The Gambia is located on the West African coast and extends about 400 km inland, with a population density of 176 people per square kilometre (The Gambia, 2013 census). The width of the country varies from 24 to 28 kilometres and has a land area of 10,689 square kilometres. According to the Population and Housing Census (2013) projections, the population is estimated at 2.4 million in 2020 (50.7% female) with an annual growth rate of 3.1%. The population size is set to reach 2.8 million in 2025. The crude birth rate is 46 per 1000 population while the total fertility rate is 4.4 births per woman (GDHS 2019-20). The high fertility level has resulted in a very youthful population structure. Nearly 44% of the population is below 15 years and 19% between the ages 15 to 24. The average life expectancy at birth is 61.5 years overall (62.3 years female; 59.6 years male) (Census 2013).
Access to health care services in The Gambia has been clearly articulated in the National Development Plan (2018 – 2021). The Government, during the lifespan of the NDP, will give priority to boosting investment in its people to build the requisite human capital for improved living standards and to power the economy. The goal for human capital development in the NDP is therefore: “quality health, education, and basic social services accessible and affordable to all and improved social and child protection systems in place for the most vulnerable”.
Although The Gambia has registered significant achievements because of improved access to basic health services across the country, Primary Health Care (PHC) has substantially changed overtime and services such as delivery of birth are no longer encouraged to be conducted by unskilled birth attendants. As the country is going through an epidemiological transition, there is considerable growth in Non-Communicable Diseases (NCDs), high out-of pocket expenditures for healthcare, serious challenges relating to maternal and women’s health, and inadequate supply of skilled health personnel are affecting the performance of the health system.
To address these issues and other challenges mentioned earlier, it is recognised that the government should invest in health system research especially on health economics and building, re-orienting and re-aligning the health system in The Gambia towards Universal Health Coverage (UHC), with an emphasis on the revised PHC structure, and maintaining effective systems to ensure improved financial protection and affordability for the most vulnerable populations, including women, children and the youth while intensifying focus on quality and equity (NDP, 2018 – 2021).
Published: April 2021