish a three-quarters decline in maternal mortality and a two-thirds
p.000002: decline in mortality among children under five; to halt and reverse the spread of HIV/AIDS and to
p.000002: provide special assistance to AIDS orphans; and put the country on a strong footing to attaining the Vision of
p.000002: the President.
p.000002:
p.000002: Development of human capital stock since then has been a leading priority in the development agenda of The
p.000002: Government of The Gambia, civil society, donors’ community and academia. Health, along with education and
p.000002: nutrition, is considered as one of the key elements of human capital stock formation. Consistent with the strategic
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p.000002:
p.000002: The revised policy is expected to reform the health system by addressing the major traditional problems of health,
p.000002: the new challenges and the double burden of communicable and non-communicable diseases, curbing the
p.000002: HIV/AIDS pandemic and overcoming a weak health system. This reform is in line with the Local Government
p.000002: decentralization and planning based upon the Local Government ACT of (2002), Vision 2020 and the
p.000002: anti-poverty Programme for Accelerated Growth and Employment (PAGE), attainment of MDG: 4 Reduce Child Mortality; MDG:
p.000002: 5 Improve Maternal Health; and MDG: 6 Combat HIV/AIDS, Malaria and Other Diseases.
p.000002:
p.000002: Implementation of policy measures will certainly impact on reducing morbidity and mortality of major diseases, promote
p.000002: healthy lifestyle, and reduce health risks and exposures associated with negative environmental consequences. It
p.000002: provides basis for an institutional and legal framework for implementation of policy measures. It also identifies
p.000002: relevant stakeholders that contribute to health service provision and the institutional framework for mobilizing
p.000002: sector- wide resources for health development. The policy update therefore provides an impetus and new direction for
p.000002: health sector development that will serve as the basis for driving our health sector priorities and planning as well
p.000002: guiding resource allocation processes in the next few years to come.
p.000002:
p.000002:
p.000002: Honourable Mme. Fatim Badjie Minister of Health & Social Welfare
p.000002: April 2012
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p.000002: Health Policy 2012-2020
p.000002: Page 3
p.000002:
p.000002: Table of content
p.000002: FOREWORD
p.000002: 2
p.000002: ABBREVIATIONS
p.000006: 6
p.000006: 1.0 INTRODUCTION
p.000008: 8
p.000008: 1.1 LOCATION, SIZE AND CLIMATE
p.000008: 8
p.000008: 1.2 DEMOGRAPHIC CHARACTERISTICS ERROR! BOOKMARK NOT
p.000008: DEFINED.
p.000008: 1.3 HEALTH SYSTEM
p.000010: 10
p.000010: 1.3.1. Health Sector Coordination Structures Error! Bookmark not defined.
p.000010: I. DIRECTORATE OF HEALTH SERVICES (DHS)
p.000011: 11
p.000011: II. DIRECTORATE OF PLANNING AND INFORMATION (DPI)
p.000011: 11
p.000011: III. DIRECTORATE OF FOOD STANDARDS, QUALITY AND HYGIENE ENFORCEMENT (FSQHE) 12
p.000011: IV. DIRECTORATE OF NATIONAL PUBLIC HEALTH LABORATORY SERVICES (NPHLS) 12
p.000011: V. DIRECTORATE OF HEALTH PROMOTION AND EDUCATION (DHPE) 12
p.000011: 1.4. HEALTH SERVICE DELIVERY
p.000014: 14
p.000014: 1.5 HEALTH STATUS OF THE POPULATION ERROR! BOOKMARK NOT DEFINED.
p.000014: 1.6: POLICY ORIENTATION
p.000010: 10
p.000010: 1.7 PROBLEM STATEMENT
p.000010: 10
p.000010: 2. 0 VISION AND MISSION
p.000015: 15
p.000015: 3.0 GUIDING PRINCIPLES
p.000017: 17
p.000017: 4.0 GOAL AND TARGETS
p.000015: 15
p.000015: 4.1. GOAL
p.000016: 16
p.000016: 4. 2 TARGETS
p.000016: 16
p.000016: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES 19
p.000016: 5.1.1 ENVIRONMENT, HEALTH AND SAFETY
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p.000048: 1.5.1 Central Level
p.000048: The MOH&SW Head Office in Banjul is responsible for overall formulation and direction of the national health
p.000048: agenda, including policy and regulatory frameworks, national health planning and priority setting, coordination,
p.000048: and monitoring and evaluation of health sector performance. It is also responsible for resource
p.000048: mobilization and allocation, and provision of technical support and supervision to the regions and specific health
p.000048: programmes. In order to facilitate efficient and effective performance of these functions, MOH&SW has established
p.000048: coordination structures at national level, which include specific directorates and programme management units,
p.000048: responsible for coordinating specific areas of focus. The current organizational structure at the Ministry includes
p.000048: the following main departments, directorates, and programme units;
p.000048:
p.000048: (a) Department of Medical and Health
p.000048: The department of Medical and Health comprised of the following directorates:
p.000048: • Directorate of Health Services (DHS)
p.000048: • Directorate of Planning and Information (DPI)
p.000048: • Directorate of Food Standards, Quality and Hygiene Enforcement (FSQHE)
p.000048: • Directorate of National Public Health Laboratory Services (NPHLS)
p.000048: • Directorate of Health Promotion and Education (HPE)
p.000048:
p.000048: i. Directorate of Health Services (DHS)
p.000048: The DHS is responsible for the coordination, management, monitoring and supervision of health care
p.000048: services within the country. The DHS provides technical advice to the Permanent Secretary and the Minister of Health
p.000048: and Social Welfare.
p.000048: It also coordinates the functions of the following programme areas: Reproductive and Child Health,
p.000048: Integrated Management of Neonatal and Childhood Illnesses (IMNCI), Expanded Programme on Immunization (EPI),
p.000048: Public Health,, National Leprosy and Tuberculosis Control Programme (NLTP), National Aids Control
p.000048: Programme (NACP), National Malaria Control Programme (NMCP), Bamako Initiative (BI), Nursing, Traditional
p.000048: Medicine and Regional Health Services provision and pharmaceutical services.
p.000048:
p.000048: ii. Directorate of Planning and Information (DPI)
p.000048: The Directorate of Planning and Information is responsible for the overall planning, budgeting, monitoring and policy
p.000048: and strategy formulation. It includes the following
p.000048:
p.000048:
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p.000048: Page 11
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: programme areas: Budget, Planning and Policy Analysis; Human Resource Management; Health Planning,
p.000048: Monitoring and evaluation, Policy Implementation, Health System Research, Registration of Births and Deaths,
p.000048: Disease Control, Maintenance Policy Monitoring, Information Technology and Health Management Information
p.000048: System.
p.000048:
p.000048: iii. Directorate of Food Standards, Quality and Hygiene Enforcement (FSQHE)
p.000048:
p.000048: This Directorate has a clearly defined Term of References and is charged with the responsibility to execute laws under
p.000048: the Food Act 2005 as follows:
p.000048: • Control of foods in restaurants, hotels, schools, and other boarding facilities (Section14( a)
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p.000048: • Monitoring and supervision of national health laboratory services in both public and private
p.000048: v. Directorate of Health Promotion and Education (DHPE)
p.000048: Health Promotion and Education involves behavioural change communication, advocacy and social
p.000048: mobilization. The components of the Directorate of Health Promotion and Education includes the following areas
p.000048: such as: Print, Electronic and Traditional Media; Non-Communicable Diseases, School Health, Community-based Information
p.000048: Education and Communication (IEC)/Behaviour Change Communication (BCC); Behavioural Research, Monitoring and
p.000048: Evaluation, Nutrition Education and
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Promotion, Injury and Road Traffic Accidents, Hygiene and Sanitation Education, Environmental Communication
p.000048: and Population Health.
p.000048: The mandate and responsibilities of Health Promotion and Education Directorate shall include the following:
p.000048: • Planning, designing, implementing, evaluating and coordinating overall health promotion and education
p.000048: interventions for the Ministry of Health and Social Welfare;
p.000048: • Foster collaboration between the health and other sectors of government as well as institutions, organizations and
p.000048: the private sector to address the broad determinants of health;
p.000048: • Support and coordinate formulation of and or strengthening the implementation of national health promotion policy
p.000048: and national health policy, legislations or strategies for tobacco control in line with the WHO Framework Convention on
p.000048: Tobacco Control;
p.000048: • Provision of technical advice to the Ministry of Health and Social Welfare on International protocols, instruments
p.000048: and conventions that have a public health and health promotion underpinning;
p.000048: • Act as the technical adviser to the Ministry of Health and Social Welfare and oversee patient
p.000048: education/counselling in the country’s medical institutions as part of the health promoting hospital initiatives with a
p.000048: view to ensuring quality care for the poor and the socially deprived;
p.000048: • Act as the technical body to regulate health information dissemination in the country.
p.000048:
p.000048: (b) Department of Social Welfare
p.000048:
p.000048: Directorate of Social Welfare (DSW)
p.000048:
p.000048: The Department comprised of the Directorate of Social Welfare (DSW).It is responsible for the
p.000048: promotion and protection of the rights and welfare of vulnerable persons such as children, the elderly, persons
p.000048: with disability and adults in difficult circumstances. To enable them maximize their potential and minimize
p.000048: problems arising out of the imbalance between themselves and their environment as a result of social change. Their
p.000048: services focus on the social protection of individual families and groups.This includes the welfare services to the
p.000048: vulnerable families and individuals, child rights and protection services, elderly care, disability care services and
p.000048: regional social welfare services provision and management.
p.000048:
p.000048: 1.5.2: Regional Level
p.000048: The Regional Health Directorates are headed by Regional Directors of Health Services, who are directly
p.000048: responsible to the Permanent Secretary through the Director of Health Services. Regional Directors of Health
p.000048: Services are responsible for coordinating policy interpretation, planning and implementation of health services, and
p.000048: monitoring and evaluation of health service delivery, within their respective
p.000048:
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p.000048: HEALTH IS WEALTH
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p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
p.000048: 1) Primary Level (Village Health Services (VHS)
p.000048:
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p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
p.000048: • Set up and maintain a Data Base System for information sharing for all the Units of the Ministry of health by 2015
p.000048: • Establish a National Social Welfare Trust Fund for the needy and vulnerable groups including children and persons
p.000048: with disabilities by 2015.
p.000048: • Develop a National Child Protection Strategy and operational Plan by 2013.
p.000048: • Advocate for the signing and eventual ratification of the UN Convention for persons with disabilities
p.000048: by end of 2012.
p.000048: • Set up a National Plan of Action for the prevention of disability and rehabilitation of
p.000048: persons with disabilities in accordance with the United
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
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p.000048: role, most notably in: the recognition of qualifications, the registration of health
p.000048: practitioners, the management of problems relating to professional ethics, and the elaboration and
p.000048: revision of professional classifications according to qualification and specialisation as set out in Appendix I.
p.000048: Equally, they must support the Ministry of Health in the accreditation of services and the certification of
p.000048: professionals.
p.000048:
p.000048: In order to fulfil the above functions, an effective quality assurance system which has the potential to improve
p.000048: quality health care services according to set standards, reduce risks and produce positive impact on morbidity,
p.000048: mortality, differentially-abled and malnourished children will be put in place. A comprehensive quality assurance
p.000048: mechanism within the health sector will be developed and introduced using these existing structures.
p.000048:
p.000048: 14.1: Public Health Council
p.000048: In view of the function of public health cadre which include environmental health activities, food safety
p.000048: and quality, occupational health, immunization and health promotion, just to mention a few; the need to regulate
p.000048: public health practice in the Gambia is very crucial. Therefore the establishment of a Public Health Council
p.000048: to regulate public health functions is paramount. The organisational relationship of this body with the wider set
p.000048: of other institutions is illustrated in the organogram of the Ministry of Health and Social Welfare represented
p.000048: by Appendix J.
p.000048:
p.000048: The Public Health Council shall be established by an Act of Parliament and its function shall include,
p.000048: among other things:
p.000048: • Registration of public health officers.
p.000048: • Provide guideline for the training of PHOs.
p.000048: • Set standards for public health practice.
p.000048:
p.000048: 14.2: Clinical Audit Unit
p.000048: Establish Clinical Audit Units in all health facilities so as to strengthen routine assessment of adherence
p.000048: to set standards and norms. This is the mandate of the Medical and Dental Council in collaboration with the
p.000048: Ministry of Health and Social Welfare.
p.000048:
p.000048: 14.3: Board of Health
p.000048: A Board of Health to be established to comprise of representatives of the various Councils, policy makers
p.000048: within and out of the Health Sector, health professionals within and outside the Public Health System.
p.000048:
p.000048: The functions of the Board shall include, among other things:
p.000048: • Review and approve national health service standards
p.000048: • Monitor quality of health services nationally
p.000048: • Accredit all public, private and NGOs health facilities for service delivery
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048:
p.000048:
p.000048: 15: CONCLUSION
p.000048: This Policy was developed through consultations with and inputs from all stakeholders including
p.000048: Sector Ministries, Local Government Authorities, Faith-based Organisations, NGOs, Opinion leaders, Catchment
p.000048: Area Committees, Multi- Disciplinary Facilitation Teams (MDFT’s), and other partners in the provision of
p.000048: health care across the country. The Ministry and partners, notably from WHO and UNICEF, have demonstrated sustained
p.000048: interest and commitment to the policy process.
p.000048:
p.000048: The need to address the general health system challenges including the effects of high population growth rate;
p.000048: inadequate financial and logistic support; weak health information system; uncoordinated donor support; shortage
p.000048: of adequately and appropriately trained health staff; high attrition rate and lack of efficient and effective
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p.000000: Laboratories
p.000000: NBTS – National Blood Transfusion Services BEU – Biomedical Engineering Unit
p.000000: CL- Clinical Laboratories
p.000000: DHS - Directorate of Health Services
p.000000: DDHS – Deputy Directorate of Health Services
p.000000: PHC – Assistant Director Family Health / Primary Health Care RCH – Reproductive and Child Health
p.000000: EPI – Expanded Programme of Immunisation OHS – Occupational Health Services
p.000000: EH – Environmental Health VC – Vector Control
p.000000: IMNCI – Integrated Management of Childhood Neonatal Illnesses CNO – Chief Nursing Officer
p.000000: CPHO – Chief Public Health Officer CP – Chief Pharmacist
p.000000: NPS – national Pharmaceutical Services CMS – Central Medical Stores
p.000000: NMCP – National Malaria Control Programme
p.000000: NLTP – National Leprosy and Tuberculosis Control Programme NACP – National Aids Control Programme
p.000000: NEHP – National Eyecare Health Programme TM - Traditional Medicine
p.000000: BI – Bamako Initiative
p.000000: DFSHQE – Directorate of Food Standards Quality Hygiene Enforcement IHE - Inspection & Hygiene Enforcement
p.000000: FSQ - Foods Standard & Quality
p.000000: DHPE – Directorate of Health Promotion and Education DDHPE – Directorate of Health Promotion and Education NCD –
p.000000: Non-Communicable Diseases
p.000000: MH – Mental Health
p.000000: WS – Water and Sanitation Hygiene HC – Health Communication
p.000000: NHR – National Health Research HPP – School Health and Nutrition
p.000000: SWRO – Social Welfare Regional Offices CC - Child Care
p.000000: DU - Disability Unit AC - Adult Care
p.000000: PS – Professional Services
p.000000: RVTH – Royal Victoria Teaching Hospital SJJH – Sulayman Junkung Jammeh Hospital
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p.000000: JFPH – Jammeh Foundation for Peace Hospital SGH – Serekunda General Hospital
p.000000: AFPRC – Armed Forces Patriotic Ruling Council Hospital BSG – Bansang Hospital
p.000000: GMDC – Gambia Medical and Dental Council GNMC – Gambia Nurses and Midwives Council MB – Medicine’s Board
p.000000: CIO – Central Inspectorate Office
p.000000: RHDW1 – Regional Health Directorate Western 1 RHDW2 – Regional Health Directorate Western 2 RHDNBW – Regional Health
p.000000: Directorate North Bank West RHDNBE – Regional Health Directorate North Bank East
p.000000: RHDCRR – Regional Health Directorate Central River Region RHDURR – Regional Health Directorate Upper River Region
p.000000: RHDLRR – Regional Health Directorate Lower River Region VHS – Village Health Services
p.000000: VHW – Village Health Worker TBA – Traditional Birth Attendant
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p.000048: that about 16% of urban women are obese compare to only 1% of rural women. A WHO survey in 2008 reveals the
p.000048: prevalence of other NCD risk factors as follows:
p.000048: • 24.5% prevalence rate of smoking amongst 13-15 year olds.
p.000048: • 31.3% prevalence rate of smoking among youths aged 25 to 34 years.
p.000048: • About 2% of the adult population, aged 25 – 64 years, drink alcohol
p.000048: • Low consumption of fruits and vegetables, with the average mean number of days for fruits and
p.000048: vegetable consumption among adult males and females estimated at 3.3 and 5.0 respectively
p.000048: • About 22% of the adult population (males and females) have a low level of physical activity, whilst
p.000048: nearly 59% of adults do not engage in rigorous physical activity. In the same vein, on average, Gambian adults spend
p.000048: 231 minutes per day on sedentary activities
p.000048: • On average, 41.4% of adults Gambians never had their blood pressure tested. Similarly, about 24.4% of the adult
p.000048: population have raised blood pressure (25.5% for men and 23.4% for women)
p.000048: • About 90.5% of adults (92.1% of men and 89% of women) never had their blood sugar tested
p.000048: • About 39.5% of the adult population (33.7% for men and 45.3%) are considered overweight with mean BMI >25kgM2
p.000048:
p.000048: Safe water is an essential pillar of sustainable health for the population. Access to safe water is 85.1% of the
p.000048: overall households; with 79.9% urban and 64.9% rural and access to proper sanitary facilities are not encouraging
p.000048: thus limiting to only 26% (PRSPII) for the entire country.
p.000048:
p.000048: The 2008 poverty assessment indicated that overall poverty to be at 55.5% with a poverty gap of 25.9% and poverty
p.000048: severity at 14.3%. However there are regional variation with rural poverty incident of 63% and an urban
p.000048: incident of 57%. See Appendix: D.
p.000048:
p.000048: Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in
p.000048: recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly
p.000048: Community Initiative and the Bamako Initiative.
p.000048:
p.000048: Also, relevant policy documents were developed including that of Nutrition, Drug , Malaria Reproductive and
p.000048: Child Health , Human Resource for Health , Maintenance , Mental Health , HIV/AIDS , Health Management Information
p.000048: System , National Blood Transfusion , Information Technology , and others such as Traditional Medicine,
p.000048: National Public Health Laboratory and the Health Research Policies at various stages of development.
p.000048:
p.000048:
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p.000048: Page 9
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.3: Problem Statement
...
p.000048:
p.000048: 2. 0. VISION AND MISSION
p.000048: 2. 1 Vision
p.000048: Provision of quality and affordable Health Services for All By 2020
p.000048:
p.000048: 2. 2 Mission
p.000048: Promote and protect the health of the population through the equitable provision of quality health care.
p.000048:
p.000048: 3.0 GOAL AND TARGETS
p.000048: Noting the challenges confronting the health sector, and having conceived the vision, mission and guiding
p.000048: principles, a number of key result areas were identified that would collectively have potential for
p.000048: maximum impact on the health status of the citizenry.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 3.1. Goal:
p.000048: Reduce morbidity and mortality to contribute significantly to quality of life in the population.
p.000048:
p.000048: Morbidity and mortality rates due to communicable diseases have decreased over the years but more pronounced
p.000048: in non-communicable diseases especially among youths and women. In addition to the earlier mentioned health
p.000048: challenges, the main factors contributing to this high morbidity in the population include social
p.000048: determinants and related factors such as poverty, unhealthy environment, unsafe working conditions, poor
p.000048: sanitation, poor nutrition, road traffic accidents, poor access to safe water and poor housing for many. The main
p.000048: causes of mortality within the population are: Malaria, Pneumonia, Anaemia, Diarrhoeal Diseases, road traffic
p.000048: accidents, pregnancy complications and Cardiovascular Diseases. Of increasing concern are the incidences of
p.000048: Tuberculosis and HIV/AIDS in the population.
p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
...
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
p.000048: Community empowerment; active involvement of the private sector, NGOs, local government authorities and civil
p.000048: society; effective donor co-ordination
p.000048:
p.000048: 4.9 Evidence based health care
p.000048: Health planning, programming and service delivery shall be informed by evidence- based research.
p.000048:
p.000048: 4.10: Patient bill of rights
p.000048: The Patient's Bill of Rights helps patients feel more confident in the health care system. It assures that
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
p.000048: 4.10.2 Choice of providers and plans
p.000048: Where possible every patient shall have the right to choose health care providers who can give him/her
p.000048: high-quality health care when needed.
p.000048:
p.000048: 4.10.3 Access to emergency services
p.000048: In emergency health situations including severe pain, an injury, or sudden illness that makes a person believe that
p.000048: his/her health is in serious danger, he/she shall have the right to be screened and stabilized using emergency
p.000048: services. He/she should be able to use these services whenever and wherever needed without needing to wait for
p.000048: authorization and any financial payment.
p.000048:
p.000048: 4.10.4 Participation in treatment decisions
p.000048: Every patient shall have the right to know his/her treatment options and take part in decisions about his/her care.
p.000048: Parents, guardians, family members, or others that they identify can represent them if he/she cannot make his/her
p.000048: own decisions.
p.000048:
p.000048: 4.10.5 Respect and non-discrimination
p.000048: Every patient must have a right to considerate, respectful and non-discriminatory care from his/her health
p.000048: care provider (s),
p.000048:
p.000048: 4.10.6 Confidentiality of health information
p.000048: All patients must have the right to talk privately with health care providers and to have his/her health
p.000048: care information protected. He/she shall have the right to read and copy his/her own medical record. He/she shall have
p.000048: the right to ask that his/her health care provider change his/her record if it is not correct, relevant, or complete.
p.000048:
p.000048: 4.10.7 Complaints and appeals
...
p.000048: that there is effective detection, investigation, and management of any suspected and confirmed cases of priority.
p.000048: Cross border surveillance will also be strengthened with the effective implementation of IHR (International
p.000048: Health Regulations).
p.000048:
p.000048: The monitoring of diseases both emerging and re-emerging will be strengthened with the empowerment of regions to
p.000048: carry out proper monitoring and supervision of interventions. Disaster management requires a multi-sectoral
p.000048: approach: hence, the Ministry of Health will take the necessary measures to ensure there is an adequate level of
p.000048: preparedness and ability to respond to those disasters using collaborative strategies quickly and adequately.
p.000048:
p.000048: Objectives
p.000048:
p.000048: • To reduce the burden of communicable diseases to a level that they cease to be a public health problem
p.000048:
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p.000048:
p.000048: • To promote healthy life styles, increase understanding on the prevention and management of all diseases.
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen disease surveillance and response capacity at all levels
p.000048: • Provision of appropriate case management capacity at various levels of health care delivery system
p.000048: • Community empowerment on disease prevention and control measures
p.000048:
p.000048: 5.4.1 COMMUNICABLE DISEASES
p.000048: 5.4.1 (i): Malaria Policy Measures
p.000048: • Community empowerment on malaria prevention and control
p.000048: • Increase availability and access to LLINs for the general population.
p.000048: • Strengthen integrated vector control interventions (including in indoor residual spraying)
p.000048: • Strengthen the availability and accessibility of effective malaria chemoprophylaxis
p.000048: for all pregnant women
p.000048: • Strengthen Malaria Case management in all health facilities
p.000048: • Strengthen collaboration with partners in research
p.000048: • Strengthen community management of malaria
p.000048:
p.000048: 5.4.1(ii): Tuberculosis Policy Measures
p.000048: • Promote the expansion of high-quality Directly Observed Treatment Short course (DOTS)
p.000048: • Support the implementation of advocacy, communication and social mobilisation activities (ACSM)
p.000048: • Inter-sectoral coordination to address the synergistic challenges posed by TB/HIV
p.000048:
p.000048: 5.4.1(iii): HIV/AIDS
p.000048: Policy Measures
p.000048: • Expand and strengthen HIV/AIDS Counselling & Testing (HCT) and Prevention of Mother to child
p.000048: transmission (PMTCT) services.
p.000048: • Support and expand Anti-Retroviral Therapy (ART)
p.000048: • Expand the care and support services for People Living With HIV/AIDS (PLWHAs)
p.000048: • Support sentinel surveillance and research in HIV/AIDS
p.000048: • Intensify IEC/BCC/CSC interventions on HIV/AIDS
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048: 5.4.1(iv): Sexually Transmitted Infections (STIS) (Other Than HIV/AIDS) Policy Measures
p.000048: • Effective information, education and counselling of the populace
p.000048: • Provision of STIs drugs and supplies in all facilities with a view to increase access
p.000048: • Train health care workers on the syndromic treatment and management of STIs with a view to provide
p.000048: proper treatment
p.000048: • Set up well equipped laboratories in all major health centres and hospitals
p.000048: • Establish STI clinics targeted specifically for most at risk populations (MARPs)
p.000048: • Provision and distribution of condoms to MARPs
p.000048: • Monitoring and supervision of STI services
p.000048:
p.000048: 5.4.1(v): Diarrhoeal Diseases Policy Measures
p.000048: • Increase access to safe water and improved sanitary facilities
p.000048: • Strengthen case management , prevention and control
p.000048:
p.000048: 5.4.1(vi): Trachoma (Eye Disease) Policy Measures
p.000048: • Elimination of blinding trachoma
p.000048: • Reduce the prevalence of active trachoma to below 5% in all communities
p.000048: • Intensify IEC/BCC/CSC intervention
p.000048: • Conduct a survey to determine the prevalence of cataract per region and set up regional cataract surgery
p.000048: targets after Training more nyateros to identify and refer all cataract cases in their communities
p.000048: • Adequate supply of equipment, drugs and consumables for eye surgery (cataract, glaucoma, retina)
p.000048: • Training of eye care providers in the prevention and management of corneal ulcers
p.000048: • Provision of optometrist assistant in each secondary eye care unit to deliver services in each division
p.000048: • Development of a national Eye care program policy
p.000048:
p.000048: 5.4.2: NON- COMMUNICABLE DISEASES (NCDs)
p.000048: Preamble
p.000048: The World Health Organization (WHO) 2005 Report on chronic diseases indicated that the majority of deaths worldwide
p.000048: for all ages are due to chronic diseases such as cardiovascular diseases (mainly heart disease and stroke),
p.000048: cancer, chronic respiratory diseases, and diabetes. Non Communicable Diseases (NCDs) are a consequence of
p.000048: unhealthy diet and lifestyle such as tobacco use, physical inactivity and harmful use of alcohol, constitute a major
p.000048: public health problem and are known, for both their high financial and social cost for families, communities and
p.000048: countries.
p.000048:
p.000048:
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p.000048:
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p.000048:
p.000048: 5.5: Mental Health Preamble
p.000048: It is estimated that approximately 27,000 people in the Gambia are suffering from a severe mental and/or substance
p.000048: abuse disorder and that a further 91,000 Gambians have a mild disorder still requiring treatment (World health
p.000048: Survey, 2004) .A local prevalence study in the Gambia, puts prevalence rates higher (at 20%) and leads to estimates
p.000048: of approximately 180,000 people suffering from a mental or substance abuse disorder. Providing effective
p.000048: treatment and support to all these people is challenging, given the scarce health resources in the
p.000048: Gambia and an overall situation of poverty in the country, where 34% of the population live below the
p.000048: poverty line and 18% of the population are extremely poor. However, consultation
p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: with many different experts, health professions and key individuals from different government sectors has
p.000048: highlighted the great need, willingness and strategies required to strengthen the overall mental health system in
p.000048: order to provide effective treatment and care to those in need as well as to promote the mental health of all Gambians.
p.000048:
p.000048: Objective
p.000048:
p.000048: • Improve access to quality mental health care for all Gambians
p.000048: Policy Measures
p.000048:
p.000048: • Implement the Mental Health Policy and Strategy
p.000048: • Strengthening capacity for the diagnosis, management, prevention and control of mental and
p.000048: neurological disorders
p.000048: • Providing quality, equitable and affordable mental health services to the general population
p.000048: • Promote IEC on substance abuse
p.000048: • Promoting advocacy for the reduction of stigma and discrimination against people with mental and
p.000048: neurological disorders
p.000048: • Strengthening community involvement and participation in mental health care service delivery
p.000048: • Operationalise the revised current Lunatics’ Detention Act of 1917 taking into account a new mental health
p.000048: legislation Establishing and strengthening capacity for mental health research
p.000048: • Strengthen the prevention, case management and control of mental health illnesses country wide
p.000048: • Develop a Mental Health Act.
p.000048:
p.000048: 5.6: Reproductive and Child Health Preamble
p.000048: RCH services are provided at all levels of the health system by both public and
p.000048: private facilities at base and outreach through a network of health facilities across the country. With an impressive
p.000048: nationwide coverage RCH indicators have over the years been reduced significantly. For example, MMR high has reduced
...
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
p.000048: Stark regional variations also exist with the above indicators. For example, MMR is two-fold higher in rural
p.000048: than in urban areas and under-five mortality is three-fold higher in Lower River Region than that of
p.000048: Banjul (137 vs. 41).
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: A combination of factors (health and non-health service related) is responsible for the above high RCH
p.000048: indicators. Unmet need for RCH services particularly emergency obstetric care services resulting
p.000048: mainly from lack of basic RH equipments and supplies, acute shortage of skilled health
p.000048: professionals, weak referral system and inadequate financial resources for RCH services are some of the health
p.000048: services. In addition to these, non-health service related factors including high fertility rate (national 5.4), poor
p.000048: and inadequate nutrition, poor socio-economic status manifested by poor housing, limited availability and access to
p.000048: safe water and basic sanitation are important determinants.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity related to but not limited to childhood, reproduction and the
p.000048: reproductive system across the country
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen and promote 24/7 Emergency Obstetric Care concept;
p.000048: • Strengthen and promote Emergency neonatal care;
p.000048: • Advocate and ensure Implementation of the national reproductive health commodity security plan;
p.000048: • Introduce and institutionalise peri-natal reviews and audits;
p.000048: • Maintain, promote and protect the free of cost policy for MCH services;
p.000048: • Establish a minimum RCH care package;
p.000048: • Monitoring, evaluation and research
p.000048: • Increase awareness on sexual, reproductive and child health issues;
p.000048: • Promote partnership and coordination among all stake holders in the field of RCH;
p.000048: • Create opportunities for the improvement of the nutritional status of the vulnerable groups.
p.000048: • Operationalize operating theatres in all major health facilities.
p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
p.000048: and Childhood Illness (IMNCI) strategy in 1999 to address the high morbidity and mortality among children
...
p.000048: impact on health
p.000048: e.g. community water supplies, sanitation, home based care for malaria, etc.
p.000048:
p.000048:
p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: In order to restore the functionality of all existing PHC villages, the Ministry of Health in collaboration with
p.000048: stakeholders and the community will review the present VDC system.
p.000048: The development of the VHS has been in isolation to the BHS. The latter possesses a wide range of resources to support
p.000048: the VHS. The policy calls for define linkages between the BHS and the VHS. A basic health facility will be linked to a
p.000048: number of trekking stations and PHC villages. This group of facilities and the population it serves
p.000048: (including non primary health care villages) will constitute a CATCHMENT AREA.
p.000048: The basic health facility will perform the first line supervision and provide support in the areas of training and
p.000048: supply of drugs to the VHS. Each catchment area will have a catchment area committee. The latter will be closely
p.000048: involved in the management, planning, monitoring and evaluation of services provided in the area under its
p.000048: jurisdiction.
p.000048: 6.1.1 Service Expansion
p.000048: At present, health services are provided by 546 health posts at the primary level. When PHC was introduced
p.000048: in 1979 some villages which did not qualify for reasons of numbers now qualify. The present policy of
p.000048: establishing PHC in villages with a population of 400 or more or where access is difficult will
p.000048: continue so as to accommodate new villages. In view of the numbers of villages to be involved, villages
p.000048: in vulnerable areas will be given first consideration, especially those in the north bank of CRR and URR as per the
p.000048: recent UNICEF MICS findings.
p.000048: To provide the required supervision and support, new key villages and circuits will be established simultaneously.
p.000048: NGO and Government partnership is essential and will be encouraged especially in the planning and inauguration of new
p.000048: PHC villages, so that NGO intervention and resources can be better maximised.
p.000048: Currently 21 NGO health facilities and 19 private clinics and 18 Community-owned/ managed Clinics complement
p.000048: government health services. In spite of the fact that this health policy calls for participation of the private
p.000048: sector and communities in the provision and management of health services delivery, the absence of
p.000048: clear guidelines and enabling policies and Acts has limited the capacity of the Ministry to control the unprecedented
p.000048: wave of expansion of services at these levels. New health mapping studies will be undertaken to determine
p.000048: health services expansion, especially in key growth centres and within the urban areas where population
p.000048: continue to grow at an alarming rate.
p.000048:
p.000048: Objective
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To ensure the functionality of all existing PHC villages
p.000048: Policy Measures
p.000048: • Strengthen/ build capacity at primary level
p.000048: • Regulate service delivery/expansion at primary levels
p.000048: • Mobilise and provide the pre-requisite resources
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 6.1.2 Community Participation
p.000048:
p.000048: Preamble
p.000048: Communities (individual and families) are recipients of health services. Thus, their involvement and
p.000048: participation in planning and implementation of health serviced delivery is crucial for health care services
p.000048: uptake and sustainability.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To build the capacity of communities to enhance their participation and involvement in health service
p.000048: delivery.
p.000048:
p.000048: Policy Measures
p.000048: • Promote community involvement and participation on health and health related issues.
p.000048: • Build community capacity to make Informed decision on matters relating to their health
p.000048:
p.000048: 6.1.3 Bamako Initiative (BI) Preamble
p.000048: The concept of Bamako Initiative as a strategy was adopted in 1993. It aims at
p.000048: strengthening Primary Health Care (PHC) by providing a framework for co-financing and co-management of health
p.000048: services by government, donors and beneficiaries communities. It serves as a basis for provision of
p.000048: essential health care services especially at village level.
p.000048:
...
p.000048: • Minimize recurrent costs and balance cost-sharing with the community in order to ensure efficiency,
p.000048: sustainability and equity.
p.000048: • Strengthen community empowerment for sustainability
p.000048:
p.000048: 6.2 SECONDARY HEALTH CARE SERVICE
p.000048:
p.000048: 6.2.1 Major Health Centres
p.000048: The Major Health centre at the intermediate level has been designed to provide referral services for
p.000048: obstetric emergencies, essential surgical and medical care. A fully functional MHC is one of the strategies for
p.000048: the reduction of the high MMR and
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: IMR. Providing quality services at this level develops confidence in the PHC system whilst ensuring that such services
p.000048: are brought closer to the community. In spite of the critical role that Major Health Centres have to play, their full
p.000048: impact is yet to be felt, because of several constraints All Major Health Centres are still to be provided with the
p.000048: full complement of equipment and supporting facilities such as blood transfusion services, etc. Human
p.000048: resources to carry out all the envisioned functions are in short supply whilst shortage of accommodation has
p.000048: prevented the few available staff from taking up residence. A fully functional Major Health Centre is vital in
p.000048: providing not only referral services but also the necessary environment for training all health workers in the
p.000048: Regions and fostering an atmosphere for operational research.
