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 built around three levels to deliver the healthcare services to its population: These are  primary, secondary, and tertiary. There are, to date, four  referral hospitals which the government operates are Royal Victoria Teaching Hospital ,Bansang Hospital , Bundung Maternal & Child Health Hospital , Sulayman Junkung General Hospital and Medical  research Council.

 In addition, there are eight main health centres, 16 smaller centres, 200 plus mobile clinic unit teams, and the Medical Research Council, which the UK Government funds. Several privately run clinics and a few health-focused NGOs operate in Gambia.

Primary Health Care:

This is focused on villages with a population of over 400 individuals where a Village Health Worker   and the Community Health Nurse and Traditional Midwife  ( Traditional Birth  Attendance ) would be initially trained and then assigned to deliver primary health care to their villages  of responsibility. 

They are responsible for providing out-patient care, community health education, and ensuring sufficient essential medical services were  at home visitations. Apart from assisting expectant mothers to be in home births, the midwife would refer any mothers who seem to be at risk to the local health centres.

Secondary Health Care:

At this level, medical care is provided by large and small health centres. There are around seven government-run / private health centres and 12 smaller centres, each providing in-patient and out-patient treatment. Each has its resident nurses, doctors and ancillary staff.

Tertiary Health Care:

At this 3rd level, healthcare  services are delivered by four main referral hospitals, the Medical Research Council (MRC), and several private and NGO-operated clinics. The main referral hospital is at the RVTH on Independence Drive in the capital city, Banjul. The other three are located at Bansang, Farafenni and Bwiam.

https://www.accessgambia.com/extra/general-hospitals.html

https://www.accessgambia.com/mbiz/general-hospitals.html

HOME BIRTH  VERSUS  HOSPITAL AND  ITS   EFFECT  IN  GAMBIA 

Home delivery is defined as an event of pregnant women giving birth in their home without skilled health professional assistance. It is continuing as a public health problem since it is responsible for the death of women and newborns  in poor rural community in the Gambia .

In Gambia, there is a high maternal mortality rate, which may be related to home delivery. Therefore, this study aimed to assess the trend of home delivery and identify predictors using the Gambia Demographic and Health Survey (GDHS) 2013 and 2019–2020 data sets.

There has been a dramatic decrement in maternal home delivery in Gambia . The maternal mortality ratio (MMR) for The Gambia is 289 maternal deaths per 100,000 live births for the 7-year period before the survey. The confidence interval for the 2019-20 GDHS MMR ranges from 204 to 375 deaths per 100,000 live births.www.dhsprogram.com

This reduction is real because there was a change in the characteristics effect of the population and the coefficient effect of some variables in the home delivery. Changes in characteristics effect of husband education, women's education, rural residents, more than three antenatal care follow-ups, and no problem reaching health facilities played a significant role in reducing home delivery. Urban residents and women who had occupations were variables that positively affected coefficient effect change.

In this study, the home delivery rate steeply declined in Gambia during the study period of the two surveys. Just above a nine-tenth decrease in in-home delivery rate resulted because there was a change in the characteristics effect of the study participants. Enhancing the number of citizens who attend high school and above, narrowing the gap between rural and urban in terms of accessing health facilities, and improving the availability of infrastructure should be done.

Vedam S.(2003), home birth versus hospital birth: Questioning the quality of the evidence on Safety. Birth (30(1)). pmid:12581041.

By Saraswathi Vedam MSN CNM.

World Health Organization and United Nations Children's Fund WHO database/ 

UNICEF global databases, 2018, based on MICS, DHS and other nationally representative household surveys. https://data.unicef.org/wp-content/uploads/infograms/10147/index.html.

The  above  studies  suggested  that overall  reductions in   infant and maternal mortality ratio  in the Gambia on a  certain demographic   levels  due to several  contributing factors .  However  rural communities /settlers   lack access to basic and urgent medical services , patients  will have to travel  for a long distance  or  hours  to nearest healthcare facilities  . In order to  reduce MMR  and safe lives and to deliver healthcare services to the people most importantly the  vulnerable patients , women and children in the communities  to have quick  access to medical services  at their doorsteps   that is why we Dampha Kunda Diaspora organisation aligned with  WHO  ( 2030 Agenda for SDGs means  Sustainable Development Goals  ) Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care within our communities .

To deliver on this promise, countries need to have strong, efficient and equitable health systems that are rooted in the communities they serve. Primary health care (PHC) is the most effective and cost-efficient way to get there. Every country has a different path to achieving UHC and to decide what to cover based on the needs of their populations and the resources at hand. Investing in PHC ensures that all those needs are identified, prioritized 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.

In  conjunction with The Gambia Government policy on Health and social care  : (www.uhc2030.org  ) ,we Dampha Kunda Diaspora organisation`s  community development initiatives  agenda  have  embarked  on building a much needed community Health center in Dampha Kunda Village  to facilitate and support the  healthcare system in  the Gambia   to   reduce   maternal mortality ratio (MMR) particularly  in  the  poor rural communities who have limited or  no access to  medical services.

WHY DAMPHA KUNDA NEED A COMMUNITY  HEALTH CENTRE.

