DAMPHA KUNDA COMMUNITY HEALTH CENTRE CONSTRUCTION PROJECT PHOTO GALLERY

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THE HEALTHCARE  SYSTEM  AND CENTRES  IN THE GAMBIA

Introduction:

The healthcare system in Gambia is structured around three levels of care: primary, secondary, and tertiary. Currently, four government-operated referral hospitals serve the country: Royal Victoria Teaching Hospital, Bansang Hospital, Bundung Maternal & Child Health Hospital, and Sulayman Junkung General Hospital. The Medical Research Council also plays a significant role in healthcare delivery.

Additionally, the country has eight main health centres, sixteen smaller centres, and over 200 mobile clinic unit teams. The Medical Research Council, funded by the UK Government, also contributes to healthcare services. Several privately operated clinics and health-focused non-governmental organisations (NGOs) are present in Gambia.

Primary Health Care

Primary health care targets villages with populations greater than 400 residents. In these communities, Village Health Workers, Community Health Nurses, and Traditional Midwives (Traditional Birth Attendants) are trained and assigned to provide essential health services.

These health professionals provide outpatient care, community health education, guidance, and support. They ensure the availability of essential medical services within the community and conduct home visits. Community Health Nurses support expectant mothers during home births and refer those at risk to local health centres.

Secondary Health Care

At the secondary level, medical services are delivered by both large and small health centres. Approximately seven government-run and twelve private health centres provide inpatient and outpatient services, each staffed by nurses, doctors, and ancillary personnel.

Tertiary Health Care

At the tertiary level, healthcare services are provided by four main referral hospitals, the Medical Research Council (MRC), and several private and NGO-operated clinics. The principal referral hospital is the Royal Victoria Teaching Hospital (RVTH) on Independence Drive in Banjul, the capital city. The other three referral hospitals are located in Bansang, Farafenni, and Bwiam (pt, 2026).

HOME BIRTH VERSUS HOSPITAL AND ITS   EFFECT IN GAMBIA 

Home delivery refers to childbirth occurring in the home without the assistance of skilled health professionals. This practice remains a significant public health concern, contributing to maternal and neonatal mortality in impoverished rural communities in The Gambia.

The Gambia experiences a high maternal mortality rate, which may be associated with the prevalence of home deliveries. This study aims to assess trends in home delivery and identify associated predictors using the Gambia Demographic and Health Survey (GDHS) datasets from 2013 and 2019–2020 (Bureau, 2021).

A substantial decline in home deliveries by women has been observed in The Gambia. The maternal mortality ratio (MMR) stands at 289 maternal deaths per 100,000 live births for the seven years preceding the survey. The 2019–2020 GDHS reports an MMR confidence interval of 204-375 deaths per 100,000 live births (GBoS and ICF).

This reduction is attributable to shifts in population characteristics and changes in the coefficients of variables within the home delivery model. Notable factors contributing to the decline in home deliveries include increased levels of education among husbands and women, rural residence, more than three antenatal care visits, and improved access to health facilities. Additionally, urban residency and women's employment status positively influenced the observed changes in coefficient effects.

The findings indicate a substantial decline in the home delivery rate in The Gambia during the period covered by the two surveys. This reduction, exceeding 90 percent, is primarily attributed to changes in participant characteristics. Efforts should focus on increasing educational attainment beyond high school, reducing disparities in health facility access between rural and urban areas, and enhancing infrastructure availability (Vedam, 2003) (index.nutrition.tufts.edu, 2018) (UNICEF, 2018).

Previous studies indicate that reductions in infant and maternal mortality rates in The Gambia have been concentrated among specific demographic groups, influenced by multiple factors. Nevertheless, rural communities continue to face significant barriers to accessing essential and emergency medical services, often requiring patients to travel considerable distances to reach healthcare facilities. To reduce the maternal mortality ratio (MMR) and improve health outcomes, it is essential to provide timely healthcare services, particularly for vulnerable populations such as women and children. The Dampha Kunda Diaspora organisation aligns its initiatives with the World Health Organisation's 2030 Agenda for Sustainable Development Goals and the pursuit of universal health coverage (WHO, 2024).

Universal health coverage ensures that everyone has access to a comprehensive range of high-quality health services when and where needed, without incurring financial hardship. This encompasses the full continuum of essential health services, from health promotion and prevention to treatment, rehabilitation, and palliative care, delivered within communities.

To deliver on this promise, countries need strong, efficient, and equitable health systems rooted in the communities they serve. Primary health care (PHC) is the most effective and cost-efficient approach to achieving this. Every country has a different path to achieving UHC and deciding what to cover based on its population's needs and available resources. Investing in PHC ensures that all those needs are identified, prioritised, and addressed in an integrated way; that there is a robust and equipped health and care workforce; and that all sectors of society contribute to confronting the environmental and socio-economic factors that affect health and well-being, including preparing for, responding to and recovering from emergencies.

Aligned with The Gambia Government's health and social care policy (www.uhc2030.org), the Dampha Kunda Diaspora organisation has initiated construction of a community health centre in Dampha Kunda Village. This initiative aims to strengthen the healthcare system in The Gambia and reduce the maternal mortality ratio, particularly in underserved rural communities with limited access to medical services.

