Improvements to water quality are linked to health outcomes across the country.
Alongside providing people with safe drinking water and sanitation, my government, through the Ministry of Health, is scaling up its efforts to improve our health delivery systems, especially for women and children. As a first step, we have obtained additional assets to support primary health care provision in the country. This includes 800 pedal bicycles and 29 motorbikes for Village Health Workers and Community Health Nurses across the country’s seven health regions.
I am pleased to report that the World Bank has approved US$7 million in additional funding for the Maternal and Child Health as well as the Nutrition Result Project. My government has also submitted a proposal to the EU to enhance food security. We would welcome their support to help us treat acute malnutrition and prevent all forms of under-nutrition.
With more than 95 percent coverage, we are also getting support from the Global Alliance for Vaccine Initiative (GAVI) to help us consolidate our strong track record on child immunizations. This project, estimated at US$4.6 million will help strengthen and enhance our immunization systems.” President Barrow, July 24, 2017.
A review of the President’s deliberation on health would conclude that it was entirely based on primary healthcare, which fortunately has been the most active component of the Gambian health delivery systems since the first republic, with both the secondary and tertiary remaining as strugglers.
How do we then as a nation improve the functions of the two other important components of the health system?
At a personal level and in consideration of the small size of our population, I will suggest an emulation of the National Health Service (NHS) UK and in this, primary health care should be made free or next to free in order to make it readily available as a measure of preventing disease burden while maintaining it completely at Health Centre level.
Furthermore, all the regional hospitals including Bundung Maternal and Child (formerly Jammeh Foundation) hospital be upgraded into proper general hospitals to provide affordable secondary care for each administrative region with Polyclinic serving as a secondary care service centre for Banjul.
And the Edward Francis Small Teaching Hospital and Serrekunda General Hospital can then be given full autonomy to be managed by their own independent administrations and as well upgraded as proper and well equipped tertiary hospitals for Medical & Surgical and Maternal & Child Care respectively.
However, the care at the tertiary level should be purely advanced specialist paid for services in order to meet their maintenance cost and most be made adequate and readily available by the respective hospitals.
This will help decongest both hospitals in terms of capacity needs and as well reduce the burden related to demand overriding supply which has always been the cause of deficit in services rendered at the tertiary level.
Moreover, to prevent the stagnation of the health personal (doctors and nurses) particularly doctors, the Medical and Dental council can restructure the internship program for graduates of the medical school into two phases; a one year 3 monthly rotation at the teaching hospitals and a year rotation at the regional hospitals.
This can come with three benefiting results;
1 – it will reduce the expenditure relating to increased staff capacity of the teaching hospitals thus creating funds for the improvement of other areas of the hospitals. 2 – it will improve performance by creating competition for those doctors/nurses that may want to return to the tertiary hospitals at the end of their regional hospital rotations. 3 – it will broaden and enrich the experience of those posted doctors and nurses.
How can we improve the human resource capacity to maintain the functionality of these systems?
It is commendable to say that the country has trained many doctors, nurses, public health officers and other cadres. However, in health, training without specialisation is synonymous to building a multipurpose house without furniture.
Hence the need to graduate the government’s concentration from undergraduate to postgraduate training with diversification of specialty for both doctors and nurses while creating attractive incentives for those abroad to return and contribute in the strengthening of the existing systems.
And to avoid brain drain, flexible bonds with as well incentives should be attached to postgraduate training grants which can be gained through bilateral and multilateral cooperation’s with countries like Nigeria, Turkey, India, Senegal, China etc thus instead of building a $50M conference centre or a $48M forensic lab for example, these funds can be used to train 10 -15 specialists whom in 5years upon their return can save the government more than the amount spent on their training.
It is therefore paramount for the government to work on redirecting its foreign aid policy from monetary to human resource development which will thus prevent the drainage of funds into unknown wells and as well reduce corruption.