 GEOGRAPHICAL  LOCATION

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

The neighbouring villages are Chamoi, Tambasansang, Tinkinjo, kiss-kiss, Kulukuley, Sanuding and Medina Yorro  with an estimated population of over 10,000 inhabitants  including Dampha Kunda Village according to the 2013 population census of the Gambia.  These catchment areas in rural Gambia lack healthcare facilities to support and provide urgent medical services. Some of the village residents will have to  travel about 15 to 20 Km to the nearest Health centre  in Basse  due to the shortages of the health care facilities to the Rural settlements  in the Gambia . Therefore Dampha Kunda Diaspora Organisation found out that there is a need to provide  essential medical  services in the community to safe  and improve standard of life  by embarking on the construction of Dampha Kunda Community Health Centre  that will positively impact the local people.

One of the most distressing ever witnessed by many in the Diaspora communities during their vacations, particularly in Dampha Kunda Village, is avoidable suffering of the people of Dampha Kunda and neighbouring villages due to common illnesses, other preventable diseases, sudden death of infants and maternity in the communities compared to the Western world Healthcare system.

Everyone  has  the right to have access to basic  medical services, especially the most vulnerable people in society  such as the old, infants, babies, disabled, pregnant women  those who mostly  regular users and  medical care in the communities .Cases like  pregnant women will go into labour and requires urgent medical care to safe her  liveborn baby  relatives will have to rush  her to the nearest health centre and there is neither nor   Ambulance  and Emergency services  available or a  medical facility in the village due   to shortages of medically  trained nurses and doctors in the social and Healthcare system in the Gambia, particularly in the rural communities  where largely affected to  admit or  attend her   to conduct necessary medical checks to know and determine the state of her liveborn baby and mother's wellbeing before taking her to the nearest health centre in Basse . 

The only alternative means of transport  travel  available is on a  donkey cart accompanying with her family members, husband, and relatives. for 7Km,  She has to travel  to such a long distance unbearable  constant pain and a maximum temperature of 35°. Sadly, in some cases, halfway through the journey, she will pass away before reaching the nearest Health Centre in Basse due to pain , heatwave and hydration. Family members , her body and stillborn baby will have to embark on the return journey on the Donkey Cart back into the village , her husband and the grieving families, relatives and friends sitting around the shrouded bodies.

Imagine the trauma this woman went  throughout   nine calendar months of pregnancy from gestation to birth such as  vomiting , sicknesses ,  weakness upon weakness , The joyful moment of cuddling her newborn baby and welcoming a new arrival into the family turned into  a nightmare and sadness within seconds. Instead preparing funeral services by grieving families, relatives and friends in the communities. Sometimes  burials of  mother and her stillborn baby lost of  two lives . These causes and effects  have  negative impact at certain levels that   can be prevented if community outreach medical services intervention schemes is properly implemented  and well manage by the central and local government in order to  provide  urgent essential medical  services for the communities through building a Healthcare facility to reduce maternal mortality rates especially in the rural communities .

 The primary objective of our organisation  is to build a healthcare facility  within the reach of the communities that is affordable and accessible and will provide high-quality primary healthcare services to the  residents . This health centre will offer various medical services to support the existing healthcare system in The Gambia  to enhance an effort to  meet the  healthcare demand. This  facility  will include Ambulance and emergency services, inpatient and outpatient department, maternal and child health clinic, vaccinations and, treatment centres for common illnesses, and overall general medical check-ups for patient to manage Diabetes, Blood pressure etc. 

By addressing these basic healthcare needs in our communities. We aim to significantly improve the well-being of the people of Dampha Kunda and the neighbouring villages. Dampha Kunda Diaspora Organisation initiated this project in collaboration with the Village Development Committee VDC, which aligns with our community development strategy and funding goals , which is  driven by our ambitious plan to bring change to support the existing healthcare system to the  doorsteps of our  less privilege  rural communities .

This community Health Centre will serve as a beacon of hope for the people of Dampha Kunda and the neighbouring villages without urgent medical services available to support them to provide better healthcare services to minimise maternal and mortality rates an effort to eradicate the effects of common illness and other preventable diseases.

HOW DO WE FUND OUR PROJECTS 

The construction project began in April 2022 and is mainly funded by  our  members' annual contributions of  D11,000 GMD Dalasis (€200 )  for five (5) years fundraising  campaign programmes  and  also several donations from individuals, organisations, donors, and sponsors to build a health care facility  for  our communities. Our fundraising campaign strategy enables us to complete erection of main building complex (brickwork) Roofing, plastering, ceiling, tiling, plumbing, some fixtures and fittings including doors and windows.   However, more work still needs to be done to finish such as construction of RCH  centre where pregnant women , babies  and child under five (5) years old  will have their  monthly EPI vaccines and staff quarter  and including fencing, electrical installations, fixtures, fittings, and office furniture, IT equipment and  Hospital equipment anything that could enhance Healthcare facility to operate  and fully   functional to serve  everyone at the point of need. This health centre can l  serve as an early intervention to diagnose, signpost, and refer patients to nearby Health Centres and hospitals nationwide in the Gambia.

Furthermore, people with other medical conditions, such as diabetes and high blood pressure, can also have regular checkups and prescribed medication to manage and control their health and well-being and, most importantly, to give help and advice to patients at the local level within communities .