The healthcare system in the Gambia is built around 3 levels. Primary is focused on villages with populations of over 400 individuals. Secondary is provided by the large and small health centres. Tertiary is delivered by 4 main referral hospitals, the Medical Research Council (MRC), several private clinics and NGO operated clinics. In addition to the 4 referral hospitals, there are 8 main health centres and a further 16 smaller centres, 200 plus mobile clinic unit teams as well as the Medical Research Council which is funded by the UK Government. There are also a number of privately run clinics as well as a few health focused NGOs operating in the Gambia. Although the health facility coverage is amongst the best in Africa (more than 80% of the population have access), the staffing of these facilities is highly inadequate.

What happens if you need to see a doctor?
People see a doctor based on their own decision and are not usually encouraged to see a doctor as a way to help to manage their diabetes. The government does not allow people living with diabetes to have free access to consultation at any given time, but it promotes individual interest in living a good and healthy life. If you need to visit a doctor for advice there is an associated cost.

Who decides what medicine a doctor can prescribe?
The hospital decides the medicine that people with diabetes use but only for those who collect their supply at the central hospital. These medicines are for both type 1 and type 2 diabetes. The ministry of health does not have any hand in the availability of drugs - it is left to the Hospital Management Board to allocate funds to buy the medicines needed for people living with diabetes.

Practically, what is it like to live with type 1 diabetes in The Gambia?
In The Gambia if someone needs advance and adequate drugs, they must buy it within or outside the country. If someone has a relative abroad who can send the medicine, that is ideal. Most of the time people use both the Western and Traditional medicines to treat diabetes, especially if the hospital runs out of supply. In short, living with Type 1 diabetes is expensive and has too many social burdens on the family due to dietary needs of the person with diabetes, the care and attention needed, and the medical expenses.

What about getting admitted to hospital?
It is free to be admitted but it is difficult to get a bed and proper treatment from qualified and well known nurses and doctors who know about diabetes issues. Some have been taken to hospitals and clinics where none of the staff were aware of their condition.

How does diabetes care vary throughout the country?
Most of the facilities are centralized, meaning most of the things needed (like insulin and supplies) are found in the Capital City. People can only have access to medicines if it is available and there is not very much advanced equipment available such as insulin pumps.

A big thanks to Lamin Dibba for helping us with this content.