WHY DAMPHA KUNDA NEED A COMMUNITY HEALTH CENTRE

GEOGRAPHICAL LOCATION

Dampha Kunda is one of the largest villages in the Fulladu East District, Tumana Constituency, Basse. Upper River Region, The Gambia, West Africa. It is 7 km to the nearest health centre in Basse, approximately 60 km to Bansang Hospital, and 377 km to the Royal Victoria Teaching Hospital (RVTH) in Banjul, the capital city. Dampha Kunda village has approximately 5200 residents.

The neighbouring villages—Chamoi, Tambasansang, Tinkinjo, Kiss-Kiss, Kulukuley, Sanuding, and Fulla Medina Yorro—have a combined estimated population of over 10,000 inhabitants, including Dampha Kunda Village, according to the World Bank (2013) population census of The Gambia. These rural catchment areas lack healthcare facilities capable of providing urgent and essential medical services. Many residents must travel 15-20 km to the nearest health centre in Basse because of the shortage of healthcare facilities in rural settlements. Recognising this need, the Dampha Kunda Diaspora Organisation initiated the construction of the Dampha Kunda Community Health Centre to provide essential medical services, improve access to basic healthcare, save lives, and enhance the standard of living for these communities.

Many in the Diaspora communities, particularly during visits to Dampha Kunda Village, have witnessed the preventable suffering experienced by rural residents due to communicable and noncommunicable diseases. Conditions such as malaria, sudden infant deaths, and maternal mortality are more prevalent in these communities compared to urban areas and countries with more developed healthcare systems.

Everyone has the right to have access to basic medical services, especially the most vulnerable people in society, such as expectant mothers, infants, babies, older people, people with disabilities, and those who have regular needs of medical care in the communities to control their conditions.

If a pregnant woman goes into labour and requires urgent medical care, her relatives must transport her to the nearest health centre. There are no ambulances or emergency services available, nor is there a medical facility in the village, due to shortages of medically trained nurses and doctors in The Gambia’s healthcare system. This shortage is particularly acute in rural communities, where there are insufficient resources to admit or attend to patients and conduct necessary medical checks to assess the well-being of both mother and child before transfer to the health centre in Basse.

The only available means of transport is a donkey cart, typically accompanied by family members. The woman must endure a 7 km journey in constant pain, often in temperatures reaching 35°C. Tragically, in some cases, she may pass away before reaching the health centre in Basse due to pain, heat, and dehydration. Family members are then forced to return to the village with her body and the stillborn baby, joined by grieving relatives and friends.

The trauma experienced by women during pregnancy, from gestation to birth, includes persistent illness and physical weakness. The anticipated joy of welcoming a newborn can quickly turn to tragedy, resulting in the loss of both mother and child. Such events have lasting negative impacts on families and communities. These outcomes could be prevented through the proper implementation and management of community outreach medical service interventions by central and local governments, including the construction of healthcare facilities to provide urgent and essential medical services. This approach would help reduce maternal mortality rates, particularly in rural areas.

Our organisation’s primary aim is to construct an affordable, accessible healthcare facility within reach of communities, providing high-quality primary healthcare services at the point of need. The health centre will offer a range of medical services to support the existing healthcare system in The Gambia and help meet healthcare demand. Planned services include ambulance and emergency care, inpatient and outpatient departments, a maternal and child health clinic, vaccination programs, treatment centres for common illnesses, and general medical check-ups for conditions such as diabetes and hypertension.

By addressing these basic healthcare needs, we aim to significantly improve residents' well-being in Dampha Kunda and neighbouring villages. The Dampha Kunda Diaspora Organisation initiated this project in collaboration with the Village Development Committee (VDC), aligning with our community development strategy and funding objectives. This initiative is part of our broader plan to support the existing healthcare system and deliver essential services to underserved rural communities.

This community health centre can serve as a beacon of hope for Dampha Kunda and neighbouring villages by providing urgent medical services, improving healthcare outcomes, and reducing maternal and child mortality. The facility will also help mitigate the effects of common illnesses and other preventable diseases.

HOW DO WE FUND OUR PROJECTS 

The construction project commenced in April 2022 and is financed through annual member contributions of D11,000 GMD Dalasis (€200) as part of a five-year fundraising campaign, supplemented by donations from individuals, organisations, donors, and sponsors. The fundraising strategy has facilitated the completion of the main building complex, including brickwork, roofing, plastering, ceiling installation, tiling, plumbing, and the installation of fixtures and fittings such as doors and windows. However, additional work remains, including the construction of a Reproductive and Child Health (RCH) centre for the provision of monthly EPI vaccines to pregnant women, infants, and children under five years of age, as well as staff quarters, fencing, electrical installations, further fixtures and fittings, office furniture, IT equipment, and hospital equipment necessary for the facility to become fully operational. Once completed, the health centre will offer early intervention, diagnosis, signposting, and referrals to nearby health centres and hospitals throughout The Gambia.

Additionally, individuals with chronic medical conditions such as diabetes and hypertension will be able to receive regular checkups, prescribed medications, and access to support and guidance from local community-based services to manage their health and well-being.