p.000048:
p.000048: Objectives
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To ensure the full operationaility of all six (6) Major and thirty eight (38) Minor Health Centres by 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen all Major and Minor Health Centres
p.000048: • Increasing staffing capacity and equipment of the existing public health centres to meet the national
p.000048: standards.
p.000048: • Support to health care reforms and infrastructural development and expansion of health care facilities
p.000048: • Advocate and encourage establishment of Maternal and Child Health clinics operated by Registered Nurse-Midwives
p.000048: Ensure that all major and minor health centres are provided with all required standard equipment, logistics and
p.000048: support facilities to make them fully functional
p.000048: • Development of an up-to-date standard list of equipment for Major and Minor Health Centres
p.000048: • Encourage NGO provision of basic health care for the rural communities.
p.000048: • Assessment and certification of all private and NGO health centres and clinics
p.000048: • Provision of minimum staffing levels as well as adequately furnished accommodation for such
p.000048: staff
p.000048: • Provision of vehicles to ensure that trekking and evacuation functions are executed simultaneously
p.000048:
p.000048: 6.2.2 Minor Health centres
p.000048: The physical infrastructure of the majority of Minor Health Centres is in a state of disrepair and
p.000048: dilapidation due inadequate maintenance. The majority lack the required equipment because of wear and tear and
p.000048: non replacement, a situation that is not conducive to good work and, staff morale or efficiency. The
p.000048: absence of an inventory system has made it difficult to establish accountability. Attention will be given
p.000048: to the provision of logistics such as stand by generating sets, water tanks, telecommunication sets
p.000048: including ICTs facilities.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 30
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To refurbish and equip the existing thirty-eight (38) Minor Health Centres
p.000048:
p.000048: Policy Measures
p.000048: • Increasing staffing capacity and equipment of the existing public health centres to meet the national
p.000048: standards.
p.000048: • Support to health care reforms and infrastructural development and expansion of health care facilities
p.000048: • Advocate and encourage establishment of Maternal and Child Health clinics operated by Registered Nurse-Midwives
p.000048: Carry out a physical assessment of all Minor Health Centres in order to establish the state of disrepair
p.000048: • Establish an electronic database for physical infrastructure
p.000048: • Put in place an Inventory System for all the equipment and rules to determine their retention and disposal
p.000048: • Encourage NGO provision of basic health care for the rural communities.
p.000048: • Assessment and certification of all private and NGO health centres and clinics.
p.000048:
p.000048: 6.3 TERTIARY HEALTH CARE SERVICE
p.000048: The seven (7) Public Hospitals (1 Teaching, 5 General and 1 Regional Eye Care) will serve as the referral points for
p.000048: all cases referred from primary and secondary levels. Emergency cases referred and transported from secondary
p.000048: level will enjoy free treatment. Those otherwise referred will be exempted from consultations.
p.000048:
p.000048: Services provided will depend on available resources, priority health problems and prevailing health conditions as
...
p.000048: exacerbated by inadequate output from the health training institutions and the high attrition rate.
p.000048: Inequitable distribution of available health care professionals is a major concern. The pay and incentive packages
p.000048: for health care professionals needs to be revised to attract and retain health staff.
p.000048:
p.000048:
p.000048:
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p.000048: Page 32
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048:
p.000048: • To establish a vibrant and critical mass of human resources for health by 2020
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen staffing, code of conduct and standards
p.000048: • Accelerate and support HRH training
p.000048: • Strengthen and support equitable HRH distribution, motivation and retention
p.000048: • Draw and attract funding for HR development.
p.000048: • Strengthen the human resource unit
p.000048: • Advocate for Incentive schemes for trained professionals
p.000048:
p.000048: 6.6: Infrastructure and Logistics Preamble
p.000048: Availability of appropriate infrastructure and medical equipment is a major cross-
p.000048: cutting intervention in strengthening the implementation of health programmes. Inadequate and inequitable
p.000048: distribution of health infrastructure and equipment across the country has continued to present major challenges to the
p.000048: health sector.
p.000048: Over the past 5 years, significant efforts and resources have been invested in strengthening health
p.000048: infrastructure, equipment and transport. Currently, the infrastructure and logistical arrangements and
p.000048: maintenance policy need to be reviewed for equity and prompt access to health care services. The main
p.000048: objective is to significantly improve the availability, distribution and state of essential
p.000048: infrastructure and medical equipment, so as to improve equity of access and quality of health services. A Capital
p.000048: Investment Plan (CIP) covering the period 2012-2015 will be developed, in conjunction with the Districts and Regional
p.000048: Health Teams. The CIP has been prioritized and will be the main tool for planning on capital investment. Significant
p.000048: efforts will also be directed towards renovation of the existing health infrastructure and, the renovation
p.000048: and expansion of health training institutions. These efforts are also being supplemented with the private sector
p.000048: initiatives, which have led to the renovation and construction of several public health infrastructures. :
p.000048:
p.000048:
p.000048: Objective
p.000048: • To improve the infrastructure and logistic requirements of the public health system for quality health
p.000048: care by 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen the maintenance team at all levels
p.000048: • Strengthen the available infrastructure and logistics for public health facilities.
p.000048: • Develop and maintain infrastructural standards for all categories of health facilities
p.000048:
p.000048: 6.7: Health Management Information System (HMIS) and Research Preamble
p.000048:
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p.000048: Page 33
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Reliable and readily available health information is crucial for evidence based planning, monitoring and
p.000048: decision making for health service management.
p.000048:
p.000048: Currently HMIS needs to be reviewed to address the limited capacity and resource requirement for research and effective
p.000048: management of national health information.
...
p.000048: findings. Research has led to tangible improvements. It has a key role to play in the ongoing health development
p.000048: process. The first priority is to set up a database of all research conducted in the country and a review of
p.000048: their findings. One of the reasons for this is the fact that the Directorate of Planning and Information (DPI)
p.000048: presently lacks material resources that will enable an effective and efficient running of the Health Systems
p.000048: Research and Documentation Unit.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To improve timely collection of health data and availability of reliable health information by 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Advocate, support and promote interest in research.
p.000048: • Establish monitoring and evaluation plan
p.000048: • Strengthen the existing health information system for effective utilization
p.000048: • Strengthen capacity towards health system research and documentation.
p.000048: • Promote and strengthen birth and death registration.
p.000048:
p.000048: 7.0: HEALTH FINANCING
p.000048: Preamble
p.000048: In 1988 a Cost Recovery Program was started as part of the national health development program. This
p.000048: established the Drug Revolving Fund and the introduction of user fees as a form of health financing. The
p.000048: Bamako Initiative (BI) was introduced in 1993 as a further development on the Cost Recovery Program. Although
p.000048: some successes were registered with both types of financing strategy, universal access and coverage still
p.000048: remains a major challenge.
p.000048:
p.000048: Healthcare service financing is a challenge the world over but more pronounced in developing countries where government
p.000048: budgetary allocation to the health sector is less than optimal and health insurance schemes have limited
p.000048: coverage or non- existent. There is need for health financing policy for the country. Government
p.000048: allocations to the health sector as a percentage of the total national budget continue
p.000048:
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p.000048: Page 34
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: to improve, ranging from 7% to 10% in the past five years1. This is still below the Abuja Declaration of 15% budgetary
p.000048: allocation to the health sector. Health care is provided almost free, especially for maternal and child health
p.000048: services since the introduction of the policy in 2007 by of President of the Republic.
p.000048:
p.000048: In 2007, the first National Health Accounts (NHA) for The Gambia was constructed covering the fiscal years 2002 – 2004.
p.000048: The results revealed marginal increase in total health expenditure (THE). As a percentage of GDP, the THE was 16.1%
p.000048: in 2002, 13.9% in 2003 and 14.9% in 2004. Per capita health expenditure was D895 in 2002, D1026 in 2003 and D1203 in
p.000048: 2004. This ranges between US$33 and US$40, almost matching the WHO Commission for Macroeconomics and
p.000048: Health (CMH) recommendation of US$ 34 per capita expenditure for a package of essential health services. It is
p.000048: instructive that the bulk of these funding came from donors as over 66% of the total health funding came from
...
p.000048:
p.000048: 10.3: Laboratory Services Preamble
p.000048: For accurate diagnosis and appropriate patient management, effective and functional
p.000048: laboratory services are required. However, The Gambia is still dependant on laboratories outside the
p.000048: country for some specialized investigations. Therefore, laboratory service in The Gambia should be
p.000048: strengthened and expanded. The Private sector and NGO though few compliments the public sector. However, their
p.000048: services are not affordable to a vast majority of Gambians.
p.000048:
p.000048: Objectives
p.000048: • To institute timely, accessible, availability, affordability and reliable results for accurate diagnosis
p.000048: Policy Measures
p.000048: • Strengthen capacity of the laboratory programme for improved service delivery.
p.000048: • Expansion of laboratory services to meet service demands of the population
p.000048: • Expansion of the laboratory surveillance programme
p.000048: • Strengthen quality control and quality assurance for laboratory services.
p.000048: • Promote research in laboratory service
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 39
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 10.4: Radiology Services Preamble
p.000048: Radiology like laboratory services is key to accurate diagnosis and proper patient management. However,
p.000048: radiology services though has expanded over the years is still limited to few public health facilities (RVTH,
p.000048: Bansang, AFPRC and Sulayman Junkung hospitals) and certain private and NGO health facilities. In addition to the
p.000048: limited services, access and affordability, provision of X-ray equipment and maintenance are still
p.000048: challenges to a majority of Gambians. Therefore, the need for improvement and expansion is critical.
p.000048:
p.000048: Objectives
p.000048: • To ensure uninterrupted supply of x-ray consumables and equipment
p.000048: • To ensure affordable and accessible service delivery for prompt and accurate diagnosis
p.000048: Policy Measures
p.000048: • Strengthen capacity of the radiology programme for improved service delivery.
p.000048: • Expansion of radiology services to meet service demands of the population.
p.000048: • Strengthen quality control and quality assurance for radiology services.
p.000048: • Promote research in radiology services.
p.000048: 10.5: Referral System
p.000048:
p.000048: Preamble
p.000048: Effective and efficient referral services from one level of health care to another (community, secondary
p.000048: to tertiary and community) are important in patient management and disease outcome. However, the
p.000048: current referral system still has major challenges. Some of the challenges include inadequate
p.000048: number of ambulances, intermittent shortage of fuel, inadequate capacity to manage cases effectively,
p.000048: inadequate feedback mechanism, inadequate referral protocol and guidelines and late referrals especially at
p.000048: community level. This situation is further compounded by limited (only receiving) telecommunication services
p.000048: within health facilities. A referral system that enhances speedy and safe evacuation of patients is necessary.
p.000048:
p.000048: Objective
...
Social / Age
Searching for indicator age:
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p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
p.000048: and Childhood Illness (IMNCI) strategy in 1999 to address the high morbidity and mortality among children
p.000048: under five years. The IMNCI strategy combines improved case management of childhood illness in first-level health
p.000048: facilities with aspects of nutrition, immunization, disease prevention, and promotion of growth and
p.000048: development. There are three components of IMNCI which are: improving the skills of health workers; improving the
p.000048: health system, and improving household and community practices.
p.000048:
p.000048: The IMNCI strategy is a technically sound, comprehensive and evidence-based strategy focusing on the main
p.000048: threats to children’s health and focus mainly on the prevention and adequate treatment of malaria, diarrhoea,
p.000048: pneumonia, measles and malnutrition because they are responsible for about 70% of deaths among children
p.000048:
p.000048:
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p.000048: Page 26
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: under five years. It targets children under five years and focus on the five main causes of mortality in
p.000048: children under the age of five.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity associated with major causes of disease in children less than five years of age.
p.000048: Policy Measures
p.000048:
p.000048: • To monitor growth and development of children under the ages of five
p.000048: • To build the capacities of health workers on IMNCI Case Management Skills
p.000048: • To strengthen collaboration with traditional healers and other community partners for effective
p.000048: implementation of community component of the IMNCI strategy.
p.000048: • To strengthen the implementation of the IMNCI strategy in all seven health regions in the country.
p.000048:
p.000048: 6.0: BASIC HEALTH CARE AND LEVELS OF DELIVERY
p.000048: 6.1 PRIMARY HEALTH CARE (PHC) SERVICE
p.000048:
p.000048: Preamble
p.000048: The Gambia adopted Primary Health Care (PHC) in 1979 following the Alma- Ata declaration in 1978. Subsequently
p.000048: a PHC Plan of Action for the period 1980 to 1985 was formulated which formed the basis for a National Health Policy.
p.000048: In the Plan of Action, PHC has been defined as:
p.000048:
p.000048: An approach aimed at mobilising all potential resources including the communities’ own resources, towards the
p.000048: development of the National Health Care System, the aim being to extend health services coverage to the entire Gambian
p.000048: population and to attract the main disease problems of the communities. PHC is also a mechanism for ensuring an
p.000048: equitable re-distribution of the limited health resources available in the country in favour of the under-served
p.000048: majority, who live and work in the rural area.
p.000048:
p.000048: At present quite a number of PHC villages are not functioning optimally. Reasons for non performance are attributed to
...
Social / Child
Searching for indicator child:
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p.000002: upon becomes a reality only when a healthy population can contribute to improved productivity, increased GDP
p.000002: and sustained economic growth and overall ensure social equilibrium. Hence the slogan:
p.000002:
p.000002: “A Healthy population is a Wealthy population”.
p.000002:
p.000002: The mission of the Ministry of Health is to contribute to socioeconomic development and wealth creation
p.000002: by promoting and protecting the health of the population through equitable provision of quality health
p.000002: care within the context of Primary Health Care. This mission puts the concept of health beyond the
p.000002: confines of curative care to other socio-economic determinants of health.
p.000002:
p.000002: The health sector despite remarkable achievements registered since 1994 to date is still under great pressure due to a
p.000002: number of factors: high population growth rate, increasing morbidity and mortality, insufficient financial and
p.000002: logistic support, deterioration of physical infrastructure, inadequacies of supplies and equipment,
p.000002: shortage of adequately and appropriately trained health personnel, high attrition rate as well as
p.000002: inadequate referral system. Poverty and ignorance have led to inappropriate health seeking behaviours thus
p.000002: contributing to ill health.
p.000002:
p.000002:
p.000002:
p.000002: Health Policy 2012-2020
p.000002: Page 2
p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: Indicators of child and maternal mortality are particularly worrying. This situation is worsened by other
p.000002: factors related to the poverty in general resulting to the high prevalence of communicable and
p.000002: non-communicable diseases such as Malaria, Diarrhoea, Upper Respiration Tract Infection, Tuberculosis, Skin
p.000002: Disease, Accidents, Hypertension, Cancers, Eye Infection, and Pregnancy related conditions, Helminthiasis and
p.000002: malnutrition and HIV/AIDS and its spread. Most of these diseases can easily be prevented if appropriate
p.000002: environmental and lifestyle measures are taken, with more attention paid to development of health
p.000002: promotion and prevention actions than merely focusing on curative care alone.
p.000002:
p.000002: The revised policy is expected to reform the health system by addressing the major traditional problems of health,
p.000002: the new challenges and the double burden of communicable and non-communicable diseases, curbing the
p.000002: HIV/AIDS pandemic and overcoming a weak health system. This reform is in line with the Local Government
p.000002: decentralization and planning based upon the Local Government ACT of (2002), Vision 2020 and the
p.000002: anti-poverty Programme for Accelerated Growth and Employment (PAGE), attainment of MDG: 4 Reduce Child Mortality; MDG:
p.000002: 5 Improve Maternal Health; and MDG: 6 Combat HIV/AIDS, Malaria and Other Diseases.
p.000002:
p.000002: Implementation of policy measures will certainly impact on reducing morbidity and mortality of major diseases, promote
p.000002: healthy lifestyle, and reduce health risks and exposures associated with negative environmental consequences. It
p.000002: provides basis for an institutional and legal framework for implementation of policy measures. It also identifies
p.000002: relevant stakeholders that contribute to health service provision and the institutional framework for mobilizing
p.000002: sector- wide resources for health development. The policy update therefore provides an impetus and new direction for
p.000002: health sector development that will serve as the basis for driving our health sector priorities and planning as well
p.000002: guiding resource allocation processes in the next few years to come.
p.000002:
p.000002:
p.000002: Honourable Mme. Fatim Badjie Minister of Health & Social Welfare
p.000002: April 2012
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: Health Policy 2012-2020
p.000002: Page 3
p.000002:
p.000002: Table of content
p.000002: FOREWORD
p.000002: 2
p.000002: ABBREVIATIONS
p.000006: 6
p.000006: 1.0 INTRODUCTION
p.000008: 8
p.000008: 1.1 LOCATION, SIZE AND CLIMATE
p.000008: 8
p.000008: 1.2 DEMOGRAPHIC CHARACTERISTICS ERROR! BOOKMARK NOT
p.000008: DEFINED.
p.000008: 1.3 HEALTH SYSTEM
p.000010: 10
...
p.000011: V. DIRECTORATE OF HEALTH PROMOTION AND EDUCATION (DHPE) 12
p.000011: 1.4. HEALTH SERVICE DELIVERY
p.000014: 14
p.000014: 1.5 HEALTH STATUS OF THE POPULATION ERROR! BOOKMARK NOT DEFINED.
p.000014: 1.6: POLICY ORIENTATION
p.000010: 10
p.000010: 1.7 PROBLEM STATEMENT
p.000010: 10
p.000010: 2. 0 VISION AND MISSION
p.000015: 15
p.000015: 3.0 GUIDING PRINCIPLES
p.000017: 17
p.000017: 4.0 GOAL AND TARGETS
p.000015: 15
p.000015: 4.1. GOAL
p.000016: 16
p.000016: 4. 2 TARGETS
p.000016: 16
p.000016: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES 19
p.000016: 5.1.1 ENVIRONMENT, HEALTH AND SAFETY
p.000019: 19
p.000019: 5.1. HEALTH PROMOTION AND EDUCATION
p.000020: 20
p.000020: 5.2. EXPANDED PROGRAMME ON IMMUNISATION (EPI)
p.000020: 20
p.000020: 5.3: DISEASE CONTROL
p.000021: 21
p.000021: 5.3.1 COMMUNICABLE DISEASES
p.000022: 22
p.000022: 5.4: MALARIA
p.000022: 22
p.000022: 5.5: TUBERCULOSIS
p.000022: 22
p.000022: 5.6: HIV/AIDS
p.000022: 22
p.000022: 5.7: SEXUALLY TRANSMITTED INFECTIONS (STIs) (other than HIV/AIDS) 23
p.000022: 5.8: DIARRHOEAL DISEASES
p.000023: 23
p.000023: 5.9: TRACHOMA/EYE DISEASES
p.000023: 23
p.000023: 5.10: RESPIRATORY TRACT INFECTIONS Error! Bookmark not
p.000023: defined.
p.000023: 5.11: NON- COMMUNICABLE DISEASES (NCDs)
p.000023: 23
p.000023: 5.12: MENTAL HEALTH
p.000024: 24
p.000024: 5.13: REPRODUCTIVE AND CHILD HEALTH
p.000025: 25
p.000025: 6.0: BASIC HEALTH CARE
p.000027: 27
p.000027: 6.1 TERTIARY CARE
p.000032: 32
p.000032: 6.2 ORGANISATION AND MANAGEMENT
p.000032: 32
p.000032: 6.3: HUMAN RESOURCE MANAGEMENT
p.000032: 32
p.000032: 6.4: INFRASTRUCTURE AND LOGISTICS
p.000033: 33
p.000033: 6.5: HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) AND RESEARCH 33
p.000033: 6.6: HEALTH FINANCING
p.000034: 34
p.000034: 6.7 LEGAL FRAMEWORK
p.000036: 36
p.000036: 6.8 PARTNERSHIPS
p.000036: 36
p.000036: 7.0. TECHNICAL SUPPORT SERVICES
p.000037: 37
p.000037: 7.1 PHARMACEUTICAL SERVICES (ESSENTIAL MEDICINES, VACCINES, EQUIPMENT AND OTHER MEDICAL SUPPLIES)
p.000037: 37
p.000037: 7.2 NATIONAL BLOOD TRANSFUSION SERVICES 38
p.000037: 7.3 LABORATORY SERVICES
p.000039: 39
p.000039: 7.4 RADIOLOGY SERVICES
p.000040: 40
p.000040:
p.000040: HEALTH IS WEALTH
p.000040: 7.5 REFERRAL SYSTEM
p.000040: 40
p.000040: 8.0 LEVELS OF HEALTH SERVICE DELIVERY Error! Bookmark not defined.
p.000040: 8.1 PRIMARY HEALTH CARE (PHC) SERVICE ERROR! BOOKMARK NOT DEFINED.
p.000040: 8.1.1 SEVICE EXPANSION ERROR! BOOKMARK NOT DEFINED.
p.000040: 8.1.2 COMMUNITY PARTICIPATION Error! Bookmark not defined.
p.000040: 8.1.3 BAMAKO INITIATIVE (BI) ERROR! BOOKMARK NOT DEFINED.
p.000040: 8.2 SECONDARY CARE HEALTH SERVICE ERROR! BOOKMARK NOT DEFINED.
p.000040: 9.0 TERTIARY HEALTH CARE SERVICE ERROR! BOOKMARK NOT DEFINED.
p.000040: 10.0: TRADITIONAL MEDICINE
p.000041: 41
...
p.000048: HMIS - Health Management Information System
p.000048: HRH - Human Resources for Health
p.000048: IEC - Information, Education and Communication
p.000048: IHR - International Health Regulations Illnesses
p.000048: IMNCI - Integrated Management of Neonatal & Childhood IPT - Intermittent
p.000048: Preventive Treatment
p.000048: ITN - Insecticide Treated Nets
p.000048: MDGs - Millennium Development Goals
p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
p.000048: PRSP - Poverty Reduction Strategy Programme
p.000048: RCH - Reproductive and Child Health
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 6
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: RFH - Riders for Health
p.000048: RH - Reproductive Health
p.000048: RHD - Regional Health Directorate
p.000048: RHO - Regional Health Officer
p.000048: RHT - Regional Health Teams
p.000048: RTI - Respiratory Tract Infections
p.000048: STI - Sexually Transmitted Diseases
p.000048: SWAp - Sector Wide Approach
p.000048: TB - Tuberculosis
p.000048: TH - Traditional Healer
p.000048: TM - Traditional Medicine
p.000048: TOR - Terms of Reference
p.000048: VC - Vector Control
p.000048: VCT - Voluntary Counselling and Testing
p.000048: VDC - Village Development Committee
p.000048: VDRL - Venereal diseases reference laboratory
p.000048: VHC - Village Health Committee
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...
p.000048: The Gambia is located on the West African coast and extends about 400 km inland, with a population density of 128
p.000048: persons per square kilometre. The width of the country varies from 24 to 28 kilometres and has a land
p.000048: area of 10,689 square kilometres. It is bordered on the North, South and East by the Republic of Senegal and on
p.000048: the West by the Atlantic Ocean. The country has a tropical climate characterised by two seasons: rainy
p.000048: season (June – October) and dry season (November-May).
p.000048: According to the Population and Housing Census (2003), the population is estimated at 1.79 million, with annual growth
p.000048: rate of 2.74 %. About 60% of the population live in the rural area; and women constitute 51% of the total
p.000048: population. The crude birth rate is 46 per 1000 population while the total fertility rate is 5.4 births per woman.
p.000048: The high fertility level has resulted in a very youthful population structure. Nearly 44% of the
p.000048: population is below 15 years and 19% between the ages 15 to 24. Average life expectancy at birth is 64
p.000048: years overall with females constituting 59 and males 55. Please see Appendices: A & B.
p.000048: 1.2: Health Status of the Population
p.000048: The Gambia has an Infant Mortality Rate of 75/1000 live births, 60% of which is attributable to malaria,
p.000048: diarrhoeal diseases and acute respiratory tract infections. The main causes of mortality in infants (0-12
p.000048: months) are neonatal sepsis, premature deliveries, malaria, respiratory infections, diarrhoeal diseases and
p.000048: malnutrition. For child mortality, main causes are: malaria, pneumonia, malnutrition, and diarrhoeal diseases.
p.000048: The Maternal Mortality Ratio is estimated at 730/100,000 live births, the majority of which are due to
p.000048: sepsis, haemorrhage and eclampsia (Maternal and Neonatal Survey 2001).
p.000048:
p.000048: The period 1999 to 2009 has witnessed a decline of total outpatient consultations from 40% to 32.5%
p.000048: respectively, while diarrhoeal diseases for under fives accounts for 19.5% and pneumonia 16.4% of IMNCI cases
p.000048: reported for 2009. Severe diarrhoea is 10.8% compared with severe pneumonia, which is 48.8% for IMNCI
p.000048: admissions respectively. The HIV prevalence rate is 1.6% for HIV1 and 0.4% for HIV2 (sentinel surveillance,
p.000048: 2008).
p.000048:
p.000048: Tuberculosis remains a disease of public health importance in The Gambia. Generally, the case
p.000048: notification for all forms of TB has also markedly increased in recent years. A total number of 2053 TB patients (all
p.000048: forms) was detected in 2008 in the Gambia. The rate of new smear positive cases have been increasing
p.000048: steadily from 61 per 100,000 in 1994 to 87 per 100,000 in 2006, 2007 and 2008 respectively. Similarly, the rate for All
p.000048: Forms of TB (New sputum Smear positive, New negative, Extra-pulmonary TB, Relapse, Failure and Return after
p.000048: default, others) have also increased. This increase is attributed to both improved surveillance and
p.000048: increased incidence as a secondary infection associated with HIV-1.
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...
p.000048: • About 90.5% of adults (92.1% of men and 89% of women) never had their blood sugar tested
p.000048: • About 39.5% of the adult population (33.7% for men and 45.3%) are considered overweight with mean BMI >25kgM2
p.000048:
p.000048: Safe water is an essential pillar of sustainable health for the population. Access to safe water is 85.1% of the
p.000048: overall households; with 79.9% urban and 64.9% rural and access to proper sanitary facilities are not encouraging
p.000048: thus limiting to only 26% (PRSPII) for the entire country.
p.000048:
p.000048: The 2008 poverty assessment indicated that overall poverty to be at 55.5% with a poverty gap of 25.9% and poverty
p.000048: severity at 14.3%. However there are regional variation with rural poverty incident of 63% and an urban
p.000048: incident of 57%. See Appendix: D.
p.000048:
p.000048: Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in
p.000048: recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly
p.000048: Community Initiative and the Bamako Initiative.
p.000048:
p.000048: Also, relevant policy documents were developed including that of Nutrition, Drug , Malaria Reproductive and
p.000048: Child Health , Human Resource for Health , Maintenance , Mental Health , HIV/AIDS , Health Management Information
p.000048: System , National Blood Transfusion , Information Technology , and others such as Traditional Medicine,
p.000048: National Public Health Laboratory and the Health Research Policies at various stages of development.
p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.3: Problem Statement
p.000048: • General health system challenges including the effects of previous high population growth
p.000048: rate; inadequate financial and logistic support; weak health information system; uncoordinated donor
p.000048: support; shortage of adequately and appropriately trained health staff; high attrition rate and lack of
p.000048: efficient and effective referral system. In addition, poverty, low awareness of health issues and poor attitude of
p.000048: service providers have led to inappropriate health seeking behaviours and contributed to ill health. These
p.000048: factors have seriously constrained efforts to reduce morbidity and mortality rates as desired and as a result health
p.000048: care delivery throughout the country has not lived up to expectation.
p.000048:
p.000048: • The frequent changes in top management positions at The Ministry of Health have been hampering
p.000048: continuity, institutional memory and policy flow. The need to have a clear direction to improve quality of health
...
p.000048: and monitoring and evaluation of health sector performance. It is also responsible for resource
p.000048: mobilization and allocation, and provision of technical support and supervision to the regions and specific health
p.000048: programmes. In order to facilitate efficient and effective performance of these functions, MOH&SW has established
p.000048: coordination structures at national level, which include specific directorates and programme management units,
p.000048: responsible for coordinating specific areas of focus. The current organizational structure at the Ministry includes
p.000048: the following main departments, directorates, and programme units;
p.000048:
p.000048: (a) Department of Medical and Health
p.000048: The department of Medical and Health comprised of the following directorates:
p.000048: • Directorate of Health Services (DHS)
p.000048: • Directorate of Planning and Information (DPI)
p.000048: • Directorate of Food Standards, Quality and Hygiene Enforcement (FSQHE)
p.000048: • Directorate of National Public Health Laboratory Services (NPHLS)
p.000048: • Directorate of Health Promotion and Education (HPE)
p.000048:
p.000048: i. Directorate of Health Services (DHS)
p.000048: The DHS is responsible for the coordination, management, monitoring and supervision of health care
p.000048: services within the country. The DHS provides technical advice to the Permanent Secretary and the Minister of Health
p.000048: and Social Welfare.
p.000048: It also coordinates the functions of the following programme areas: Reproductive and Child Health,
p.000048: Integrated Management of Neonatal and Childhood Illnesses (IMNCI), Expanded Programme on Immunization (EPI),
p.000048: Public Health,, National Leprosy and Tuberculosis Control Programme (NLTP), National Aids Control
p.000048: Programme (NACP), National Malaria Control Programme (NMCP), Bamako Initiative (BI), Nursing, Traditional
p.000048: Medicine and Regional Health Services provision and pharmaceutical services.
p.000048:
p.000048: ii. Directorate of Planning and Information (DPI)
p.000048: The Directorate of Planning and Information is responsible for the overall planning, budgeting, monitoring and policy
p.000048: and strategy formulation. It includes the following
p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: programme areas: Budget, Planning and Policy Analysis; Human Resource Management; Health Planning,
p.000048: Monitoring and evaluation, Policy Implementation, Health System Research, Registration of Births and Deaths,
p.000048: Disease Control, Maintenance Policy Monitoring, Information Technology and Health Management Information
p.000048: System.
p.000048:
p.000048: iii. Directorate of Food Standards, Quality and Hygiene Enforcement (FSQHE)
p.000048:
p.000048: This Directorate has a clearly defined Term of References and is charged with the responsibility to execute laws under
p.000048: the Food Act 2005 as follows:
p.000048: • Control of foods in restaurants, hotels, schools, and other boarding facilities (Section14( a)
p.000048: • Responsible for assuring food hygiene ,safety and sanitation in hospitals and health facilities, food
p.000048: establishments and premises including markets and streets(section14(b)
...
p.000048: view to ensuring quality care for the poor and the socially deprived;
p.000048: • Act as the technical body to regulate health information dissemination in the country.
p.000048:
p.000048: (b) Department of Social Welfare
p.000048:
p.000048: Directorate of Social Welfare (DSW)
p.000048:
p.000048: The Department comprised of the Directorate of Social Welfare (DSW).It is responsible for the
p.000048: promotion and protection of the rights and welfare of vulnerable persons such as children, the elderly, persons
p.000048: with disability and adults in difficult circumstances. To enable them maximize their potential and minimize
p.000048: problems arising out of the imbalance between themselves and their environment as a result of social change. Their
p.000048: services focus on the social protection of individual families and groups.This includes the welfare services to the
p.000048: vulnerable families and individuals, child rights and protection services, elderly care, disability care services and
p.000048: regional social welfare services provision and management.
p.000048:
p.000048: 1.5.2: Regional Level
p.000048: The Regional Health Directorates are headed by Regional Directors of Health Services, who are directly
p.000048: responsible to the Permanent Secretary through the Director of Health Services. Regional Directors of Health
p.000048: Services are responsible for coordinating policy interpretation, planning and implementation of health services, and
p.000048: monitoring and evaluation of health service delivery, within their respective
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p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
p.000048: 1) Primary Level (Village Health Services (VHS)
p.000048:
p.000048: The VHS consist of community health workers (traditional birth attendants (TBA) and village health workers (VHW)
p.000048: who are often the first point of contact between individuals, families and communities within the health
p.000048: system. These community health workers are supervised by trained community health nurses (CHN). TBAs
p.000048: provide care for pregnant women, conduct normal deliveries, identify and refer obstetrics emergencies. The
p.000048: VHWs on the other hand are involved in health promotion and prevention measures, the treatment of minor
p.000048: ailments, and refer cases beyond their scope of management.
p.000048:
p.000048: The village health services are complemented by the Reproductive and Child Health (RCH) trekking visits from the health
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • Major Health Centres
p.000048: The major health centre serves as the referral point for minor health centres for services such as:
p.000048: comprehensive emergency obstetric care (surgical, blood transfusion services and further medical care).
...
