Country: The Gambia
Partnership: Scaling-up the national response to non-communicable diseases to achieve the sustainable development goal 3.4; reducing by one third pre-mature mortality from NCDs by 2030
The Gambia is Africa's smallest non-island country and one of its most densely populated. The Smiling Coast, as it is also known due to its location on the map cutting through the middle of Senegal in a position that appears like that of a smile, has a significant young population - about two-thirds is under age 30. Yet roughly 37 per cent of its people died in 2019 from NCDs - most of the mortalities occurring from cardiovascular diseases, cancers, respiratory diseases and diabetes, with major risk factors being tobacco use, alcohol consumption, physical inactivity and unhealthy diets.
During the past two years, the dire situation caused by the high rates of infections of COVID-19 put even more pressure on health systems globally, threatening progress towards addressing NCDs. For Least Developed Countries (LDCs) such as The Gambia, this was an even heavier burden to carry. "The pandemic came at a time when most of our countries were struggling with basic health service provision, capacity gaps, infrastructural challenges, and other problems such as supply chain interruption. For instance, we faced a shortage of glucose test strips, which is essential for people suffering from diabetes", explains Dr Ahmadou Lamin Samateh, Minister of Health of The Gambia.
However, The Gambia decided to turn the tide and take the lead in the region to scale up NCD services, improve access to care, and provide financial protection to its population. Accordingly, the Ministry of Health of The Gambia requested the support of The Defeat-NCD Partnership and has jointly led a collaborative, multi-sectoral approach to develop the countries' first National Multi-Sectorial Strategy and Costed Action Plan for the Prevention and Control of NCD in The Gambia (2022-2027), which was launched by the President of The Gambia on 6 July 2022.
"Our focus in the past was mostly on tertiary healthcare, however, people do not usually go to the health facilities because they might be far from the main road or might not have access to a vehicle or money to reach the closest facility. The new strategy and its action plan have a major focus on increased access to essential NCD services across the Country", said Dr Ahmadou Lamin Samateh, Minister of Health of The Gambia.
As the government started to review its national NCD policy it realized an all-hands-on-deck effort was much needed. "Developing a strategy is not easy and the resources and capacities of our NCD department are limited", shares Omar Badjie, NCD Programme Manager and National Tobacco Control Focal Point. Following expressed interest by the government, The Defeat-NCD Partnership eagerly came on board with its technical expertise and network in order to support the development of The Gambia's five-year National Multi-Sectoral Strategy and Costed Action Plan for the Prevention and Control of NCDs. "The Partnership has been very useful in the development of our policy since its inception and helped us mobilize people and partners", adds Mr Badjie.
The work around the NCD strategy and its costed action plan places a particular focus on addressing those diseases and habits that cause the most mortalities in the country. It includes the development of the country's tobacco control strategy, considered by Dr Samateh as "one of the strongest in the region", and a nutrition policy integrating the management of dietary risk factors related to NCDs. Cardiovascular diseases are at the core of all six strategic objectives of the policy and the plan to address diabetes and cancer is also highlighted in the plan. As a matter of fact, 25 clinics providing NCD care have been approved already to scale-up services and cover the entire country - instead of six clinics as it used to be - and public-private-people partnerships were established to provide diabetes and other NCD community screening. "We understood that we had to change the strategy and go into the communities because our people deserve it. We started for the first time in the history of the country a community ambulance system. People now can call a toll-free number and the ambulance will drive to the patient's doorstep, pick the patient up and drive the patient to the health facility", reveals Dr Samateh.
Together with the government, The Defeat-NCD Partnership also mapped current practices, stakeholders, resources, capacities, and referral channels. A national consensus for the establishment of a cancer specialized centre was also agreed upon within The Gambia's teaching hospital.
According to Dr Samateh, the entire strategy is designed "to set clear NCD interventions with expanded service packages to be provided by the different levels of the health system with its aim of accelerating the country's progress to achieving the global targets." As a result of the first steps taken towards improving The Gambia's approach to tackling NCDs, the government observed already a 14.1% increase in the number of NCD patients presenting in health facilities in 2021 in comparison with the previous year.
"We are very happy with this partnership because it is based on national leadership. Rather than imposing solutions, the Defeat-NCD Partnership team is supporting our vision and helping build our capacities, bringing their technical skills, and promoting encouragement of other partners to come on board. We want The Gambia to showcase what partnership for the good of humanity can do", concludes Dr Samateh. We too want to see The Gambia and all our partner countries excel in defeating this common enemy!
