On 24.01.2019 Project Aid The Gambia, Projekthilfe Gambia e.V. (Germany) and Dr. Isatou Touray, Minister of Health *, signed a Memorandum of Understanding to improve health care in the rural Gambia.
1. Initial situation
The state health service in The Gambia is disastrous. The larger state run hospitals lack medicines and medical devices. The same applies to rural health centers spread across the country.
The rural health centers are structurally and hygienically in a desolate condition. Very few have a supply of electricity and running water. Health centers connected to the electricity grid have a monthly budget for electricity (“cash power”) that is too small and often used up in the middle of the month. Nocturnal births take place in the light of flashlights or cell phones.
The lack of medicines means that patients need to buy their medicines for treatment in nearby private pharmacies at overpriced prices. These private pharmacies are operated by well-trained nurses who were formerly employed in the state health care system and are now lacking the state system.
Specialist doctors are missing throughout the country. For example, in Gambia there is only one diabetologist who can treat only a very small number of diabetics – and that only in the capital area of Banjul and only with the help of an association in Germany.
Many rural nurses have left the civil service because the ministry can not provide them and their families with housing in or near the health centers.
Medical equipment donated from Germany and other European countries often does not last long, as there are no training ocapacities for technical personnel and / or lack of money for maintenance and repairs.
In 2011/2012, Project Aid The Gambia e.V., with funding from the German BMZ (Federal Ministry for Cooperation and Development), rebuilt the state run health centre in the village of Njaba Kunda as a model clinic and handed it over to the Gambian Ministry of Health.
In 2009/2010 Project Aid The Gambia e.V. carried out a structural survey of all 33 then existing rural health centers. Floor plan drawings and photos are available from that survey.
Through the project described below The Gambia could become a model region in Africa.
2. Project description
Buildings / Equipment
- The health centers shall be renovated / renovated.
- The hygienic conditions shall be improved: creation of a water supply, tiling of all premises etc.
- In each chealth centre a small laboratory shall be set up
- Housing for staff, not from the surrounding villages, should be created (new building)
- Establishment of a central “Facility Management” team of local craftsmen who are responsible for maintenance / repairs of the buildings (planned: over a period of 10 years after initial renovation or new construction
Energy and water supply
- If possible, all rural health centers shall be equipped with an uninterruptible 24/7 (solar) power and water supply – by installing small PV systems including storage batteries.
- Medical equipment (second-hand) for state hospitals shall be get hold of in Germany (donation or purchase) and be shipped to The Gambia
- Training for technical personnel
- Creating a facility for maintenance / repair of medical equipment locally in The Gambia
- The existing system of free delivery of – non-existing medicines – to patients shall be abolished. Patients shall in the future purchase prescribed drugs at the purchase price (wholesale prices) plus 10% surcharge. This has already been agreed in the present MOU.
- From drug sales and patient treatment fees, new medicines can be purchased
- The procurement of medicines incl. Logistics (delivery / storage) should be outsourced to local private wholesale pharmacies.
- This would cut off the business basis of the small private pharmacies in the neighborhoods of the health centers. The owners (nurses) would return to the state health service.
Health Centre App
Project Aid Thee Gambia is currently developing an App for smartphones, with which the operation of a health centers can be completed, including
- Registration of patients
- Revenue fees for medical treatment and laboratory services
- Diagnosis / treatment inclunding medical guidelines for the treatment / medication of the most common diseases
- Laboratory results
- Issue / prescription of medication
- Possibility of data transfer from of symptoms / diseases to UN / WHO or other international organizations.
The app sends all data daily and automatically for evaluation to a central server (via Internet or SMS)
Information on the number of patients treated and diseases are available on the same day.
The accumulation of diseases in specific places / regions and possible incipient epidemics can be detected and combated at an early stage.
Information about the number of medicines issued is available on the same day and can be used for reordering / logistics.
In larger health stations, a small network (“intranet”) with server (PC, laptop) for data storage / forwarding must be set up. Prerequisite for this is an uninterruptible 24/7 power supply. This is guaranteed by the installed PV system(s) and storage batteries.
3. Status of the Project
At the moment Project Aid The Gambia is awaiting information from the Gambian Ministry of Health about
- Number / designation of the rural health centers to be renovated / renovated
- structural condition of each health centre
- Connection to the mains
- Number of patients / year
- Existing medical equipment in state hospitals
- lack of medical equipment in state hospitals
Subsequently, the financing requirement can be determined, a cost calculation and a scheduling can be worked out. At present, partners are being sought for the implementation of the Memorandum of Understanding (MOU).
* Update: On March 15th, 2019, the Minister of Health, Dr. Isatou Touray, was appointed as the Vice President. On March 27th, 2019, Dr. Ahmadou Lamin Samateh was appointed as the new Minister of Health.