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Making basic health care accessible to rural communities - a case study of Kiang West district

in rural part of the Gambia

Edward Saja SannehEdward Saja SannehNational Taipei University of TechnologyNational Taipei University of Technology

Institute of Environmental Engineering and Management Institute of Environmental Engineering and Management Advisor: Professor Allen H Hu Advisor: Professor Allen H Hu

Corporate and Environmental Systems Management LabCorporate and Environmental Systems Management Lab

Tomorrow People OrganizationPoverty and Social Protection Conference, 12th

March 2009, Bangkok, Thailand

National Taipei University of Technology

OUTLINE Introduction

Cycle of Health and Poverty

Maternal and child health

Kiang West Methodology of Making Health Accessible to the Poor

Results and Discussions

Conclusion and Suggestions

poverty continues to contribute to poor health, and poor health anchors large populations in poverty

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INTRODUCTION

Inequalities in health are almost always to the Inequalities in health are almost always to the disadvantagedisadvantage of the poor and they tend to die earlier and of the poor and they tend to die earlier and to have higher levels of to have higher levels of morbiditymorbidity than the better-off than the better-off

Health care Health care resourcesresources are overwhelmingly concentrated are overwhelmingly concentrated in urban areasin urban areas

Contribute to Contribute to BOP knowledgeBOP knowledge not only in general terms not only in general terms but particularly as regards to meeting the health needs of but particularly as regards to meeting the health needs of those communities who live on less than those communities who live on less than $1 a day$1 a day


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The Bottom of The Pyramid Concept


4 Billion

2 Billion

75-100 million

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Poor countries tend to have worse Poor countries tend to have worse health outcomeshealth outcomes than better- than better-off countries off countries

Millions of parents living in developing countries face a Millions of parents living in developing countries face a tough dilemma: How can they protect the lives of their children tough dilemma: How can they protect the lives of their children if they don't have access to if they don't have access to basic health carebasic health care??

Primary health care has been officially recognized as the Primary health care has been officially recognized as the

universal solutionuniversal solution for improving world health since the Alma for improving world health since the Alma Ata Conference in 1978 Ata Conference in 1978

Evidently, development in health is a precondition for Evidently, development in health is a precondition for economic economic developmentdevelopment of a nation of a nation

INTRODUCTION


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Cycle of Health and Poverty

poverty continues to contribute to poor health, and poor health anchors large populations in poverty.

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An estimated An estimated 529,000529,000 women died from women died from complicationscomplications of of pregnancy and childbirth in 2000, virtually all in pregnancy and childbirth in 2000, virtually all in developing countries. developing countries.

For every woman who dies, roughly For every woman who dies, roughly 20 more20 more suffer suffer serious injury or disability - between serious injury or disability - between 8 8 and and 20 million20 million a a year year

This loss impacts not only on the family and society, but This loss impacts not only on the family and society, but also on the economyalso on the economy

Maternal Health poverty continues to contribute to poor health, and poor health anchors large populations in poverty.

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Maternal Deaths in 1990 and 2005


(Source: UN, Millennium Goals)8/16


Net under 5 mortality per 1000 live births, 1990 and 2005


(Source: UN, Millennium Goals)9/16


Medical Research Council Research, MCH service and OPD

Kiang Karantaba Health CenterProvides health service to the districts inhabitants

The Gambia Government Provide resources and health personnel

WHO and UNICEFSupport government efforts by funding

Kiang West Methodology of Making Health Accessible to the Poor


Collaboration between Government, MRC, WHO and UNICEF to support Kiang Karantaba Health center

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The two main providers of formal The two main providers of formal health carehealth care are the Gambia are the Gambia government and Medical Research Council government and Medical Research Council

Every month, Every month, trekkingtrekking is done by the staffs of the is done by the staffs of the government owned health center to satellite villages as this is government owned health center to satellite villages as this is their catchments area their catchments area

For those villages that are far from the health center, a For those villages that are far from the health center, a village village health worker (VHW)health worker (VHW) is trained who will manage minor is trained who will manage minor health cases. health cases.

Kiang West Methodology of Making Health Accessible to the Poor (CONTD)


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The The poverty penaltypoverty penalty describes the facts that, because describes the facts that, because of meager of meager infrastructureinfrastructure like health and increased like health and increased vulnerability to diseases, the poor often pay for a vulnerability to diseases, the poor often pay for a higherhigher percentage of their healthcare out-of-pocket percentage of their healthcare out-of-pocket

Physical distance between Physical distance between provider and consumerprovider and consumer has has been recognized as an important barrier to care for been recognized as an important barrier to care for several decadesseveral decades and studies have shown that most and studies have shown that most people will travel farther than people will travel farther than 5 km5 km to basic to basic preventive and curative carepreventive and curative care



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If travel to a hospital or health clinic If travel to a hospital or health clinic costs more in cash or costs more in cash or lost wageslost wages than the service itself, anecdotal evidence than the service itself, anecdotal evidence suggests, price-sensitive BOP households may defer suggests, price-sensitive BOP households may defer treatment until a condition is relatively serious treatment until a condition is relatively serious

For villages For villages 30kms30kms from the health center, coupled with from the health center, coupled with the lack of transport and communication services, it will the lack of transport and communication services, it will be be catastrophic catastrophic if there wasn’t a system in which the if there wasn’t a system in which the health center staffs would travel to the villages to provide health center staffs would travel to the villages to provide health services health services



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The role played by the Village health worker The role played by the Village health worker (VHW) and (VHW) and Traditional birth attendant (TBA)Traditional birth attendant (TBA) is is very important for it will make the people to very important for it will make the people to participateparticipate responsibly in the health affairs of their responsibly in the health affairs of their community. community.

The provision of bed nets by UNICEF will help in The provision of bed nets by UNICEF will help in preventing both preventing both antenatal and infantantenatal and infant related malaria related malaria cases.cases.



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Trekking sessions conducted by the Trekking sessions conducted by the Medical Medical Research Council (MRC)Research Council (MRC) would go a long way in would go a long way in complementing government efforts complementing government efforts

These settlements though within a rural setting, far These settlements though within a rural setting, far from from hospitalshospitals, , inaccessibleinaccessible and lack and lack communication communication structuresstructures are provided with basic health services are provided with basic health services through the collaboration of the government and through the collaboration of the government and MRCMRC



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Government and international organizations should Government and international organizations should take the lead in providing health services to the take the lead in providing health services to the people in rural areas by creating more people in rural areas by creating more village health village health postsposts with a doctor and community health nurse with a doctor and community health nurse

The effects of the poverty penalty are exacerbated by The effects of the poverty penalty are exacerbated by the high price of the high price of pharmaceuticals pharmaceuticals imported to imported to developing countries from the US and Europedeveloping countries from the US and Europe

Countries such as India, China and Egypt have Countries such as India, China and Egypt have healthy pharmaceutical-manufacturing industries healthy pharmaceutical-manufacturing industries and .can provide affordable drugs for millions of and .can provide affordable drugs for millions of people around the worldpeople around the world

Conclusion and Suggestionspoverty continues to contribute to poor health, and poor health anchors large populations in poverty.

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