The need for an integrated approach to the provision of essential health care services: a study from the Gambia
Walker, G.J.; Cham, M.K.
Journal of Tropical Medicine and Hygiene 84(5): 203-208
1981
ISSN/ISBN: 0022-5304 PMID: 7299878 Document Number: 171890
Some aspects of the type or preparatory work that can be useful to planning and managers when developments to increase the coverage of health care are being considered are presented. In 1979 the Gambia declared its commitment to a primary health care policy. There are 3 main acute hospitals in the Gambia--2 operated by government and 1 operated by the Medical Research Council. It was decided to review the details of a representative sample of patients admitted to each of the hospitals for 1978. While in 1971, only 14% of all patients admitted to the Royal Victoria Hospital (RVH) in Banjul came from further than 25 miles away, this had increased to 22% in 1978 and for general medicine it has almost doubled from 18-32%. The catchment area of the Bansang Hospital is also quite large. Located less than 10 miles from the "border" with Senegal, a significant proportion of its inpatients come from across the border. In the Medical Research Council Hospital, where clinical research is stressed, the diagnoses of patients are less representative of the more prevalent serious diseases seen in the Gambia. By a combination of the data on the distances travelled to the various hospitals with that on the distribution of the population, it is possible to estimate hospitalization rates for people living in different parts of the country. There appears to be large variations in admission rates for people living in different parts of Gambia. Persons living within 5 miles of Banjul and Bansang, i.e., just over 10% of the total population, have admission rates over 5 times greater than the over 55% living further than 25 miles from these centers. During the visits made to rural health centers, dispensaries, and sub-dispensaries, several areas were identified which are likely to affect the efficient working of those units. These include: difficulties concerning the availability of reliable transport; a lack of adequate basic equipment; buildings and furnishings in need of repair; and inadequate and irregular allocation of essential and basic drug supplies. Patients did not usually travel far to rural facilities for outpatient care. If the provision of primary health care by community health workers is to have a reasonable chance of success, then it is essential that its development be integrated with the existing health service system. It is also critical that the rural basic health services are sufficiently well managed to provide effective support to the primary health care workers.