Introduction to Country Context
The Republic of the Gambia is one of the smallest countries in Africa and is surrounded by the Republic of Senegal with the river as its dominant geographical landmark. The swamps and creeks that cover about one third of the surface area of the country serve as breeding grounds for mosquitoes that transmit malaria, making the Gambia an endemic malaria country.
The country is divided into five administrative regions (Western, Lower River, Central River, Upper River and North Bank) and two municipalities (Kanifing and Banjul). The decentralization of health services closely follows these divisions for ease of administration and this supports the decentralization process.
The Gambia experiences a short rainy season between June and October, followed by a long dry spell between November and June. Disease patterns follow these two seasons closely, with high malaria transmission in the rainy season and respiratory diseases and diarrhoea more common in the dry season.
Major road networks link large towns and river crossing points between the south and north banks of the country. Occasionally, these river crossing points are non-functional, leading to delays in patient referrals and thus compromising the quality of health services.
The Gambia is classified as a least developed country with a gross domestic product per capita of US$ 320 in 2005. The national household survey estimated that 61.2% of the population was classified as "poor". This high poverty rate suggests vulnerability of this group to disease with attendant public health implications.
The population trends from the 2003 population and housing census showed that 4% of the population was aged under 1 year, 20% was aged under 5 years, 45% was aged under 15 years and 55% was aged above 15 years. This youthful population means that the Government of the Gambia has to invest heavily in education, health care and job creation. The capital city, Banjul, and the adjoining municipality of Kanifing have a population of 715 397 (52% of the population of the Gambia). The concentration of the population in the urban areas poses challenges to the Government in the provision of proper housing, sanitation and quality health care.