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The provision of public facilities and their location within the country had had challenges in the past. Myopic and or political interference had negative threats in the Gambia; namely the siting of a community well, prayer house, cemetery and a health facility.
The provision of medical and health services, irrespective of the cost and location, is a function of the Ministry of Health. The Ministry comprises a department of Medical and Health and equipped with a Health Planning Unit. This Unit relies much on other specialists for statistical analysis, epidemiology and demography observations. A good knowledge of these scientific observations are necessary to determine the need and location of a health facility. The required population must exist, so too the prevailing health needs, priorities and sustainability. The current debate as to the appropriateness of constructing a hospital or a health clinic inside or outside the State House further exposes the weakness apparent at the Ministry of Health and the dire need for ‘System Change’ in the Gambia. If the Ministry of Health is failing in its responsibility, another institution namely State House will fill the gap.
The Gambia may accept any form of assistance from other development partners but the ‘need’ must be established and differentiated from a ‘want’. The Medical and Health Providers (The Minister of Health and Director of Medical and Health Services) shall objectively assess the provision of a hospital or dispensary in the country. The department, guided by the National Health Policy and the Sustainable Development Goals (SDG) will determine the specialty of the facility, intended catchment areas, prevailing diseases etc. It is worth mentioning that the national development plan focuses on the following priorities:
Quality and Equitable Essential Health services to all towards a Universal Health Coverage
Maternal, Childhood, and Reproductive Services
Communicable, Non- Communicable Diseases and Injuries
Policy priorities are measures that will reduce morbidity and mortality of major diseases, promote healthy lifestyle, and reduce health risks and exposures associated with negative environmental consequences. The MOH aims at raising the standard of living of The Gambian population rather than a privileged group. The Department of Health has been on record refusing medical supplies from a Danish philanthropy who dictated where they were to be distributed. The director insisted that, having a better understanding of the Gambia’s health needs, would utilize them where needed most.
Locating a health facility within the State House will restrict access by the public or interfere with required security within the State House. The public, especially Banjulians, used to have greater access to State House vicinity enjoying the ‘Change of Guards’ and a ‘Shortcut’ way to and from the Albert Market; this is no more. The justification for the fortification of the State House has been for security reasons. The existing State House therefore, may be provided with a ‘First Aid’ Room/Facility to care for its staff in an emergency waiting for evacuation/transfer to a hospital. This is the situation for institutions or places of work typically: manufacturing industries, educational institutions and sports facilities.
For The Gambia Our Homeland!
By; Philip Saine
Rtd. Public Health Officer