The Gambia
HEALTH SITUATION The burden of communicable and noncommunicable diseases in The Gambia is high. The causes of morbidity that drive the demand for public health services in children are acute respiratory infections, diarrhoeal diseases, helminthic infections and skin disorders. Cardiovascular diseases including hypertension, diabetes, cancers and trauma are the common diseases/conditions in adults. These health conditions are responsible for over 75% of the outpatient and inpatient care delivered through the government’s health care system. The leading causes of inpatient deaths in children are: malaria, pneumonia, malnutrition, anaemia, neonatal sepsis, premature births, gastroenteritis, septicaemia and meningitis. In adults, the leading causes of inpatient deaths are maternal deaths, pneumonia, cerebrovascular accidents, trauma especially road traffic injuries, malaria, hypertension, anaemia, diabetes, heart failure and cancer. The maternal mortality ratio (MMR) still remains unacceptably high. The main causes of maternal mortality are haemorrhages, eclampsia, anaemia, malaria in pregnancy and postpartum sepsis. Poor maternal nutrition contributes to complications during pregnancy and delivery, and shortage of skilled birth attendants further exacerbates the problem. Some natural disasters do occur in The Gambia for example, floods and droughts. In addition, there are epidemics such as yellow fever, meningitis and cholera. Cancer, especially liver cancer, is secondary to hepatitis B infection which is prevalent in the country. The prevalence rate for hepatitis B infection is estimated at 90% but the chronic carrier rate is 15%.
http:// www.who.int/countries/en/ WHO region World Bank income group CURRENT HEALTH INDICATORS Total population in thousands (2012) % Population under 15 (2012) % Population over 60 (2012) Life expectancy at birth (2012) Total, Male, Female 1791 45.9 3.72 61 (Both sexes) 59 (Male) 63 (Female) 28 [17-48] (Both sexes) 73 [52-100] (Both sexes) 360 [170-820] 98 56.1 0.107 0.865 4.4 11.3 Africa Low-income
HEALTH POLICIES AND SYSTEMS The national Programme for Accelerated Growth and Employment (PAGE) 20122015, has identified health as a priority area of focus for enhancing economic development, in line with the National Vision 20/20 document. While a number of policies are in place at the programme level to steer health sector reform for better health service delivery and outcomes, the country is currently finalizing a national health strategic plan to implement the National Health Policy (20122020). The vision and mission of the National Health Policy is: Provision of quality and affordable health services for all by 2020 and to promote and protect the health of the population through the equitable provision of quality health care. The government is the major provider of health services. The public health care system has three tiers, based on the primary health care strategy. Presently, services are provided by six hospitals at the tertiary level, 38 health centers at the secondary level and 492 health posts at the primary level. The system is complemented by 34 private and nongovernmental organization (NGO) clinics. For most communities, the first point of contact with health care services is the informal sector through traditional healers.
Neonatal mortality rate per 1000 live births (2012) Under-5 mortality rate per 1000 live births (2012) Maternal mortality ratio per 100 000 live births (2010) % DTP3 Immunization coverage among 1-year olds (2012) % Births attended by skilled health workers (2010) Density of physicians per 1000 population (2008) Density of nurses and midwives per 1000 population (2008) Total expenditure on health as % of GDP (2011) General government expenditure on health as % of total government expenditure (2011) Private expenditure on health as % of total expenditure on health (2011) Adult (15+) literacy rate total (2010)
COOPERATION FOR HEALTH The Gambia signed on to the global compact of the International Health Partnership and related initiative (IHP+) in May 2012, and is currently developing a country compact to guide the implementation of the national health strategic plan. As a result of the small number of multilateral organisations providing development assistance to the health sector, the role of UN Agencies is very important in terms of contribution to technical support in health. Although WHO is the leading partner in health, other development partners have been supporting The Gambia’s effort in overall health development, including United Nations (UN) Agencies (UNAIDS, UNDP, UNFPA, UNHCR, UNICEF, WFP), the Global Alliance for Vaccines and Immunization (GAVI) and the Global Fund to fight AIDS, Tuberculosis and Malaria. Bilateral Partners active in health include Cuba, Egypt, The European Union, Germany, Italy, Nigeria, Turkey, United Kingdom, USA, and Venezuela. Key multilateral partners include the African Development Bank, the European Development Fund, the Islamic Development Bank and the World Bank.
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50 85 (Rural) 92 (Urban) 89 (Total) 65 (Rural) 70 (Urban) 68 (Total)
Population using improved drinking-water sources (%) (2011)
Population using improved sanitation facilities (%) (2011) Poverty headcount ratio at $1.25 a day (PPP) (% of population) Gender-related Development Index rank out of 148 countries (2012) Human Development Index rank out of 186 countries (2012) Sources of data: Global Health Observatory April 2014 http://apps.who.int/gho/data/node.cco
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WHO COUNTRY COOPERATION STRATEGIC AGENDA (2008-2015) Strategic Priorities STRATEGIC PRIORITY 1: Reduce morbidity and mortality due to communicable diseases
Main Focus Areas for WHO Cooperation Support the development or review and implementation of national policies and strategic plans for malaria; HIV/AIDS and tuberculosis Support the country’s epidemic alert and response mechanism and its capacity for the implementation of the International Health Regulations (IHR 2005) and the continued implementation and monitoring of the Integrated Disease Surveillance and Response (IDSR) system. Support the maintenance of the high immunisation coverage
STRATEGIC PRIORITY 2: Reduce morbidity and mortality due to noncommunicable diseases and conditions and strengthen health promotion capacity at all levels.
