From Frontline Voices to National Impact: Strengthening Health Systems in The Gambia

Across various health facilities in the Central River Region (CRR), The Gambia, a quiet but impactful collaboration is unfolding: one that places frontline health workers at the heart of improving health outcomes nationwide. As health partners in The Gambia, the World Health Organization (WHO), UNICEF, and the United Nations Population Fund (UNFPA) undertook an H6 joint scoping mission from 8-10 April to engage directly with frontline health workers, better understand service delivery realities at facility level, and identify system gaps and opportunities for strengthening essential health services. This mission was also conducted in preparation for the development of a United Nations joint programme aimed at improving maternal and child health outcomes in the Central River Region.

While the mission included visits to health facilities in the Central River Region, its broader aim is to strengthen health system delivery across the country. The exercise created space for dialogue, learning, and co-creation of solutions alongside health workers at both community and facility levels ensuring that national priorities are grounded in frontline realities.

As part of the mission, the joint team visited key facilities including Bansang, Brikamaba, Janjanbureh, Njau, Karantaba Tenda, Kudan, Kuntaur, and Kaur, as well as the Regional Health Directorate. At each site, the team worked closely with frontline staff to understand how essential services are delivered in practice, with a focus on maternal, newborn and child health, reproductive health and family planning, immunization, nutrition and adolescent-friendly services.

Frontline health workers shared practical insights into service delivery dynamics across facilities, under the tenets of the Ouagadougou declaration of primary health care and health systems viz: Leadership and governance, service delivery, health system financing, health workforce, medical products, vaccines and technologies and health information systems, community ownership and participation, partnerships for health development and research for health.

Overall, service delivery capacity was broadly aligned with service utilization patterns, as reflected in key outputs such as deliveries, immunization coverage, and outpatient consultations. The health workforce was found to be adequate to meet current service demands across facilities. In addition, essential supplies and equipment were sufficiently available to support ongoing service delivery.

Opportunities to strengthen the use of available health products were highlighted during discussions, including the need for continued orientation of service providers and enhanced community engagement to support their effective use within routine service delivery. The mission also reviewed key system enablers such as oxygen supply systems. At Bansang Government hospital, the importance of uninterrupted oxygen availability for essential clinical care was emphasized. The oxygen plant has been inoperable for over three months, forcing the hospital to procure oxygen from private providers at a high cost. This underscores the need for the immediate repair of the oxygen plant to ensure a reliable supply of critical care services.

By engaging directly with frontline health workers, WHO, UNICEF, and UNFPA worked in close collaboration with the Ministry of Health to identify service delivery priorities grounded in real-world conditions. This approach reflects a shared commitment to using frontline evidence to guide decisions, strengthen service delivery, and support continuous improvement of health systems. It is consistent with this year's World Health Day theme, "Together for Health: Stand with science," which underscores the value of collaboration and evidence in advancing health outcome

The mission further underscored the importance of strengthened coordination among partners and with the Ministry of Health. Harmonized planning and integrated service delivery were identified as essential to reducing fragmentation and improving overall system efficiency. Equally important were the enabling factors highlighted by health workers themselves: supportive supervision, continuous capacity strengthening, and enhanced community engagement.

Looking ahead, the findings from this mission will guide coordinated follow-up with the Ministry of Health, regional health authorities, and local partners to address the identified priorities and strengthen service delivery in the Central River Region. WHO, UNICEF, and UNFPA remain committed to working alongside frontline health workers and government counterparts to translate identified priorities into concrete, actionable interventions that strengthen health systems across The Gambia.

Through sustained partnership and collective action, these agencies aim to support resilient, responsive, and people-centered health services ensuring equitable access to quality care and that no one is left behind.