The healthcare system in The Gambia and Senegal: A look at the challenges and realities

kanjicodevelopment4
Jun 2
5 min read

Published on Jun 2, 2025

West Africa is a region full of contrasts, where the cultural richness and vitality of its people coexist with structural challenges, especially in the field of health.

In this post, we explore how the healthcare systems operate in Gambia and Senegal, two neighboring countries with similar histories and contexts, but with particularities that reflect their social and economic realities. From public infrastructure to traditional medicine, here we explain how healthcare is organized and the challenges their populations face.

The healthcare system in Senegal:

A pyramid structure with limitations

In Senegal, the public health system has been organized in a pyramidal manner since the 1996 decentralization reform. This model is divided into three levels:

Central level: Led by the Ministry of Health, which oversees national policies, departments, and services.

Regional level: Each administrative region has a medical zone responsible for coordinating care.

Peripheral level: Composed of 50 health districts, each with at least one health center and a network of health posts in rural communities and villages.

Learning from The Gambia and Senegal -

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The system covers 100% (according to the latest decree, whose implementation is questionable) of medical, surgical, hospital, pharmaceutical, and rehabilitation costs for workers (Senegalese or foreign) affiliated with the social security system.

However, this coverage is limited to those with formal employment, which excludes a large portion of the population, as the informal economy predominates.

Since 2006, the "Sésame" plan has allowed people over 60 years of age to access free care, but its scope is limited. Private and mutual insurance companies also exist, although they are difficult to access for most due to their costs.

In rural areas, health posts run by community workers or midwives are essential, especially for maternal and child care. However, infrastructure is often poor, and medications, although expensive, may be in short supply. Medical consultations are expensive (for example, €4.50 for a general consultation and €7.60 for a specialized one), which can be prohibitive in a country where the average salary is around €130 per month. This leads many to delay medical care, exacerbating health problems.

Traditional medicine remains a widely used alternative, especially in rural areas. Although marabouts and traditional remedies are an integral part of the culture, they are not always effective against epidemics or serious illnesses, highlighting the need for a more robust public system.

Organizations such as https://doctorsoftheworld.org, present since 2003, work to improve access to health care, especially in areas such as maternal and child health, universal coverage, and the prevention of diseases such as HIV/AIDS and malaria.

The Gambian healthcare system:

A government priority with limited resourcess

In The Gambia, the government is the primary provider of health services, and the public system is also organized into three levels:

Tertiary level: Includes six referral hospitals, such as the Edward Francis Small Teaching Hospital in Banjul, as well as private and NGO-operated clinics.

Secondary level: Larger health centers that offer intermediate care.

Primary level: Comprised of 492 medical posts distributed throughout the country, focusing on basic and preventive care.

Despite being a government priority, access to health care remains one of the greatest challenges, according to the United Nations Development Programme (UNDP). The Gambia has one doctor per 1,000 inhabitants, a low figure that reflects the shortage of professionals.

Facilities are limited, especially in rural areas, although new clinics are being built. Traditional medicine is very important, and many communities turn first to local healers, combining these methods with Western medicine whenever possible.

The Edward Francis Small Teaching Hospital is the backbone of the system, but its capacity is insufficient to serve the entire population. Furthermore, a lack of resources and extreme poverty (17.2% of the population lives on less than $2.15 a day) hinder access to medicines and treatment.

Rural women, in particular, face significant barriers, such as a lack of transportation to medical centers, which contributes to high maternal and infant mortality rates. Initiatives such as the recent donation of medical supplies and ambulances from the Canary Islands seek to mitigate these shortcomings, especially in maternal and infant care.

Common challenges and hope on the horizon

In both The Gambia and Senegal, healthcare systems face similar problems: poor infrastructure, a shortage of professionals, and prohibitive costs for a large portion of the population. Reliance on traditional medicine, although culturally valued, does not always meet modern healthcare needs. Furthermore, inequalities between urban and rural areas are stark, and the lack of universal coverage limits equitable access.

However, there are notable efforts to improve. In Senegal, the government is working on strategies to reduce maternal and child mortality, while in Gambia, the construction of new clinics and the training of community health workers are steps forward. International organizations and donations, such as the recent campaign in the Canary Islands, are helping to close gaps.

From the perspective of co-development and horizontal cooperation, the health systems of Gambia and Senegal invite us to rethink health not as an imposed vertical solution, but as a collective process where communities, governments, and external actors weave networks of action based on mutual respect and reciprocity.

In both countries, the pyramidal structure of the health systems reflects an effort to organize scarce resources, but also highlights the flaws in a model that doesn't always engage with local realities.

Traditional medicine, for example, is not a mere complement, but a cultural pillar that could be more effectively integrated with modern medicine if bridges of trust and shared knowledge were built.

Co-development challenges us not to view The Gambia and Senegal as "recipients" of aid, but as partners with their own knowledge and capabilities. Community initiatives, such as health posts run by local staff in Senegal or efforts to train health workers in The Gambia, are examples of how communities are already leading bottom-up solutions. Horizontal cooperation, therefore, must amplify these voices, supporting the training of local professionals, strengthening infrastructure without imposing external models, and promoting exchanges that allow these societies to share their own innovations.

The recent donation of medical supplies should not only be an act of delivery, but the beginning of an ongoing dialogue:

How can Gambian communities participate in the management of these resources?

What local knowledge could enrich the training of those who operate the new ambulances?

Co-development focuses on these questions, on building joint capacities where no one is a "savior" or "saved," but rather co-creators of a more just health system.

On the horizon, hope lies not in grand promises, but in small collaborative steps: integrating traditional and modern medicine, empowering rural communities to manage their own resources, and fostering partnerships that respect cultural specificities.

The Gambia and Senegal teach us that health is a right that is built from the local level, with the hands of many, in an exercise of cooperation that not only heals bodies, but also inequalities.

Together, we can make healthcare a right, not a privilege.

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