The other side of healthcare: When primary and hospital care don’t meet
- Fátima
- Oct 3
- 3 min read
Published on Oct 03, 2025
Practicing nursing in Spain and practicing it in The Gambia are two experiences that seem to belong to completely different worlds, although both share the same goal: caring. Since I arrived, what has struck me most is not only the lack of material resources, but the very real difficulty of accessing primary care for the majority of the population.
The main gap
In rural communities, basic healthcare is a privilege not everyone can reach. The nearest health posts may be several kilometers away, often on foot, under the scorching sun and without transportation available. This means that something we resolve fairly quickly in Spain at a health center; a fever, a wound, a pregnancy check-up, a routine exam, here becomes an obstacle course where every minute counts.
When the wall is too tall
In recent years, studies have shown that these barriers are widespread across West Africa.
In The Gambia, it is estimated that around 26% of women face distance-related barriers to accessing primary healthcare when they need it, and 27% experience problems due to lack of financial resources. In fact, nearly half of women (45.5%) reported difficulties in accessing health services. In Ghana’s Upper West region, only 29.9% of the population lives within 2 km of a primary care facility, although this rises to 61.5% within 5 km.
These figures reveal that accessibility is not only a matter of distance, but also of economic inequality and an overloaded referral system when primary care fails to fulfill its role.
These data are the only ones found in records from the last decade. We are certain that they are not up to date and do not fully represent that reality
Deep, in the roots
But the challenge does not end once people reach a health post. There is a significant disconnect between primary and hospital care. Many cases that need referral are lost along the way. Coordination is minimal, referrals do not always arrive, and patient follow-up becomes nearly impossible.
I have seen mothers travel long distances to vaccinate their children, only to find that no doses were available. I have accompanied patients referred to hospitals without receiving clear information or support, left adrift in a system that feels fragmented.
As a nurse, this reality deeply challenges me. In Spain, we take continuity of care for granted: a clinical report, a referral, a digital record that connects the entire process.
Here, primary and hospital care operate as two separate worlds that rarely intersect. And in between, patients, the most vulnerable ones, are left unprotected.
Final thoughts
My experience in The Gambia reminds me every day why Kanji.Codevelopment was created and continues to work: to be a bridge, to provide tools, training, and support in contexts where health is still not understood as a guaranteed right, but as a privilege depending on where you were born.
Walking these dusty roads alongside patients has taught me that accessibility is not measured only in kilometers, but also in a system’s ability to accompany people from the most basic needs to the most complex. And it is in that gap where, as a nurse and as a woman, I feel I can truly make a difference.
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