Author: Health Policy Plus
Type of publication: Report
Date of publication: November 2019
Health Financing Overview Health financing policy and reform in The Gambia is guided by The Gambia National Health Financing Strategic Plan 2019-2024. At the macro level, health financing indicators in The Gambia present a mixed picture.
The government of The Gambia allocates a higher proportion of its total government spending to health than average among African nations. Though rising, out-of-pocket spending on health is 10 percentage points lower than the average in Africa. Total spending on health as a percent of GDP is higher than the Africa-wide average, though because The Gambia is one of Africa’s poorest countries, this higher proportional spending masks a per capita spending level about half the Africa-wide average.
Health spending in the country is heavily dependent on external partner resources. Nearly half of the total reported expenditures on health and more than two-thirds of government spending on health is donor-derived. The Gambia is committed to universal health coverage. All Gambian residents have physical access to the country’s publicly managed service delivery structure. User fees apply at the point of service and Gambian stakeholders interviewed for this assessment believe these fees are affordable for nearly all Gambians.
Only about 4 percent of the population is covered by a health insurance scheme
At the same time, system deficiencies have encouraged rising out-of-pocket spending by consumers. One example is low availability of pharmaceutical products at health facilities, which drives consumers to private pharmacies even as user fees are intended to include pharmaceuticals. In addition, poorly equipped and maintained primary healthcare facilities drive consumers to higher levels of care, where they face higher costs, and to private providers, who require fees for service. Non-Gambia residents higher user fees.
Data available from the most recent National Health Accounts (NHA 2015)) analysis report out-of-pocket costs to be 24 percent, low by international standards but a 5 percentage point increase from two years previously. If this figure is correct, it indicates that financial access to health services is relatively good. Health insurance coverage, which like the government system, can provide a pathway to universal health coverage, is very low in The Gambia; only about 4 percent of the population is covered by a health insurance scheme. A recent health financing assessment commissioned by the MOH and supported by the World Bank said increasing health insurance coverage should be investigated as a strategy for achieving universal health coverage.
Epidemiology of The Gambia’s Disease Burden
As with many countries in the region, The Gambia’s epidemiological profile is in transition. Communicable diseases are still the most common cause of death, though noncommunicable diseases are thought to be under-diagnosed and underreported as a cause of illness and death. Among official data, communicable diseases have in the aggregate declined by 8.3 percent, now comprising 55 percent of all deaths (compared to 60 percent in 2010).
Tuberculosis incidence is notably declining
Tuberculosis incidence is notably declining. The proportion of all deaths caused by noncommunicable diseases remained constant at 34 percent from 2010 to 2016, while injuries increased from 6 percent to 11 percent of all deaths, an increase in the proportion of 83 percent. Within non-communicable diseases, the relative contributions of a given disease appear to have remained largely constant over this period with the prevalence of hypertension, according to informants, the highest among non-communicable diseases.
The cause is not established for many deaths in The Gambia and actual disease distribution may differ from that based on reported deaths. The Medical Research Council maintains a cancer registry but it captures an unknown proportion of cases and the registry has not been used to estimate incidence or prevalence rates.
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