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
p.000048: • Set up and maintain a Data Base System for information sharing for all the Units of the Ministry of health by 2015
p.000048: • Establish a National Social Welfare Trust Fund for the needy and vulnerable groups including children and persons
p.000048: with disabilities by 2015.
p.000048: • Develop a National Child Protection Strategy and operational Plan by 2013.
p.000048: • Advocate for the signing and eventual ratification of the UN Convention for persons with disabilities
p.000048: by end of 2012.
p.000048: • Set up a National Plan of Action for the prevention of disability and rehabilitation of
p.000048: persons with disabilities in accordance with the United
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
...
p.000048: • Community empowerment on disease prevention and control measures
p.000048:
p.000048: 5.4.1 COMMUNICABLE DISEASES
p.000048: 5.4.1 (i): Malaria Policy Measures
p.000048: • Community empowerment on malaria prevention and control
p.000048: • Increase availability and access to LLINs for the general population.
p.000048: • Strengthen integrated vector control interventions (including in indoor residual spraying)
p.000048: • Strengthen the availability and accessibility of effective malaria chemoprophylaxis
p.000048: for all pregnant women
p.000048: • Strengthen Malaria Case management in all health facilities
p.000048: • Strengthen collaboration with partners in research
p.000048: • Strengthen community management of malaria
p.000048:
p.000048: 5.4.1(ii): Tuberculosis Policy Measures
p.000048: • Promote the expansion of high-quality Directly Observed Treatment Short course (DOTS)
p.000048: • Support the implementation of advocacy, communication and social mobilisation activities (ACSM)
p.000048: • Inter-sectoral coordination to address the synergistic challenges posed by TB/HIV
p.000048:
p.000048: 5.4.1(iii): HIV/AIDS
p.000048: Policy Measures
p.000048: • Expand and strengthen HIV/AIDS Counselling & Testing (HCT) and Prevention of Mother to child
p.000048: transmission (PMTCT) services.
p.000048: • Support and expand Anti-Retroviral Therapy (ART)
p.000048: • Expand the care and support services for People Living With HIV/AIDS (PLWHAs)
p.000048: • Support sentinel surveillance and research in HIV/AIDS
p.000048: • Intensify IEC/BCC/CSC interventions on HIV/AIDS
p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 5.4.1(iv): Sexually Transmitted Infections (STIS) (Other Than HIV/AIDS) Policy Measures
p.000048: • Effective information, education and counselling of the populace
p.000048: • Provision of STIs drugs and supplies in all facilities with a view to increase access
p.000048: • Train health care workers on the syndromic treatment and management of STIs with a view to provide
p.000048: proper treatment
p.000048: • Set up well equipped laboratories in all major health centres and hospitals
p.000048: • Establish STI clinics targeted specifically for most at risk populations (MARPs)
p.000048: • Provision and distribution of condoms to MARPs
p.000048: • Monitoring and supervision of STI services
p.000048:
p.000048: 5.4.1(v): Diarrhoeal Diseases Policy Measures
...
p.000048: highlighted the great need, willingness and strategies required to strengthen the overall mental health system in
p.000048: order to provide effective treatment and care to those in need as well as to promote the mental health of all Gambians.
p.000048:
p.000048: Objective
p.000048:
p.000048: • Improve access to quality mental health care for all Gambians
p.000048: Policy Measures
p.000048:
p.000048: • Implement the Mental Health Policy and Strategy
p.000048: • Strengthening capacity for the diagnosis, management, prevention and control of mental and
p.000048: neurological disorders
p.000048: • Providing quality, equitable and affordable mental health services to the general population
p.000048: • Promote IEC on substance abuse
p.000048: • Promoting advocacy for the reduction of stigma and discrimination against people with mental and
p.000048: neurological disorders
p.000048: • Strengthening community involvement and participation in mental health care service delivery
p.000048: • Operationalise the revised current Lunatics’ Detention Act of 1917 taking into account a new mental health
p.000048: legislation Establishing and strengthening capacity for mental health research
p.000048: • Strengthen the prevention, case management and control of mental health illnesses country wide
p.000048: • Develop a Mental Health Act.
p.000048:
p.000048: 5.6: Reproductive and Child Health Preamble
p.000048: RCH services are provided at all levels of the health system by both public and
p.000048: private facilities at base and outreach through a network of health facilities across the country. With an impressive
p.000048: nationwide coverage RCH indicators have over the years been reduced significantly. For example, MMR high has reduced
p.000048: from 1050 to 730 per 100,000 live births between 1990 and 2001(DOSH 2001). Child health indicators have
p.000048: equally been reduced. Infant mortality rate has improved from 167 (1983) to 75 per 1000 live births (2003); and
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
p.000048: Stark regional variations also exist with the above indicators. For example, MMR is two-fold higher in rural
p.000048: than in urban areas and under-five mortality is three-fold higher in Lower River Region than that of
p.000048: Banjul (137 vs. 41).
p.000048:
p.000048:
p.000048:
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p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: A combination of factors (health and non-health service related) is responsible for the above high RCH
p.000048: indicators. Unmet need for RCH services particularly emergency obstetric care services resulting
p.000048: mainly from lack of basic RH equipments and supplies, acute shortage of skilled health
p.000048: professionals, weak referral system and inadequate financial resources for RCH services are some of the health
p.000048: services. In addition to these, non-health service related factors including high fertility rate (national 5.4), poor
p.000048: and inadequate nutrition, poor socio-economic status manifested by poor housing, limited availability and access to
p.000048: safe water and basic sanitation are important determinants.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity related to but not limited to childhood, reproduction and the
p.000048: reproductive system across the country
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen and promote 24/7 Emergency Obstetric Care concept;
p.000048: • Strengthen and promote Emergency neonatal care;
p.000048: • Advocate and ensure Implementation of the national reproductive health commodity security plan;
p.000048: • Introduce and institutionalise peri-natal reviews and audits;
p.000048: • Maintain, promote and protect the free of cost policy for MCH services;
p.000048: • Establish a minimum RCH care package;
p.000048: • Monitoring, evaluation and research
p.000048: • Increase awareness on sexual, reproductive and child health issues;
p.000048: • Promote partnership and coordination among all stake holders in the field of RCH;
p.000048: • Create opportunities for the improvement of the nutritional status of the vulnerable groups.
p.000048: • Operationalize operating theatres in all major health facilities.
p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
p.000048: and Childhood Illness (IMNCI) strategy in 1999 to address the high morbidity and mortality among children
p.000048: under five years. The IMNCI strategy combines improved case management of childhood illness in first-level health
p.000048: facilities with aspects of nutrition, immunization, disease prevention, and promotion of growth and
p.000048: development. There are three components of IMNCI which are: improving the skills of health workers; improving the
p.000048: health system, and improving household and community practices.
p.000048:
p.000048: The IMNCI strategy is a technically sound, comprehensive and evidence-based strategy focusing on the main
p.000048: threats to children’s health and focus mainly on the prevention and adequate treatment of malaria, diarrhoea,
p.000048: pneumonia, measles and malnutrition because they are responsible for about 70% of deaths among children
p.000048:
...
p.000048: are brought closer to the community. In spite of the critical role that Major Health Centres have to play, their full
p.000048: impact is yet to be felt, because of several constraints All Major Health Centres are still to be provided with the
p.000048: full complement of equipment and supporting facilities such as blood transfusion services, etc. Human
p.000048: resources to carry out all the envisioned functions are in short supply whilst shortage of accommodation has
p.000048: prevented the few available staff from taking up residence. A fully functional Major Health Centre is vital in
p.000048: providing not only referral services but also the necessary environment for training all health workers in the
p.000048: Regions and fostering an atmosphere for operational research.
p.000048:
p.000048: Objectives
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To ensure the full operationaility of all six (6) Major and thirty eight (38) Minor Health Centres by 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen all Major and Minor Health Centres
p.000048: • Increasing staffing capacity and equipment of the existing public health centres to meet the national
p.000048: standards.
p.000048: • Support to health care reforms and infrastructural development and expansion of health care facilities
p.000048: • Advocate and encourage establishment of Maternal and Child Health clinics operated by Registered Nurse-Midwives
p.000048: Ensure that all major and minor health centres are provided with all required standard equipment, logistics and
p.000048: support facilities to make them fully functional
p.000048: • Development of an up-to-date standard list of equipment for Major and Minor Health Centres
p.000048: • Encourage NGO provision of basic health care for the rural communities.
p.000048: • Assessment and certification of all private and NGO health centres and clinics
p.000048: • Provision of minimum staffing levels as well as adequately furnished accommodation for such
p.000048: staff
p.000048: • Provision of vehicles to ensure that trekking and evacuation functions are executed simultaneously
p.000048:
p.000048: 6.2.2 Minor Health centres
p.000048: The physical infrastructure of the majority of Minor Health Centres is in a state of disrepair and
p.000048: dilapidation due inadequate maintenance. The majority lack the required equipment because of wear and tear and
p.000048: non replacement, a situation that is not conducive to good work and, staff morale or efficiency. The
p.000048: absence of an inventory system has made it difficult to establish accountability. Attention will be given
p.000048: to the provision of logistics such as stand by generating sets, water tanks, telecommunication sets
p.000048: including ICTs facilities.
p.000048:
p.000048:
p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To refurbish and equip the existing thirty-eight (38) Minor Health Centres
p.000048:
p.000048: Policy Measures
p.000048: • Increasing staffing capacity and equipment of the existing public health centres to meet the national
p.000048: standards.
p.000048: • Support to health care reforms and infrastructural development and expansion of health care facilities
p.000048: • Advocate and encourage establishment of Maternal and Child Health clinics operated by Registered Nurse-Midwives
p.000048: Carry out a physical assessment of all Minor Health Centres in order to establish the state of disrepair
p.000048: • Establish an electronic database for physical infrastructure
p.000048: • Put in place an Inventory System for all the equipment and rules to determine their retention and disposal
p.000048: • Encourage NGO provision of basic health care for the rural communities.
p.000048: • Assessment and certification of all private and NGO health centres and clinics.
p.000048:
p.000048: 6.3 TERTIARY HEALTH CARE SERVICE
p.000048: The seven (7) Public Hospitals (1 Teaching, 5 General and 1 Regional Eye Care) will serve as the referral points for
p.000048: all cases referred from primary and secondary levels. Emergency cases referred and transported from secondary
p.000048: level will enjoy free treatment. Those otherwise referred will be exempted from consultations.
p.000048:
p.000048: Services provided will depend on available resources, priority health problems and prevailing health conditions as
p.000048: dictated by existing Health Policy. Hospitasl will also serve as the National Centre for training, biomedical
p.000048: and clinical research. Apart from established research centres and medical training institutions, they will
p.000048: be preserved to lead the Ministry’s science, technology and innovation policy initiatives. The role and
p.000048: relationships of the RVTH as a teaching hospital vis-a-vis academic institutions such as the University of the
p.000048: Gambia (UTG) under the Ministry of Higher Education, Research, Science and Technology (MOHERST) will be clarified.
p.000048:
p.000048: Objective
...
p.000048: • Strengthen capacity towards health system research and documentation.
p.000048: • Promote and strengthen birth and death registration.
p.000048:
p.000048: 7.0: HEALTH FINANCING
p.000048: Preamble
p.000048: In 1988 a Cost Recovery Program was started as part of the national health development program. This
p.000048: established the Drug Revolving Fund and the introduction of user fees as a form of health financing. The
p.000048: Bamako Initiative (BI) was introduced in 1993 as a further development on the Cost Recovery Program. Although
p.000048: some successes were registered with both types of financing strategy, universal access and coverage still
p.000048: remains a major challenge.
p.000048:
p.000048: Healthcare service financing is a challenge the world over but more pronounced in developing countries where government
p.000048: budgetary allocation to the health sector is less than optimal and health insurance schemes have limited
p.000048: coverage or non- existent. There is need for health financing policy for the country. Government
p.000048: allocations to the health sector as a percentage of the total national budget continue
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: to improve, ranging from 7% to 10% in the past five years1. This is still below the Abuja Declaration of 15% budgetary
p.000048: allocation to the health sector. Health care is provided almost free, especially for maternal and child health
p.000048: services since the introduction of the policy in 2007 by of President of the Republic.
p.000048:
p.000048: In 2007, the first National Health Accounts (NHA) for The Gambia was constructed covering the fiscal years 2002 – 2004.
p.000048: The results revealed marginal increase in total health expenditure (THE). As a percentage of GDP, the THE was 16.1%
p.000048: in 2002, 13.9% in 2003 and 14.9% in 2004. Per capita health expenditure was D895 in 2002, D1026 in 2003 and D1203 in
p.000048: 2004. This ranges between US$33 and US$40, almost matching the WHO Commission for Macroeconomics and
p.000048: Health (CMH) recommendation of US$ 34 per capita expenditure for a package of essential health services. It is
p.000048: instructive that the bulk of these funding came from donors as over 66% of the total health funding came from
p.000048: international health development partners.
p.000048:
p.000048: While Government’s contribution to THE grew from 18% in 2002 to 24% in 2004, evidence indicates a
p.000048: decline in household’s direct out-of-pocket payments (OOP) contribution to total health expenditure, contributing
p.000048: 12% in 2002, 11% in 2003 and 9% in 2004. Total Out-of-pocket expenditure on health as percentage (%) of private
p.000048: expenditure on health is estimated to be consistently high at 70%2 for 2004, 2005 and 2006 signalling the heavy burden
p.000048: of funding health on households.
p.000048:
p.000048: Health financing system in The Gambia is organized through government tax revenue, allocated by the
p.000048: Ministry of Finance and Economic Affairs to various financing agents, e.g. Ministry of Health, Education,
p.000048: Defence, Interior and Foreign Affairs. The contribution from direct out-of-pocket payments (OOPs) for health goods
...
p.000048: Reliable availability of essential medicines (drugs, basic equipment, vaccines,
p.000048: contraceptives and other medical supplies) are critical to provide quality health care service and towards the
p.000048: attainment of positive health outcomes. However, uninterrupted availability of supplies requires that the
p.000048: needed financial resources are allocated. The Gambia still provide free health care services.
p.000048:
p.000048: Government budgetary allocation for health products has not increased significantly lately. There has been a major
p.000048: increase in demand due to population increase and coupled with the rapid expansion of health facilities. These
p.000048: factors contribute to the periodic shortages of medicines and other medical supplies. The bureaucratic process
p.000048: involves in the procurement of pharmaceuticals and other medical supply requires improvement. However the
p.000048: Global Fund is providing some amounts of funds for pharmaceutical and health products to complement government’s
p.000048: effort in the fight against HIV/AIDS, Malaria and tuberculosis.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Government funding is supported by Global Alliance for Vaccine and Immunisation (GAVI) for the introduction of new
p.000048: vaccines, and UNICEF continues to support the vaccine procurement process. However, there is an urgent need for
p.000048: government to increase investment in the new vaccines on a sustainable basis.
p.000048:
p.000048: Availability of contraceptives is essential for promoting reproductive and child health outcomes and has always been a
p.000048: challenge as support provided by donors is limited thus, creating intermittent shortages.
p.000048:
p.000048: Lately the Logistic Management information System (LMIS) is being set up for strengthening the supply
p.000048: management chain. The system will be used for capturing, collecting and provision of data on medicines
p.000048: and other medical supplies consumption from health facilities which will be analysed and results used
p.000048: for informed decision making.
p.000048:
p.000048: Objective
p.000048: • To ensure available and affordable essential medicines that are safe, efficacious and of the
p.000048: required quality
p.000048: • To ensure availability of consumption data on medicines and other medical supplies
p.000048:
p.000048: Policy Measures
p.000048: • Transform the supply management system for essential medicines for the public sector into a semi
p.000048: autonomous institution
p.000048: • Advocate for increased government funding for pharmaceuticals
p.000048: • Improve the drug supply system and promote the rational use of medicines and supplies.
p.000048: • Strengthen the National Medicines Regulatory Authority and enact the necessary laws toward
p.000048: attaining quality products
p.000048: • Encourage greater private sector involvement in the provision of essential medicines especially for the
p.000048: rural community
p.000048: • Establish quality control testing of pharmaceuticals.
p.000048: • Strengthen and maintain the Logistics Management Information System (LMIS).
p.000048: 10.2: National Blood Transfusion Services Preamble
p.000048: Availability of safe blood for transfusion is an essential element in the delivery of health services
p.000048: particularly those related to maternal and child health services. Unreliable supply of blood interrupts
p.000048: general clinical care for example surgical operations and road traffic accidents. There is need for an
p.000048: uninterrupted supply of safe blood.
p.000048:
p.000048: Blood transfusion services in The Gambia were limited to RVTH and Bansang hospital for several years. Over
p.000048: the years transfusion services have been expanded to other tertiary hospitals (the Sulayman Junkung General
p.000048: Hospital in Bwiam, The Armed Forces Provisional Ruling Council Hospital in Farafenni) and some major
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: health centres. Although efforts have been made in the past through public campaign but expansion of
p.000048: services coupled with limited number of voluntary blood donor has created a gap between the need and availability of
p.000048: safe blood in health facilities in the country. This has implications on receiving prompt and timely care.
p.000048:
p.000048: A blood bank has also been established at the RVTH, which supplies blood to the other hospitals. However, the
p.000048: demand is always greater than the supply. Furthermore, during emergencies, transportation of blood to
p.000048: the other peripheral centres experience delays in delivering the right quantity at the right time. In order to make
p.000048: safe blood available to the population in times of need, blood banks should be established in all major health
p.000048: centres and hospitals in the country and more bleeding centres in the communities
p.000048:
p.000048: Objective
p.000048: • The provision of adequate and safe blood for appropriate treatment of patients at all times.
p.000048:
...
p.000092: APPENDIX F
p.000092: Table 2: showing distribution of hospitals by health region
p.000092: Region General Hospitals NGO/Private Hospital Teaching Hospital URR 0 0
p.000000: 0
p.000000: LRR 0 0 0
p.000000: CRR 1 0 0
p.000000: NBR 1 0 0
p.000000: WR 1 0 0
p.000000: KMC 2 3 0
p.000000: BCC 0 1
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: APPENDIX G
p.000000:
p.000000: Table 3: MINIMUM HEALTH CARE PACKAGE
p.000000: VHS Minor H/C Major H/C
p.000000: Regional Hospital Teaching Hospital
p.000000:
p.000000: • Primary care service (including treatment of minor illnesses and referrals, environmental health & sanitation,
p.000000: antenatal, delivery and postpartum care, home visits, community health promotion activities s
p.000000: • Maternity care (antenatal, delivery and postpartum
p.000000: • Family Planning
p.000000: • STIs/RTIs/HIV/AIDS prevention and control
p.000000: • IMNCI
p.000000: • Immunisation
p.000000: • Neonatal and child health
p.000000: • Maternal and child nutrition
p.000000: • Basic EMOC
p.000000: • Basic emergency newborn care (ENC)
p.000000: • Disease prevention and control( malaria, TB, etc)
p.000000: • Health protection and control
p.000000: • Basic Lab services(HB, BF, VDRL, Urine analysis TB and HIV screening)
p.000000: • in-patient service
p.000000: • Referral services
p.000000: • Dispensary
p.000000: • Eye care services
p.000000: • Out-patient services
p.000000: • Registration of births and Deaths
p.000000: • All services provided at minor H/C level
p.000000: • Comprehensive emergency obstetric care (including theatre and blood transfusion services)
p.000000: • Functional theatre
p.000000: • Comprehensive emergency newborn care
p.000000: • In-patient services
p.000000: • Pharmacy Services
p.000000: • Basic Lab. services including HIV and TB Screening.
p.000000: • All services provided at major H/C level
p.000000: • Specialist care and service
p.000000: • Higher level referral services
p.000000: • Specialised dental and eye care services
p.000000: • Comprehensive laboratory services
p.000000: • Radiology services
p.000000: • All services provided at regional hospital level
p.000000: • Specialist hospital services (in- and out-patient services)
p.000000: • Post-mortem and embalmment services
p.000000: • Overseas referral
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
...
p.000000: H B H B H
p.000000: W A W A W
p.000000: T V T V T V T V T B H
p.000000: B H B H B H B A W A W A
p.000000: W A W A
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
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p.000000:
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p.000000:
p.000000:
p.000000: Organogram Abbreviation:
p.000000: DPS-F&A – Deputy Permanent Secretary – Finance & Administration DPS-T – Deputy Permanent Secretary - Technical
p.000000: DPI – Directorate of Planning and Information
p.000000: DDPI – Deputy Director of Planning and Information HRH – Human Resources for Health
p.000000: M&E – Monitoring and Evaluation
p.000000: MIS – Management Information System EDC – Epidemiology and Disease Control B&D – Births and Deaths
p.000000: PAB – Policy Analysis and Budgeting QA – Quality Assurance
p.000000: FM - Facilities Maintenance IT – Information Technology
p.000000: DNPHLS – Directorate of national Public Health Laboratory Services NPHRL – National Public Health Reference
p.000000: Laboratories
p.000000: NBTS – National Blood Transfusion Services BEU – Biomedical Engineering Unit
p.000000: CL- Clinical Laboratories
p.000000: DHS - Directorate of Health Services
p.000000: DDHS – Deputy Directorate of Health Services
p.000000: PHC – Assistant Director Family Health / Primary Health Care RCH – Reproductive and Child Health
p.000000: EPI – Expanded Programme of Immunisation OHS – Occupational Health Services
p.000000: EH – Environmental Health VC – Vector Control
p.000000: IMNCI – Integrated Management of Childhood Neonatal Illnesses CNO – Chief Nursing Officer
p.000000: CPHO – Chief Public Health Officer CP – Chief Pharmacist
p.000000: NPS – national Pharmaceutical Services CMS – Central Medical Stores
p.000000: NMCP – National Malaria Control Programme
p.000000: NLTP – National Leprosy and Tuberculosis Control Programme NACP – National Aids Control Programme
p.000000: NEHP – National Eyecare Health Programme TM - Traditional Medicine
p.000000: BI – Bamako Initiative
p.000000: DFSHQE – Directorate of Food Standards Quality Hygiene Enforcement IHE - Inspection & Hygiene Enforcement
p.000000: FSQ - Foods Standard & Quality
p.000000: DHPE – Directorate of Health Promotion and Education DDHPE – Directorate of Health Promotion and Education NCD –
p.000000: Non-Communicable Diseases
p.000000: MH – Mental Health
p.000000: WS – Water and Sanitation Hygiene HC – Health Communication
p.000000: NHR – National Health Research HPP – School Health and Nutrition
p.000000: SWRO – Social Welfare Regional Offices CC - Child Care
p.000000: DU - Disability Unit AC - Adult Care
p.000000: PS – Professional Services
p.000000: RVTH – Royal Victoria Teaching Hospital SJJH – Sulayman Junkung Jammeh Hospital
p.000000:
p.000000:
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p.000000:
p.000000: JFPH – Jammeh Foundation for Peace Hospital SGH – Serekunda General Hospital
p.000000: AFPRC – Armed Forces Patriotic Ruling Council Hospital BSG – Bansang Hospital
p.000000: GMDC – Gambia Medical and Dental Council GNMC – Gambia Nurses and Midwives Council MB – Medicine’s Board
p.000000: CIO – Central Inspectorate Office
p.000000: RHDW1 – Regional Health Directorate Western 1 RHDW2 – Regional Health Directorate Western 2 RHDNBW – Regional Health
p.000000: Directorate North Bank West RHDNBE – Regional Health Directorate North Bank East
p.000000: RHDCRR – Regional Health Directorate Central River Region RHDURR – Regional Health Directorate Upper River Region
p.000000: RHDLRR – Regional Health Directorate Lower River Region VHS – Village Health Services
p.000000: VHW – Village Health Worker TBA – Traditional Birth Attendant
p.000000:
p.000000: ********
p.000000:
p.000000:
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p.000000:
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p.000000:
p.000000: Health Policy 2012-2020
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Searching for indicator children:
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p.000002:
p.000002:
p.000002:
p.000002:
p.000002: NATIONAL HEALTH POLICY
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: REPUBLIC OF THE GAMBIA
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: “HEALTH IS
p.000002: WEALTH” 2012 - 2020
p.000002:
p.000002:
p.000002: “Acceleration of Quality Health Services and Universal Coverage”
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: MINISTRY OF HEALTH & SOCIAL WELFARE BANJUL, THE GAMBIA
p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: FOREWORD
p.000002:
p.000002: Since 1996, it was deemed imperative for The Gambia to map out clearly a strategy for socio-economic development that
p.000002: aims at raising the standard of living of The Gambian population by transforming The Gambia into a dynamic middle
p.000002: –income economy. This is the fundamental objective of “The Gambia incorporated … Vision 2020”. To the President, Vision
p.000002: 2020 is not a dream and the Government is committed to its attainment.
p.000002:
p.000002: This health policy is line with the Vision 2020 and the Millennium Development Goals (MDGs),
p.000002: the Gambia National Development Strategy (2012-2015) and Investment Program – The Program for Accelerated Growth
p.000002: and Employment (PAGE) – which will lead to achievement of all the Millennium Development Goals,
p.000002: especially those related to health; accomplish a three-quarters decline in maternal mortality and a two-thirds
p.000002: decline in mortality among children under five; to halt and reverse the spread of HIV/AIDS and to
p.000002: provide special assistance to AIDS orphans; and put the country on a strong footing to attaining the Vision of
p.000002: the President.
p.000002:
p.000002: Development of human capital stock since then has been a leading priority in the development agenda of The
p.000002: Government of The Gambia, civil society, donors’ community and academia. Health, along with education and
p.000002: nutrition, is considered as one of the key elements of human capital stock formation. Consistent with the strategic
p.000002: direction for improving human capital stock, makes health central to The Gambia’s development efforts.
p.000002:
p.000002: The theme, “health is wealth”, which is the current philosophy which our national health policy is hinged
p.000002: upon becomes a reality only when a healthy population can contribute to improved productivity, increased GDP
p.000002: and sustained economic growth and overall ensure social equilibrium. Hence the slogan:
p.000002:
p.000002: “A Healthy population is a Wealthy population”.
p.000002:
p.000002: The mission of the Ministry of Health is to contribute to socioeconomic development and wealth creation
p.000002: by promoting and protecting the health of the population through equitable provision of quality health
p.000002: care within the context of Primary Health Care. This mission puts the concept of health beyond the
p.000002: confines of curative care to other socio-economic determinants of health.
p.000002:
p.000002: The health sector despite remarkable achievements registered since 1994 to date is still under great pressure due to a
...
p.000048: sepsis, haemorrhage and eclampsia (Maternal and Neonatal Survey 2001).
p.000048:
p.000048: The period 1999 to 2009 has witnessed a decline of total outpatient consultations from 40% to 32.5%
p.000048: respectively, while diarrhoeal diseases for under fives accounts for 19.5% and pneumonia 16.4% of IMNCI cases
p.000048: reported for 2009. Severe diarrhoea is 10.8% compared with severe pneumonia, which is 48.8% for IMNCI
p.000048: admissions respectively. The HIV prevalence rate is 1.6% for HIV1 and 0.4% for HIV2 (sentinel surveillance,
p.000048: 2008).
p.000048:
p.000048: Tuberculosis remains a disease of public health importance in The Gambia. Generally, the case
p.000048: notification for all forms of TB has also markedly increased in recent years. A total number of 2053 TB patients (all
p.000048: forms) was detected in 2008 in the Gambia. The rate of new smear positive cases have been increasing
p.000048: steadily from 61 per 100,000 in 1994 to 87 per 100,000 in 2006, 2007 and 2008 respectively. Similarly, the rate for All
p.000048: Forms of TB (New sputum Smear positive, New negative, Extra-pulmonary TB, Relapse, Failure and Return after
p.000048: default, others) have also increased. This increase is attributed to both improved surveillance and
p.000048: increased incidence as a secondary infection associated with HIV-1.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
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p.000048: HEALTH IS WEALTH
p.000048:
p.000048: There has been an increase in national coverage for fully immunized children to a present level of 79.6 % for under 1
p.000048: year and 84.9% for the under 2 year (2004 EPI cluster survey). The routine national immunization coverage is above
p.000048: 90% in 2010 for all the antigens (EPI, 2010). Please see Appendix C.
p.000048: Malnutrition continues to be a major public health problem in The Gambia. The MICS 2006 indicated 19% stunting, 6.8%
p.000048: wasting and 17% underweight. Diabetes Mellitus is estimated to affect about 1% of the population while a study found
p.000048: that about 16% of urban women are obese compare to only 1% of rural women. A WHO survey in 2008 reveals the
p.000048: prevalence of other NCD risk factors as follows:
p.000048: • 24.5% prevalence rate of smoking amongst 13-15 year olds.
p.000048: • 31.3% prevalence rate of smoking among youths aged 25 to 34 years.
p.000048: • About 2% of the adult population, aged 25 – 64 years, drink alcohol
p.000048: • Low consumption of fruits and vegetables, with the average mean number of days for fruits and
p.000048: vegetable consumption among adult males and females estimated at 3.3 and 5.0 respectively
p.000048: • About 22% of the adult population (males and females) have a low level of physical activity, whilst
p.000048: nearly 59% of adults do not engage in rigorous physical activity. In the same vein, on average, Gambian adults spend
p.000048: 231 minutes per day on sedentary activities
p.000048: • On average, 41.4% of adults Gambians never had their blood pressure tested. Similarly, about 24.4% of the adult
p.000048: population have raised blood pressure (25.5% for men and 23.4% for women)
...
p.000048: • Support and coordinate formulation of and or strengthening the implementation of national health promotion policy
p.000048: and national health policy, legislations or strategies for tobacco control in line with the WHO Framework Convention on
p.000048: Tobacco Control;
p.000048: • Provision of technical advice to the Ministry of Health and Social Welfare on International protocols, instruments
p.000048: and conventions that have a public health and health promotion underpinning;
p.000048: • Act as the technical adviser to the Ministry of Health and Social Welfare and oversee patient
p.000048: education/counselling in the country’s medical institutions as part of the health promoting hospital initiatives with a
p.000048: view to ensuring quality care for the poor and the socially deprived;
p.000048: • Act as the technical body to regulate health information dissemination in the country.
p.000048:
p.000048: (b) Department of Social Welfare
p.000048:
p.000048: Directorate of Social Welfare (DSW)
p.000048:
p.000048: The Department comprised of the Directorate of Social Welfare (DSW).It is responsible for the
p.000048: promotion and protection of the rights and welfare of vulnerable persons such as children, the elderly, persons
p.000048: with disability and adults in difficult circumstances. To enable them maximize their potential and minimize
p.000048: problems arising out of the imbalance between themselves and their environment as a result of social change. Their
p.000048: services focus on the social protection of individual families and groups.This includes the welfare services to the
p.000048: vulnerable families and individuals, child rights and protection services, elderly care, disability care services and
p.000048: regional social welfare services provision and management.
p.000048:
p.000048: 1.5.2: Regional Level
p.000048: The Regional Health Directorates are headed by Regional Directors of Health Services, who are directly
p.000048: responsible to the Permanent Secretary through the Director of Health Services. Regional Directors of Health
p.000048: Services are responsible for coordinating policy interpretation, planning and implementation of health services, and
p.000048: monitoring and evaluation of health service delivery, within their respective
p.000048:
p.000048:
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p.000048:
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...
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
p.000048: 1) Primary Level (Village Health Services (VHS)
p.000048:
p.000048: The VHS consist of community health workers (traditional birth attendants (TBA) and village health workers (VHW)
p.000048: who are often the first point of contact between individuals, families and communities within the health
p.000048: system. These community health workers are supervised by trained community health nurses (CHN). TBAs
p.000048: provide care for pregnant women, conduct normal deliveries, identify and refer obstetrics emergencies. The
p.000048: VHWs on the other hand are involved in health promotion and prevention measures, the treatment of minor
p.000048: ailments, and refer cases beyond their scope of management.
p.000048:
p.000048: The village health services are complemented by the Reproductive and Child Health (RCH) trekking visits from the health
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048: • Major Health Centres
p.000048: The major health centre serves as the referral point for minor health centres for services such as:
p.000048: comprehensive emergency obstetric care (surgical, blood transfusion services and further medical care).
p.000048: Additionally, they also offer services such as infant welfare and ante natal services, surveillance and dental
p.000048: services. The standard bed capacity for major health centres range from110 -150 beds per 150,000 - 200,000
p.000048: population.
p.000048:
p.000048: 3) Tertiary Level
...
p.000048: Tuberculosis and HIV/AIDS in the population.
p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
p.000048: • Set up and maintain a Data Base System for information sharing for all the Units of the Ministry of health by 2015
p.000048: • Establish a National Social Welfare Trust Fund for the needy and vulnerable groups including children and persons
p.000048: with disabilities by 2015.
p.000048: • Develop a National Child Protection Strategy and operational Plan by 2013.
p.000048: • Advocate for the signing and eventual ratification of the UN Convention for persons with disabilities
p.000048: by end of 2012.
p.000048: • Set up a National Plan of Action for the prevention of disability and rehabilitation of
p.000048: persons with disabilities in accordance with the United
p.000048:
p.000048:
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p.000048: Page 16
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
...
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity related to but not limited to childhood, reproduction and the
p.000048: reproductive system across the country
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen and promote 24/7 Emergency Obstetric Care concept;
p.000048: • Strengthen and promote Emergency neonatal care;
p.000048: • Advocate and ensure Implementation of the national reproductive health commodity security plan;
p.000048: • Introduce and institutionalise peri-natal reviews and audits;
p.000048: • Maintain, promote and protect the free of cost policy for MCH services;
p.000048: • Establish a minimum RCH care package;
p.000048: • Monitoring, evaluation and research
p.000048: • Increase awareness on sexual, reproductive and child health issues;
p.000048: • Promote partnership and coordination among all stake holders in the field of RCH;
p.000048: • Create opportunities for the improvement of the nutritional status of the vulnerable groups.
p.000048: • Operationalize operating theatres in all major health facilities.
p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
p.000048: and Childhood Illness (IMNCI) strategy in 1999 to address the high morbidity and mortality among children
p.000048: under five years. The IMNCI strategy combines improved case management of childhood illness in first-level health
p.000048: facilities with aspects of nutrition, immunization, disease prevention, and promotion of growth and
p.000048: development. There are three components of IMNCI which are: improving the skills of health workers; improving the
p.000048: health system, and improving household and community practices.
p.000048:
p.000048: The IMNCI strategy is a technically sound, comprehensive and evidence-based strategy focusing on the main
p.000048: threats to children’s health and focus mainly on the prevention and adequate treatment of malaria, diarrhoea,
p.000048: pneumonia, measles and malnutrition because they are responsible for about 70% of deaths among children
p.000048:
p.000048:
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p.000048: Page 26
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: under five years. It targets children under five years and focus on the five main causes of mortality in
p.000048: children under the age of five.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity associated with major causes of disease in children less than five years of age.
p.000048: Policy Measures
p.000048:
p.000048: • To monitor growth and development of children under the ages of five
p.000048: • To build the capacities of health workers on IMNCI Case Management Skills
p.000048: • To strengthen collaboration with traditional healers and other community partners for effective
p.000048: implementation of community component of the IMNCI strategy.
p.000048: • To strengthen the implementation of the IMNCI strategy in all seven health regions in the country.
p.000048:
p.000048: 6.0: BASIC HEALTH CARE AND LEVELS OF DELIVERY
p.000048: 6.1 PRIMARY HEALTH CARE (PHC) SERVICE
p.000048:
p.000048: Preamble
p.000048: The Gambia adopted Primary Health Care (PHC) in 1979 following the Alma- Ata declaration in 1978. Subsequently
p.000048: a PHC Plan of Action for the period 1980 to 1985 was formulated which formed the basis for a National Health Policy.
p.000048: In the Plan of Action, PHC has been defined as:
p.000048:
p.000048: An approach aimed at mobilising all potential resources including the communities’ own resources, towards the
p.000048: development of the National Health Care System, the aim being to extend health services coverage to the entire Gambian
p.000048: population and to attract the main disease problems of the communities. PHC is also a mechanism for ensuring an
p.000048: equitable re-distribution of the limited health resources available in the country in favour of the under-served
p.000048: majority, who live and work in the rural area.
p.000048:
p.000048: At present quite a number of PHC villages are not functioning optimally. Reasons for non performance are attributed to
p.000048: several factors namely an ineffective VDC, lack of support for community health workers, shortage of drugs and lack of
p.000048: supervision. A selective PHC programme has been designed to intervene at village level to control priority diseases
p.000048: such as Acute Respiratory Infection, Diarrhoeal Diseases, Tuberculosis, Malaria, Preventive Eye Care and
p.000048: HIV/AIDS.
p.000048:
p.000048: Support to and capacity building at primary level are essential for sustaining of basic PHC technologies needed to
p.000048: address common health problems affecting women and children, and management of development projects which have an
p.000048: impact on health
p.000048: e.g. community water supplies, sanitation, home based care for malaria, etc.
p.000048:
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: In order to restore the functionality of all existing PHC villages, the Ministry of Health in collaboration with
p.000048: stakeholders and the community will review the present VDC system.
p.000048: The development of the VHS has been in isolation to the BHS. The latter possesses a wide range of resources to support
p.000048: the VHS. The policy calls for define linkages between the BHS and the VHS. A basic health facility will be linked to a
p.000048: number of trekking stations and PHC villages. This group of facilities and the population it serves
p.000048: (including non primary health care villages) will constitute a CATCHMENT AREA.
p.000048: The basic health facility will perform the first line supervision and provide support in the areas of training and
p.000048: supply of drugs to the VHS. Each catchment area will have a catchment area committee. The latter will be closely
p.000048: involved in the management, planning, monitoring and evaluation of services provided in the area under its
p.000048: jurisdiction.
p.000048: 6.1.1 Service Expansion
p.000048: At present, health services are provided by 546 health posts at the primary level. When PHC was introduced
p.000048: in 1979 some villages which did not qualify for reasons of numbers now qualify. The present policy of
p.000048: establishing PHC in villages with a population of 400 or more or where access is difficult will
...
p.000048: • Perform continuous monitoring on the implementation of all programs and projects including those
p.000048: supported by donors.
p.000048: • Utilise the existing DHIS2 and other software products available to monitor and evaluate the
p.000048: effectiveness and efficiency of health services delivery.
p.000048:
p.000048: 14.0: QUALITY ASSURANCE FRAMEWORK
p.000048: Preamble:
p.000048: The existence of professional health associations helps the Ministry of Health to better organise the
p.000048: medical, dental, pharmaceutical, nursing and paramedical
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: professions. The strengthening of their structures will allow them to better understand their
p.000048: role, most notably in: the recognition of qualifications, the registration of health
p.000048: practitioners, the management of problems relating to professional ethics, and the elaboration and
p.000048: revision of professional classifications according to qualification and specialisation as set out in Appendix I.
p.000048: Equally, they must support the Ministry of Health in the accreditation of services and the certification of
p.000048: professionals.
p.000048:
p.000048: In order to fulfil the above functions, an effective quality assurance system which has the potential to improve
p.000048: quality health care services according to set standards, reduce risks and produce positive impact on morbidity,
p.000048: mortality, differentially-abled and malnourished children will be put in place. A comprehensive quality assurance
p.000048: mechanism within the health sector will be developed and introduced using these existing structures.
p.000048:
p.000048: 14.1: Public Health Council
p.000048: In view of the function of public health cadre which include environmental health activities, food safety
p.000048: and quality, occupational health, immunization and health promotion, just to mention a few; the need to regulate
p.000048: public health practice in the Gambia is very crucial. Therefore the establishment of a Public Health Council
p.000048: to regulate public health functions is paramount. The organisational relationship of this body with the wider set
p.000048: of other institutions is illustrated in the organogram of the Ministry of Health and Social Welfare represented
p.000048: by Appendix J.
p.000048:
p.000048: The Public Health Council shall be established by an Act of Parliament and its function shall include,
p.000048: among other things:
p.000048: • Registration of public health officers.
p.000048: • Provide guideline for the training of PHOs.
p.000048: • Set standards for public health practice.
p.000048:
p.000048: 14.2: Clinical Audit Unit
p.000048: Establish Clinical Audit Units in all health facilities so as to strengthen routine assessment of adherence
p.000048: to set standards and norms. This is the mandate of the Medical and Dental Council in collaboration with the
p.000048: Ministry of Health and Social Welfare.
p.000048:
p.000048: 14.3: Board of Health
p.000048: A Board of Health to be established to comprise of representatives of the various Councils, policy makers
...
