Author(s): Andrew Green, The Lancet
Date of Publication: February 2017
Gambia’s new president has stated that maternal and child health will be his first priority and experts are hoping for a new focus on health in the country. Andrew Green reports.
Following a tumultuous, but ultimately peaceful handover of power in The Gambia, aid agencies are hopeful that the new government will focus attention and resources on the small, west African country’s health needs. That includes immediate attention to the impact of potential food shortages after tens of thousands of people fled their homes in the political turmoil.
There are also calls to address the more systemic problems created by long-term governmental neglect, especially in the sectors of maternal and child health, but also the emerging threat of non-communicable diseases. Amid so many competing priorities, though, and with little immediate international support, there are worries that progress will be slow.
Incumbent President Yahya Jammeh initially agreed to step down after he lost a national vote in early December, 2016, but sparked a regional crisis when he quickly reversed course. Jammeh agreed to leave the country after neighbouring countries deployed troops in The Gambia in January, allowing Adama Barrow, who won the December poll, to assume power.
Barrow’s government has a long list of problems to address—across both health and other sectors, but few resources with which to do it. His situation is rendered even more difficult because Jammeh is reported to have taken US$11 million from the country’s treasury with him into exile, according to officials in the new administration. Still, it is clear Barrow is aware of the health-care challenges facing his country. In his inaugural address, which he delivered even before Jammeh had agreed to hand over the presidency, he made improving maternal and child health his first priority.
The country reduced infant mortality by 32% between 1998 and 2013 to 34 deaths per 1000 livebirths, according to the most recent Demographic and Health Survey. That rate jumps to 44 deaths per 1000 livebirths in rural areas, though, where health facilities are more scarce. Maternal mortality stood at 433 deaths for every 100 000 livebirths in 2013.
Meanwhile, “infectious diseases still represent a major burden, but, due to urbanisation and changes in lifestyle, the country suffers from the so-called double burden, with non-communicable diseases rising rapidly”, said Umberto D’Alessandro, the unit director of the Medical Research Council (MRC) Unit in The Gambia.
Despite the challenges created under the previous administration—and heightened during the recent turmoil—D’Alessandro said the country’s health system is positioned for rapid improvement. He pointed to a diaspora of Gambian health professionals who could return to the country and help shore-up services. “The Gambian health system has tremendous potential if freed from political interference, which previously undermined leadership, and if health services and systems are offered the level of support they deserve”, he said.
Although emergency funds have not been forthcoming, there are indications long-term support might be on the way. The European Union confirmed this month that it was releasing €33 million in aid it had frozen under the Jammeh administration.
Before the political crisis was resolved, an estimated 76 000 people fled the country, according to a rapid assessment undertaken by four humanitarian agencies. An additional 162 000 people were displaced within The Gambia.
Many of the displaced turned to family members in rural areas for safety, said Tony Jansen, The Gambia country director of United Purpose, one of the four agencies involved in the assessment. Even as the displaced individuals are now returning to their homes, he said that there is a risk that some of the people who provided shelter might have seen their resources overstretched during the emergency period.
Jansen is worried that without a quick intervention followed by sustained development efforts the potential food shortages could develop into a much larger crisis. But it is not clear who will mount this response. Few agencies were active in the country, a result of Jammeh’s pariah status within the international community, and any new interest seems to have stalled since the political crisis was resolved.
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