2015年-世界发展银行全球_The_Gambia_Impact_Evaluation_Baseline_Report___Health_System_4页_749kb

Technical Brief Summary: The Gambia Health System Baseline Report

Core Content

This technical brief summarizes the findings of the baseline evaluation of the Maternal and Child Nutrition and Health Results Project (MCNHRP) in The Gambia, conducted between November 2014 and February 2015. The evaluation focused on three regions: Central River Region (CRR), North Bank Region-West (NBR-W), and Upper River Region (URR). It aimed to establish a baseline for assessing the project's future impact on maternal and child health services.

Key Findings

1. Health Facility Infrastructure

• Challenges: Health facilities in all three regions face acute infrastructure issues, including insufficient ward space, lack of basic drugs and equipment, inadequate electricity supply, and poor waiting areas.
• Common Complaints: Both health workers and clients reported the unavailability of essential items such as drugs, cord scissors, and incinerators.
• Power and Water Outages: Over half of the health facilities experienced power outages, and almost two-fifths had water outages in the week before the survey.
• Ambulance Access: All facilities had access to an ambulance, but other basic amenities were lacking.
• Regional Variation: NBR-W had the best-equipped laboratories, while CRR had the least capacity for basic laboratory services.

2. Availability of Supplies, Drugs, Equipment, and Services

• Drug Availability: Paracetamol, Fansidar, and Coartem were generally available, but other essential drugs such as Rifampin and Amoxicillin were frequently in stockout.
• Supply Shortages: Regional variation in supply availability was significant, with NBR-W experiencing the least stockouts.
• Service Limitations: The lack of resources constrained the ability of health facilities to perform laboratory and other services.

3. Human Resources for Health

• Staffing Shortages: There is a significant shortage of health workers across all cadres (doctors, nurses, lab technicians, etc.), with health worker density ranging from 0.5 to 1.4 per 1,000 population.
• Impact on Services: Shortages affect daily operations, especially in data collection and health information activities.
• Training Needs: There is a high demand for training, particularly in areas such as IMCI, tuberculosis, postnatal care, and nutrition.
• Absenteeism: High absenteeism rates were reported, with nearly one in four staff in URR absent without permission. In CRR and URR, only about 60% of staff were on duty during the survey.

4. Health Worker Satisfaction

• Positive Aspects: Health workers generally felt satisfied with their job and the opportunity to use their skills.
• Negative Aspects: Dissatisfaction with salary and benefits was high, with 81% dissatisfied with pay and 77% with benefits.
• Desire for Change: 65% of health workers expressed a preference to work at a different facility.

5. Leadership and Management

• Supervision: Formal supervision was limited, with many staff not satisfied with the quality of internal or external supervision.
• Management Issues: Over 25% of staff were less than satisfied with the quality of management.
• Budgeting and Planning: Budgeting and planning were weak across regions, with only 21% of facilities having a budget and 30% having a workplan.
• Autonomy Requests: Health workers and administrators desired more budgetary autonomy to better manage their facilities' needs.

6. Health Care Financing

• Funding Shortfalls: Most regional health directorates (RHDs) and health facilities reported acute funding shortages, limiting their operational capacity.
• User Fees: User fees were the primary source of revenue, but some facilities charged higher fees than government-sanctioned ones.
• Exemption Policies: Exemption policies existed for vulnerable groups, but still, 20% of households reported significant health expenses.

Main Views and Implications

• The health system in The Gambia is heavily constrained by inadequate infrastructure, limited supplies, and staff shortages.
• High absenteeism and low satisfaction with salaries and benefits contribute to poor service delivery and motivation among health workers.
• Weak management and budgeting practices hinder effective planning and resource allocation.
• Client-oriented attitudes and strong staff-community relationships are positive aspects that can support service delivery.
• The need for improved training and supervision is critical to enhancing the quality and efficiency of health services.

Conclusion

The baseline report highlights critical challenges in The Gambia's health system, including infrastructure deficiencies, supply shortages, staffing issues, and weak management practices. These factors collectively affect the ability of health workers to deliver quality services and contribute to dissatisfaction and high turnover. Addressing these issues is essential for the success of the MCNHRP and for improving maternal and child health outcomes in the country.