Social / Elderly
Searching for indicator elderly:
(return to top)
p.000048: and national health policy, legislations or strategies for tobacco control in line with the WHO Framework Convention on
p.000048: Tobacco Control;
p.000048: • Provision of technical advice to the Ministry of Health and Social Welfare on International protocols, instruments
p.000048: and conventions that have a public health and health promotion underpinning;
p.000048: • Act as the technical adviser to the Ministry of Health and Social Welfare and oversee patient
p.000048: education/counselling in the country’s medical institutions as part of the health promoting hospital initiatives with a
p.000048: view to ensuring quality care for the poor and the socially deprived;
p.000048: • Act as the technical body to regulate health information dissemination in the country.
p.000048:
p.000048: (b) Department of Social Welfare
p.000048:
p.000048: Directorate of Social Welfare (DSW)
p.000048:
p.000048: The Department comprised of the Directorate of Social Welfare (DSW).It is responsible for the
p.000048: promotion and protection of the rights and welfare of vulnerable persons such as children, the elderly, persons
p.000048: with disability and adults in difficult circumstances. To enable them maximize their potential and minimize
p.000048: problems arising out of the imbalance between themselves and their environment as a result of social change. Their
p.000048: services focus on the social protection of individual families and groups.This includes the welfare services to the
p.000048: vulnerable families and individuals, child rights and protection services, elderly care, disability care services and
p.000048: regional social welfare services provision and management.
p.000048:
p.000048: 1.5.2: Regional Level
p.000048: The Regional Health Directorates are headed by Regional Directors of Health Services, who are directly
p.000048: responsible to the Permanent Secretary through the Director of Health Services. Regional Directors of Health
p.000048: Services are responsible for coordinating policy interpretation, planning and implementation of health services, and
p.000048: monitoring and evaluation of health service delivery, within their respective
p.000048:
p.000048:
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p.000048: Page 13
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
...
Social / Ethnicity
Searching for indicator ethnic:
(return to top)
p.000048: persons with disabilities in accordance with the United
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 16
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
...
Social / Infant
Searching for indicator infant:
(return to top)
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 7
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.0 INTRODUCTION
p.000048: 1.1 Location, Size and Climate
p.000048: The Gambia is located on the West African coast and extends about 400 km inland, with a population density of 128
p.000048: persons per square kilometre. The width of the country varies from 24 to 28 kilometres and has a land
p.000048: area of 10,689 square kilometres. It is bordered on the North, South and East by the Republic of Senegal and on
p.000048: the West by the Atlantic Ocean. The country has a tropical climate characterised by two seasons: rainy
p.000048: season (June – October) and dry season (November-May).
p.000048: According to the Population and Housing Census (2003), the population is estimated at 1.79 million, with annual growth
p.000048: rate of 2.74 %. About 60% of the population live in the rural area; and women constitute 51% of the total
p.000048: population. The crude birth rate is 46 per 1000 population while the total fertility rate is 5.4 births per woman.
p.000048: The high fertility level has resulted in a very youthful population structure. Nearly 44% of the
p.000048: population is below 15 years and 19% between the ages 15 to 24. Average life expectancy at birth is 64
p.000048: years overall with females constituting 59 and males 55. Please see Appendices: A & B.
p.000048: 1.2: Health Status of the Population
p.000048: The Gambia has an Infant Mortality Rate of 75/1000 live births, 60% of which is attributable to malaria,
p.000048: diarrhoeal diseases and acute respiratory tract infections. The main causes of mortality in infants (0-12
p.000048: months) are neonatal sepsis, premature deliveries, malaria, respiratory infections, diarrhoeal diseases and
p.000048: malnutrition. For child mortality, main causes are: malaria, pneumonia, malnutrition, and diarrhoeal diseases.
p.000048: The Maternal Mortality Ratio is estimated at 730/100,000 live births, the majority of which are due to
p.000048: sepsis, haemorrhage and eclampsia (Maternal and Neonatal Survey 2001).
p.000048:
p.000048: The period 1999 to 2009 has witnessed a decline of total outpatient consultations from 40% to 32.5%
p.000048: respectively, while diarrhoeal diseases for under fives accounts for 19.5% and pneumonia 16.4% of IMNCI cases
p.000048: reported for 2009. Severe diarrhoea is 10.8% compared with severe pneumonia, which is 48.8% for IMNCI
p.000048: admissions respectively. The HIV prevalence rate is 1.6% for HIV1 and 0.4% for HIV2 (sentinel surveillance,
p.000048: 2008).
p.000048:
p.000048: Tuberculosis remains a disease of public health importance in The Gambia. Generally, the case
p.000048: notification for all forms of TB has also markedly increased in recent years. A total number of 2053 TB patients (all
p.000048: forms) was detected in 2008 in the Gambia. The rate of new smear positive cases have been increasing
p.000048: steadily from 61 per 100,000 in 1994 to 87 per 100,000 in 2006, 2007 and 2008 respectively. Similarly, the rate for All
...
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 14
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • Major Health Centres
p.000048: The major health centre serves as the referral point for minor health centres for services such as:
p.000048: comprehensive emergency obstetric care (surgical, blood transfusion services and further medical care).
p.000048: Additionally, they also offer services such as infant welfare and ante natal services, surveillance and dental
p.000048: services. The standard bed capacity for major health centres range from110 -150 beds per 150,000 - 200,000
p.000048: population.
p.000048:
p.000048: 3) Tertiary Level
p.000048: The general hospitals serve as referral points for the Major health centres as they provide specialised services.
p.000048: The Royal Victoria Teaching Hospital (RVTH) also serves as the referral hospital for the general hospitals.
p.000048:
p.000048: (b) Private Health Sector
p.000048: This includes the private for profit and private for non-profit. These are few (numbering less than 20) and
p.000048: smaller in sizes each with bed capacity less than 50 and less than 10 per cent of these are located in the
p.000048: rural community. The large majority are located in the Greater Banjul Area, making choice in health
p.000048: services delivery point in the rural community very limited.
p.000048:
p.000048: (c) Traditional Medicine
p.000048: The traditional healing system has been with us from time immemorial. The system includes bone setters, herbalists,
p.000048: spiritualists, birth attendants and those who combine the methods. The System continues to contribute
p.000048: significantly to the health of the population hence the need for their promotion and strengthening collaboration with
p.000048: the orthodox medicine. However, major concerns have been raised about the activities of quacks in the traditional
p.000048: system and the demand for the urgent regulation of the system is equally paramount.
p.000048:
p.000048: 2. 0. VISION AND MISSION
p.000048: 2. 1 Vision
...
p.000048: maximum impact on the health status of the citizenry.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 15
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 3.1. Goal:
p.000048: Reduce morbidity and mortality to contribute significantly to quality of life in the population.
p.000048:
p.000048: Morbidity and mortality rates due to communicable diseases have decreased over the years but more pronounced
p.000048: in non-communicable diseases especially among youths and women. In addition to the earlier mentioned health
p.000048: challenges, the main factors contributing to this high morbidity in the population include social
p.000048: determinants and related factors such as poverty, unhealthy environment, unsafe working conditions, poor
p.000048: sanitation, poor nutrition, road traffic accidents, poor access to safe water and poor housing for many. The main
p.000048: causes of mortality within the population are: Malaria, Pneumonia, Anaemia, Diarrhoeal Diseases, road traffic
p.000048: accidents, pregnancy complications and Cardiovascular Diseases. Of increasing concern are the incidences of
p.000048: Tuberculosis and HIV/AIDS in the population.
p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
...
p.000048: neurological disorders
p.000048: • Providing quality, equitable and affordable mental health services to the general population
p.000048: • Promote IEC on substance abuse
p.000048: • Promoting advocacy for the reduction of stigma and discrimination against people with mental and
p.000048: neurological disorders
p.000048: • Strengthening community involvement and participation in mental health care service delivery
p.000048: • Operationalise the revised current Lunatics’ Detention Act of 1917 taking into account a new mental health
p.000048: legislation Establishing and strengthening capacity for mental health research
p.000048: • Strengthen the prevention, case management and control of mental health illnesses country wide
p.000048: • Develop a Mental Health Act.
p.000048:
p.000048: 5.6: Reproductive and Child Health Preamble
p.000048: RCH services are provided at all levels of the health system by both public and
p.000048: private facilities at base and outreach through a network of health facilities across the country. With an impressive
p.000048: nationwide coverage RCH indicators have over the years been reduced significantly. For example, MMR high has reduced
p.000048: from 1050 to 730 per 100,000 live births between 1990 and 2001(DOSH 2001). Child health indicators have
p.000048: equally been reduced. Infant mortality rate has improved from 167 (1983) to 75 per 1000 live births (2003); and
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
p.000048: Stark regional variations also exist with the above indicators. For example, MMR is two-fold higher in rural
p.000048: than in urban areas and under-five mortality is three-fold higher in Lower River Region than that of
p.000048: Banjul (137 vs. 41).
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 25
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: A combination of factors (health and non-health service related) is responsible for the above high RCH
p.000048: indicators. Unmet need for RCH services particularly emergency obstetric care services resulting
p.000048: mainly from lack of basic RH equipments and supplies, acute shortage of skilled health
p.000048: professionals, weak referral system and inadequate financial resources for RCH services are some of the health
p.000048: services. In addition to these, non-health service related factors including high fertility rate (national 5.4), poor
p.000048: and inadequate nutrition, poor socio-economic status manifested by poor housing, limited availability and access to
p.000048: safe water and basic sanitation are important determinants.
...
Social / Linguistic Proficiency
Searching for indicator language:
(return to top)
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
p.000048: Community empowerment; active involvement of the private sector, NGOs, local government authorities and civil
p.000048: society; effective donor co-ordination
p.000048:
p.000048: 4.9 Evidence based health care
p.000048: Health planning, programming and service delivery shall be informed by evidence- based research.
p.000048:
p.000048: 4.10: Patient bill of rights
p.000048: The Patient's Bill of Rights helps patients feel more confident in the health care system. It assures that
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
p.000048: 4.10.2 Choice of providers and plans
p.000048: Where possible every patient shall have the right to choose health care providers who can give him/her
p.000048: high-quality health care when needed.
p.000048:
p.000048: 4.10.3 Access to emergency services
p.000048: In emergency health situations including severe pain, an injury, or sudden illness that makes a person believe that
p.000048: his/her health is in serious danger, he/she shall have the right to be screened and stabilized using emergency
p.000048: services. He/she should be able to use these services whenever and wherever needed without needing to wait for
p.000048: authorization and any financial payment.
p.000048:
p.000048: 4.10.4 Participation in treatment decisions
p.000048: Every patient shall have the right to know his/her treatment options and take part in decisions about his/her care.
p.000048: Parents, guardians, family members, or others that they identify can represent them if he/she cannot make his/her
p.000048: own decisions.
p.000048:
p.000048: 4.10.5 Respect and non-discrimination
p.000048: Every patient must have a right to considerate, respectful and non-discriminatory care from his/her health
p.000048: care provider (s),
p.000048:
p.000048: 4.10.6 Confidentiality of health information
...
Social / Occupation
Searching for indicator job:
(return to top)
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
p.000048: Community empowerment; active involvement of the private sector, NGOs, local government authorities and civil
p.000048: society; effective donor co-ordination
p.000048:
p.000048: 4.9 Evidence based health care
p.000048: Health planning, programming and service delivery shall be informed by evidence- based research.
p.000048:
p.000048: 4.10: Patient bill of rights
p.000048: The Patient's Bill of Rights helps patients feel more confident in the health care system. It assures that
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
p.000048: 4.10.2 Choice of providers and plans
p.000048: Where possible every patient shall have the right to choose health care providers who can give him/her
p.000048: high-quality health care when needed.
p.000048:
p.000048: 4.10.3 Access to emergency services
...
Social / Police Officer
Searching for indicator officer:
(return to top)
p.000048: Preventive Treatment
p.000048: ITN - Insecticide Treated Nets
p.000048: MDGs - Millennium Development Goals
p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
p.000048: PRSP - Poverty Reduction Strategy Programme
p.000048: RCH - Reproductive and Child Health
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 6
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: RFH - Riders for Health
p.000048: RH - Reproductive Health
p.000048: RHD - Regional Health Directorate
p.000048: RHO - Regional Health Officer
p.000048: RHT - Regional Health Teams
p.000048: RTI - Respiratory Tract Infections
p.000048: STI - Sexually Transmitted Diseases
p.000048: SWAp - Sector Wide Approach
p.000048: TB - Tuberculosis
p.000048: TH - Traditional Healer
p.000048: TM - Traditional Medicine
p.000048: TOR - Terms of Reference
p.000048: VC - Vector Control
p.000048: VCT - Voluntary Counselling and Testing
p.000048: VDC - Village Development Committee
p.000048: VDRL - Venereal diseases reference laboratory
p.000048: VHC - Village Health Committee
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 7
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.0 INTRODUCTION
p.000048: 1.1 Location, Size and Climate
p.000048: The Gambia is located on the West African coast and extends about 400 km inland, with a population density of 128
p.000048: persons per square kilometre. The width of the country varies from 24 to 28 kilometres and has a land
...
p.000000: W A W A
p.000000:
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p.000000:
p.000000:
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p.000000:
p.000000:
p.000000:
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p.000000:
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p.000000:
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p.000000:
p.000000:
p.000000:
p.000000: Health Policy 2012-2020
p.000000: Page 50
p.000000:
p.000000:
p.000000: HEALTH IS WEALTH
p.000000:
p.000000:
p.000000: Organogram Abbreviation:
p.000000: DPS-F&A – Deputy Permanent Secretary – Finance & Administration DPS-T – Deputy Permanent Secretary - Technical
p.000000: DPI – Directorate of Planning and Information
p.000000: DDPI – Deputy Director of Planning and Information HRH – Human Resources for Health
p.000000: M&E – Monitoring and Evaluation
p.000000: MIS – Management Information System EDC – Epidemiology and Disease Control B&D – Births and Deaths
p.000000: PAB – Policy Analysis and Budgeting QA – Quality Assurance
p.000000: FM - Facilities Maintenance IT – Information Technology
p.000000: DNPHLS – Directorate of national Public Health Laboratory Services NPHRL – National Public Health Reference
p.000000: Laboratories
p.000000: NBTS – National Blood Transfusion Services BEU – Biomedical Engineering Unit
p.000000: CL- Clinical Laboratories
p.000000: DHS - Directorate of Health Services
p.000000: DDHS – Deputy Directorate of Health Services
p.000000: PHC – Assistant Director Family Health / Primary Health Care RCH – Reproductive and Child Health
p.000000: EPI – Expanded Programme of Immunisation OHS – Occupational Health Services
p.000000: EH – Environmental Health VC – Vector Control
p.000000: IMNCI – Integrated Management of Childhood Neonatal Illnesses CNO – Chief Nursing Officer
p.000000: CPHO – Chief Public Health Officer CP – Chief Pharmacist
p.000000: NPS – national Pharmaceutical Services CMS – Central Medical Stores
p.000000: NMCP – National Malaria Control Programme
p.000000: NLTP – National Leprosy and Tuberculosis Control Programme NACP – National Aids Control Programme
p.000000: NEHP – National Eyecare Health Programme TM - Traditional Medicine
p.000000: BI – Bamako Initiative
p.000000: DFSHQE – Directorate of Food Standards Quality Hygiene Enforcement IHE - Inspection & Hygiene Enforcement
p.000000: FSQ - Foods Standard & Quality
p.000000: DHPE – Directorate of Health Promotion and Education DDHPE – Directorate of Health Promotion and Education NCD –
p.000000: Non-Communicable Diseases
p.000000: MH – Mental Health
p.000000: WS – Water and Sanitation Hygiene HC – Health Communication
p.000000: NHR – National Health Research HPP – School Health and Nutrition
p.000000: SWRO – Social Welfare Regional Offices CC - Child Care
p.000000: DU - Disability Unit AC - Adult Care
p.000000: PS – Professional Services
p.000000: RVTH – Royal Victoria Teaching Hospital SJJH – Sulayman Junkung Jammeh Hospital
p.000000:
p.000000:
p.000000: Health Policy 2012-2020
p.000000: Page 51
p.000000:
p.000000:
p.000000: HEALTH IS WEALTH
p.000000:
p.000000: JFPH – Jammeh Foundation for Peace Hospital SGH – Serekunda General Hospital
p.000000: AFPRC – Armed Forces Patriotic Ruling Council Hospital BSG – Bansang Hospital
p.000000: GMDC – Gambia Medical and Dental Council GNMC – Gambia Nurses and Midwives Council MB – Medicine’s Board
p.000000: CIO – Central Inspectorate Office
...
Social / Property Ownership
Searching for indicator home:
(return to top)
p.000048: In the Plan of Action, PHC has been defined as:
p.000048:
p.000048: An approach aimed at mobilising all potential resources including the communities’ own resources, towards the
p.000048: development of the National Health Care System, the aim being to extend health services coverage to the entire Gambian
p.000048: population and to attract the main disease problems of the communities. PHC is also a mechanism for ensuring an
p.000048: equitable re-distribution of the limited health resources available in the country in favour of the under-served
p.000048: majority, who live and work in the rural area.
p.000048:
p.000048: At present quite a number of PHC villages are not functioning optimally. Reasons for non performance are attributed to
p.000048: several factors namely an ineffective VDC, lack of support for community health workers, shortage of drugs and lack of
p.000048: supervision. A selective PHC programme has been designed to intervene at village level to control priority diseases
p.000048: such as Acute Respiratory Infection, Diarrhoeal Diseases, Tuberculosis, Malaria, Preventive Eye Care and
p.000048: HIV/AIDS.
p.000048:
p.000048: Support to and capacity building at primary level are essential for sustaining of basic PHC technologies needed to
p.000048: address common health problems affecting women and children, and management of development projects which have an
p.000048: impact on health
p.000048: e.g. community water supplies, sanitation, home based care for malaria, etc.
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 27
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: In order to restore the functionality of all existing PHC villages, the Ministry of Health in collaboration with
p.000048: stakeholders and the community will review the present VDC system.
p.000048: The development of the VHS has been in isolation to the BHS. The latter possesses a wide range of resources to support
p.000048: the VHS. The policy calls for define linkages between the BHS and the VHS. A basic health facility will be linked to a
p.000048: number of trekking stations and PHC villages. This group of facilities and the population it serves
p.000048: (including non primary health care villages) will constitute a CATCHMENT AREA.
p.000048: The basic health facility will perform the first line supervision and provide support in the areas of training and
p.000048: supply of drugs to the VHS. Each catchment area will have a catchment area committee. The latter will be closely
p.000048: involved in the management, planning, monitoring and evaluation of services provided in the area under its
p.000048: jurisdiction.
p.000048: 6.1.1 Service Expansion
p.000048: At present, health services are provided by 546 health posts at the primary level. When PHC was introduced
p.000048: in 1979 some villages which did not qualify for reasons of numbers now qualify. The present policy of
p.000048: establishing PHC in villages with a population of 400 or more or where access is difficult will
p.000048: continue so as to accommodate new villages. In view of the numbers of villages to be involved, villages
...
p.000092: WR 5 5 9 3 30
p.000092: KMC 2 4 2 10 18
p.000092: Banjul 2 - - - 100
p.000092: Health Policy 2012-2020
p.000092: Page 46
p.000092:
p.000092: HEALTH IS WEALTH
p.000092:
p.000092:
p.000092: APPENDIX F
p.000092: Table 2: showing distribution of hospitals by health region
p.000092: Region General Hospitals NGO/Private Hospital Teaching Hospital URR 0 0
p.000000: 0
p.000000: LRR 0 0 0
p.000000: CRR 1 0 0
p.000000: NBR 1 0 0
p.000000: WR 1 0 0
p.000000: KMC 2 3 0
p.000000: BCC 0 1
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: APPENDIX G
p.000000:
p.000000: Table 3: MINIMUM HEALTH CARE PACKAGE
p.000000: VHS Minor H/C Major H/C
p.000000: Regional Hospital Teaching Hospital
p.000000:
p.000000: • Primary care service (including treatment of minor illnesses and referrals, environmental health & sanitation,
p.000000: antenatal, delivery and postpartum care, home visits, community health promotion activities s
p.000000: • Maternity care (antenatal, delivery and postpartum
p.000000: • Family Planning
p.000000: • STIs/RTIs/HIV/AIDS prevention and control
p.000000: • IMNCI
p.000000: • Immunisation
p.000000: • Neonatal and child health
p.000000: • Maternal and child nutrition
p.000000: • Basic EMOC
p.000000: • Basic emergency newborn care (ENC)
p.000000: • Disease prevention and control( malaria, TB, etc)
p.000000: • Health protection and control
p.000000: • Basic Lab services(HB, BF, VDRL, Urine analysis TB and HIV screening)
p.000000: • in-patient service
p.000000: • Referral services
p.000000: • Dispensary
p.000000: • Eye care services
p.000000: • Out-patient services
p.000000: • Registration of births and Deaths
p.000000: • All services provided at minor H/C level
p.000000: • Comprehensive emergency obstetric care (including theatre and blood transfusion services)
p.000000: • Functional theatre
p.000000: • Comprehensive emergency newborn care
p.000000: • In-patient services
p.000000: • Pharmacy Services
p.000000: • Basic Lab. services including HIV and TB Screening.
...
Social / Religion
Searching for indicator faith:
(return to top)
p.000048: by Appendix J.
p.000048:
p.000048: The Public Health Council shall be established by an Act of Parliament and its function shall include,
p.000048: among other things:
p.000048: • Registration of public health officers.
p.000048: • Provide guideline for the training of PHOs.
p.000048: • Set standards for public health practice.
p.000048:
p.000048: 14.2: Clinical Audit Unit
p.000048: Establish Clinical Audit Units in all health facilities so as to strengthen routine assessment of adherence
p.000048: to set standards and norms. This is the mandate of the Medical and Dental Council in collaboration with the
p.000048: Ministry of Health and Social Welfare.
p.000048:
p.000048: 14.3: Board of Health
p.000048: A Board of Health to be established to comprise of representatives of the various Councils, policy makers
p.000048: within and out of the Health Sector, health professionals within and outside the Public Health System.
p.000048:
p.000048: The functions of the Board shall include, among other things:
p.000048: • Review and approve national health service standards
p.000048: • Monitor quality of health services nationally
p.000048: • Accredit all public, private and NGOs health facilities for service delivery
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 43
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048:
p.000048:
p.000048: 15: CONCLUSION
p.000048: This Policy was developed through consultations with and inputs from all stakeholders including
p.000048: Sector Ministries, Local Government Authorities, Faith-based Organisations, NGOs, Opinion leaders, Catchment
p.000048: Area Committees, Multi- Disciplinary Facilitation Teams (MDFT’s), and other partners in the provision of
p.000048: health care across the country. The Ministry and partners, notably from WHO and UNICEF, have demonstrated sustained
p.000048: interest and commitment to the policy process.
p.000048:
p.000048: The need to address the general health system challenges including the effects of high population growth rate;
p.000048: inadequate financial and logistic support; weak health information system; uncoordinated donor support; shortage
p.000048: of adequately and appropriately trained health staff; high attrition rate and lack of efficient and effective
p.000048: referral system has been highlighted. Therefore, renewed commitment is required from staff of Ministry, as well as
p.000048: Government and NGO and all citizens to achieve our desired goal of a “healthy and wealthy nation”.
p.000048:
p.000048: There is clear evidence that from 1994 to date there has been massive expansion in terms of health infrastructural
p.000048: development and health care needs. The commitment of the Government to implement this policy is demonstrated by the
p.000048: current structures established at both central and regional levels, the strengthening of health training institutions
p.000048: and capacity building through the training of staff both at local and international levels. The country’s
p.000048: vision statement also gave a very clear direction as to where the Gambia would want to be by 2020.
p.000048:
p.000048: ********
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
...
Searching for indicator religious:
(return to top)
p.000048: persons with disabilities in accordance with the United
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 16
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
p.000048: Community empowerment; active involvement of the private sector, NGOs, local government authorities and civil
p.000048: society; effective donor co-ordination
p.000048:
p.000048: 4.9 Evidence based health care
p.000048: Health planning, programming and service delivery shall be informed by evidence- based research.
p.000048:
p.000048: 4.10: Patient bill of rights
p.000048: The Patient's Bill of Rights helps patients feel more confident in the health care system. It assures that
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
...
Social / Soldier
Searching for indicator armedXforces:
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p.000000: IMNCI – Integrated Management of Childhood Neonatal Illnesses CNO – Chief Nursing Officer
p.000000: CPHO – Chief Public Health Officer CP – Chief Pharmacist
p.000000: NPS – national Pharmaceutical Services CMS – Central Medical Stores
p.000000: NMCP – National Malaria Control Programme
p.000000: NLTP – National Leprosy and Tuberculosis Control Programme NACP – National Aids Control Programme
p.000000: NEHP – National Eyecare Health Programme TM - Traditional Medicine
p.000000: BI – Bamako Initiative
p.000000: DFSHQE – Directorate of Food Standards Quality Hygiene Enforcement IHE - Inspection & Hygiene Enforcement
p.000000: FSQ - Foods Standard & Quality
p.000000: DHPE – Directorate of Health Promotion and Education DDHPE – Directorate of Health Promotion and Education NCD –
p.000000: Non-Communicable Diseases
p.000000: MH – Mental Health
p.000000: WS – Water and Sanitation Hygiene HC – Health Communication
p.000000: NHR – National Health Research HPP – School Health and Nutrition
p.000000: SWRO – Social Welfare Regional Offices CC - Child Care
p.000000: DU - Disability Unit AC - Adult Care
p.000000: PS – Professional Services
p.000000: RVTH – Royal Victoria Teaching Hospital SJJH – Sulayman Junkung Jammeh Hospital
p.000000:
p.000000:
p.000000: Health Policy 2012-2020
p.000000: Page 51
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p.000000: HEALTH IS WEALTH
p.000000:
p.000000: JFPH – Jammeh Foundation for Peace Hospital SGH – Serekunda General Hospital
p.000000: AFPRC – Armed Forces Patriotic Ruling Council Hospital BSG – Bansang Hospital
p.000000: GMDC – Gambia Medical and Dental Council GNMC – Gambia Nurses and Midwives Council MB – Medicine’s Board
p.000000: CIO – Central Inspectorate Office
p.000000: RHDW1 – Regional Health Directorate Western 1 RHDW2 – Regional Health Directorate Western 2 RHDNBW – Regional Health
p.000000: Directorate North Bank West RHDNBE – Regional Health Directorate North Bank East
p.000000: RHDCRR – Regional Health Directorate Central River Region RHDURR – Regional Health Directorate Upper River Region
p.000000: RHDLRR – Regional Health Directorate Lower River Region VHS – Village Health Services
p.000000: VHW – Village Health Worker TBA – Traditional Birth Attendant
p.000000:
p.000000: ********
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p.000000: Health Policy 2012-2020
...
Social / Threat of Stigma
Searching for indicator stigma:
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p.000048: treatment and support to all these people is challenging, given the scarce health resources in the
p.000048: Gambia and an overall situation of poverty in the country, where 34% of the population live below the
p.000048: poverty line and 18% of the population are extremely poor. However, consultation
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 24
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: with many different experts, health professions and key individuals from different government sectors has
p.000048: highlighted the great need, willingness and strategies required to strengthen the overall mental health system in
p.000048: order to provide effective treatment and care to those in need as well as to promote the mental health of all Gambians.
p.000048:
p.000048: Objective
p.000048:
p.000048: • Improve access to quality mental health care for all Gambians
p.000048: Policy Measures
p.000048:
p.000048: • Implement the Mental Health Policy and Strategy
p.000048: • Strengthening capacity for the diagnosis, management, prevention and control of mental and
p.000048: neurological disorders
p.000048: • Providing quality, equitable and affordable mental health services to the general population
p.000048: • Promote IEC on substance abuse
p.000048: • Promoting advocacy for the reduction of stigma and discrimination against people with mental and
p.000048: neurological disorders
p.000048: • Strengthening community involvement and participation in mental health care service delivery
p.000048: • Operationalise the revised current Lunatics’ Detention Act of 1917 taking into account a new mental health
p.000048: legislation Establishing and strengthening capacity for mental health research
p.000048: • Strengthen the prevention, case management and control of mental health illnesses country wide
p.000048: • Develop a Mental Health Act.
p.000048:
p.000048: 5.6: Reproductive and Child Health Preamble
p.000048: RCH services are provided at all levels of the health system by both public and
p.000048: private facilities at base and outreach through a network of health facilities across the country. With an impressive
p.000048: nationwide coverage RCH indicators have over the years been reduced significantly. For example, MMR high has reduced
p.000048: from 1050 to 730 per 100,000 live births between 1990 and 2001(DOSH 2001). Child health indicators have
p.000048: equally been reduced. Infant mortality rate has improved from 167 (1983) to 75 per 1000 live births (2003); and
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
p.000048: Stark regional variations also exist with the above indicators. For example, MMR is two-fold higher in rural
...
Searching for indicator threat:
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p.000048: especially at health facility and regional Health Office levels and over-aged cold chain equipment. . Surveillance
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 20
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: is very important in the management of vaccine preventable diseases and is done in collaboration with the disease
p.000048: control unit for overall coordination.
p.000048:
p.000048: The vaccine independent initiative introduced in the mid 1990s into the EPI programme led to the creation of
p.000048: a budget line for vaccine and logistics. This budget line has been increasing over the years for the
p.000048: procurement of all traditional vaccines, and the logistics, while new vaccines are funded by GAVI.
p.000048:
p.000048: Objectives
p.000048: • To increase immunization coverage to at least 90% for all antigens at national and regional levels.
p.000048: • To ensure vaccine security for all vaccine preventable diseases
p.000048:
p.000048: Policy Measures
p.000048: • Mobilize additional financial resources for the EPI programme
p.000048: • Strengthen the effectiveness and efficiency of the EPI delivery system
p.000048: • Improve surveillance mechanism for early detection and response to vaccine preventable disease outbreaks
p.000048:
p.000048: 5.4. Disease Control Preamble
p.000048: Strategies/programmes based on Integrated Disease Surveillance and Response (IDSR) have been put in place
p.000048: to control diseases such as, HIV/AIDS, malaria, Tuberculosis, measles and eye diseases. However, the
p.000048: threat of epidemic prone diseases including meningococcal meningitis, cholera and yellow fever constitute a major
p.000048: public health concern. Other diseases such as poliomyelitis, lymphatic filariasis and leprosy are
p.000048: at the point of elimination. Non-communicable diseases such as diabetes, hypertension, mental health
p.000048: illnesses, asthma, cardiovascular diseases, including other neglected chronic diseases and cancers continue to pose
p.000048: major public health challenges. To maintain a ready state of preparedness and a swift response to diseases
p.000048: with epidemic potential, the Government of The Gambia will strengthen the epidemiological surveillance system so
p.000048: that there is effective detection, investigation, and management of any suspected and confirmed cases of priority.
p.000048: Cross border surveillance will also be strengthened with the effective implementation of IHR (International
p.000048: Health Regulations).
p.000048:
p.000048: The monitoring of diseases both emerging and re-emerging will be strengthened with the empowerment of regions to
p.000048: carry out proper monitoring and supervision of interventions. Disaster management requires a multi-sectoral
p.000048: approach: hence, the Ministry of Health will take the necessary measures to ensure there is an adequate level of
p.000048: preparedness and ability to respond to those disasters using collaborative strategies quickly and adequately.
p.000048:
p.000048: Objectives
p.000048:
p.000048: • To reduce the burden of communicable diseases to a level that they cease to be a public health problem
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 21
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
...
Social / Threat of Violence
Searching for indicator violence:
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p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
...
Social / Victim of Abuse
Searching for indicator abuse:
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p.000048: unhealthy diet and lifestyle such as tobacco use, physical inactivity and harmful use of alcohol, constitute a major
p.000048: public health problem and are known, for both their high financial and social cost for families, communities and
p.000048: countries.
