Maternal and child health
We're working with partners to promote and provide equitable access to health care for mothers and children in The Gambia.
The challenge
Like most developing countries, preventable and treatable diseases like malaria, respiratory infections, diarrhoeal disease, malnutrition, and neonatal sepsis are largely responsible for childhood mortality and morbidity in The Gambia.
According to the MICS 2018 survey, under-five mortality in The Gambia is at 57 per 1,000 live births; infant mortality is at 41 per 1000 live births; and neonatal mortality is at 31 per 1,000 live births. There has been a steady decline in mortality rates, however for neonatal mortality (deaths occurring within the first 28 days of life) there has been a slight increase from the last 5 years from 28 to 31/1000 live births. This trend is worrying and needs urgent attention. The maternal mortality ratio is 433 per 100,000 live births, and accounts for 36 per cent of all deaths among women aged between 15 and 49 years old according to the demographic and health survey 2013.
These statistics are compounded by a weak health sector, due to insufficient financial and logistical support, a deteriorating physical infrastructure, lack of supplies and equipment, shortages of adequately and appropriately trained health personnel, high attrition rates, and an inadequate referral system.
Despite the challenges, The Gambia continues to make gains in primary health care (PHC) coverage, especially in immunization coverage, to ensure protection from vaccine-preventable diseases.
The solution
Revitalizing and further strengthening primary health care, which includes both preventive and curative services, strong referral system provides an opportunity for the underserved to have quick access to health care and save lives. This includes health promotion and prevention, support to immunization (both campaigns and routine, basic drug provision and case referral by village health workers (VHWs). Community led, simple and quick responses to the main childhood diseases have proven to be an efficient and cost-effective tool in addressing the major causes of mortality and morbidity. Strong referral practices at community level to health facilities ensure that more complicated cases get more appropriate timely treatment. To achieve this goal and in line with the Sustainable Development Goals, UNICEF supports government, Community Based Organizations (CBOs) and other health partners through several approaches and activities.
We provide technical advice and support at policy level, to enhance institutional capacities, intersectoral coordination, health financing, and the development of various policies and plans on maternal and child health services.
We support the promotion and advocacy for more innovation, knowledge management, and evidence-generation ensuring that the needs of children and women are well researched/documented to adequately guide and inform programme and policy design.
We advocate for, and mobilise financial resources, to support the provision of quality integrated service delivery in the PHC settings, This includes supporting immunization services, providing health facilities with basic pediatric drugs for the management of common childhood diseases such as diarrhoea and pneumonia, which remain among the three top killers of children under five and also supporting the management of the childhood illnesses at community level through Integrated Community Case Management (iCCM) approach. Also, strengthening the management of severe acute malnutrition, as well as the cold-chain system and effective vaccine management practices.
We promote advocacy and awareness raising, as well as encouraging ownership of interventions at community levels, to improve the capacities of caregivers, mothers, families, and communities to adopt essential care practice for child survival. This component supports the scale-up of social behaviour change through Communication for Development strategies to ensure the adoption of key family care practices that improve the health of the mothers, children, fathers and the wider community.
Our work also includes fostering and leveraging partnerships with different stakeholders to achieve the objectives and expected results of our country programme, with a focus on strengthening our ongoing partnerships with key UN agencies (WHO, UNAIDS, UNFPA). We will continue to diversify partnerships through engaging with civil society organizations, private sectors and developing the capacities of small CBOs.
A critical support provided by UNICEF in terms of evidence generation is carrying out the Heath Services Assessment as part of the overall Health System Assessment initiative. The results of this assessment are used by the MoH to guide its future planning with geographical equity and improved response to the needs of the population. The results of the assessment are also used in other critical work including Public Health Expenditure Analysis, development of essential health service packages, National Health Insurance Scheme, and Result Based Financing