Support the development and implementation of an NCD policy Support the development and implementation of a national health promotion policy and strategic plan; and a national road safety strategy Support the implementation of the ratified WHO Framework Convention for Tobacco Control (FCTC)
STRATEGIC PRIORITY 3: Improve health and reduce maternal, neonatal and childhood morbidity and mortality
Mobilize resources for the implementation of the Country Specific Road Map to accelerate reduction of maternal and newborn deaths Support the expansion of the IMNCI strategy in all six Health Regions of the country and the implementation of other child survival strategies Support the re-commissioning of the major health facilities for the provision of basic and comprehensive emergency obstetric care (EmOC) services and improve the referral system for complicated obstetric cases
STRATEGIC PRIORITY 4: Improve the healthcare delivery system in the country using PHC as the strategy while promoting evidence based decision making in the planning and management of health services delivery
Support the implementation of the HRH Policy and Strategic plan including the retention of skilled health personnel Strengthening the functional capacity of public health system at all levels, including the provision of technical assistance and support in the provision of operational logistics Promoting evidence based decision making in the planning and management of health services delivery through supporting the strengthening of the Health Management Information System and research
STRATEGIC PRIORITY 5: Contribute to the improvement in the general standards of health of the population and address health consequences of emergencies
Support the development and implementation of the national environmental health policy with emphasis on the provision of a sustainable waste management system Support the formulation and implementation of health specific emergency preparedness and response plans Support the implementation of the policy on occupational health and safety
© World Health Organization 2014 - All rights reserved. The Country Cooperation Strategy briefs are not a formal publication of WHO and do not necessarily represent the decisions or the stated policy of the Organization. The presentation of maps contained herein does not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of an y country, territory, city or area or of its authorities, or concerning the delineation of its frontiers or boundaries.
WHO/CCU/14.03/The Gambia
Updated: May 2014
Gabon HEALTH SITUATION Malaria, premature birth, acute respiratory infections, HIV and diarrhoeal diseases are the leading causes of death among children under 5. Penta-3 immunization coverage is 79% and measles immunization coverage is 71% (2012). Gabon has fulfilled the standard criteria for certification of polio eradication. Since surveillance was put in place in 1999, only one case of wild poliovirus has been detected. Although progress has been made, Gabon will not achieve Millennium Development Goals 4 and 5 by 2015. Malaria remains the leading cause of morbidity for all ages, with nearly 200 000 (187 714) cases reported in 2008; the malaria mortality rate was 96 per 100 000 of population in 2009. HIV prevalence is low, estimated at 4.1% in 2012. Tuberculosis prevalence is 505 per 100 000 of population, with incidence estimated to be 450 per 100 000. Human African trypanosomiasis (HAT) incidence has risen in recent years. Also noteworthy is the emergence and re-emergence of diseases such as Chikungunya, dengue and Buruli ulcer, which have been responsible for outbreaks since 2007. Outbreaks of Ebola-type haemorrhagic fever occurred in Gabon between 1994 and 2002. There has been an increase in the prevalence of noncommunicable diseases, in particular cardiovascular diseases, diabetes, renal failure and cancers. Gabon bears a double burden of communicable and noncommunicable disease. The mortality rate is 610 per 100 000 of population for communicable diseases and 716 per 100 000 for noncommunicable diseases.
http:// www.who.int/countries/en/ WHO region World Bank income group CURRENT HEALTH INDICATORS Total population (2012) % Population under 15 (2012) % Population over 60 (2012) 7.38 Life expectancy at birth (2012) Total, Male, Female Neonatal mortality rate per 1000 live births (2012) Under-5 mortality rate per 1000 live births (2012) Maternal mortality ratio per 100 000 live births (2010) % DTP3 Immunization coverage among 1-year-olds (2012) % Births attended by skilled health workers (2012) Density of physicians per 1000 population (2004) Density of nurses and midwives per 1000 population (2004) Total expenditure on health as % of GDP (2011) General government expenditure on health as % of total government expenditure (2011) Private expenditure on health as % of total expenditure on health (2011) Adult (15+) literacy rate total (2010) 62 (Male) 63 (Both sexes) 64 (Female) 25 [15-42] both sexes 65 [48-79] (Both sexes) 230 [130-390] 82 89.3 0.29 5.01 3.2 6.6 46.6 88.4 88 (Total) 41 (Rural) 95 (Urban) 33 (Total) 33 (Urban) 30 (Rural) 4.8 105 106 1 633 000 38.49 Africa Upper middle-income
HEALTH POLICIES AND SYSTEMS In 2010, a new national health policy was adopted, with the goal of improving public health and well-being by reducing maternal, infant and child mortality and the prevalence of malaria, HIV/AIDS, tuberculosis, neglected tropical diseases and noncommunicable diseases. In 2011 Gabon adopted a national health development plan for the period 2011-2015 with a view to implementing health policies that would expedite achievement of the health-related Millennium Development Goals. National policies on human resources and a human resources development programme have also been drawn up to address quantitative and qualitative shortcomings in this area. Following a 2008 health financing reform, Gabon has put in place a system of mandatory health insurance and established a national mandatory health insurance and social security fund. Coverage for the poor is funded through an innovative tax on mobile phones and financial transactions. Today, this fund covers 60% of the population, in particular the poor, students and government and private-sector workers. The creation and institutionalization of health accounts enables countries to have access to evidence-based data. The health system has a number of obstacles to contend with: some health departments are not operational, the quality of health care is poor, essential medicines are scarce, information systems are dysfunctional, and the community is not involved in the management of health issues. The principal challenges facing the health system are to reduce maternal and infant mortality, and to control communicable and noncommunicable diseases. Issues related to health and the environment are also national priorities, within the scope of the Libreville Declaration.