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 23
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: As stated earlier, chronic non-communicable diseases such as hypertension, diabetes and cancers are
p.000048: on the increase in the Gambia. A population-based situation analysis conducted in 2001 revealed
p.000048: that 8.6% of the adult urban population and 1.4% of the rural adult population had diabetes mellitus. The
p.000048: same study revealed that between 10 to 20% of the population was chronically infected with hepatitis B.
p.000048: These findings are not at great variance from studies conducted by Van Der Sande et al (1996 & 2001) which showed 9.5%
p.000048: of adults over 15 years were hypertensive according to WHO criteria (a diastolic blood pressure of 95 mmHg or above
p.000048: and/or systolic blood pressure of 160 mmHg or above.
p.000048:
p.000048: There is a risk of the health system being confronted by an increase in the number of cases of non-communicable
p.000048: diseases and as such adequate measures are being taken to alert those responsible for the prevention, diagnosis,
p.000048: treatment including the management of such diseases. These diseases are commonly cancer, diabetes, cataract,
p.000048: arterial hypertension and those associated with tobacco consumption, alcohol abuse, an inactive life style
p.000048: and environmental pollution. Oral health, the prevention of blindness and physical rehabilitation services for
p.000048: handicapped people are to be improved.
p.000048:
p.000048: Objective
p.000048: • To reduce the burden of NCDs Risk factors in the Gambian population through the promotion of healthy
p.000048: behaviours, lifestyles and appropriate care by end 2020
p.000048:
p.000048: Policy Measures
p.000048: • To finalize and implement national NCD Policy and Strategic Plan.
p.000048: • Strengthening capacity for the management, prevention and control of NCDs
p.000048: • Supporting broad based participation in support of NCD prevention and control.
p.000048: • Creating supportive environment for addressing the risk factors for NCD
p.000048: • Building and strengthening capacity for NCD research
p.000048: • Scaling up of IMNCI strategies to all levels
p.000048: • Develop and provide essential (basic) Health Care Packages at different service delivery levels
p.000048:
p.000048: 5.5: Mental Health Preamble
p.000048: It is estimated that approximately 27,000 people in the Gambia are suffering from a severe mental and/or substance
p.000048: abuse disorder and that a further 91,000 Gambians have a mild disorder still requiring treatment (World health
p.000048: Survey, 2004) .A local prevalence study in the Gambia, puts prevalence rates higher (at 20%) and leads to estimates
p.000048: of approximately 180,000 people suffering from a mental or substance abuse disorder. Providing effective
p.000048: treatment and support to all these people is challenging, given the scarce health resources in the
p.000048: Gambia and an overall situation of poverty in the country, where 34% of the population live below the
p.000048: poverty line and 18% of the population are extremely poor. However, consultation
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 24
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: with many different experts, health professions and key individuals from different government sectors has
p.000048: highlighted the great need, willingness and strategies required to strengthen the overall mental health system in
p.000048: order to provide effective treatment and care to those in need as well as to promote the mental health of all Gambians.
p.000048:
p.000048: Objective
p.000048:
p.000048: • Improve access to quality mental health care for all Gambians
p.000048: Policy Measures
p.000048:
p.000048: • Implement the Mental Health Policy and Strategy
p.000048: • Strengthening capacity for the diagnosis, management, prevention and control of mental and
p.000048: neurological disorders
p.000048: • Providing quality, equitable and affordable mental health services to the general population
p.000048: • Promote IEC on substance abuse
p.000048: • Promoting advocacy for the reduction of stigma and discrimination against people with mental and
p.000048: neurological disorders
p.000048: • Strengthening community involvement and participation in mental health care service delivery
p.000048: • Operationalise the revised current Lunatics’ Detention Act of 1917 taking into account a new mental health
p.000048: legislation Establishing and strengthening capacity for mental health research
p.000048: • Strengthen the prevention, case management and control of mental health illnesses country wide
p.000048: • Develop a Mental Health Act.
p.000048:
p.000048: 5.6: Reproductive and Child Health Preamble
p.000048: RCH services are provided at all levels of the health system by both public and
p.000048: private facilities at base and outreach through a network of health facilities across the country. With an impressive
p.000048: nationwide coverage RCH indicators have over the years been reduced significantly. For example, MMR high has reduced
p.000048: from 1050 to 730 per 100,000 live births between 1990 and 2001(DOSH 2001). Child health indicators have
p.000048: equally been reduced. Infant mortality rate has improved from 167 (1983) to 75 per 1000 live births (2003); and
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
...
Social / Women
Searching for indicator women:
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p.000048: TOR - Terms of Reference
p.000048: VC - Vector Control
p.000048: VCT - Voluntary Counselling and Testing
p.000048: VDC - Village Development Committee
p.000048: VDRL - Venereal diseases reference laboratory
p.000048: VHC - Village Health Committee
p.000048:
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p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 7
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.0 INTRODUCTION
p.000048: 1.1 Location, Size and Climate
p.000048: The Gambia is located on the West African coast and extends about 400 km inland, with a population density of 128
p.000048: persons per square kilometre. The width of the country varies from 24 to 28 kilometres and has a land
p.000048: area of 10,689 square kilometres. It is bordered on the North, South and East by the Republic of Senegal and on
p.000048: the West by the Atlantic Ocean. The country has a tropical climate characterised by two seasons: rainy
p.000048: season (June – October) and dry season (November-May).
p.000048: According to the Population and Housing Census (2003), the population is estimated at 1.79 million, with annual growth
p.000048: rate of 2.74 %. About 60% of the population live in the rural area; and women constitute 51% of the total
p.000048: population. The crude birth rate is 46 per 1000 population while the total fertility rate is 5.4 births per woman.
p.000048: The high fertility level has resulted in a very youthful population structure. Nearly 44% of the
p.000048: population is below 15 years and 19% between the ages 15 to 24. Average life expectancy at birth is 64
p.000048: years overall with females constituting 59 and males 55. Please see Appendices: A & B.
p.000048: 1.2: Health Status of the Population
p.000048: The Gambia has an Infant Mortality Rate of 75/1000 live births, 60% of which is attributable to malaria,
p.000048: diarrhoeal diseases and acute respiratory tract infections. The main causes of mortality in infants (0-12
p.000048: months) are neonatal sepsis, premature deliveries, malaria, respiratory infections, diarrhoeal diseases and
p.000048: malnutrition. For child mortality, main causes are: malaria, pneumonia, malnutrition, and diarrhoeal diseases.
p.000048: The Maternal Mortality Ratio is estimated at 730/100,000 live births, the majority of which are due to
p.000048: sepsis, haemorrhage and eclampsia (Maternal and Neonatal Survey 2001).
p.000048:
p.000048: The period 1999 to 2009 has witnessed a decline of total outpatient consultations from 40% to 32.5%
p.000048: respectively, while diarrhoeal diseases for under fives accounts for 19.5% and pneumonia 16.4% of IMNCI cases
p.000048: reported for 2009. Severe diarrhoea is 10.8% compared with severe pneumonia, which is 48.8% for IMNCI
p.000048: admissions respectively. The HIV prevalence rate is 1.6% for HIV1 and 0.4% for HIV2 (sentinel surveillance,
p.000048: 2008).
p.000048:
p.000048: Tuberculosis remains a disease of public health importance in The Gambia. Generally, the case
p.000048: notification for all forms of TB has also markedly increased in recent years. A total number of 2053 TB patients (all
p.000048: forms) was detected in 2008 in the Gambia. The rate of new smear positive cases have been increasing
p.000048: steadily from 61 per 100,000 in 1994 to 87 per 100,000 in 2006, 2007 and 2008 respectively. Similarly, the rate for All
p.000048: Forms of TB (New sputum Smear positive, New negative, Extra-pulmonary TB, Relapse, Failure and Return after
p.000048: default, others) have also increased. This increase is attributed to both improved surveillance and
p.000048: increased incidence as a secondary infection associated with HIV-1.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 8
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: There has been an increase in national coverage for fully immunized children to a present level of 79.6 % for under 1
p.000048: year and 84.9% for the under 2 year (2004 EPI cluster survey). The routine national immunization coverage is above
p.000048: 90% in 2010 for all the antigens (EPI, 2010). Please see Appendix C.
p.000048: Malnutrition continues to be a major public health problem in The Gambia. The MICS 2006 indicated 19% stunting, 6.8%
p.000048: wasting and 17% underweight. Diabetes Mellitus is estimated to affect about 1% of the population while a study found
p.000048: that about 16% of urban women are obese compare to only 1% of rural women. A WHO survey in 2008 reveals the
p.000048: prevalence of other NCD risk factors as follows:
p.000048: • 24.5% prevalence rate of smoking amongst 13-15 year olds.
p.000048: • 31.3% prevalence rate of smoking among youths aged 25 to 34 years.
p.000048: • About 2% of the adult population, aged 25 – 64 years, drink alcohol
p.000048: • Low consumption of fruits and vegetables, with the average mean number of days for fruits and
p.000048: vegetable consumption among adult males and females estimated at 3.3 and 5.0 respectively
p.000048: • About 22% of the adult population (males and females) have a low level of physical activity, whilst
p.000048: nearly 59% of adults do not engage in rigorous physical activity. In the same vein, on average, Gambian adults spend
p.000048: 231 minutes per day on sedentary activities
p.000048: • On average, 41.4% of adults Gambians never had their blood pressure tested. Similarly, about 24.4% of the adult
p.000048: population have raised blood pressure (25.5% for men and 23.4% for women)
p.000048: • About 90.5% of adults (92.1% of men and 89% of women) never had their blood sugar tested
p.000048: • About 39.5% of the adult population (33.7% for men and 45.3%) are considered overweight with mean BMI >25kgM2
p.000048:
p.000048: Safe water is an essential pillar of sustainable health for the population. Access to safe water is 85.1% of the
p.000048: overall households; with 79.9% urban and 64.9% rural and access to proper sanitary facilities are not encouraging
p.000048: thus limiting to only 26% (PRSPII) for the entire country.
p.000048:
p.000048: The 2008 poverty assessment indicated that overall poverty to be at 55.5% with a poverty gap of 25.9% and poverty
p.000048: severity at 14.3%. However there are regional variation with rural poverty incident of 63% and an urban
p.000048: incident of 57%. See Appendix: D.
p.000048:
p.000048: Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in
p.000048: recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly
p.000048: Community Initiative and the Bamako Initiative.
p.000048:
p.000048: Also, relevant policy documents were developed including that of Nutrition, Drug , Malaria Reproductive and
...
p.000048: monitoring and evaluation of health service delivery, within their respective
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 13
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
p.000048: 1) Primary Level (Village Health Services (VHS)
p.000048:
p.000048: The VHS consist of community health workers (traditional birth attendants (TBA) and village health workers (VHW)
p.000048: who are often the first point of contact between individuals, families and communities within the health
p.000048: system. These community health workers are supervised by trained community health nurses (CHN). TBAs
p.000048: provide care for pregnant women, conduct normal deliveries, identify and refer obstetrics emergencies. The
p.000048: VHWs on the other hand are involved in health promotion and prevention measures, the treatment of minor
p.000048: ailments, and refer cases beyond their scope of management.
p.000048:
p.000048: The village health services are complemented by the Reproductive and Child Health (RCH) trekking visits from the health
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 14
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p.000048:
p.000048: (c) Traditional Medicine
p.000048: The traditional healing system has been with us from time immemorial. The system includes bone setters, herbalists,
p.000048: spiritualists, birth attendants and those who combine the methods. The System continues to contribute
p.000048: significantly to the health of the population hence the need for their promotion and strengthening collaboration with
p.000048: the orthodox medicine. However, major concerns have been raised about the activities of quacks in the traditional
p.000048: system and the demand for the urgent regulation of the system is equally paramount.
p.000048:
p.000048: 2. 0. VISION AND MISSION
p.000048: 2. 1 Vision
p.000048: Provision of quality and affordable Health Services for All By 2020
p.000048:
p.000048: 2. 2 Mission
p.000048: Promote and protect the health of the population through the equitable provision of quality health care.
p.000048:
p.000048: 3.0 GOAL AND TARGETS
p.000048: Noting the challenges confronting the health sector, and having conceived the vision, mission and guiding
p.000048: principles, a number of key result areas were identified that would collectively have potential for
p.000048: maximum impact on the health status of the citizenry.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 15
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 3.1. Goal:
p.000048: Reduce morbidity and mortality to contribute significantly to quality of life in the population.
p.000048:
p.000048: Morbidity and mortality rates due to communicable diseases have decreased over the years but more pronounced
p.000048: in non-communicable diseases especially among youths and women. In addition to the earlier mentioned health
p.000048: challenges, the main factors contributing to this high morbidity in the population include social
p.000048: determinants and related factors such as poverty, unhealthy environment, unsafe working conditions, poor
p.000048: sanitation, poor nutrition, road traffic accidents, poor access to safe water and poor housing for many. The main
p.000048: causes of mortality within the population are: Malaria, Pneumonia, Anaemia, Diarrhoeal Diseases, road traffic
p.000048: accidents, pregnancy complications and Cardiovascular Diseases. Of increasing concern are the incidences of
p.000048: Tuberculosis and HIV/AIDS in the population.
p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
p.000048: • Advocate for and influence the enactment of an all-purpose Social Welfare Act by 2013
p.000048: • Set minimum care standards of practice for institutions caring for children by 2013
p.000048: • Decentralise social welfare service to all regions by end of 2014
p.000048: • Set up and maintain a Data Base System for information sharing for all the Units of the Ministry of health by 2015
p.000048: • Establish a National Social Welfare Trust Fund for the needy and vulnerable groups including children and persons
p.000048: with disabilities by 2015.
...
p.000048: • Advocate for the signing and eventual ratification of the UN Convention for persons with disabilities
p.000048: by end of 2012.
p.000048: • Set up a National Plan of Action for the prevention of disability and rehabilitation of
p.000048: persons with disabilities in accordance with the United
p.000048:
p.000048:
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p.000048: Page 16
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
...
p.000048: carry out proper monitoring and supervision of interventions. Disaster management requires a multi-sectoral
p.000048: approach: hence, the Ministry of Health will take the necessary measures to ensure there is an adequate level of
p.000048: preparedness and ability to respond to those disasters using collaborative strategies quickly and adequately.
p.000048:
p.000048: Objectives
p.000048:
p.000048: • To reduce the burden of communicable diseases to a level that they cease to be a public health problem
p.000048:
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p.000048: Page 21
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • To promote healthy life styles, increase understanding on the prevention and management of all diseases.
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen disease surveillance and response capacity at all levels
p.000048: • Provision of appropriate case management capacity at various levels of health care delivery system
p.000048: • Community empowerment on disease prevention and control measures
p.000048:
p.000048: 5.4.1 COMMUNICABLE DISEASES
p.000048: 5.4.1 (i): Malaria Policy Measures
p.000048: • Community empowerment on malaria prevention and control
p.000048: • Increase availability and access to LLINs for the general population.
p.000048: • Strengthen integrated vector control interventions (including in indoor residual spraying)
p.000048: • Strengthen the availability and accessibility of effective malaria chemoprophylaxis
p.000048: for all pregnant women
p.000048: • Strengthen Malaria Case management in all health facilities
p.000048: • Strengthen collaboration with partners in research
p.000048: • Strengthen community management of malaria
p.000048:
p.000048: 5.4.1(ii): Tuberculosis Policy Measures
p.000048: • Promote the expansion of high-quality Directly Observed Treatment Short course (DOTS)
p.000048: • Support the implementation of advocacy, communication and social mobilisation activities (ACSM)
p.000048: • Inter-sectoral coordination to address the synergistic challenges posed by TB/HIV
p.000048:
p.000048: 5.4.1(iii): HIV/AIDS
p.000048: Policy Measures
p.000048: • Expand and strengthen HIV/AIDS Counselling & Testing (HCT) and Prevention of Mother to child
p.000048: transmission (PMTCT) services.
p.000048: • Support and expand Anti-Retroviral Therapy (ART)
p.000048: • Expand the care and support services for People Living With HIV/AIDS (PLWHAs)
p.000048: • Support sentinel surveillance and research in HIV/AIDS
p.000048: • Intensify IEC/BCC/CSC interventions on HIV/AIDS
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 22
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 5.4.1(iv): Sexually Transmitted Infections (STIS) (Other Than HIV/AIDS) Policy Measures
...
p.000048: 6.1 PRIMARY HEALTH CARE (PHC) SERVICE
p.000048:
p.000048: Preamble
p.000048: The Gambia adopted Primary Health Care (PHC) in 1979 following the Alma- Ata declaration in 1978. Subsequently
p.000048: a PHC Plan of Action for the period 1980 to 1985 was formulated which formed the basis for a National Health Policy.
p.000048: In the Plan of Action, PHC has been defined as:
p.000048:
p.000048: An approach aimed at mobilising all potential resources including the communities’ own resources, towards the
p.000048: development of the National Health Care System, the aim being to extend health services coverage to the entire Gambian
p.000048: population and to attract the main disease problems of the communities. PHC is also a mechanism for ensuring an
p.000048: equitable re-distribution of the limited health resources available in the country in favour of the under-served
p.000048: majority, who live and work in the rural area.
p.000048:
p.000048: At present quite a number of PHC villages are not functioning optimally. Reasons for non performance are attributed to
p.000048: several factors namely an ineffective VDC, lack of support for community health workers, shortage of drugs and lack of
p.000048: supervision. A selective PHC programme has been designed to intervene at village level to control priority diseases
p.000048: such as Acute Respiratory Infection, Diarrhoeal Diseases, Tuberculosis, Malaria, Preventive Eye Care and
p.000048: HIV/AIDS.
p.000048:
p.000048: Support to and capacity building at primary level are essential for sustaining of basic PHC technologies needed to
p.000048: address common health problems affecting women and children, and management of development projects which have an
p.000048: impact on health
p.000048: e.g. community water supplies, sanitation, home based care for malaria, etc.
p.000048:
p.000048:
p.000048:
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p.000048: Page 27
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: In order to restore the functionality of all existing PHC villages, the Ministry of Health in collaboration with
p.000048: stakeholders and the community will review the present VDC system.
p.000048: The development of the VHS has been in isolation to the BHS. The latter possesses a wide range of resources to support
p.000048: the VHS. The policy calls for define linkages between the BHS and the VHS. A basic health facility will be linked to a
p.000048: number of trekking stations and PHC villages. This group of facilities and the population it serves
p.000048: (including non primary health care villages) will constitute a CATCHMENT AREA.
p.000048: The basic health facility will perform the first line supervision and provide support in the areas of training and
p.000048: supply of drugs to the VHS. Each catchment area will have a catchment area committee. The latter will be closely
p.000048: involved in the management, planning, monitoring and evaluation of services provided in the area under its
p.000048: jurisdiction.
p.000048: 6.1.1 Service Expansion
p.000048: At present, health services are provided by 546 health posts at the primary level. When PHC was introduced
p.000048: in 1979 some villages which did not qualify for reasons of numbers now qualify. The present policy of
...
Social / Youth/Minors
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p.000048: regional social welfare services provision and management.
p.000048:
p.000048: 1.5.2: Regional Level
p.000048: The Regional Health Directorates are headed by Regional Directors of Health Services, who are directly
p.000048: responsible to the Permanent Secretary through the Director of Health Services. Regional Directors of Health
p.000048: Services are responsible for coordinating policy interpretation, planning and implementation of health services, and
p.000048: monitoring and evaluation of health service delivery, within their respective
p.000048:
p.000048:
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p.000048: Page 13
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: regions. They are also responsible for providing technical support oversight to the basic health facilities.
p.000048:
p.000048: 1.5.3: Community Level
p.000048:
p.000048: The Village health services were established in the early 80’s to provide primary care at community level. Village
p.000048: health post (VHP) were set up in all settlements with a population of more than 400 inhabitants, served by a trained
p.000048: village health worker (VHW) and a trained traditional birth attendant (TBA) who are supervised by the
p.000048: Community Health Nurses (CHNs). They are also selected and supported by the Village Development committees
p.000048: (VDCs) at community level.
p.000048:
p.000048: 1.6: Health Service Delivery
p.000048:
p.000048: (a) Public Health Sector
p.000048: Health Service delivery is organized into three tier system:
p.000048: (1) Primary (Village Health Services)
p.000048: (2) Secondary (Minor and major Health Centres)
p.000048: (3) Tertiary (Hospitals)
p.000048:
p.000048: 1) Primary Level (Village Health Services (VHS)
p.000048:
p.000048: The VHS consist of community health workers (traditional birth attendants (TBA) and village health workers (VHW)
p.000048: who are often the first point of contact between individuals, families and communities within the health
p.000048: system. These community health workers are supervised by trained community health nurses (CHN). TBAs
p.000048: provide care for pregnant women, conduct normal deliveries, identify and refer obstetrics emergencies. The
p.000048: VHWs on the other hand are involved in health promotion and prevention measures, the treatment of minor
p.000048: ailments, and refer cases beyond their scope of management.
p.000048:
p.000048: The village health services are complemented by the Reproductive and Child Health (RCH) trekking visits from the health
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 14
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • Major Health Centres
p.000048: The major health centre serves as the referral point for minor health centres for services such as:
p.000048: comprehensive emergency obstetric care (surgical, blood transfusion services and further medical care).
p.000048: Additionally, they also offer services such as infant welfare and ante natal services, surveillance and dental
p.000048: services. The standard bed capacity for major health centres range from110 -150 beds per 150,000 - 200,000
p.000048: population.
p.000048:
p.000048: 3) Tertiary Level
p.000048: The general hospitals serve as referral points for the Major health centres as they provide specialised services.
p.000048: The Royal Victoria Teaching Hospital (RVTH) also serves as the referral hospital for the general hospitals.
p.000048:
p.000048: (b) Private Health Sector
p.000048: This includes the private for profit and private for non-profit. These are few (numbering less than 20) and
p.000048: smaller in sizes each with bed capacity less than 50 and less than 10 per cent of these are located in the
p.000048: rural community. The large majority are located in the Greater Banjul Area, making choice in health
p.000048: services delivery point in the rural community very limited.
p.000048:
p.000048: (c) Traditional Medicine
p.000048: The traditional healing system has been with us from time immemorial. The system includes bone setters, herbalists,
p.000048: spiritualists, birth attendants and those who combine the methods. The System continues to contribute
p.000048: significantly to the health of the population hence the need for their promotion and strengthening collaboration with
...
p.000048:
p.000048: 6.2.1 Major Health Centres
p.000048: The Major Health centre at the intermediate level has been designed to provide referral services for
p.000048: obstetric emergencies, essential surgical and medical care. A fully functional MHC is one of the strategies for
p.000048: the reduction of the high MMR and
p.000048:
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p.000048: Page 29
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: IMR. Providing quality services at this level develops confidence in the PHC system whilst ensuring that such services
p.000048: are brought closer to the community. In spite of the critical role that Major Health Centres have to play, their full
p.000048: impact is yet to be felt, because of several constraints All Major Health Centres are still to be provided with the
p.000048: full complement of equipment and supporting facilities such as blood transfusion services, etc. Human
p.000048: resources to carry out all the envisioned functions are in short supply whilst shortage of accommodation has
p.000048: prevented the few available staff from taking up residence. A fully functional Major Health Centre is vital in
p.000048: providing not only referral services but also the necessary environment for training all health workers in the
p.000048: Regions and fostering an atmosphere for operational research.
p.000048:
p.000048: Objectives
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To ensure the full operationaility of all six (6) Major and thirty eight (38) Minor Health Centres by 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen all Major and Minor Health Centres
p.000048: • Increasing staffing capacity and equipment of the existing public health centres to meet the national
p.000048: standards.
p.000048: • Support to health care reforms and infrastructural development and expansion of health care facilities
p.000048: • Advocate and encourage establishment of Maternal and Child Health clinics operated by Registered Nurse-Midwives
p.000048: Ensure that all major and minor health centres are provided with all required standard equipment, logistics and
p.000048: support facilities to make them fully functional
p.000048: • Development of an up-to-date standard list of equipment for Major and Minor Health Centres
p.000048: • Encourage NGO provision of basic health care for the rural communities.
p.000048: • Assessment and certification of all private and NGO health centres and clinics
p.000048: • Provision of minimum staffing levels as well as adequately furnished accommodation for such
p.000048: staff
p.000048: • Provision of vehicles to ensure that trekking and evacuation functions are executed simultaneously
p.000048:
p.000048: 6.2.2 Minor Health centres
p.000048: The physical infrastructure of the majority of Minor Health Centres is in a state of disrepair and
p.000048: dilapidation due inadequate maintenance. The majority lack the required equipment because of wear and tear and
p.000048: non replacement, a situation that is not conducive to good work and, staff morale or efficiency. The
p.000048: absence of an inventory system has made it difficult to establish accountability. Attention will be given
p.000048: to the provision of logistics such as stand by generating sets, water tanks, telecommunication sets
p.000048: including ICTs facilities.
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 30
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To refurbish and equip the existing thirty-eight (38) Minor Health Centres
p.000048:
p.000048: Policy Measures
p.000048: • Increasing staffing capacity and equipment of the existing public health centres to meet the national
p.000048: standards.
p.000048: • Support to health care reforms and infrastructural development and expansion of health care facilities
p.000048: • Advocate and encourage establishment of Maternal and Child Health clinics operated by Registered Nurse-Midwives
p.000048: Carry out a physical assessment of all Minor Health Centres in order to establish the state of disrepair
p.000048: • Establish an electronic database for physical infrastructure
p.000048: • Put in place an Inventory System for all the equipment and rules to determine their retention and disposal
p.000048: • Encourage NGO provision of basic health care for the rural communities.
p.000048: • Assessment and certification of all private and NGO health centres and clinics.
p.000048:
p.000048: 6.3 TERTIARY HEALTH CARE SERVICE
p.000048: The seven (7) Public Hospitals (1 Teaching, 5 General and 1 Regional Eye Care) will serve as the referral points for
p.000048: all cases referred from primary and secondary levels. Emergency cases referred and transported from secondary
p.000048: level will enjoy free treatment. Those otherwise referred will be exempted from consultations.
p.000048:
p.000048: Services provided will depend on available resources, priority health problems and prevailing health conditions as
p.000048: dictated by existing Health Policy. Hospitasl will also serve as the National Centre for training, biomedical
p.000048: and clinical research. Apart from established research centres and medical training institutions, they will
p.000048: be preserved to lead the Ministry’s science, technology and innovation policy initiatives. The role and
p.000048: relationships of the RVTH as a teaching hospital vis-a-vis academic institutions such as the University of the
p.000048: Gambia (UTG) under the Ministry of Higher Education, Research, Science and Technology (MOHERST) will be clarified.
p.000048:
p.000048: Objective
p.000048: • To ensure strengthening tertiary health care services
p.000048:
p.000048: Policy Measures
...
p.000097: 97
p.000097: TT2 82.0 70.0 46.54 70.0 71.48 84 79.76
p.000097: 79 75
p.000097: Measles 51.8 83.0 67.47 82.0 81.47 90 85 90.74 96
p.000092: 92
p.000092: Yellow Fever 32.3 85.0 67.97 82.0 87 89 85 94.01 96
p.000092: 92
p.000092:
p.000092: Source: EPI, MOH
p.000092:
p.000092:
p.000092:
p.000092: APPENDIX D
p.000092: Percentage of population below poverty lines 1989, 1992, 1998 and 2003
p.000092: Food poverty Overall poverty
p.000092: Banjul Urban Rural Banjul urban rural 1989
p.000092: 33 44 64 76
p.000092: 1992 5 9 23 17 40 41
p.000092: 1998* 7 22 45 21 48 61
p.000092: 2003 N/A N/A N/A 10.6 57 63
p.000092:
p.000092: Source: Reports on the 1989 and 1993-94, 1998 & 2003/04 Household Surveys.
p.000092: *Estimated for comparative purposes using a CPI based inflation of the 1992 poverty lines
p.000092:
p.000092:
p.000092:
p.000092:
p.000092:
p.000092: APPENDIX E
p.000092:
p.000092: Table 1: showing distribution of minor health facilities
p.000092: Public NGO Community Private % coverage URR 6 1
p.000092: 6 - 67
p.000092: LRR 3 - 2 1 60
p.000092: CRR 7 2 - 2 75
p.000092: NBR 8 2 1 - 100
p.000092: WR 5 5 9 3 30
p.000092: KMC 2 4 2 10 18
p.000092: Banjul 2 - - - 100
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p.000092: Page 46
p.000092:
p.000092: HEALTH IS WEALTH
p.000092:
p.000092:
p.000092: APPENDIX F
p.000092: Table 2: showing distribution of hospitals by health region
p.000092: Region General Hospitals NGO/Private Hospital Teaching Hospital URR 0 0
p.000000: 0
p.000000: LRR 0 0 0
p.000000: CRR 1 0 0
p.000000: NBR 1 0 0
p.000000: WR 1 0 0
p.000000: KMC 2 3 0
p.000000: BCC 0 1
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: APPENDIX G
p.000000:
p.000000: Table 3: MINIMUM HEALTH CARE PACKAGE
p.000000: VHS Minor H/C Major H/C
p.000000: Regional Hospital Teaching Hospital
p.000000:
p.000000: • Primary care service (including treatment of minor illnesses and referrals, environmental health & sanitation,
p.000000: antenatal, delivery and postpartum care, home visits, community health promotion activities s
p.000000: • Maternity care (antenatal, delivery and postpartum
p.000000: • Family Planning
p.000000: • STIs/RTIs/HIV/AIDS prevention and control
p.000000: • IMNCI
p.000000: • Immunisation
p.000000: • Neonatal and child health
p.000000: • Maternal and child nutrition
p.000000: • Basic EMOC
p.000000: • Basic emergency newborn care (ENC)
p.000000: • Disease prevention and control( malaria, TB, etc)
p.000000: • Health protection and control
p.000000: • Basic Lab services(HB, BF, VDRL, Urine analysis TB and HIV screening)
p.000000: • in-patient service
p.000000: • Referral services
p.000000: • Dispensary
p.000000: • Eye care services
p.000000: • Out-patient services
p.000000: • Registration of births and Deaths
p.000000: • All services provided at minor H/C level
p.000000: • Comprehensive emergency obstetric care (including theatre and blood transfusion services)
p.000000: • Functional theatre
p.000000: • Comprehensive emergency newborn care
p.000000: • In-patient services
p.000000: • Pharmacy Services
p.000000: • Basic Lab. services including HIV and TB Screening.
p.000000: • All services provided at major H/C level
p.000000: • Specialist care and service
p.000000: • Higher level referral services
p.000000: • Specialised dental and eye care services
p.000000: • Comprehensive laboratory services
p.000000: • Radiology services
p.000000: • All services provided at regional hospital level
p.000000: • Specialist hospital services (in- and out-patient services)
p.000000: • Post-mortem and embalmment services
p.000000: • Overseas referral
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: Health Policy 2012-2020
p.000000: Page 47
p.000000:
p.000000:
p.000000: HEALTH IS WEALTH
p.000000:
p.000000: APPENDIX H
p.000000: Table 4: Functions of various levels of the health system including hospitals in the implementation and monitoring of
p.000000: the policy
p.000000: Central Level Regional Level (Hospitals)
p.000000:
p.000000:
p.000000: • Policy formulation, setting standards, and quality assurance.
p.000000: • Resource mobilisation and allocation
p.000000: • Capacity development and technical support.
