Thank you Mr. Jawneh Mboge for your brilliant, thoughtful and well articulation of very important topic, “The state of public health in the Gambia.” The Socioeconomic determinants of health in the Gambia is a great concern which the new administration should look into and come up with better economic and health policies in order to improve healthcare outcomes for patients and general health of the population. As you have rightly indicated “health is wealth”. This concept is indeed a very important concept which needs to be promoted and articulated in our health policies. These policies should gear towards improving social, economic and environmental factors which all contribute to the health of any country. Though socioeconomic determinants of health are broad concept considering their physiological, social and environmental impacts on health of individual citizen, I think wealth or income is key concept which we need to focus on to address majority of our health care problems.
Wealth as an economic determinant of health is one of the most significant factors which determines health accessibility and also contribute to quality of health care outcomes and patients satisfaction. The Gambia and her citizens are not wealthy by any standard, therefore our healthcare services and its quality or outcomes are obviously undesirable. More than half of the population are Low Income earners who live in abject poverty,which grossly contributes to poor health care outcomes and satisfaction. The country’s poor economic development also results to underfunding of public health and its total neglect since independence. Our hospitals lack latest technological innovations and equipment such as MRI, CT Scan, X-ray and computerised or electronic documentation of health information (electronic medical records). We need these latest technological innovations and experts in these fields so that our healthcare system can meet the standard of 21st century. In the Gambia, many people go to Senegal for these diagnostic services. Services like cardiovascular diseases treatment, orthopedic services, and other highly need specialties treatments. The Gambia still haven’t made progress in these areas because of lack of funding and visionary leadership in the advancement of healthcare in the country. The causes of all these underdevelopment in our healthcare sector is lack of wealth or adequate financial resources both at individual and government level.
Another problem is lack of access to health education as a socioeconomic determinant of health in both general population and in school system. The general public is not educated enough about disease prevention and health promotion strategies, thus escalating the public health crisis (The result disposal of waste products, open toileting in some communities) we are currently witnessing in the country. Health information resources are also not easily available and accessible to the public. And in some communities, even primary care providers are absent. In essence, healthcare sector in the Gambia is in final transition stage from primitive to modern healthcare systems.
How do we alleviate the current trajectory?
As Mr. Mboge has stated, I also believe that “primary healthcare system approach” is indeed the best way to ensure health promotion and disease prevention in the country. It is cost effective since it lays emphasis on disease prevention and health promotion strategies. Primary strategies that encourage health promotion and disease prevention including diabetes education, provision of health information on diseases as well as disease screening for patients and their families. At community clinic level, secondary strategies can help to prevent disease development into complex conditions or before they reach tertiary, critical or chronic conditions which can be expensive and need long term rehabilitation. These can all be achieved through better healthcare, political will, advocacy and activism to ensure that resources and policies are available for functioning primary healthcare system in the country.
Leadership which encourages partnership or collaboration with public and private sectors are crucial in this effort. The Gambia needs to have National Assembly members who truly are advocates of better healthcare for all. We need deputies who have background in health or medicine so that they can truly advocate for better health policy. Deputies should partnership with leaders of communities, business, private sector and other leaders in school of nursing and medicine to play a significant role in creating strategic advocacy of comprehensive healthcare policy and system that would meet the 21 st century healthcare needs of Gambian people.
Since the government is extremely in poor economic and financial standing, Gambians in Europe and America should invest in healthcare industry by building clinics, transfer technological innovations and services such as specialty treatment services, mobile X-ray services, and other diagnostic and imaging services in the Gambia. These services will only not improve healthcare outcomes but they will also play a significant role in creating employment opportunities for Gambian people. Hence, this will serves as a poverty reduction mechanism in the country. Wealth creation through investment in healthcare business in the country will be key determinant factor to improve both our healthcare system and health of our people. Currently, foreign businessmen are leading the healthcare industry in the country and I think Gambians should take the lead since they know the cultural and social dynamics of the country. This is the way forward.