Analytical summary - Community ownership and participation
In the Gambia, one of the guiding principles of the health policy is "changing for good" community participation and empowerment. The Bamako Initiative was implemented in some health facilities where the community were given the opportunity to manage their facilities. No legal framework exists in this regard but in Bamako Initiative facilities, communities have a major say in the running of health facilities in matters relating to financial accountability, purchasing of medication and the state of the facility.
Although there is no documented study on patient satisfaction, complaints received generally concern intermittent shortages of medications and staff attitude, especially during labour and delivery. In contrast, in non-Bamako Initiative facilities communities have little say in the running of their facilities and sometimes do not have a way of expressing their needs.
Traditional communicators are engaged in dissemination of health messages through drama, singing and demonstrations and in this way contribute health information in the local languages. Open field days have also been used as a health education strategy at the community level. However, there is a gap between knowledge and practice, which has prompted the Ministry of Health and Social Welfare to shift its health education/promotion approach towards behaviour change communication strategies to create awareness.
Health facilities are spread all over the country and most communities having a facility within 5 km distance. Each health facility has a number of outreach stations that are visited monthly to deliver antenatal care as well as infant welfare services. The outreach posts are usually temporary sites that are often poorly equipped with an inadequate number of examination beds and benches. Some labour wards do not provide adequate privacy, which is a cause for concern by the directorates of health services who are seeking to rectify such design gaps.
All health facilities are run on a 24-hour basis such that communities have access to care at all times. Long queues in some facilities, especially during the morning hours, prompt patients to delay seeking health services. Pregnant women, children aged under 5 years and those with chronic communicable diseases are exempted from service delivery fees.
Civil society organizations and structures work with communities at the grass-roots level but are usually not involved in policy-making as partners. However, given the experiences of these organizations, it will be an advantage to involve them in policy formulation.