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Social / education
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p.000002:
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p.000002:
p.000002: MINISTRY OF HEALTH & SOCIAL WELFARE BANJUL, THE GAMBIA
p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: FOREWORD
p.000002:
p.000002: Since 1996, it was deemed imperative for The Gambia to map out clearly a strategy for socio-economic development that
p.000002: aims at raising the standard of living of The Gambian population by transforming The Gambia into a dynamic middle
p.000002: –income economy. This is the fundamental objective of “The Gambia incorporated … Vision 2020”. To the President, Vision
p.000002: 2020 is not a dream and the Government is committed to its attainment.
p.000002:
p.000002: This health policy is line with the Vision 2020 and the Millennium Development Goals (MDGs),
p.000002: the Gambia National Development Strategy (2012-2015) and Investment Program – The Program for Accelerated Growth
p.000002: and Employment (PAGE) – which will lead to achievement of all the Millennium Development Goals,
p.000002: especially those related to health; accomplish a three-quarters decline in maternal mortality and a two-thirds
p.000002: decline in mortality among children under five; to halt and reverse the spread of HIV/AIDS and to
p.000002: provide special assistance to AIDS orphans; and put the country on a strong footing to attaining the Vision of
p.000002: the President.
p.000002:
p.000002: Development of human capital stock since then has been a leading priority in the development agenda of The
p.000002: Government of The Gambia, civil society, donors’ community and academia. Health, along with education and
p.000002: nutrition, is considered as one of the key elements of human capital stock formation. Consistent with the strategic
p.000002: direction for improving human capital stock, makes health central to The Gambia’s development efforts.
p.000002:
p.000002: The theme, “health is wealth”, which is the current philosophy which our national health policy is hinged
p.000002: upon becomes a reality only when a healthy population can contribute to improved productivity, increased GDP
p.000002: and sustained economic growth and overall ensure social equilibrium. Hence the slogan:
p.000002:
p.000002: “A Healthy population is a Wealthy population”.
p.000002:
p.000002: The mission of the Ministry of Health is to contribute to socioeconomic development and wealth creation
p.000002: by promoting and protecting the health of the population through equitable provision of quality health
p.000002: care within the context of Primary Health Care. This mission puts the concept of health beyond the
p.000002: confines of curative care to other socio-economic determinants of health.
p.000002:
p.000002: The health sector despite remarkable achievements registered since 1994 to date is still under great pressure due to a
p.000002: number of factors: high population growth rate, increasing morbidity and mortality, insufficient financial and
p.000002: logistic support, deterioration of physical infrastructure, inadequacies of supplies and equipment,
p.000002: shortage of adequately and appropriately trained health personnel, high attrition rate as well as
p.000002: inadequate referral system. Poverty and ignorance have led to inappropriate health seeking behaviours thus
...
p.000002: relevant stakeholders that contribute to health service provision and the institutional framework for mobilizing
p.000002: sector- wide resources for health development. The policy update therefore provides an impetus and new direction for
p.000002: health sector development that will serve as the basis for driving our health sector priorities and planning as well
p.000002: guiding resource allocation processes in the next few years to come.
p.000002:
p.000002:
p.000002: Honourable Mme. Fatim Badjie Minister of Health & Social Welfare
p.000002: April 2012
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
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p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: Health Policy 2012-2020
p.000002: Page 3
p.000002:
p.000002: Table of content
p.000002: FOREWORD
p.000002: 2
p.000002: ABBREVIATIONS
p.000006: 6
p.000006: 1.0 INTRODUCTION
p.000008: 8
p.000008: 1.1 LOCATION, SIZE AND CLIMATE
p.000008: 8
p.000008: 1.2 DEMOGRAPHIC CHARACTERISTICS ERROR! BOOKMARK NOT
p.000008: DEFINED.
p.000008: 1.3 HEALTH SYSTEM
p.000010: 10
p.000010: 1.3.1. Health Sector Coordination Structures Error! Bookmark not defined.
p.000010: I. DIRECTORATE OF HEALTH SERVICES (DHS)
p.000011: 11
p.000011: II. DIRECTORATE OF PLANNING AND INFORMATION (DPI)
p.000011: 11
p.000011: III. DIRECTORATE OF FOOD STANDARDS, QUALITY AND HYGIENE ENFORCEMENT (FSQHE) 12
p.000011: IV. DIRECTORATE OF NATIONAL PUBLIC HEALTH LABORATORY SERVICES (NPHLS) 12
p.000011: V. DIRECTORATE OF HEALTH PROMOTION AND EDUCATION (DHPE) 12
p.000011: 1.4. HEALTH SERVICE DELIVERY
p.000014: 14
p.000014: 1.5 HEALTH STATUS OF THE POPULATION ERROR! BOOKMARK NOT DEFINED.
p.000014: 1.6: POLICY ORIENTATION
p.000010: 10
p.000010: 1.7 PROBLEM STATEMENT
p.000010: 10
p.000010: 2. 0 VISION AND MISSION
p.000015: 15
p.000015: 3.0 GUIDING PRINCIPLES
p.000017: 17
p.000017: 4.0 GOAL AND TARGETS
p.000015: 15
p.000015: 4.1. GOAL
p.000016: 16
p.000016: 4. 2 TARGETS
p.000016: 16
p.000016: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES 19
p.000016: 5.1.1 ENVIRONMENT, HEALTH AND SAFETY
p.000019: 19
p.000019: 5.1. HEALTH PROMOTION AND EDUCATION
p.000020: 20
p.000020: 5.2. EXPANDED PROGRAMME ON IMMUNISATION (EPI)
p.000020: 20
p.000020: 5.3: DISEASE CONTROL
p.000021: 21
p.000021: 5.3.1 COMMUNICABLE DISEASES
p.000022: 22
p.000022: 5.4: MALARIA
p.000022: 22
p.000022: 5.5: TUBERCULOSIS
p.000022: 22
p.000022: 5.6: HIV/AIDS
p.000022: 22
p.000022: 5.7: SEXUALLY TRANSMITTED INFECTIONS (STIs) (other than HIV/AIDS) 23
p.000022: 5.8: DIARRHOEAL DISEASES
p.000023: 23
p.000023: 5.9: TRACHOMA/EYE DISEASES
p.000023: 23
p.000023: 5.10: RESPIRATORY TRACT INFECTIONS Error! Bookmark not
p.000023: defined.
p.000023: 5.11: NON- COMMUNICABLE DISEASES (NCDs)
p.000023: 23
p.000023: 5.12: MENTAL HEALTH
p.000024: 24
p.000024: 5.13: REPRODUCTIVE AND CHILD HEALTH
p.000025: 25
p.000025: 6.0: BASIC HEALTH CARE
p.000027: 27
p.000027: 6.1 TERTIARY CARE
p.000032: 32
p.000032: 6.2 ORGANISATION AND MANAGEMENT
p.000032: 32
p.000032: 6.3: HUMAN RESOURCE MANAGEMENT
p.000032: 32
p.000032: 6.4: INFRASTRUCTURE AND LOGISTICS
p.000033: 33
p.000033: 6.5: HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) AND RESEARCH 33
p.000033: 6.6: HEALTH FINANCING
p.000034: 34
p.000034: 6.7 LEGAL FRAMEWORK
p.000036: 36
p.000036: 6.8 PARTNERSHIPS
p.000036: 36
p.000036: 7.0. TECHNICAL SUPPORT SERVICES
p.000037: 37
p.000037: 7.1 PHARMACEUTICAL SERVICES (ESSENTIAL MEDICINES, VACCINES, EQUIPMENT AND OTHER MEDICAL SUPPLIES)
p.000037: 37
p.000037: 7.2 NATIONAL BLOOD TRANSFUSION SERVICES 38
p.000037: 7.3 LABORATORY SERVICES
p.000039: 39
...
p.000048: BI - Bamako Initiative
p.000048: BTS - Blood Transfusion Services
p.000048: CBO - Community Based Organisation
p.000048: CP - Chief Pharmacist
p.000048: CSD - Central Statistics Department
p.000048: DFSQHE - Directorate of Food Security, Quality and Hygiene Enforcement DHS -
p.000048: Director of Health Services
p.000048: DNPHLS - Directorate of National Public Health Laboratory Services DOTS -
p.000048: Directly Observed Treatment Short course
p.000048: DPI - Directorate of Planning and Information
p.000048: DRF - Drug Revolving Fund
p.000048: EDC - Epidemiology and Disease Control
p.000048: EH - Environmental Health
p.000048: ENC - Emergency newborn care
p.000048: EOC - Emergency Obstetric Care
p.000048: EPI - Expanded Program on Immunization
p.000048: FP - Family Planning
p.000048: GAVI - Global Alliance for Vaccine Initiative
p.000048: HIV - Human Immunodeficiency Virus
p.000048: HMIS - Health Management Information System
p.000048: HRH - Human Resources for Health
p.000048: IEC - Information, Education and Communication
p.000048: IHR - International Health Regulations Illnesses
p.000048: IMNCI - Integrated Management of Neonatal & Childhood IPT - Intermittent
p.000048: Preventive Treatment
p.000048: ITN - Insecticide Treated Nets
p.000048: MDGs - Millennium Development Goals
p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
p.000048: PRSP - Poverty Reduction Strategy Programme
p.000048: RCH - Reproductive and Child Health
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 6
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: RFH - Riders for Health
p.000048: RH - Reproductive Health
...
p.000048: planning, organisation and coordination of the health sector at national, regional, district and community
p.000048: levels. In order to facilitate efficient and effective coordination of the sector, the following coordination
p.000048: structures have been established.
p.000048: 1.5.1 Central Level
p.000048: The MOH&SW Head Office in Banjul is responsible for overall formulation and direction of the national health
p.000048: agenda, including policy and regulatory frameworks, national health planning and priority setting, coordination,
p.000048: and monitoring and evaluation of health sector performance. It is also responsible for resource
p.000048: mobilization and allocation, and provision of technical support and supervision to the regions and specific health
p.000048: programmes. In order to facilitate efficient and effective performance of these functions, MOH&SW has established
p.000048: coordination structures at national level, which include specific directorates and programme management units,
p.000048: responsible for coordinating specific areas of focus. The current organizational structure at the Ministry includes
p.000048: the following main departments, directorates, and programme units;
p.000048:
p.000048: (a) Department of Medical and Health
p.000048: The department of Medical and Health comprised of the following directorates:
p.000048: • Directorate of Health Services (DHS)
p.000048: • Directorate of Planning and Information (DPI)
p.000048: • Directorate of Food Standards, Quality and Hygiene Enforcement (FSQHE)
p.000048: • Directorate of National Public Health Laboratory Services (NPHLS)
p.000048: • Directorate of Health Promotion and Education (HPE)
p.000048:
p.000048: i. Directorate of Health Services (DHS)
p.000048: The DHS is responsible for the coordination, management, monitoring and supervision of health care
p.000048: services within the country. The DHS provides technical advice to the Permanent Secretary and the Minister of Health
p.000048: and Social Welfare.
p.000048: It also coordinates the functions of the following programme areas: Reproductive and Child Health,
p.000048: Integrated Management of Neonatal and Childhood Illnesses (IMNCI), Expanded Programme on Immunization (EPI),
p.000048: Public Health,, National Leprosy and Tuberculosis Control Programme (NLTP), National Aids Control
p.000048: Programme (NACP), National Malaria Control Programme (NMCP), Bamako Initiative (BI), Nursing, Traditional
p.000048: Medicine and Regional Health Services provision and pharmaceutical services.
p.000048:
p.000048: ii. Directorate of Planning and Information (DPI)
p.000048: The Directorate of Planning and Information is responsible for the overall planning, budgeting, monitoring and policy
p.000048: and strategy formulation. It includes the following
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 11
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: programme areas: Budget, Planning and Policy Analysis; Human Resource Management; Health Planning,
p.000048: Monitoring and evaluation, Policy Implementation, Health System Research, Registration of Births and Deaths,
p.000048: Disease Control, Maintenance Policy Monitoring, Information Technology and Health Management Information
p.000048: System.
p.000048:
...
p.000048: • Responsible for assuring food hygiene ,safety and sanitation in hospitals and health facilities, food
p.000048: establishments and premises including markets and streets(section14(b)
p.000048: • Responsible for the control of meat, poultry, milk and other processed and unprocessed foods of plants or animal
p.000048: origin after post-mortem inspections including those in markets and groceries.
p.000048: • Responsible for the control of exports and imports of poultry, animals and products of animal origin,
p.000048: including milk and shall be effected in conjunction with authorized officers at the points of entry.
p.000048: • Responsible for the certification of food businesses and all other certification pertaining to
p.000048: food including food handler’s
p.000048:
p.000048: iv. Directorate of National Public Health Laboratory Services (NPHLS)
p.000048: National Public Health Laboratory Services (NPHLS) is the institution coordinating the services of a network
p.000048: of laboratories. Its roles and functions include:
p.000048: • Set standards, protocols and guidelines relating to national health laboratory services for public and private.
p.000048: • To ensure equitable distribution of laboratory infrastructure, equipment and supplies throughout the
p.000048: country.
p.000048: • Provision of support (technical and laboratory services) to other institutions for public and private
p.000048: • To establish and enforce quality assurance mechanism for both public and private institution
p.000048: • Monitoring and supervision of national health laboratory services in both public and private
p.000048: v. Directorate of Health Promotion and Education (DHPE)
p.000048: Health Promotion and Education involves behavioural change communication, advocacy and social
p.000048: mobilization. The components of the Directorate of Health Promotion and Education includes the following areas
p.000048: such as: Print, Electronic and Traditional Media; Non-Communicable Diseases, School Health, Community-based Information
p.000048: Education and Communication (IEC)/Behaviour Change Communication (BCC); Behavioural Research, Monitoring and
p.000048: Evaluation, Nutrition Education and
p.000048:
p.000048:
p.000048:
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p.000048: Page 12
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Promotion, Injury and Road Traffic Accidents, Hygiene and Sanitation Education, Environmental Communication
p.000048: and Population Health.
p.000048: The mandate and responsibilities of Health Promotion and Education Directorate shall include the following:
p.000048: • Planning, designing, implementing, evaluating and coordinating overall health promotion and education
p.000048: interventions for the Ministry of Health and Social Welfare;
p.000048: • Foster collaboration between the health and other sectors of government as well as institutions, organizations and
p.000048: the private sector to address the broad determinants of health;
p.000048: • Support and coordinate formulation of and or strengthening the implementation of national health promotion policy
p.000048: and national health policy, legislations or strategies for tobacco control in line with the WHO Framework Convention on
p.000048: Tobacco Control;
p.000048: • Provision of technical advice to the Ministry of Health and Social Welfare on International protocols, instruments
p.000048: and conventions that have a public health and health promotion underpinning;
p.000048: • Act as the technical adviser to the Ministry of Health and Social Welfare and oversee patient
p.000048: education/counselling in the country’s medical institutions as part of the health promoting hospital initiatives with a
p.000048: view to ensuring quality care for the poor and the socially deprived;
p.000048: • Act as the technical body to regulate health information dissemination in the country.
p.000048:
p.000048: (b) Department of Social Welfare
p.000048:
p.000048: Directorate of Social Welfare (DSW)
p.000048:
p.000048: The Department comprised of the Directorate of Social Welfare (DSW).It is responsible for the
p.000048: promotion and protection of the rights and welfare of vulnerable persons such as children, the elderly, persons
p.000048: with disability and adults in difficult circumstances. To enable them maximize their potential and minimize
p.000048: problems arising out of the imbalance between themselves and their environment as a result of social change. Their
p.000048: services focus on the social protection of individual families and groups.This includes the welfare services to the
...
p.000048: (refuse collection, removal of household waste, and health inspections), management of hazardous chemicals and
p.000048: pesticides traffic safety, prevention of road accidents, workplace safety; prevention of work-related injury and
p.000048: illness, activities providing food supplements to people who need it and medico-social activities for vulnerable
p.000048: groups.
p.000048:
p.000048: The Government is cognisant of the effects of the environment on the socioeconomic growth and development
p.000048: including health, and henceforth developed and implemented the National Environment Management Act
p.000048: (1994), the Food Act (2005), and the Public Health Act (1990). Additionally, the President initiative
p.000048: ‘Operation Clean The nation’ is geared toward addressing environmental issues. In recent years, there has been noted
p.000048: increase in the incidence of road and domestic accidents and those from industry thus warranting
p.000048: interventions to address occupational hazards.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 19
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048: • To reduce the frequency of environmental health and safety related diseases/conditions by 30% by
p.000048: 2020.
p.000048:
p.000048: Policy Measures
p.000048: • Enforcement of environmental health related Acts
p.000048: • Institute proper management of solid, gaseous and liquid wastes
p.000048: • Strengthen the environmental units of key municipalities
p.000048: 5.2. Health Promotion and Education Preamble
p.000048: Health education and promotion, mainstreamed in all health care programmes is important to the National
p.000048: health care services delivery. At present there is no Health education and promotion policy to guide the
p.000048: effective dissemination of health messages in the general population.
p.000048:
p.000048: This has led to the current situation of uncoordinated approach to the development and dissemination of
p.000048: comprehensive health messages. As a result the desired impact of the programme continued to pose
p.000048: challenges in the health services delivery.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To raise awareness among the population through the provision of relevant health information that would
p.000048: promote, protect and improve health outcomes.
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Develop and implement a comprehensive health education and promotion policy.
p.000048: • Establish an effective coordinating mechanism among all stakeholders for correct and consistent health
p.000048: messages.
p.000048: • Strengthen the capacity of service providers on information, communication and education and behavioural
p.000048: change communication strategies.
p.000048: 5.3. Expanded Programme on Immunisation (EPI) Preamble
p.000048: Though immunisation coverage continues to be impressive in The Gambia vaccine preventable diseases such as measles, TB,
p.000048: DPT poses as important challenges for the health sector. However, due to frequent staff movement and high attrition
p.000048: rates, inadequate government and donor funding, cancellation of outreach clinics and high defaulter rates, the routine
p.000048: coverage has dropped from 93.08 % in 2004 to 89.2 % in 2005. Other challenges include limited storage capacity
p.000048: especially at health facility and regional Health Office levels and over-aged cold chain equipment. . Surveillance
p.000048:
p.000048:
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p.000048: Page 20
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: is very important in the management of vaccine preventable diseases and is done in collaboration with the disease
p.000048: control unit for overall coordination.
p.000048:
p.000048: The vaccine independent initiative introduced in the mid 1990s into the EPI programme led to the creation of
p.000048: a budget line for vaccine and logistics. This budget line has been increasing over the years for the
p.000048: procurement of all traditional vaccines, and the logistics, while new vaccines are funded by GAVI.
p.000048:
p.000048: Objectives
p.000048: • To increase immunization coverage to at least 90% for all antigens at national and regional levels.
p.000048: • To ensure vaccine security for all vaccine preventable diseases
p.000048:
p.000048: Policy Measures
p.000048: • Mobilize additional financial resources for the EPI programme
p.000048: • Strengthen the effectiveness and efficiency of the EPI delivery system
...
p.000048: • Strengthen collaboration with partners in research
p.000048: • Strengthen community management of malaria
p.000048:
p.000048: 5.4.1(ii): Tuberculosis Policy Measures
p.000048: • Promote the expansion of high-quality Directly Observed Treatment Short course (DOTS)
p.000048: • Support the implementation of advocacy, communication and social mobilisation activities (ACSM)
p.000048: • Inter-sectoral coordination to address the synergistic challenges posed by TB/HIV
p.000048:
p.000048: 5.4.1(iii): HIV/AIDS
p.000048: Policy Measures
p.000048: • Expand and strengthen HIV/AIDS Counselling & Testing (HCT) and Prevention of Mother to child
p.000048: transmission (PMTCT) services.
p.000048: • Support and expand Anti-Retroviral Therapy (ART)
p.000048: • Expand the care and support services for People Living With HIV/AIDS (PLWHAs)
p.000048: • Support sentinel surveillance and research in HIV/AIDS
p.000048: • Intensify IEC/BCC/CSC interventions on HIV/AIDS
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
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p.000048: Page 22
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 5.4.1(iv): Sexually Transmitted Infections (STIS) (Other Than HIV/AIDS) Policy Measures
p.000048: • Effective information, education and counselling of the populace
p.000048: • Provision of STIs drugs and supplies in all facilities with a view to increase access
p.000048: • Train health care workers on the syndromic treatment and management of STIs with a view to provide
p.000048: proper treatment
p.000048: • Set up well equipped laboratories in all major health centres and hospitals
p.000048: • Establish STI clinics targeted specifically for most at risk populations (MARPs)
p.000048: • Provision and distribution of condoms to MARPs
p.000048: • Monitoring and supervision of STI services
p.000048:
p.000048: 5.4.1(v): Diarrhoeal Diseases Policy Measures
p.000048: • Increase access to safe water and improved sanitary facilities
p.000048: • Strengthen case management , prevention and control
p.000048:
p.000048: 5.4.1(vi): Trachoma (Eye Disease) Policy Measures
p.000048: • Elimination of blinding trachoma
p.000048: • Reduce the prevalence of active trachoma to below 5% in all communities
p.000048: • Intensify IEC/BCC/CSC intervention
p.000048: • Conduct a survey to determine the prevalence of cataract per region and set up regional cataract surgery
p.000048: targets after Training more nyateros to identify and refer all cataract cases in their communities
p.000048: • Adequate supply of equipment, drugs and consumables for eye surgery (cataract, glaucoma, retina)
p.000048: • Training of eye care providers in the prevention and management of corneal ulcers
p.000048: • Provision of optometrist assistant in each secondary eye care unit to deliver services in each division
...
p.000048: Carry out a physical assessment of all Minor Health Centres in order to establish the state of disrepair
p.000048: • Establish an electronic database for physical infrastructure
p.000048: • Put in place an Inventory System for all the equipment and rules to determine their retention and disposal
p.000048: • Encourage NGO provision of basic health care for the rural communities.
p.000048: • Assessment and certification of all private and NGO health centres and clinics.
p.000048:
p.000048: 6.3 TERTIARY HEALTH CARE SERVICE
p.000048: The seven (7) Public Hospitals (1 Teaching, 5 General and 1 Regional Eye Care) will serve as the referral points for
p.000048: all cases referred from primary and secondary levels. Emergency cases referred and transported from secondary
p.000048: level will enjoy free treatment. Those otherwise referred will be exempted from consultations.
p.000048:
p.000048: Services provided will depend on available resources, priority health problems and prevailing health conditions as
p.000048: dictated by existing Health Policy. Hospitasl will also serve as the National Centre for training, biomedical
p.000048: and clinical research. Apart from established research centres and medical training institutions, they will
p.000048: be preserved to lead the Ministry’s science, technology and innovation policy initiatives. The role and
p.000048: relationships of the RVTH as a teaching hospital vis-a-vis academic institutions such as the University of the
p.000048: Gambia (UTG) under the Ministry of Higher Education, Research, Science and Technology (MOHERST) will be clarified.
p.000048:
p.000048: Objective
p.000048: • To ensure strengthening tertiary health care services
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen the service delivery capacity of Hospitals to provide the needed specialist care
p.000048: • Classification and accreditation of all existing hospitals (Public & Private)
p.000048: • Develop Tertiary Care packages for all the categories of hospitals
p.000048: • Develop equipment, infrastructure standards and staffing norms for hospitals
p.000048: • Refurbish, equip and ensure full functionality of the hospitals
p.000048:
p.000048:
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p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • Develop a strategic plan to map out future developments to ensure sustainability.
p.000048: • Revive the Inventory System and ensure the upkeep of all assets (equipment and infrastructure) for improved
p.000048: service delivery.
p.000048:
p.000048: The hospitals will continue to enjoy semi autonomous status within the MOH with control over administrative
p.000048: and financial management according to set government financial and administrative rules and regulations. Key
p.000048: professional staff will be provided on a secondment basis according to set terms and conditions from a MOH pool.
p.000048:
p.000048: The percentage coverage presented in Appendix E estimates the number and distribution of all type health
p.000048: facilities in the country while Appendix F shows the distribution of hospitals in the Regions.
p.000048:
p.000048: Basic/minimum care package for each level of care delivery is important to enhancing standards
...
p.000048: services since the introduction of the policy in 2007 by of President of the Republic.
p.000048:
p.000048: In 2007, the first National Health Accounts (NHA) for The Gambia was constructed covering the fiscal years 2002 – 2004.
p.000048: The results revealed marginal increase in total health expenditure (THE). As a percentage of GDP, the THE was 16.1%
p.000048: in 2002, 13.9% in 2003 and 14.9% in 2004. Per capita health expenditure was D895 in 2002, D1026 in 2003 and D1203 in
p.000048: 2004. This ranges between US$33 and US$40, almost matching the WHO Commission for Macroeconomics and
p.000048: Health (CMH) recommendation of US$ 34 per capita expenditure for a package of essential health services. It is
p.000048: instructive that the bulk of these funding came from donors as over 66% of the total health funding came from
p.000048: international health development partners.
p.000048:
p.000048: While Government’s contribution to THE grew from 18% in 2002 to 24% in 2004, evidence indicates a
p.000048: decline in household’s direct out-of-pocket payments (OOP) contribution to total health expenditure, contributing
p.000048: 12% in 2002, 11% in 2003 and 9% in 2004. Total Out-of-pocket expenditure on health as percentage (%) of private
p.000048: expenditure on health is estimated to be consistently high at 70%2 for 2004, 2005 and 2006 signalling the heavy burden
p.000048: of funding health on households.
p.000048:
p.000048: Health financing system in The Gambia is organized through government tax revenue, allocated by the
p.000048: Ministry of Finance and Economic Affairs to various financing agents, e.g. Ministry of Health, Education,
p.000048: Defence, Interior and Foreign Affairs. The contribution from direct out-of-pocket payments (OOPs) for health goods
p.000048: and services do not go through any resource pooling and risk-sharing mechanism. Some private sector operators (Banks
p.000048: and NGOs) do provide medical cover for their employees, either through self-operated health clinics (e.g. Gambia Ports
p.000048: Authority (GPA) Clinic) or by paying premiums into private health insurance schemes. However there is no
p.000048: social health insurance in the Gambia. Other innovations include the Private Sector adopting hospital wards in
p.000048: health facilities for funding.
p.000048:
p.000048: Currently the funding from international donors (e.g. bilateral and multi-lateral agencies, Global Fund for
p.000048: AIDS, Tuberculosis and Malaria, GAVI) is channelled directly to the intervention programmes through the
p.000048: Ministry of Health. To a lesser extent the Local Government Authorities also contribute to health financing
p.000048: in the area of environmental sanitation and the employment of auxiliary health workers. Therefore, there is
p.000048: a need to establish a strong coordination mechanism in order to ensure accountability and transparency for the
p.000048: use of funds obtained from both Government and donor sources.
p.000048:
p.000048: This policy is in favour of the transition to universal coverage so as to contribute to meeting the needs of the
p.000048: population for health care and improving its quality, reducing poverty, attaining the Millennium
...
p.000000: M&E – Monitoring and Evaluation
p.000000: MIS – Management Information System EDC – Epidemiology and Disease Control B&D – Births and Deaths
p.000000: PAB – Policy Analysis and Budgeting QA – Quality Assurance
p.000000: FM - Facilities Maintenance IT – Information Technology
p.000000: DNPHLS – Directorate of national Public Health Laboratory Services NPHRL – National Public Health Reference
p.000000: Laboratories
p.000000: NBTS – National Blood Transfusion Services BEU – Biomedical Engineering Unit
p.000000: CL- Clinical Laboratories
p.000000: DHS - Directorate of Health Services
p.000000: DDHS – Deputy Directorate of Health Services
p.000000: PHC – Assistant Director Family Health / Primary Health Care RCH – Reproductive and Child Health
p.000000: EPI – Expanded Programme of Immunisation OHS – Occupational Health Services
p.000000: EH – Environmental Health VC – Vector Control
p.000000: IMNCI – Integrated Management of Childhood Neonatal Illnesses CNO – Chief Nursing Officer
p.000000: CPHO – Chief Public Health Officer CP – Chief Pharmacist
p.000000: NPS – national Pharmaceutical Services CMS – Central Medical Stores
p.000000: NMCP – National Malaria Control Programme
p.000000: NLTP – National Leprosy and Tuberculosis Control Programme NACP – National Aids Control Programme
p.000000: NEHP – National Eyecare Health Programme TM - Traditional Medicine
p.000000: BI – Bamako Initiative
p.000000: DFSHQE – Directorate of Food Standards Quality Hygiene Enforcement IHE - Inspection & Hygiene Enforcement
p.000000: FSQ - Foods Standard & Quality
p.000000: DHPE – Directorate of Health Promotion and Education DDHPE – Directorate of Health Promotion and Education NCD –
p.000000: Non-Communicable Diseases
p.000000: MH – Mental Health
p.000000: WS – Water and Sanitation Hygiene HC – Health Communication
p.000000: NHR – National Health Research HPP – School Health and Nutrition
p.000000: SWRO – Social Welfare Regional Offices CC - Child Care
p.000000: DU - Disability Unit AC - Adult Care
p.000000: PS – Professional Services
p.000000: RVTH – Royal Victoria Teaching Hospital SJJH – Sulayman Junkung Jammeh Hospital
p.000000:
p.000000:
p.000000: Health Policy 2012-2020
p.000000: Page 51
p.000000:
p.000000:
p.000000: HEALTH IS WEALTH
p.000000:
p.000000: JFPH – Jammeh Foundation for Peace Hospital SGH – Serekunda General Hospital
p.000000: AFPRC – Armed Forces Patriotic Ruling Council Hospital BSG – Bansang Hospital
p.000000: GMDC – Gambia Medical and Dental Council GNMC – Gambia Nurses and Midwives Council MB – Medicine’s Board
p.000000: CIO – Central Inspectorate Office
p.000000: RHDW1 – Regional Health Directorate Western 1 RHDW2 – Regional Health Directorate Western 2 RHDNBW – Regional Health
p.000000: Directorate North Bank West RHDNBE – Regional Health Directorate North Bank East
p.000000: RHDCRR – Regional Health Directorate Central River Region RHDURR – Regional Health Directorate Upper River Region
p.000000: RHDLRR – Regional Health Directorate Lower River Region VHS – Village Health Services
p.000000: VHW – Village Health Worker TBA – Traditional Birth Attendant
p.000000:
p.000000: ********
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
...
Social / employees
Searching for indicator employees:
(return to top)
p.000048: in 2002, 13.9% in 2003 and 14.9% in 2004. Per capita health expenditure was D895 in 2002, D1026 in 2003 and D1203 in
p.000048: 2004. This ranges between US$33 and US$40, almost matching the WHO Commission for Macroeconomics and
p.000048: Health (CMH) recommendation of US$ 34 per capita expenditure for a package of essential health services. It is
p.000048: instructive that the bulk of these funding came from donors as over 66% of the total health funding came from
p.000048: international health development partners.
p.000048:
p.000048: While Government’s contribution to THE grew from 18% in 2002 to 24% in 2004, evidence indicates a
p.000048: decline in household’s direct out-of-pocket payments (OOP) contribution to total health expenditure, contributing
p.000048: 12% in 2002, 11% in 2003 and 9% in 2004. Total Out-of-pocket expenditure on health as percentage (%) of private
p.000048: expenditure on health is estimated to be consistently high at 70%2 for 2004, 2005 and 2006 signalling the heavy burden
p.000048: of funding health on households.
p.000048:
p.000048: Health financing system in The Gambia is organized through government tax revenue, allocated by the
p.000048: Ministry of Finance and Economic Affairs to various financing agents, e.g. Ministry of Health, Education,
p.000048: Defence, Interior and Foreign Affairs. The contribution from direct out-of-pocket payments (OOPs) for health goods
p.000048: and services do not go through any resource pooling and risk-sharing mechanism. Some private sector operators (Banks
p.000048: and NGOs) do provide medical cover for their employees, either through self-operated health clinics (e.g. Gambia Ports
p.000048: Authority (GPA) Clinic) or by paying premiums into private health insurance schemes. However there is no
p.000048: social health insurance in the Gambia. Other innovations include the Private Sector adopting hospital wards in
p.000048: health facilities for funding.
p.000048:
p.000048: Currently the funding from international donors (e.g. bilateral and multi-lateral agencies, Global Fund for
p.000048: AIDS, Tuberculosis and Malaria, GAVI) is channelled directly to the intervention programmes through the
p.000048: Ministry of Health. To a lesser extent the Local Government Authorities also contribute to health financing
p.000048: in the area of environmental sanitation and the employment of auxiliary health workers. Therefore, there is
p.000048: a need to establish a strong coordination mechanism in order to ensure accountability and transparency for the
p.000048: use of funds obtained from both Government and donor sources.
p.000048:
p.000048: This policy is in favour of the transition to universal coverage so as to contribute to meeting the needs of the
p.000048: population for health care and improving its quality, reducing poverty, attaining the Millennium
p.000048: Development Goals (MDGs) and Paris Declaration on Aid Effectiveness.
p.000048:
p.000048:
p.000048:
p.000048: 1 Budget estimates for the period 2002 - 2007
p.000048: 2 World Health Report 2007
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 35
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objectives
p.000048: • To establish an effective public health sector financing mechanism by 2020;
...
Social / gender
Searching for indicator gender:
(return to top)
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 16
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Nations Standards Rules on Equalization of Opportunities for Persons with Disabilities by 2013.
p.000048: • Develop and implement various programmes for the protection and promotion of the rights and welfare of the
p.000048: differently vulnerable and needy groups in The Gambia by 2014
p.000048: • To reduce the prevalence of blinding trachoma to below 5% in any given community by 2020.
p.000048: • To ensure that at least 80% of all straightforward cataract surgery patients have visual acuity of no less than
p.000048: 6/18 with best correction by 2015
p.000048: • To increase immunization coverage to at least 90% for all regions and to sustain 96% coverage for
p.000048: Penta 3 nationally by 2015.
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
...
Social / parents
Searching for indicator parents:
(return to top)
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
p.000048: 4.10.2 Choice of providers and plans
p.000048: Where possible every patient shall have the right to choose health care providers who can give him/her
p.000048: high-quality health care when needed.
p.000048:
p.000048: 4.10.3 Access to emergency services
p.000048: In emergency health situations including severe pain, an injury, or sudden illness that makes a person believe that
p.000048: his/her health is in serious danger, he/she shall have the right to be screened and stabilized using emergency
p.000048: services. He/she should be able to use these services whenever and wherever needed without needing to wait for
p.000048: authorization and any financial payment.
p.000048:
p.000048: 4.10.4 Participation in treatment decisions
p.000048: Every patient shall have the right to know his/her treatment options and take part in decisions about his/her care.
p.000048: Parents, guardians, family members, or others that they identify can represent them if he/she cannot make his/her
p.000048: own decisions.
p.000048:
p.000048: 4.10.5 Respect and non-discrimination
p.000048: Every patient must have a right to considerate, respectful and non-discriminatory care from his/her health
p.000048: care provider (s),
p.000048:
p.000048: 4.10.6 Confidentiality of health information
p.000048: All patients must have the right to talk privately with health care providers and to have his/her health
p.000048: care information protected. He/she shall have the right to read and copy his/her own medical record. He/she shall have
p.000048: the right to ask that his/her health care provider change his/her record if it is not correct, relevant, or complete.
p.000048:
p.000048: 4.10.7 Complaints and appeals
p.000048: Every patient shall have the right to a fair, fast, and objective review of any complaint he/she may have against any
p.000048: health plan, health care provider/personnel or health
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 18
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: institution. This includes complaints about waiting times, operating hours, the actions of health care personnel, and
p.000048: the adequacy of health care facilities.
p.000048:
p.000048: 5.0: IMPLEMENTATION FRAMEWORK FOR HEALTH CARE PROGRAMS AND STRATEGIES
p.000048:
p.000048: Preamble
p.000048: The existing minimum health care package shall be strengthened to make available and accessible quality basic health
p.000048: services at all levels of the health care delivery system. This is essential towards addressing the common causes of
...
Social / philosophical differences/differences of opinion
Searching for indicator opinion:
(return to top)
p.000048: by Appendix J.
p.000048:
p.000048: The Public Health Council shall be established by an Act of Parliament and its function shall include,
p.000048: among other things:
p.000048: • Registration of public health officers.
p.000048: • Provide guideline for the training of PHOs.
p.000048: • Set standards for public health practice.
p.000048:
p.000048: 14.2: Clinical Audit Unit
p.000048: Establish Clinical Audit Units in all health facilities so as to strengthen routine assessment of adherence
p.000048: to set standards and norms. This is the mandate of the Medical and Dental Council in collaboration with the
p.000048: Ministry of Health and Social Welfare.
p.000048:
p.000048: 14.3: Board of Health
p.000048: A Board of Health to be established to comprise of representatives of the various Councils, policy makers
p.000048: within and out of the Health Sector, health professionals within and outside the Public Health System.
p.000048:
p.000048: The functions of the Board shall include, among other things:
p.000048: • Review and approve national health service standards
p.000048: • Monitor quality of health services nationally
p.000048: • Accredit all public, private and NGOs health facilities for service delivery
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 43
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048:
p.000048:
p.000048: 15: CONCLUSION
p.000048: This Policy was developed through consultations with and inputs from all stakeholders including
p.000048: Sector Ministries, Local Government Authorities, Faith-based Organisations, NGOs, Opinion leaders, Catchment
p.000048: Area Committees, Multi- Disciplinary Facilitation Teams (MDFT’s), and other partners in the provision of
p.000048: health care across the country. The Ministry and partners, notably from WHO and UNICEF, have demonstrated sustained
p.000048: interest and commitment to the policy process.
p.000048:
p.000048: The need to address the general health system challenges including the effects of high population growth rate;
p.000048: inadequate financial and logistic support; weak health information system; uncoordinated donor support; shortage
p.000048: of adequately and appropriately trained health staff; high attrition rate and lack of efficient and effective
p.000048: referral system has been highlighted. Therefore, renewed commitment is required from staff of Ministry, as well as
p.000048: Government and NGO and all citizens to achieve our desired goal of a “healthy and wealthy nation”.
p.000048:
p.000048: There is clear evidence that from 1994 to date there has been massive expansion in terms of health infrastructural
p.000048: development and health care needs. The commitment of the Government to implement this policy is demonstrated by the
p.000048: current structures established at both central and regional levels, the strengthening of health training institutions
p.000048: and capacity building through the training of staff both at local and international levels. The country’s
p.000048: vision statement also gave a very clear direction as to where the Gambia would want to be by 2020.
p.000048:
p.000048: ********
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
...