Population using improved drinking-water sources (%) (2011) Population using improved sanitation facilities (%) (2011) Poverty headcount ratio at $1.25 a day (PPP) (% of population) Gender-related Development Index rank out of 148 countries (2012) Human Development Index rank out of 186 countries (2012) Sources of data: Global Health Observatory, April 2014 http://apps.who.int/gho/data/node.cco
COOPERATION FOR HEALTH Only 1.2% of health sector resources came from external sources in 2010. Because of its GDP, Gabon has few bilateral and multilateral partners willing to invest in the health sector. Partner support is very often technical in nature, with some project financing. Most support comes from the specialized agencies of the United Nations system: WHO, UNICEF, UNFPA, UNAIDS and UNDP. Gabon adheres to the Paris Declaration on Aid Effectiveness; accordingly, it collaborates with partners in the Harmonization for Health in Africa mechanism, in particular the World Bank, the African Development Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the French Development Agency and the Japan International Cooperation Agency (JICA). Other bilateral partners (China, Italy, the United States of America and Canada) and the private sector also provide support.
WHO COUNTRY COOPERATION STRATEGIC AGENDA (2008-2015) Strategic Priorities STRATEGIC PRIORITY 1: Reduce the burden of communicable diseases, including HIV/AIDS, tuberculosis, malaria and neglected tropical diseases • • • • •
Main Focus Areas for WHO Cooperation Improve access to essential interventions for persons living with HIV Improve the number of tuberculosis patients treated successfully Improve access to first-line malaria treatment for confirmed cases Improve and maintain access to essential medicines for neglected tropical diseases Immunization and Vaccines Development: Extend immunization coverage for hard-toreach populations and communities
STRATEGIC PRIORITY 2: Reduce the burden of noncommunicable diseases (cardiac diseases, cancer, lung diseases, diabetes, mental illness) and disabilities and injuries, through health promotion, risk reduction, prevention, treatment and surveillance of noncommunicable diseases and their risk factors
• • • •
Noncommunicable diseases: Improve access to interventions aimed at preventing and addressing noncommunicable diseases and their risk factors Mental health: Improve access to interventions aimed at preventing and addressing noncommunicable diseases and their risk factors Reduce risk factors for violence and injuries, with a focus on road safety Reduce nutritional risk factors
STRATEGIC PRIORITY 3: Reduce morbidity and mortality and improve health during pregnancy, childbirth, the neonatal period, childhood and adolescence; improve sexual and reproductive health; and enable all individuals to stay active and healthy as they grow old
• • • •
Improve access to interventions aimed at improving reproductive, maternal, neonatal, child and adolescent health Increase the proportion of elderly people capable of living independently Improve intersectoral policy coordination for action on the social determinants of health Reduce environmental threats impacting negatively on health
STRATEGIC PRIORITY 4: Contribute to strengthening health systems by focusing on integrated delivery of health services and health systems financing with a view to achieving universal health coverage; strengthen human resources for health and health information systems; and ensure access to quality medicines that are affordable, safe and effective
• • • •
Support comprehensive national health policies, strategies and plans updated in the last five years Ensure the necessary policies, financing, and human resources are in place to improve access to integrated health services focused on the individual Improve access to quality medicines and health technologies that are safe, effective and utilized more rationally Support properly functioning systems of civil registration and national statistics
STRATEGIC PRIORITY 5: Support preparedness, surveillance and effective response to outbreaks and public health emergencies; contribute to health security through proper management of the health aspects of humanitarian crises
• • •
All countries have the minimum core capacities required by the International Health Regulations (2005) for all-hazard alert and response National capacity to manage public health risks posed by emergencies No cases of wild poliovirus or cases related to vaccine-derived poliovirus type 2 worldwide
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© World Health Organization 2014 - All rights reserved. The Country Cooperation Strategy briefs are not a formal publication of WHO and do not necessarily represent the decisions or the stated policy of the Organization. The presentation of maps contained herein does not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delineation of its frontiers or boundaries.
WHO/CCU/14.03/Gabon
Updated May 2014
lease note that the 3 generation CCS 2014-2018 is being finalized
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