By Madi S. Njie / Ndey Sowe
Malang Ndong, the Director of Human Resources and Administration said one of the major obstacles facing the health sector is the shortage of health personnel at all levels of the health care delivery system.
Speaking at the opening ceremony of the Anesthetists’ Society of the Gambia’s first annual congress held at the American International University complex in Kanifing, Mr. Ndong said there is a high attrition rate and slow production of new human resource capacities particularly for the health sector; that Gambia is highly dependent on external aid to finance development projects in the health sector.
“The National Health Accounts (NHA) for the fiscal years 2002 to 2004, revealed that 67% of financing for the health sector comes from donors, whilst 21% comes from Government and 12% from households’ out-of-pocket expenditure. These cadres of anesthetists have their obvious limitations of know-how and technique and they are faced with very difficult and complicated cases that must be done. In rural areas, if problems arise there will not be any higher authority to help. Shortage of staff has resulted in staff working many hours,” he said, noting that this has affected the Health Centres in the rural areas as surgical services could not continue due to lack of anesthetists.
For this reason, he said, most surgical cases are referred to the only university hospital (EFSTH) where there are only 12 nurse Anesthetists, 2 Physician Anesthetist and 4 Medical officers. “The 2 Physician Anesthetists are on technical assistance.
“Drugs and equipment are in short supply therefore restricting services to the basics at best. Pulse-oxymetry, end-tidal CO2, and ECG monitors are rarely available in most facilities.
“Donor partners such as UNICEF, WHO, UNDP, UNFPA, etc. also give maximum support to the health sector through programs and projects support,” he said.
Mr Ndong said in The Gambia, average life expectancy at birth is 58.7 years according to Human Development Report 2013, adding that the 2010 Integrated Household Survey shows that about 48% of the population lives below the poverty line i.e. US$ 1 .25 per day.
He said the government is the major provider of health services in The Gambia. Adding: “the public healthcare system in The Gambia is built around 3 levels which are Primary, Secondary and Tertiary.”
He said at the Tertiary level, there are 7 public hospitals- 1 Teaching hospital, 5 General hospitals, and 1 specialist hospital.
He said there are 6 Secondary facilities- Major Health centres, but 4 do not offer surgical services due only to lack of personnel mainly Anesthetist.
He said primarily, there are 38 Minor centres, with no surgical services.
Mr Ndong also said there are 492 people delivering primary health care to local residents.
He further said that the public-sector health is complemented by few private clinics / hospitals and NGO facilities most of which are located in the Greater Banjul Area. “To make it more complicated, their services are unaffordable and inaccessible to the vast majority of Gambian populace,” added Mr Ndong.
He also said EFSTH (RVTH) is located in the capital city, Banjul which has a population of about 50,000; with 567 beds.
He further said as the only referral hospital, the EFSTH is overwhelmed with patients 24hrs a day; and Houses most specialist units.
He said to date there is no Gambian physician anesthetist. “Before 1978 only spinal anesthesia and open drop Diethyl Ether (using a Schimmelbusch mask) were administered by senior nurses who were only trained on-the-job. This method of anesthesia caused excessive salivation and OR pollution. Thus many patients died due to drowning or aspiration pneumonitis that was at the time associated with the ‘infamous witchcraft’,” he said.