Searching for indicator philosophy:
(return to top)
p.000002: aims at raising the standard of living of The Gambian population by transforming The Gambia into a dynamic middle
p.000002: –income economy. This is the fundamental objective of “The Gambia incorporated … Vision 2020”. To the President, Vision
p.000002: 2020 is not a dream and the Government is committed to its attainment.
p.000002:
p.000002: This health policy is line with the Vision 2020 and the Millennium Development Goals (MDGs),
p.000002: the Gambia National Development Strategy (2012-2015) and Investment Program – The Program for Accelerated Growth
p.000002: and Employment (PAGE) – which will lead to achievement of all the Millennium Development Goals,
p.000002: especially those related to health; accomplish a three-quarters decline in maternal mortality and a two-thirds
p.000002: decline in mortality among children under five; to halt and reverse the spread of HIV/AIDS and to
p.000002: provide special assistance to AIDS orphans; and put the country on a strong footing to attaining the Vision of
p.000002: the President.
p.000002:
p.000002: Development of human capital stock since then has been a leading priority in the development agenda of The
p.000002: Government of The Gambia, civil society, donors’ community and academia. Health, along with education and
p.000002: nutrition, is considered as one of the key elements of human capital stock formation. Consistent with the strategic
p.000002: direction for improving human capital stock, makes health central to The Gambia’s development efforts.
p.000002:
p.000002: The theme, “health is wealth”, which is the current philosophy which our national health policy is hinged
p.000002: upon becomes a reality only when a healthy population can contribute to improved productivity, increased GDP
p.000002: and sustained economic growth and overall ensure social equilibrium. Hence the slogan:
p.000002:
p.000002: “A Healthy population is a Wealthy population”.
p.000002:
p.000002: The mission of the Ministry of Health is to contribute to socioeconomic development and wealth creation
p.000002: by promoting and protecting the health of the population through equitable provision of quality health
p.000002: care within the context of Primary Health Care. This mission puts the concept of health beyond the
p.000002: confines of curative care to other socio-economic determinants of health.
p.000002:
p.000002: The health sector despite remarkable achievements registered since 1994 to date is still under great pressure due to a
p.000002: number of factors: high population growth rate, increasing morbidity and mortality, insufficient financial and
p.000002: logistic support, deterioration of physical infrastructure, inadequacies of supplies and equipment,
p.000002: shortage of adequately and appropriately trained health personnel, high attrition rate as well as
p.000002: inadequate referral system. Poverty and ignorance have led to inappropriate health seeking behaviours thus
p.000002: contributing to ill health.
p.000002:
p.000002:
p.000002:
p.000002: Health Policy 2012-2020
p.000002: Page 2
p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: Indicators of child and maternal mortality are particularly worrying. This situation is worsened by other
...
Economic / Economic/Poverty
Searching for indicator poor:
(return to top)
p.000048: incident of 57%. See Appendix: D.
p.000048:
p.000048: Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in
p.000048: recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly
p.000048: Community Initiative and the Bamako Initiative.
p.000048:
p.000048: Also, relevant policy documents were developed including that of Nutrition, Drug , Malaria Reproductive and
p.000048: Child Health , Human Resource for Health , Maintenance , Mental Health , HIV/AIDS , Health Management Information
p.000048: System , National Blood Transfusion , Information Technology , and others such as Traditional Medicine,
p.000048: National Public Health Laboratory and the Health Research Policies at various stages of development.
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 9
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.3: Problem Statement
p.000048: • General health system challenges including the effects of previous high population growth
p.000048: rate; inadequate financial and logistic support; weak health information system; uncoordinated donor
p.000048: support; shortage of adequately and appropriately trained health staff; high attrition rate and lack of
p.000048: efficient and effective referral system. In addition, poverty, low awareness of health issues and poor attitude of
p.000048: service providers have led to inappropriate health seeking behaviours and contributed to ill health. These
p.000048: factors have seriously constrained efforts to reduce morbidity and mortality rates as desired and as a result health
p.000048: care delivery throughout the country has not lived up to expectation.
p.000048:
p.000048: • The frequent changes in top management positions at The Ministry of Health have been hampering
p.000048: continuity, institutional memory and policy flow. The need to have a clear direction to improve quality of health
p.000048: care and reduce the high morbidity and mortality rates requires a stable, supportive, organisational and
p.000048: management framework with a strong flexible and knowledgeable leadership, able and willing to take informed
p.000048: decisions.
p.000048:
p.000048: 1.4: Policy Orientation
p.000048: From the available statistics, it is important to enhance the delivery of quality health services in order to reduce
p.000048: the high prevailing morbidity and mortality rates.
p.000048: The need to review the current health policy framework has been influenced by the following factors:
p.000048: • The high disease burden (communicable and non-communicable diseases) needs intensification of efforts in
p.000048: our service delivery packages;
p.000048: • The disparity in the demand by the population and quality of services at different levels of health care;
p.000048: • Lessons learnt from the implementation of certain health projects/programmes like Primary Health Care,
p.000048: Bamako Initiative and Drug Revolving Fund to improve financing of health services;
...
p.000048:
p.000048: Promotion, Injury and Road Traffic Accidents, Hygiene and Sanitation Education, Environmental Communication
p.000048: and Population Health.
p.000048: The mandate and responsibilities of Health Promotion and Education Directorate shall include the following:
p.000048: • Planning, designing, implementing, evaluating and coordinating overall health promotion and education
p.000048: interventions for the Ministry of Health and Social Welfare;
p.000048: • Foster collaboration between the health and other sectors of government as well as institutions, organizations and
p.000048: the private sector to address the broad determinants of health;
p.000048: • Support and coordinate formulation of and or strengthening the implementation of national health promotion policy
p.000048: and national health policy, legislations or strategies for tobacco control in line with the WHO Framework Convention on
p.000048: Tobacco Control;
p.000048: • Provision of technical advice to the Ministry of Health and Social Welfare on International protocols, instruments
p.000048: and conventions that have a public health and health promotion underpinning;
p.000048: • Act as the technical adviser to the Ministry of Health and Social Welfare and oversee patient
p.000048: education/counselling in the country’s medical institutions as part of the health promoting hospital initiatives with a
p.000048: view to ensuring quality care for the poor and the socially deprived;
p.000048: • Act as the technical body to regulate health information dissemination in the country.
p.000048:
p.000048: (b) Department of Social Welfare
p.000048:
p.000048: Directorate of Social Welfare (DSW)
p.000048:
p.000048: The Department comprised of the Directorate of Social Welfare (DSW).It is responsible for the
p.000048: promotion and protection of the rights and welfare of vulnerable persons such as children, the elderly, persons
p.000048: with disability and adults in difficult circumstances. To enable them maximize their potential and minimize
p.000048: problems arising out of the imbalance between themselves and their environment as a result of social change. Their
p.000048: services focus on the social protection of individual families and groups.This includes the welfare services to the
p.000048: vulnerable families and individuals, child rights and protection services, elderly care, disability care services and
...
p.000048: system and the demand for the urgent regulation of the system is equally paramount.
p.000048:
p.000048: 2. 0. VISION AND MISSION
p.000048: 2. 1 Vision
p.000048: Provision of quality and affordable Health Services for All By 2020
p.000048:
p.000048: 2. 2 Mission
p.000048: Promote and protect the health of the population through the equitable provision of quality health care.
p.000048:
p.000048: 3.0 GOAL AND TARGETS
p.000048: Noting the challenges confronting the health sector, and having conceived the vision, mission and guiding
p.000048: principles, a number of key result areas were identified that would collectively have potential for
p.000048: maximum impact on the health status of the citizenry.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 15
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 3.1. Goal:
p.000048: Reduce morbidity and mortality to contribute significantly to quality of life in the population.
p.000048:
p.000048: Morbidity and mortality rates due to communicable diseases have decreased over the years but more pronounced
p.000048: in non-communicable diseases especially among youths and women. In addition to the earlier mentioned health
p.000048: challenges, the main factors contributing to this high morbidity in the population include social
p.000048: determinants and related factors such as poverty, unhealthy environment, unsafe working conditions, poor
p.000048: sanitation, poor nutrition, road traffic accidents, poor access to safe water and poor housing for many. The main
p.000048: causes of mortality within the population are: Malaria, Pneumonia, Anaemia, Diarrhoeal Diseases, road traffic
p.000048: accidents, pregnancy complications and Cardiovascular Diseases. Of increasing concern are the incidences of
p.000048: Tuberculosis and HIV/AIDS in the population.
p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
p.000048: • Total Fertility Rate reduced from 5.1 in 1999 to 4.6 by 2015,
p.000048: • Diagnose at least 70% of the total estimated incidence of new smear positive cases annually and cure at least 85%
p.000048: of new sputum smear positive patients by 2015,
p.000048: • Reduce morbidity due to non communicable diseases by 10% by 2015
p.000048: • Reduce morbidity due to other communicable diseases by 50% (2007 base).
p.000048: • Set up a monitoring and evaluation system to ensure timely feedback for corrective measures by 2013
...
p.000048: • Supporting broad based participation in support of NCD prevention and control.
p.000048: • Creating supportive environment for addressing the risk factors for NCD
p.000048: • Building and strengthening capacity for NCD research
p.000048: • Scaling up of IMNCI strategies to all levels
p.000048: • Develop and provide essential (basic) Health Care Packages at different service delivery levels
p.000048:
p.000048: 5.5: Mental Health Preamble
p.000048: It is estimated that approximately 27,000 people in the Gambia are suffering from a severe mental and/or substance
p.000048: abuse disorder and that a further 91,000 Gambians have a mild disorder still requiring treatment (World health
p.000048: Survey, 2004) .A local prevalence study in the Gambia, puts prevalence rates higher (at 20%) and leads to estimates
p.000048: of approximately 180,000 people suffering from a mental or substance abuse disorder. Providing effective
p.000048: treatment and support to all these people is challenging, given the scarce health resources in the
p.000048: Gambia and an overall situation of poverty in the country, where 34% of the population live below the
p.000048: poverty line and 18% of the population are extremely poor. However, consultation
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 24
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: with many different experts, health professions and key individuals from different government sectors has
p.000048: highlighted the great need, willingness and strategies required to strengthen the overall mental health system in
p.000048: order to provide effective treatment and care to those in need as well as to promote the mental health of all Gambians.
p.000048:
p.000048: Objective
p.000048:
p.000048: • Improve access to quality mental health care for all Gambians
p.000048: Policy Measures
p.000048:
p.000048: • Implement the Mental Health Policy and Strategy
p.000048: • Strengthening capacity for the diagnosis, management, prevention and control of mental and
p.000048: neurological disorders
p.000048: • Providing quality, equitable and affordable mental health services to the general population
p.000048: • Promote IEC on substance abuse
p.000048: • Promoting advocacy for the reduction of stigma and discrimination against people with mental and
p.000048: neurological disorders
p.000048: • Strengthening community involvement and participation in mental health care service delivery
p.000048: • Operationalise the revised current Lunatics’ Detention Act of 1917 taking into account a new mental health
p.000048: legislation Establishing and strengthening capacity for mental health research
...
p.000048: nationwide coverage RCH indicators have over the years been reduced significantly. For example, MMR high has reduced
p.000048: from 1050 to 730 per 100,000 live births between 1990 and 2001(DOSH 2001). Child health indicators have
p.000048: equally been reduced. Infant mortality rate has improved from 167 (1983) to 75 per 1000 live births (2003); and
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
p.000048: Stark regional variations also exist with the above indicators. For example, MMR is two-fold higher in rural
p.000048: than in urban areas and under-five mortality is three-fold higher in Lower River Region than that of
p.000048: Banjul (137 vs. 41).
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 25
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: A combination of factors (health and non-health service related) is responsible for the above high RCH
p.000048: indicators. Unmet need for RCH services particularly emergency obstetric care services resulting
p.000048: mainly from lack of basic RH equipments and supplies, acute shortage of skilled health
p.000048: professionals, weak referral system and inadequate financial resources for RCH services are some of the health
p.000048: services. In addition to these, non-health service related factors including high fertility rate (national 5.4), poor
p.000048: and inadequate nutrition, poor socio-economic status manifested by poor housing, limited availability and access to
p.000048: safe water and basic sanitation are important determinants.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity related to but not limited to childhood, reproduction and the
p.000048: reproductive system across the country
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen and promote 24/7 Emergency Obstetric Care concept;
p.000048: • Strengthen and promote Emergency neonatal care;
p.000048: • Advocate and ensure Implementation of the national reproductive health commodity security plan;
p.000048: • Introduce and institutionalise peri-natal reviews and audits;
p.000048: • Maintain, promote and protect the free of cost policy for MCH services;
p.000048: • Establish a minimum RCH care package;
p.000048: • Monitoring, evaluation and research
p.000048: • Increase awareness on sexual, reproductive and child health issues;
p.000048: • Promote partnership and coordination among all stake holders in the field of RCH;
p.000048: • Create opportunities for the improvement of the nutritional status of the vulnerable groups.
p.000048: • Operationalize operating theatres in all major health facilities.
p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
...
Searching for indicator poverty:
(return to top)
p.000002: nutrition, is considered as one of the key elements of human capital stock formation. Consistent with the strategic
p.000002: direction for improving human capital stock, makes health central to The Gambia’s development efforts.
p.000002:
p.000002: The theme, “health is wealth”, which is the current philosophy which our national health policy is hinged
p.000002: upon becomes a reality only when a healthy population can contribute to improved productivity, increased GDP
p.000002: and sustained economic growth and overall ensure social equilibrium. Hence the slogan:
p.000002:
p.000002: “A Healthy population is a Wealthy population”.
p.000002:
p.000002: The mission of the Ministry of Health is to contribute to socioeconomic development and wealth creation
p.000002: by promoting and protecting the health of the population through equitable provision of quality health
p.000002: care within the context of Primary Health Care. This mission puts the concept of health beyond the
p.000002: confines of curative care to other socio-economic determinants of health.
p.000002:
p.000002: The health sector despite remarkable achievements registered since 1994 to date is still under great pressure due to a
p.000002: number of factors: high population growth rate, increasing morbidity and mortality, insufficient financial and
p.000002: logistic support, deterioration of physical infrastructure, inadequacies of supplies and equipment,
p.000002: shortage of adequately and appropriately trained health personnel, high attrition rate as well as
p.000002: inadequate referral system. Poverty and ignorance have led to inappropriate health seeking behaviours thus
p.000002: contributing to ill health.
p.000002:
p.000002:
p.000002:
p.000002: Health Policy 2012-2020
p.000002: Page 2
p.000002:
p.000002:
p.000002: HEALTH IS WEALTH
p.000002:
p.000002: Indicators of child and maternal mortality are particularly worrying. This situation is worsened by other
p.000002: factors related to the poverty in general resulting to the high prevalence of communicable and
p.000002: non-communicable diseases such as Malaria, Diarrhoea, Upper Respiration Tract Infection, Tuberculosis, Skin
p.000002: Disease, Accidents, Hypertension, Cancers, Eye Infection, and Pregnancy related conditions, Helminthiasis and
p.000002: malnutrition and HIV/AIDS and its spread. Most of these diseases can easily be prevented if appropriate
p.000002: environmental and lifestyle measures are taken, with more attention paid to development of health
p.000002: promotion and prevention actions than merely focusing on curative care alone.
p.000002:
p.000002: The revised policy is expected to reform the health system by addressing the major traditional problems of health,
p.000002: the new challenges and the double burden of communicable and non-communicable diseases, curbing the
p.000002: HIV/AIDS pandemic and overcoming a weak health system. This reform is in line with the Local Government
p.000002: decentralization and planning based upon the Local Government ACT of (2002), Vision 2020 and the
p.000002: anti-poverty Programme for Accelerated Growth and Employment (PAGE), attainment of MDG: 4 Reduce Child Mortality; MDG:
p.000002: 5 Improve Maternal Health; and MDG: 6 Combat HIV/AIDS, Malaria and Other Diseases.
p.000002:
p.000002: Implementation of policy measures will certainly impact on reducing morbidity and mortality of major diseases, promote
p.000002: healthy lifestyle, and reduce health risks and exposures associated with negative environmental consequences. It
p.000002: provides basis for an institutional and legal framework for implementation of policy measures. It also identifies
p.000002: relevant stakeholders that contribute to health service provision and the institutional framework for mobilizing
p.000002: sector- wide resources for health development. The policy update therefore provides an impetus and new direction for
p.000002: health sector development that will serve as the basis for driving our health sector priorities and planning as well
p.000002: guiding resource allocation processes in the next few years to come.
p.000002:
p.000002:
p.000002: Honourable Mme. Fatim Badjie Minister of Health & Social Welfare
p.000002: April 2012
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002:
p.000002: Health Policy 2012-2020
p.000002: Page 3
p.000002:
p.000002: Table of content
p.000002: FOREWORD
p.000002: 2
p.000002: ABBREVIATIONS
p.000006: 6
p.000006: 1.0 INTRODUCTION
p.000008: 8
p.000008: 1.1 LOCATION, SIZE AND CLIMATE
p.000008: 8
p.000008: 1.2 DEMOGRAPHIC CHARACTERISTICS ERROR! BOOKMARK NOT
p.000008: DEFINED.
...
p.000048: HIV - Human Immunodeficiency Virus
p.000048: HMIS - Health Management Information System
p.000048: HRH - Human Resources for Health
p.000048: IEC - Information, Education and Communication
p.000048: IHR - International Health Regulations Illnesses
p.000048: IMNCI - Integrated Management of Neonatal & Childhood IPT - Intermittent
p.000048: Preventive Treatment
p.000048: ITN - Insecticide Treated Nets
p.000048: MDGs - Millennium Development Goals
p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
p.000048: PLWHA - People Living With HIV/AIDS
p.000048: PMO - Personnel Management Office
p.000048: PRSP - Poverty Reduction Strategy Programme
p.000048: RCH - Reproductive and Child Health
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 6
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: RFH - Riders for Health
p.000048: RH - Reproductive Health
p.000048: RHD - Regional Health Directorate
p.000048: RHO - Regional Health Officer
p.000048: RHT - Regional Health Teams
p.000048: RTI - Respiratory Tract Infections
p.000048: STI - Sexually Transmitted Diseases
p.000048: SWAp - Sector Wide Approach
p.000048: TB - Tuberculosis
p.000048: TH - Traditional Healer
p.000048: TM - Traditional Medicine
p.000048: TOR - Terms of Reference
p.000048: VC - Vector Control
p.000048: VCT - Voluntary Counselling and Testing
p.000048: VDC - Village Development Committee
p.000048: VDRL - Venereal diseases reference laboratory
p.000048: VHC - Village Health Committee
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
...
p.000048: • 24.5% prevalence rate of smoking amongst 13-15 year olds.
p.000048: • 31.3% prevalence rate of smoking among youths aged 25 to 34 years.
p.000048: • About 2% of the adult population, aged 25 – 64 years, drink alcohol
p.000048: • Low consumption of fruits and vegetables, with the average mean number of days for fruits and
p.000048: vegetable consumption among adult males and females estimated at 3.3 and 5.0 respectively
p.000048: • About 22% of the adult population (males and females) have a low level of physical activity, whilst
p.000048: nearly 59% of adults do not engage in rigorous physical activity. In the same vein, on average, Gambian adults spend
p.000048: 231 minutes per day on sedentary activities
p.000048: • On average, 41.4% of adults Gambians never had their blood pressure tested. Similarly, about 24.4% of the adult
p.000048: population have raised blood pressure (25.5% for men and 23.4% for women)
p.000048: • About 90.5% of adults (92.1% of men and 89% of women) never had their blood sugar tested
p.000048: • About 39.5% of the adult population (33.7% for men and 45.3%) are considered overweight with mean BMI >25kgM2
p.000048:
p.000048: Safe water is an essential pillar of sustainable health for the population. Access to safe water is 85.1% of the
p.000048: overall households; with 79.9% urban and 64.9% rural and access to proper sanitary facilities are not encouraging
p.000048: thus limiting to only 26% (PRSPII) for the entire country.
p.000048:
p.000048: The 2008 poverty assessment indicated that overall poverty to be at 55.5% with a poverty gap of 25.9% and poverty
p.000048: severity at 14.3%. However there are regional variation with rural poverty incident of 63% and an urban
p.000048: incident of 57%. See Appendix: D.
p.000048:
p.000048: Considerable progress has been made in the areas of: EPI Coverage, expansion of health facilities and in
p.000048: recruitment of trained health personnel. Success has been registered in the implementation of the Baby Friendly
p.000048: Community Initiative and the Bamako Initiative.
p.000048:
p.000048: Also, relevant policy documents were developed including that of Nutrition, Drug , Malaria Reproductive and
p.000048: Child Health , Human Resource for Health , Maintenance , Mental Health , HIV/AIDS , Health Management Information
p.000048: System , National Blood Transfusion , Information Technology , and others such as Traditional Medicine,
p.000048: National Public Health Laboratory and the Health Research Policies at various stages of development.
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 9
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 1.3: Problem Statement
p.000048: • General health system challenges including the effects of previous high population growth
p.000048: rate; inadequate financial and logistic support; weak health information system; uncoordinated donor
p.000048: support; shortage of adequately and appropriately trained health staff; high attrition rate and lack of
p.000048: efficient and effective referral system. In addition, poverty, low awareness of health issues and poor attitude of
p.000048: service providers have led to inappropriate health seeking behaviours and contributed to ill health. These
p.000048: factors have seriously constrained efforts to reduce morbidity and mortality rates as desired and as a result health
p.000048: care delivery throughout the country has not lived up to expectation.
p.000048:
p.000048: • The frequent changes in top management positions at The Ministry of Health have been hampering
p.000048: continuity, institutional memory and policy flow. The need to have a clear direction to improve quality of health
p.000048: care and reduce the high morbidity and mortality rates requires a stable, supportive, organisational and
p.000048: management framework with a strong flexible and knowledgeable leadership, able and willing to take informed
p.000048: decisions.
p.000048:
p.000048: 1.4: Policy Orientation
p.000048: From the available statistics, it is important to enhance the delivery of quality health services in order to reduce
p.000048: the high prevailing morbidity and mortality rates.
p.000048: The need to review the current health policy framework has been influenced by the following factors:
p.000048: • The high disease burden (communicable and non-communicable diseases) needs intensification of efforts in
p.000048: our service delivery packages;
p.000048: • The disparity in the demand by the population and quality of services at different levels of health care;
p.000048: • Lessons learnt from the implementation of certain health projects/programmes like Primary Health Care,
...
p.000048: significantly to the health of the population hence the need for their promotion and strengthening collaboration with
p.000048: the orthodox medicine. However, major concerns have been raised about the activities of quacks in the traditional
p.000048: system and the demand for the urgent regulation of the system is equally paramount.
p.000048:
p.000048: 2. 0. VISION AND MISSION
p.000048: 2. 1 Vision
p.000048: Provision of quality and affordable Health Services for All By 2020
p.000048:
p.000048: 2. 2 Mission
p.000048: Promote and protect the health of the population through the equitable provision of quality health care.
p.000048:
p.000048: 3.0 GOAL AND TARGETS
p.000048: Noting the challenges confronting the health sector, and having conceived the vision, mission and guiding
p.000048: principles, a number of key result areas were identified that would collectively have potential for
p.000048: maximum impact on the health status of the citizenry.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 15
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 3.1. Goal:
p.000048: Reduce morbidity and mortality to contribute significantly to quality of life in the population.
p.000048:
p.000048: Morbidity and mortality rates due to communicable diseases have decreased over the years but more pronounced
p.000048: in non-communicable diseases especially among youths and women. In addition to the earlier mentioned health
p.000048: challenges, the main factors contributing to this high morbidity in the population include social
p.000048: determinants and related factors such as poverty, unhealthy environment, unsafe working conditions, poor
p.000048: sanitation, poor nutrition, road traffic accidents, poor access to safe water and poor housing for many. The main
p.000048: causes of mortality within the population are: Malaria, Pneumonia, Anaemia, Diarrhoeal Diseases, road traffic
p.000048: accidents, pregnancy complications and Cardiovascular Diseases. Of increasing concern are the incidences of
p.000048: Tuberculosis and HIV/AIDS in the population.
p.000048:
p.000048: 3. 2 Targets
p.000048: • Infant mortality rate reduced from 75/1000 in 1999 to 28/1000 by 2015,
p.000048: • Under five Mortality rate reduced from 75/1000 in 1999 to 43/1000 by 2015,
p.000048: • Maternal Mortality ratio reduced from 730/100000 to 150/100000 by 2015,
p.000048: • Life expectancy national increased from 63.4 years to 69 years ,
p.000048: • Life Expectancy for women increased from 65 years to 70 years by 2015,
p.000048: • Life expectancy for men increased from 52.4 years to 58 years,
p.000048: • Malaria incidence reduced by 50% by 2015,
p.000048: • HIV/AIDS Prevalence reduced - HIV1 from 1.6% to 0.5% and HIV2 from 0.4% to 0.1% by 2015),
...
p.000048: behaviours, lifestyles and appropriate care by end 2020
p.000048:
p.000048: Policy Measures
p.000048: • To finalize and implement national NCD Policy and Strategic Plan.
p.000048: • Strengthening capacity for the management, prevention and control of NCDs
p.000048: • Supporting broad based participation in support of NCD prevention and control.
p.000048: • Creating supportive environment for addressing the risk factors for NCD
p.000048: • Building and strengthening capacity for NCD research
p.000048: • Scaling up of IMNCI strategies to all levels
p.000048: • Develop and provide essential (basic) Health Care Packages at different service delivery levels
p.000048:
p.000048: 5.5: Mental Health Preamble
p.000048: It is estimated that approximately 27,000 people in the Gambia are suffering from a severe mental and/or substance
p.000048: abuse disorder and that a further 91,000 Gambians have a mild disorder still requiring treatment (World health
p.000048: Survey, 2004) .A local prevalence study in the Gambia, puts prevalence rates higher (at 20%) and leads to estimates
p.000048: of approximately 180,000 people suffering from a mental or substance abuse disorder. Providing effective
p.000048: treatment and support to all these people is challenging, given the scarce health resources in the
p.000048: Gambia and an overall situation of poverty in the country, where 34% of the population live below the
p.000048: poverty line and 18% of the population are extremely poor. However, consultation
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 24
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: with many different experts, health professions and key individuals from different government sectors has
p.000048: highlighted the great need, willingness and strategies required to strengthen the overall mental health system in
p.000048: order to provide effective treatment and care to those in need as well as to promote the mental health of all Gambians.
p.000048:
p.000048: Objective
p.000048:
p.000048: • Improve access to quality mental health care for all Gambians
p.000048: Policy Measures
p.000048:
p.000048: • Implement the Mental Health Policy and Strategy
p.000048: • Strengthening capacity for the diagnosis, management, prevention and control of mental and
p.000048: neurological disorders
p.000048: • Providing quality, equitable and affordable mental health services to the general population
p.000048: • Promote IEC on substance abuse
p.000048: • Promoting advocacy for the reduction of stigma and discrimination against people with mental and
p.000048: neurological disorders
p.000048: • Strengthening community involvement and participation in mental health care service delivery
p.000048: • Operationalise the revised current Lunatics’ Detention Act of 1917 taking into account a new mental health
...
p.000048: Defence, Interior and Foreign Affairs. The contribution from direct out-of-pocket payments (OOPs) for health goods
p.000048: and services do not go through any resource pooling and risk-sharing mechanism. Some private sector operators (Banks
p.000048: and NGOs) do provide medical cover for their employees, either through self-operated health clinics (e.g. Gambia Ports
p.000048: Authority (GPA) Clinic) or by paying premiums into private health insurance schemes. However there is no
p.000048: social health insurance in the Gambia. Other innovations include the Private Sector adopting hospital wards in
p.000048: health facilities for funding.
p.000048:
p.000048: Currently the funding from international donors (e.g. bilateral and multi-lateral agencies, Global Fund for
p.000048: AIDS, Tuberculosis and Malaria, GAVI) is channelled directly to the intervention programmes through the
p.000048: Ministry of Health. To a lesser extent the Local Government Authorities also contribute to health financing
p.000048: in the area of environmental sanitation and the employment of auxiliary health workers. Therefore, there is
p.000048: a need to establish a strong coordination mechanism in order to ensure accountability and transparency for the
p.000048: use of funds obtained from both Government and donor sources.
p.000048:
p.000048: This policy is in favour of the transition to universal coverage so as to contribute to meeting the needs of the
p.000048: population for health care and improving its quality, reducing poverty, attaining the Millennium
p.000048: Development Goals (MDGs) and Paris Declaration on Aid Effectiveness.
p.000048:
p.000048:
p.000048:
p.000048: 1 Budget estimates for the period 2002 - 2007
p.000048: 2 World Health Report 2007
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 35
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objectives
p.000048: • To establish an effective public health sector financing mechanism by 2020;
p.000048: • To ensure provision of universal health coverage in order to meet the health needs of the entire population.
p.000048:
p.000048: Policy Measures
p.000048: • Advocate and mobilise financial resources for health
p.000048: • Strengthen the management of available financial resources in the health
p.000048: • sector
p.000048: • Explore other financing mechanisms to support the introduction of a national health insurance scheme
p.000048: • Introduction of SWAp in the Ministry of Health
p.000048:
p.000048: 8.0: LEGAL FRAMEWORK
p.000048: Preamble
p.000048: There are many health or health-related Laws and Acts that seek to regulate and/or influence outcomes. Some of
p.000048: these Acts or laws are outdated and do not reflect current realities in health care delivery.
p.000048: Therefore, it is necessary to review and update these laws/Acts for positive health outcomes. There is also a
p.000048: need to enact new laws given the emergence of new developments and challenges requiring control affecting
p.000048: health systems management including service delivery.
p.000048:
p.000048: Objective
p.000048: • To ensure all health and health related Acts reflect the current realities in the health domain.
p.000048:
p.000048: Policy Measure
...
p.000048:
p.000048: 4.7
p.000048:
p.000048: 5.9
p.000048: 7.0
p.000048: 7.3
p.000048: NA 6.5
p.000048: 6.6
p.000048: 6.0
p.000048:
p.000048: 4.0
p.000048:
p.000048: 5.0
p.000048: 6.1
p.000048: 5.8
p.000048: 6.2
p.000048: 6.0
p.000048: 6.2
p.000048: 5.4
p.000048:
p.000048: Source: 1993 & 2003 Population Census
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 45
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: APPENDIX C
p.000048:
p.000048: ROUTINE IMMUNISATION DATA BY YEAR/PERCENTAGE FROM 2001-2010
p.000048: Antigens 2001 2002 2003 2004 2005 2006 2007 2008 2009
p.002010: 2010
p.002010: BCG 50.6 88.0 81.85 83.4 83.4 90 95 94.49
p.002010: 94 92
p.002010: Hep 3 55.3 83.0 73.71 89.5 89.5 93 92 98.55
p.002010: OPV3 44.8 70.0 85.71 91.4 91.4 92 94 96.77 97
p.000097: 97
p.000097: DPT/Hib3 56.6 80.0 78.86 89.2 89.2 91 94 96.14 98
p.000097: 97
p.000097: TT2 82.0 70.0 46.54 70.0 71.48 84 79.76
p.000097: 79 75
p.000097: Measles 51.8 83.0 67.47 82.0 81.47 90 85 90.74 96
p.000092: 92
p.000092: Yellow Fever 32.3 85.0 67.97 82.0 87 89 85 94.01 96
p.000092: 92
p.000092:
p.000092: Source: EPI, MOH
p.000092:
p.000092:
p.000092:
p.000092: APPENDIX D
p.000092: Percentage of population below poverty lines 1989, 1992, 1998 and 2003
p.000092: Food poverty Overall poverty
p.000092: Banjul Urban Rural Banjul urban rural 1989
p.000092: 33 44 64 76
p.000092: 1992 5 9 23 17 40 41
p.000092: 1998* 7 22 45 21 48 61
p.000092: 2003 N/A N/A N/A 10.6 57 63
p.000092:
p.000092: Source: Reports on the 1989 and 1993-94, 1998 & 2003/04 Household Surveys.
p.000092: *Estimated for comparative purposes using a CPI based inflation of the 1992 poverty lines
p.000092:
p.000092:
p.000092:
p.000092:
p.000092:
p.000092: APPENDIX E
p.000092:
p.000092: Table 1: showing distribution of minor health facilities
p.000092: Public NGO Community Private % coverage URR 6 1
p.000092: 6 - 67
p.000092: LRR 3 - 2 1 60
p.000092: CRR 7 2 - 2 75
p.000092: NBR 8 2 1 - 100
p.000092: WR 5 5 9 3 30
p.000092: KMC 2 4 2 10 18
p.000092: Banjul 2 - - - 100
p.000092: Health Policy 2012-2020
p.000092: Page 46
p.000092:
p.000092: HEALTH IS WEALTH
p.000092:
p.000092:
p.000092: APPENDIX F
p.000092: Table 2: showing distribution of hospitals by health region
p.000092: Region General Hospitals NGO/Private Hospital Teaching Hospital URR 0 0
p.000000: 0
p.000000: LRR 0 0 0
p.000000: CRR 1 0 0
p.000000: NBR 1 0 0
p.000000: WR 1 0 0
p.000000: KMC 2 3 0
...
Searching for indicator socio-economic status:
(return to top)
p.000048: equally been reduced. Infant mortality rate has improved from 167 (1983) to 75 per 1000 live births (2003); and
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
p.000048: Stark regional variations also exist with the above indicators. For example, MMR is two-fold higher in rural
p.000048: than in urban areas and under-five mortality is three-fold higher in Lower River Region than that of
p.000048: Banjul (137 vs. 41).
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 25
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: A combination of factors (health and non-health service related) is responsible for the above high RCH
p.000048: indicators. Unmet need for RCH services particularly emergency obstetric care services resulting
p.000048: mainly from lack of basic RH equipments and supplies, acute shortage of skilled health
p.000048: professionals, weak referral system and inadequate financial resources for RCH services are some of the health
p.000048: services. In addition to these, non-health service related factors including high fertility rate (national 5.4), poor
p.000048: and inadequate nutrition, poor socio-economic status manifested by poor housing, limited availability and access to
p.000048: safe water and basic sanitation are important determinants.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity related to but not limited to childhood, reproduction and the
p.000048: reproductive system across the country
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen and promote 24/7 Emergency Obstetric Care concept;
p.000048: • Strengthen and promote Emergency neonatal care;
p.000048: • Advocate and ensure Implementation of the national reproductive health commodity security plan;
p.000048: • Introduce and institutionalise peri-natal reviews and audits;
p.000048: • Maintain, promote and protect the free of cost policy for MCH services;
p.000048: • Establish a minimum RCH care package;
p.000048: • Monitoring, evaluation and research
p.000048: • Increase awareness on sexual, reproductive and child health issues;
p.000048: • Promote partnership and coordination among all stake holders in the field of RCH;
p.000048: • Create opportunities for the improvement of the nutritional status of the vulnerable groups.
p.000048: • Operationalize operating theatres in all major health facilities.
p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
...
