More than 66% of the total health funding in the Gambia comes from international health development partners, raising issues of sustainability and predictability of funding to the sector, the UN health agency said.
Less than 11% of the Gambia’s national budget is dedicated to healthcare. With the increasing cost of health care, the Gambia must allocate at least 15% of its budget to the sector and secure support to supplement current funding levels needed to deliver quality services.
A large portion of The Gambia’s national budget goes to Office of The President, an unnecessary allocation that could be cut and directed to health care.
Funds allocated for health care by the government are used for capacity-building for health care workers, purchase of equipment, logistics and supplies, and medications and vaccines.
Health sector constrained with limited access for rural dwellers
In the country’s eastern districts of Kantora, access to healthcare services are limited, with nursing assistants or registered nurses visiting the area once a week.
Those that are sick have to travel west to Basse or Bansang or forced to wait for a week in pain risking death, infections or serious complications.
“The health sector is sometimes constrained in that emergency purchases are inadvertently delayed due procurement procedures,” according to WHO’s Africa Health Observatory.
But The Gambia Public Procurement Authority says it wants to ensure efficient, effective and transparent procurement of medical materials.
Hospitals are ill-equipped, out of pocket cost remains high
Gambia remains far behind with changes therapeutic and diagnostic technologies and its declining economy, which is struggling with inflation and currency fluctuations is unable to cope.
In the country’s main hospital in the capital Banjul, there is only one dialysis machine. Patients have to pay thousands of dalasis and line up to wait their turn.
However, evidence indicates a decline in household’s direct out-of-pocket payment contribution to total health expenditure, which has fallen from 9% in 2004 but it still remains high.
The Gambia is mainland Africa’s smallest country and its economy is highly dependent on foreign aid, peanut export, tourism and remittances sent from citizens living aboard.
At least 75% of rural dwellers live on less than a $1.25 a day and households earn less than $350 per year.
Although it has a struggling public health system, the country avoided the wrath of the Ebola crisis that has shut down at three of it neighbors and affected three others seriously.
The Gambia’s tourism sector was seriously hit as tourist stayed away from the region. The IMF had to give the government at least US$10 million to prevent a collapse of the economy.
Pooling of resources for health financing
Gambia’s government uses a prepayment system, where funds collected through taxes, levies, special funds and insurance contributions are used to protect citizen by reducing out-of-pocket spending.
The issue of introducing health insurance for public services is currently in progress. The government is currently working on an insurance scheme for civil servants.
But WHO says this will only cover a small percentage of the population and ways of further protecting the rest of the population are needed.
Private companies in Gambia has some form of health insurance for their employees.
They finance health services through a parallel system that is used mainly by those who can afford to pay the supplementary fees, which are higher than the Government charges to see private doctors and receive treatment in private medical facilities, which deliver better health care services.
While a week’s day in ill-equipped public hospitals could cost between $50 to $75, a stay in a private hospital in Gambia for a week could range from $250 to $500. This is unaffordable to a majority of citizens, who buy thwir own medications and are forced scramble of a few dalasis to fuel ambulances to transport their sick to major health care facilities.