General/Other / Public Emergency
Searching for indicator emergency:
(return to top)
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 5
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: ABBREVIATIONS
p.000048:
p.000048: ACSM - Advocacy Communication and Social Mobilisation AIDS - Acquired
p.000048: Immune Deficiency Syndrome
p.000048: ART - Anti – Retroviral Therapy
p.000048: BCC - Behavioural Change Communication
p.000048: BFCI - Baby Friendly Community Initiative
p.000048: BI - Bamako Initiative
p.000048: BTS - Blood Transfusion Services
p.000048: CBO - Community Based Organisation
p.000048: CP - Chief Pharmacist
p.000048: CSD - Central Statistics Department
p.000048: DFSQHE - Directorate of Food Security, Quality and Hygiene Enforcement DHS -
p.000048: Director of Health Services
p.000048: DNPHLS - Directorate of National Public Health Laboratory Services DOTS -
p.000048: Directly Observed Treatment Short course
p.000048: DPI - Directorate of Planning and Information
p.000048: DRF - Drug Revolving Fund
p.000048: EDC - Epidemiology and Disease Control
p.000048: EH - Environmental Health
p.000048: ENC - Emergency newborn care
p.000048: EOC - Emergency Obstetric Care
p.000048: EPI - Expanded Program on Immunization
p.000048: FP - Family Planning
p.000048: GAVI - Global Alliance for Vaccine Initiative
p.000048: HIV - Human Immunodeficiency Virus
p.000048: HMIS - Health Management Information System
p.000048: HRH - Human Resources for Health
p.000048: IEC - Information, Education and Communication
p.000048: IHR - International Health Regulations Illnesses
p.000048: IMNCI - Integrated Management of Neonatal & Childhood IPT - Intermittent
p.000048: Preventive Treatment
p.000048: ITN - Insecticide Treated Nets
p.000048: MDGs - Millennium Development Goals
p.000048: MDT - Multi Drug Therapy
p.000048: MICS - Multiple Indicator Cluster Survey
p.000048: MOU - Memorandum of Understanding
p.000048: NCD - Non-Communicable Diseases
p.000048: NGO - Non-Governmental Organization
p.000048: NPS - National Pharmaceutical Services
p.000048: OHS - Occupational Health and Safety
p.000048: PAGE - Program for Accelerated Growth and Employment PCU - Policy
p.000048: Coordinating Unit
p.000048: PHC - Primary Health Care
p.000048: PIU - Policy Implementation Unit
...
p.000048: who are often the first point of contact between individuals, families and communities within the health
p.000048: system. These community health workers are supervised by trained community health nurses (CHN). TBAs
p.000048: provide care for pregnant women, conduct normal deliveries, identify and refer obstetrics emergencies. The
p.000048: VHWs on the other hand are involved in health promotion and prevention measures, the treatment of minor
p.000048: ailments, and refer cases beyond their scope of management.
p.000048:
p.000048: The village health services are complemented by the Reproductive and Child Health (RCH) trekking visits from the health
p.000048: centres. The RCH package includes: antenatal care, child immunization, growth monitoring, registration of births
p.000048: and deaths and limited treatment for sick children.
p.000048:
p.000048: 2) Secondary Level
p.000048: The secondary level care delivery system consists of minor and major health centres:
p.000048: • Minor Health Centre
p.000048: The minor health centre is the unit for the delivery of basic health services including basic emergency obstetric care.
p.000048: The national standard for a minor health centre is 20-40 beds per 15,000 population. The minor health centre is to
p.000048: provide up to 70 percent of the Basic Health Care Package need of the population.
p.000048:
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 14
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • Major Health Centres
p.000048: The major health centre serves as the referral point for minor health centres for services such as:
p.000048: comprehensive emergency obstetric care (surgical, blood transfusion services and further medical care).
p.000048: Additionally, they also offer services such as infant welfare and ante natal services, surveillance and dental
p.000048: services. The standard bed capacity for major health centres range from110 -150 beds per 150,000 - 200,000
p.000048: population.
p.000048:
p.000048: 3) Tertiary Level
p.000048: The general hospitals serve as referral points for the Major health centres as they provide specialised services.
p.000048: The Royal Victoria Teaching Hospital (RVTH) also serves as the referral hospital for the general hospitals.
p.000048:
p.000048: (b) Private Health Sector
p.000048: This includes the private for profit and private for non-profit. These are few (numbering less than 20) and
p.000048: smaller in sizes each with bed capacity less than 50 and less than 10 per cent of these are located in the
p.000048: rural community. The large majority are located in the Greater Banjul Area, making choice in health
p.000048: services delivery point in the rural community very limited.
p.000048:
p.000048: (c) Traditional Medicine
p.000048: The traditional healing system has been with us from time immemorial. The system includes bone setters, herbalists,
p.000048: spiritualists, birth attendants and those who combine the methods. The System continues to contribute
p.000048: significantly to the health of the population hence the need for their promotion and strengthening collaboration with
p.000048: the orthodox medicine. However, major concerns have been raised about the activities of quacks in the traditional
...
p.000048: • To contribute to the reduction of mortality due to road traffic accidents by 50% by the year 2020.
p.000048:
p.000048: 4.0 GUIDING PRINCIPLES
p.000048: 4.1 Equity
p.000048: Provision of health care shall be based on comparative need. Accessibility and affordability of quality
p.000048: services at point of demand especially for women and children, for the marginalised and underserved, irrespective
p.000048: of political national, ethnic or religious affiliations
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
p.000048: Community empowerment; active involvement of the private sector, NGOs, local government authorities and civil
p.000048: society; effective donor co-ordination
p.000048:
p.000048: 4.9 Evidence based health care
p.000048: Health planning, programming and service delivery shall be informed by evidence- based research.
p.000048:
p.000048: 4.10: Patient bill of rights
p.000048: The Patient's Bill of Rights helps patients feel more confident in the health care system. It assures that
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
p.000048: 4.10.2 Choice of providers and plans
p.000048: Where possible every patient shall have the right to choose health care providers who can give him/her
p.000048: high-quality health care when needed.
p.000048:
p.000048: 4.10.3 Access to emergency services
p.000048: In emergency health situations including severe pain, an injury, or sudden illness that makes a person believe that
p.000048: his/her health is in serious danger, he/she shall have the right to be screened and stabilized using emergency
p.000048: services. He/she should be able to use these services whenever and wherever needed without needing to wait for
p.000048: authorization and any financial payment.
p.000048:
p.000048: 4.10.4 Participation in treatment decisions
p.000048: Every patient shall have the right to know his/her treatment options and take part in decisions about his/her care.
p.000048: Parents, guardians, family members, or others that they identify can represent them if he/she cannot make his/her
p.000048: own decisions.
p.000048:
p.000048: 4.10.5 Respect and non-discrimination
p.000048: Every patient must have a right to considerate, respectful and non-discriminatory care from his/her health
p.000048: care provider (s),
p.000048:
p.000048: 4.10.6 Confidentiality of health information
p.000048: All patients must have the right to talk privately with health care providers and to have his/her health
p.000048: care information protected. He/she shall have the right to read and copy his/her own medical record. He/she shall have
p.000048: the right to ask that his/her health care provider change his/her record if it is not correct, relevant, or complete.
p.000048:
p.000048: 4.10.7 Complaints and appeals
p.000048: Every patient shall have the right to a fair, fast, and objective review of any complaint he/she may have against any
p.000048: health plan, health care provider/personnel or health
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 18
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: institution. This includes complaints about waiting times, operating hours, the actions of health care personnel, and
p.000048: the adequacy of health care facilities.
p.000048:
...
p.000048: • Develop a Mental Health Act.
p.000048:
p.000048: 5.6: Reproductive and Child Health Preamble
p.000048: RCH services are provided at all levels of the health system by both public and
p.000048: private facilities at base and outreach through a network of health facilities across the country. With an impressive
p.000048: nationwide coverage RCH indicators have over the years been reduced significantly. For example, MMR high has reduced
p.000048: from 1050 to 730 per 100,000 live births between 1990 and 2001(DOSH 2001). Child health indicators have
p.000048: equally been reduced. Infant mortality rate has improved from 167 (1983) to 75 per 1000 live births (2003); and
p.000048: under-five mortality rate has also reduced from 154 to 99 per 1000 live births between 1990 and 2003.
p.000048:
p.000048: Despite these achievements, RCH indicators are still unacceptably high and pose as tough a challenge for the country.
p.000048: Stark regional variations also exist with the above indicators. For example, MMR is two-fold higher in rural
p.000048: than in urban areas and under-five mortality is three-fold higher in Lower River Region than that of
p.000048: Banjul (137 vs. 41).
p.000048:
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 25
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: A combination of factors (health and non-health service related) is responsible for the above high RCH
p.000048: indicators. Unmet need for RCH services particularly emergency obstetric care services resulting
p.000048: mainly from lack of basic RH equipments and supplies, acute shortage of skilled health
p.000048: professionals, weak referral system and inadequate financial resources for RCH services are some of the health
p.000048: services. In addition to these, non-health service related factors including high fertility rate (national 5.4), poor
p.000048: and inadequate nutrition, poor socio-economic status manifested by poor housing, limited availability and access to
p.000048: safe water and basic sanitation are important determinants.
p.000048:
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity related to but not limited to childhood, reproduction and the
p.000048: reproductive system across the country
p.000048:
p.000048: Policy Measures
p.000048:
p.000048: • Strengthen and promote 24/7 Emergency Obstetric Care concept;
p.000048: • Strengthen and promote Emergency neonatal care;
p.000048: • Advocate and ensure Implementation of the national reproductive health commodity security plan;
p.000048: • Introduce and institutionalise peri-natal reviews and audits;
p.000048: • Maintain, promote and protect the free of cost policy for MCH services;
p.000048: • Establish a minimum RCH care package;
p.000048: • Monitoring, evaluation and research
p.000048: • Increase awareness on sexual, reproductive and child health issues;
p.000048: • Promote partnership and coordination among all stake holders in the field of RCH;
p.000048: • Create opportunities for the improvement of the nutritional status of the vulnerable groups.
p.000048: • Operationalize operating theatres in all major health facilities.
p.000048:
p.000048: 5.7: Integrated Management of Neonatal and Childhood Illnesses Preamble
p.000048: The Government of The Gambia adopted the Integrated Management of Neonatal
p.000048: and Childhood Illness (IMNCI) strategy in 1999 to address the high morbidity and mortality among children
p.000048: under five years. The IMNCI strategy combines improved case management of childhood illness in first-level health
p.000048: facilities with aspects of nutrition, immunization, disease prevention, and promotion of growth and
p.000048: development. There are three components of IMNCI which are: improving the skills of health workers; improving the
p.000048: health system, and improving household and community practices.
p.000048:
...
p.000048: Page 30
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objective
p.000048: • To ensure access to basic health care for all Gambians
p.000048: • To improve access to tertiary health care services for the Gambian population
p.000048: • To refurbish and equip the existing thirty-eight (38) Minor Health Centres
p.000048:
p.000048: Policy Measures
p.000048: • Increasing staffing capacity and equipment of the existing public health centres to meet the national
p.000048: standards.
p.000048: • Support to health care reforms and infrastructural development and expansion of health care facilities
p.000048: • Advocate and encourage establishment of Maternal and Child Health clinics operated by Registered Nurse-Midwives
p.000048: Carry out a physical assessment of all Minor Health Centres in order to establish the state of disrepair
p.000048: • Establish an electronic database for physical infrastructure
p.000048: • Put in place an Inventory System for all the equipment and rules to determine their retention and disposal
p.000048: • Encourage NGO provision of basic health care for the rural communities.
p.000048: • Assessment and certification of all private and NGO health centres and clinics.
p.000048:
p.000048: 6.3 TERTIARY HEALTH CARE SERVICE
p.000048: The seven (7) Public Hospitals (1 Teaching, 5 General and 1 Regional Eye Care) will serve as the referral points for
p.000048: all cases referred from primary and secondary levels. Emergency cases referred and transported from secondary
p.000048: level will enjoy free treatment. Those otherwise referred will be exempted from consultations.
p.000048:
p.000048: Services provided will depend on available resources, priority health problems and prevailing health conditions as
p.000048: dictated by existing Health Policy. Hospitasl will also serve as the National Centre for training, biomedical
p.000048: and clinical research. Apart from established research centres and medical training institutions, they will
p.000048: be preserved to lead the Ministry’s science, technology and innovation policy initiatives. The role and
p.000048: relationships of the RVTH as a teaching hospital vis-a-vis academic institutions such as the University of the
p.000048: Gambia (UTG) under the Ministry of Higher Education, Research, Science and Technology (MOHERST) will be clarified.
p.000048:
p.000048: Objective
p.000048: • To ensure strengthening tertiary health care services
p.000048:
p.000048: Policy Measures
p.000048: • Strengthen the service delivery capacity of Hospitals to provide the needed specialist care
p.000048: • Classification and accreditation of all existing hospitals (Public & Private)
p.000048: • Develop Tertiary Care packages for all the categories of hospitals
p.000048: • Develop equipment, infrastructure standards and staffing norms for hospitals
p.000048: • Refurbish, equip and ensure full functionality of the hospitals
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 31
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • Develop a strategic plan to map out future developments to ensure sustainability.
...
p.000000: LRR 0 0 0
p.000000: CRR 1 0 0
p.000000: NBR 1 0 0
p.000000: WR 1 0 0
p.000000: KMC 2 3 0
p.000000: BCC 0 1
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: APPENDIX G
p.000000:
p.000000: Table 3: MINIMUM HEALTH CARE PACKAGE
p.000000: VHS Minor H/C Major H/C
p.000000: Regional Hospital Teaching Hospital
p.000000:
p.000000: • Primary care service (including treatment of minor illnesses and referrals, environmental health & sanitation,
p.000000: antenatal, delivery and postpartum care, home visits, community health promotion activities s
p.000000: • Maternity care (antenatal, delivery and postpartum
p.000000: • Family Planning
p.000000: • STIs/RTIs/HIV/AIDS prevention and control
p.000000: • IMNCI
p.000000: • Immunisation
p.000000: • Neonatal and child health
p.000000: • Maternal and child nutrition
p.000000: • Basic EMOC
p.000000: • Basic emergency newborn care (ENC)
p.000000: • Disease prevention and control( malaria, TB, etc)
p.000000: • Health protection and control
p.000000: • Basic Lab services(HB, BF, VDRL, Urine analysis TB and HIV screening)
p.000000: • in-patient service
p.000000: • Referral services
p.000000: • Dispensary
p.000000: • Eye care services
p.000000: • Out-patient services
p.000000: • Registration of births and Deaths
p.000000: • All services provided at minor H/C level
p.000000: • Comprehensive emergency obstetric care (including theatre and blood transfusion services)
p.000000: • Functional theatre
p.000000: • Comprehensive emergency newborn care
p.000000: • In-patient services
p.000000: • Pharmacy Services
p.000000: • Basic Lab. services including HIV and TB Screening.
p.000000: • All services provided at major H/C level
p.000000: • Specialist care and service
p.000000: • Higher level referral services
p.000000: • Specialised dental and eye care services
p.000000: • Comprehensive laboratory services
p.000000: • Radiology services
p.000000: • All services provided at regional hospital level
p.000000: • Specialist hospital services (in- and out-patient services)
p.000000: • Post-mortem and embalmment services
p.000000: • Overseas referral
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: Health Policy 2012-2020
p.000000: Page 47
p.000000:
p.000000:
p.000000: HEALTH IS WEALTH
p.000000:
p.000000: APPENDIX H
p.000000: Table 4: Functions of various levels of the health system including hospitals in the implementation and monitoring of
p.000000: the policy
p.000000: Central Level Regional Level (Hospitals)
p.000000:
p.000000:
p.000000: • Policy formulation, setting standards, and quality assurance.
p.000000: • Resource mobilisation and allocation
p.000000: • Capacity development and technical support.
p.000000: • Provision of nationally co- ordinated services, e.g. Epidemic control
p.000000: • Co-ordination of health research.
p.000000: • Legislation
p.000000: • Monitoring and Evaluation of the overall health sector performance (M&E Template )
p.000000: • Advocacy/Partnership with stakeholders
...
General/Other / Relationship to Authority
Searching for indicator authority:
(return to top)
p.000048: continuity, institutional memory and policy flow. The need to have a clear direction to improve quality of health
p.000048: care and reduce the high morbidity and mortality rates requires a stable, supportive, organisational and
p.000048: management framework with a strong flexible and knowledgeable leadership, able and willing to take informed
p.000048: decisions.
p.000048:
p.000048: 1.4: Policy Orientation
p.000048: From the available statistics, it is important to enhance the delivery of quality health services in order to reduce
p.000048: the high prevailing morbidity and mortality rates.
p.000048: The need to review the current health policy framework has been influenced by the following factors:
p.000048: • The high disease burden (communicable and non-communicable diseases) needs intensification of efforts in
p.000048: our service delivery packages;
p.000048: • The disparity in the demand by the population and quality of services at different levels of health care;
p.000048: • Lessons learnt from the implementation of certain health projects/programmes like Primary Health Care,
p.000048: Bamako Initiative and Drug Revolving Fund to improve financing of health services;
p.000048: • The need for stronger partnership and coordination in the health sector with the donors, NGOs, private sector and
p.000048: the community in delivering health services to the population;
p.000048: • Formulation and implementation of other sector policies impacting on the health outcomes;
p.000048: • To keep pace with the Decentralisation and Local Government Reforms which emphasises an integrated
p.000048: management of government services, including health to the regions. The devolution of authority, responsibility
p.000048: and resources to the regions shall be directed by the policy framework;
p.000048: • The absence of a co-ordinated monitoring and evaluation system to measure performance and plan for
p.000048: improvements and ensure accountability; and
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 10
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: • The limited collaboration between the traditional healers and the formal health sector.
p.000048:
p.000048: 1.5: Health System
p.000048: The Ministry Of Health and Social Welfare (MOH&SW) is responsible for overall policy formulation,
p.000048: planning, organisation and coordination of the health sector at national, regional, district and community
p.000048: levels. In order to facilitate efficient and effective coordination of the sector, the following coordination
p.000048: structures have been established.
p.000048: 1.5.1 Central Level
p.000048: The MOH&SW Head Office in Banjul is responsible for overall formulation and direction of the national health
p.000048: agenda, including policy and regulatory frameworks, national health planning and priority setting, coordination,
p.000048: and monitoring and evaluation of health sector performance. It is also responsible for resource
p.000048: mobilization and allocation, and provision of technical support and supervision to the regions and specific health
p.000048: programmes. In order to facilitate efficient and effective performance of these functions, MOH&SW has established
p.000048: coordination structures at national level, which include specific directorates and programme management units,
...
p.000048:
p.000048: 4.2 Gender Equity
p.000048: The planning and implementation of all health programmes should address gender sensitive and responsive issues
p.000048: including equal involvement of men and women in decision-making; eliminating obstacles (barriers) to services
p.000048: utilisation; prevention of gender based violence.
p.000048:
p.000048: 4.3 Ethics and Standards
p.000048: Respect for human dignity, rights and confidentiality; good management practices and quality assurance of
p.000048: service delivery.
p.000048:
p.000048: 4.4 Client Satisfaction
p.000048: Accessibility to twenty-four hour quality essential services especially emergency obstetric care and blood
p.000048: transfusion services; reduced waiting time; empathy in staff attitudes; affordability and adequate staffing in health
p.000048: facilities.
p.000048:
p.000048: 4.5 Cultural Identity
p.000048: The recognition of the importance of local values and traditions, and use of traditional structures such
p.000048: as Kabilos, kaffos, traditional healers and religious leaders.
p.000048:
p.000048: 4.6 Health System Reforms
p.000048: Devolution of political and managerial responsibilities, resources and authority in line with the Government
p.000048: decentralisation programme; capacity building for the decentralised structures (institutions)
p.000048:
p.000048: 4.7 Skilled staff retention and circulation
p.000048: Attractive service conditions (package); job satisfaction to encourage a net inflow of skills
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 17
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: 4.8 Partnerships
p.000048: Community empowerment; active involvement of the private sector, NGOs, local government authorities and civil
p.000048: society; effective donor co-ordination
p.000048:
p.000048: 4.9 Evidence based health care
p.000048: Health planning, programming and service delivery shall be informed by evidence- based research.
p.000048:
p.000048: 4.10: Patient bill of rights
p.000048: The Patient's Bill of Rights helps patients feel more confident in the health care system. It assures that
p.000048: the health care system is fair and it works to meet patients' needs; gives patients a way to address any
p.000048: problems they may have; and encourages patients to take an active role in staying or getting healthy.
p.000048:
p.000048: 4.10.1 Information disclosure
p.000048: Patients have the right to accurate and easily-understood information about his/her healthcare plan, health care
p.000048: professionals, and health care facilities. This must be done using a language understood by the patient so that
p.000048: he/she can make informed health care decisions.
p.000048:
p.000048: 4.10.2 Choice of providers and plans
...
p.000048: 2004. This ranges between US$33 and US$40, almost matching the WHO Commission for Macroeconomics and
p.000048: Health (CMH) recommendation of US$ 34 per capita expenditure for a package of essential health services. It is
p.000048: instructive that the bulk of these funding came from donors as over 66% of the total health funding came from
p.000048: international health development partners.
p.000048:
p.000048: While Government’s contribution to THE grew from 18% in 2002 to 24% in 2004, evidence indicates a
p.000048: decline in household’s direct out-of-pocket payments (OOP) contribution to total health expenditure, contributing
p.000048: 12% in 2002, 11% in 2003 and 9% in 2004. Total Out-of-pocket expenditure on health as percentage (%) of private
p.000048: expenditure on health is estimated to be consistently high at 70%2 for 2004, 2005 and 2006 signalling the heavy burden
p.000048: of funding health on households.
p.000048:
p.000048: Health financing system in The Gambia is organized through government tax revenue, allocated by the
p.000048: Ministry of Finance and Economic Affairs to various financing agents, e.g. Ministry of Health, Education,
p.000048: Defence, Interior and Foreign Affairs. The contribution from direct out-of-pocket payments (OOPs) for health goods
p.000048: and services do not go through any resource pooling and risk-sharing mechanism. Some private sector operators (Banks
p.000048: and NGOs) do provide medical cover for their employees, either through self-operated health clinics (e.g. Gambia Ports
p.000048: Authority (GPA) Clinic) or by paying premiums into private health insurance schemes. However there is no
p.000048: social health insurance in the Gambia. Other innovations include the Private Sector adopting hospital wards in
p.000048: health facilities for funding.
p.000048:
p.000048: Currently the funding from international donors (e.g. bilateral and multi-lateral agencies, Global Fund for
p.000048: AIDS, Tuberculosis and Malaria, GAVI) is channelled directly to the intervention programmes through the
p.000048: Ministry of Health. To a lesser extent the Local Government Authorities also contribute to health financing
p.000048: in the area of environmental sanitation and the employment of auxiliary health workers. Therefore, there is
p.000048: a need to establish a strong coordination mechanism in order to ensure accountability and transparency for the
p.000048: use of funds obtained from both Government and donor sources.
p.000048:
p.000048: This policy is in favour of the transition to universal coverage so as to contribute to meeting the needs of the
p.000048: population for health care and improving its quality, reducing poverty, attaining the Millennium
p.000048: Development Goals (MDGs) and Paris Declaration on Aid Effectiveness.
p.000048:
p.000048:
p.000048:
p.000048: 1 Budget estimates for the period 2002 - 2007
p.000048: 2 World Health Report 2007
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 35
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: Objectives
p.000048: • To establish an effective public health sector financing mechanism by 2020;
p.000048: • To ensure provision of universal health coverage in order to meet the health needs of the entire population.
p.000048:
p.000048: Policy Measures
...
p.000048:
p.000048: Government funding is supported by Global Alliance for Vaccine and Immunisation (GAVI) for the introduction of new
p.000048: vaccines, and UNICEF continues to support the vaccine procurement process. However, there is an urgent need for
p.000048: government to increase investment in the new vaccines on a sustainable basis.
p.000048:
p.000048: Availability of contraceptives is essential for promoting reproductive and child health outcomes and has always been a
p.000048: challenge as support provided by donors is limited thus, creating intermittent shortages.
p.000048:
p.000048: Lately the Logistic Management information System (LMIS) is being set up for strengthening the supply
p.000048: management chain. The system will be used for capturing, collecting and provision of data on medicines
p.000048: and other medical supplies consumption from health facilities which will be analysed and results used
p.000048: for informed decision making.
p.000048:
p.000048: Objective
p.000048: • To ensure available and affordable essential medicines that are safe, efficacious and of the
p.000048: required quality
p.000048: • To ensure availability of consumption data on medicines and other medical supplies
p.000048:
p.000048: Policy Measures
p.000048: • Transform the supply management system for essential medicines for the public sector into a semi
p.000048: autonomous institution
p.000048: • Advocate for increased government funding for pharmaceuticals
p.000048: • Improve the drug supply system and promote the rational use of medicines and supplies.
p.000048: • Strengthen the National Medicines Regulatory Authority and enact the necessary laws toward
p.000048: attaining quality products
p.000048: • Encourage greater private sector involvement in the provision of essential medicines especially for the
p.000048: rural community
p.000048: • Establish quality control testing of pharmaceuticals.
p.000048: • Strengthen and maintain the Logistics Management Information System (LMIS).
p.000048: 10.2: National Blood Transfusion Services Preamble
p.000048: Availability of safe blood for transfusion is an essential element in the delivery of health services
p.000048: particularly those related to maternal and child health services. Unreliable supply of blood interrupts
p.000048: general clinical care for example surgical operations and road traffic accidents. There is need for an
p.000048: uninterrupted supply of safe blood.
p.000048:
p.000048: Blood transfusion services in The Gambia were limited to RVTH and Bansang hospital for several years. Over
p.000048: the years transfusion services have been expanded to other tertiary hospitals (the Sulayman Junkung General
p.000048: Hospital in Bwiam, The Armed Forces Provisional Ruling Council Hospital in Farafenni) and some major
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 38
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: health centres. Although efforts have been made in the past through public campaign but expansion of
p.000048: services coupled with limited number of voluntary blood donor has created a gap between the need and availability of
p.000048: safe blood in health facilities in the country. This has implications on receiving prompt and timely care.
p.000048:
...
General/Other / remote/rural communities
Searching for indicator rural area:
(return to top)
p.000048: Objective
p.000048:
p.000048: • To reduce mortality and morbidity associated with major causes of disease in children less than five years of age.
p.000048: Policy Measures
p.000048:
p.000048: • To monitor growth and development of children under the ages of five
p.000048: • To build the capacities of health workers on IMNCI Case Management Skills
p.000048: • To strengthen collaboration with traditional healers and other community partners for effective
p.000048: implementation of community component of the IMNCI strategy.
p.000048: • To strengthen the implementation of the IMNCI strategy in all seven health regions in the country.
p.000048:
p.000048: 6.0: BASIC HEALTH CARE AND LEVELS OF DELIVERY
p.000048: 6.1 PRIMARY HEALTH CARE (PHC) SERVICE
p.000048:
p.000048: Preamble
p.000048: The Gambia adopted Primary Health Care (PHC) in 1979 following the Alma- Ata declaration in 1978. Subsequently
p.000048: a PHC Plan of Action for the period 1980 to 1985 was formulated which formed the basis for a National Health Policy.
p.000048: In the Plan of Action, PHC has been defined as:
p.000048:
p.000048: An approach aimed at mobilising all potential resources including the communities’ own resources, towards the
p.000048: development of the National Health Care System, the aim being to extend health services coverage to the entire Gambian
p.000048: population and to attract the main disease problems of the communities. PHC is also a mechanism for ensuring an
p.000048: equitable re-distribution of the limited health resources available in the country in favour of the under-served
p.000048: majority, who live and work in the rural area.
p.000048:
p.000048: At present quite a number of PHC villages are not functioning optimally. Reasons for non performance are attributed to
p.000048: several factors namely an ineffective VDC, lack of support for community health workers, shortage of drugs and lack of
p.000048: supervision. A selective PHC programme has been designed to intervene at village level to control priority diseases
p.000048: such as Acute Respiratory Infection, Diarrhoeal Diseases, Tuberculosis, Malaria, Preventive Eye Care and
p.000048: HIV/AIDS.
p.000048:
p.000048: Support to and capacity building at primary level are essential for sustaining of basic PHC technologies needed to
p.000048: address common health problems affecting women and children, and management of development projects which have an
p.000048: impact on health
p.000048: e.g. community water supplies, sanitation, home based care for malaria, etc.
p.000048:
p.000048:
p.000048:
p.000048: Health Policy 2012-2020
p.000048: Page 27
p.000048:
p.000048:
p.000048: HEALTH IS WEALTH
p.000048:
p.000048: In order to restore the functionality of all existing PHC villages, the Ministry of Health in collaboration with
p.000048: stakeholders and the community will review the present VDC system.
p.000048: The development of the VHS has been in isolation to the BHS. The latter possesses a wide range of resources to support
p.000048: the VHS. The policy calls for define linkages between the BHS and the VHS. A basic health facility will be linked to a
p.000048: number of trekking stations and PHC villages. This group of facilities and the population it serves
...
Orphaned Trigger Words
p.000000: • Provision of nationally co- ordinated services, e.g. Epidemic control
p.000000: • Co-ordination of health research.
p.000000: • Legislation
p.000000: • Monitoring and Evaluation of the overall health sector performance (M&E Template )
p.000000: • Advocacy/Partnership with stakeholders
p.000000: • Implementation of the Health Master Plan
p.000000: • Planning and management of regional health services
p.000000: • Provision of disease prevention, health promotion, curative and rehabilitative services, with emphasis on the
p.000000: Basic Care Package.
p.000000: • Control of Communicable Diseases of public health importance in the regions
p.000000: • Vector Control.
p.000000: • Encourage provision of safe water and environmental sanitation
p.000000: • Health data collection, management, interpretation, dissemination and utilisation
p.000000: • Health System Research
p.000000: • Community partnership and advocacy
p.000000: • Resource mobilisation and allocation
p.000000: • Supervision of health care services
p.000000: • Planning and Management of Hospital Health Services
p.000000: • Provision of Hospital Health Packages
p.000000: • Training of professional staff
p.000000: • Referral for specialist care
p.000000: • Hospital data collection, management, interpretation, dissemination and utilisation.
p.000000: • Clinical research
p.000000: • Supervision of tertiary health care
p.000000:
p.000000: APPENDIX I
p.000000:
p.000000: Table 5: showing the role of councils in quality assurance of health care services
p.000000:
p.000000: Medical and Dental Council
p.000000: • Registration of medical and dental officers
p.000000: • Regulation of Medical and dental practices and ethics
p.000000: • Provide guidelines for training of Medical Officers
p.000000: • Establish clinical audit unit
p.000000: • Conduct periodic clinical audit exercise in all regions.
p.000000: Nurses and Midwives Council
p.000000: • Registration of nurses and midwives
p.000000: • Regulation of Nursing and midwifery practices and ethics
p.000000: • Provide guidelines for training of nurses and midwives
p.000000: Pharmacy Council
p.000000:
p.000000: • Registration of pharmacists and other pharmaceutical cadres
p.000000: • Regulation of Pharmacy practices and ethics
p.000000: • Provide guidelines for training of pharmacists, technicians and assistants
p.000000: Public Health Council
p.000000: The public health council shall be established by the act of parliament and its function shall be:
p.000000: • Registration of public health officers
p.000000: • Regulation of Public health practices and ethics
p.000000: • Provide guideline for the training of PHOs.
p.000000: • Set standards for public health practices
p.000000:
p.000000: Health Policy 2012-2020
p.000000: Page 48
p.000000:
p.000000:
p.000000: HEALTH IS WEALTH
p.000000:
p.000000: APPENDIX J
p.000000:
p.000000: Figure 1: ORGANOGRAM OF THE MoH&SW
p.000000:
p.000000:
p.000000: Councils & Boards
p.000000:
p.000000:
p.000000: GMDC
p.000000: Honourable Minister of Health Permanent Secretary
p.000000:
p.000000:
p.000000: Hospital Boards
p.000000:
p.000000: GNMC
p.000000: PCU
p.000000: DPS-F&A
p.000000: DPS-T
p.000000: Administration/Secretariat
p.000000: MB CMS
p.000000: CIO
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: DPI DDPI
p.000000: HRH
p.000000:
p.000000: M&E MIS EDC
p.000000: BD
p.000000:
p.000000: PAB QA IT FM
p.000000:
p.000000: DNPHLS DDNPHLS
p.000000: NPHRL
p.000000:
p.000000: NBTS
p.000000: R
p.000000: BEU H
p.000000: D
p.000000: CL
p.000000:
p.000000: DHS
p.000000:
p.000000:
p.000000:
p.000000: DDHS
p.000000:
p.000000:
p.000000:
p.000000: CNO CPHO CP
p.000000: NPS
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: ADFH/ PHC
p.000000:
p.000000: RCH EPI OHS EH VC
p.000000: NMCP
p.000000:
p.000000: NEHP NACP NLTP IMNCI
p.000000: TM BI
p.000000:
p.000000: DFSQHE DDFSQHE
p.000000: IHE FSQ
p.000000:
p.000000: DHPE DDHPE
p.000000: NCD
p.000000:
p.000000: MH WSH HC
p.000000: NHR SHN
p.000000:
p.000000: DSW DDSW
p.000000: SWRO CC DU AC
p.000000: PS
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: Hospitals
p.000000:
p.000000: RVTH SJJH JFPH AFPRCH
p.000000: BSG
p.000000: SGH
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000:
p.000000: Health Policy 2012-2020
...
Appendix
Indicator List
| Indicator | Vulnerability |
|---|
| HIV | HIV/AIDS |
| abuse | Victim of Abuse |
| access | Access to Social Goods |
| age | Age |
| armedXforces | Soldier |
| authority | Relationship to Authority |
| blindness | visual impairment |
| child | Child |
| children | Child |
| disability | Mentally Disabled |
| drug | Drug Usage |
| education | education |
| elderly | Elderly |
| emergencies | patients in emergency situations |
| emergency | Public Emergency |
| employees | employees |
| ethnic | Ethnicity |
| faith | Religion |
| family | Motherhood/Family |
| gender | gender |
| hiv/aids | HIV/AIDS |
| home | Property Ownership |
| ill | ill |
| illness | Physically Disabled |
| indigenous | Indigenous |
| infant | Infant |
| influence | Drug Usage |
| job | Occupation |
| language | Linguistic Proficiency |
| minor | Youth/Minors |
| nation | stateless persons |
| officer | Police Officer |
| opinion | philosophical differences/differences of opinion |
| parents | parents |
| philosophy | philosophical differences/differences of opinion |
| political | political affiliation |
| poor | Economic/Poverty |
| poverty | Economic/Poverty |
| pregnant | Pregnant |
| religious | Religion |
| rural area | remote/rural communities |
| sexuallyXtransmitted | sexually transmitted disases |
| sick | Physically Ill |
| social welfare | Access to Social Goods |
| socio-economic status | Economic/Poverty |
| sti | sexually transmitted disases |
| stigma | Threat of Stigma |
| substance | Drug Usage |
| threat | Threat of Stigma |
| violence | Threat of Violence |
| vulnerable | vulnerable |
| women | Women |
Indicator Peers (Indicators in Same Vulnerability)
| Indicator | Peers |
|---|
| HIV | ['hiv/aids'] |
| access | ['socialXwelfare'] |
| child | ['children'] |
| children | ['child'] |
| drug | ['influence', 'substance'] |
| faith | ['religious'] |
| hiv/aids | ['HIV'] |
| influence | ['drug', 'substance'] |
| opinion | ['philosophy'] |
| philosophy | ['opinion'] |
| poor | ['poverty', 'socio-economicXstatus'] |
| poverty | ['poor', 'socio-economicXstatus'] |
| religious | ['faith'] |
| sexuallyXtransmitted | ['sti'] |
| social welfare | ['access'] |
| socio-economic status | ['poor', 'poverty'] |
| sti | ['sexuallyXtransmitted'] |
| stigma | ['threat'] |
| substance | ['drug', 'influence'] |
| threat | ['stigma'] |
Trigger Words
capacity
cultural
developing
ethics
protect
protection
risk
sensitive
welfare
Applicable Type / Vulnerability / Indicator Overlay for this Input