National Multi-Sectoral Strategy and Costed Action Plan for Non-Communicable Disease Prevention and Control in The Gambia (2022-2027)

Objectives

The National Multi-Sectoral Strategy and Costed Action Plan for Non-Communicable Disease Prevention and Control covers May 2022 to April 2027. It envisages a Gambia free from the avoidable burden of non-communicable diseases (NCDs), pursuing a healthier population through multisectoral action and a one-third reduction in premature NCD deaths by 2027.[1][2][3]It contributes to Sustainable Development Goal target 3.4 and responds to an estimated annual burden exceeding 5,500 premature NCD deaths.[4]

• Raise the national and regional priority of NCD prevention and control through collaboration, advocacy, resource mobilisation and policy engagement.[1][5][6]
• Strengthen leadership, governance, multisectoral coordination, institutional capacity and partnerships.[1][7][8]
• Reduce modifiable risk factors and their social determinants through health promotion and education, addressing tobacco, unhealthy diets, physical inactivity, harmful alcohol use, air pollution, infections associated with NCDs and road safety.[9][10][11]
• Expand people-centred primary health care and universal health coverage, providing safe, affordable, effective and high-quality essential NCD services without financial hardship, particularly for vulnerable groups and people with disabilities.[5][12]
• Build national research capacity and strengthen surveillance, monitoring and evaluation to support data-informed policy and decision-making.[1][13]

The plan prioritises cardiovascular diseases, cancers, diabetes, chronic respiratory diseases and injuries, while also encompassing mental, oral, eye and ear health.[14][15]Its strategic principles include a life-course approach, human rights, equity, empowerment, evidence-based action, service integration and universal health coverage.[16][3]Prevention and early detection are paired with diagnosis, treatment, continuing care, rehabilitation, psychosocial support and palliative care.[17][18][19]

Priority outcomes include stronger prevention and risk-factor control, better access to quality NCD services, a capable workforce, dependable medicines and technologies, specialised diagnostic and treatment capacity, sustainable financing, research, and improved data quality.[9][20][21]The costed plan estimates that full-scale implementation requires 3.01 billion Gambian dalasi, equivalent to USD 57.8 million, over 2022 to 2027.[9]

Implementation

Implementation is designed as a Ministry of Health-led, whole-of-government and whole-of-society response involving other ministries, the Office of the President, the National Assembly, local communities, civil society, academia, development partners and the private sector.[4][14][8]The delivery model combines population-level prevention with integrated services across community, primary, district, secondary and tertiary levels, supported by referral and follow-up pathways.[17][22]

• Establish a National Multisectoral Steering Committee, chaired by the Office of the President, and a Multisectoral Technical Working Group with defined terms of reference, regular meetings and stakeholder representation.[5][7][8]
• Integrate NCD prevention, screening, treatment and care with HIV/AIDS, tuberculosis, maternal, child and community health services, while expanding NCD clinics and community-based screening.[22][18][23]
• Implement the World Health Organization Package of Essential Noncommunicable Disease Interventions in primary and district facilities, with PEN-Plus services for severe chronic conditions at district hospitals.[18][23]
• Develop clinical guidelines, referral documentation, medical records, self-care materials and continuing professional education for health workers and community structures.[22][19][24]
• Strengthen supply chains through updated essential-medicine and equipment lists, improved forecasting, procurement and distribution, digital stock management and action on stock-outs.[22][25]
• Develop specialised centres and services, including cardiac, renal, cancer, nuclear medicine, laboratory, trauma and rehabilitation capacity, supported by business plans and investment mobilisation.[13][26]

Risk-factor action combines legislation, fiscal measures, public communication, school and workplace initiatives, community engagement and enforcement.[10][12]Proposed mechanisms include a tobacco levy and progressive excise increases, subsidies and improved affordability for fruit and vegetables, a sugar-sweetened beverage tax, nutrition standards and labelling, physical-activity promotion, alcohol policy, cleaner household technologies, vaccination and road-safety measures.[10][27][28][29][30]

Financing is expected to combine government allocations, health insurance, taxes on NCD risk factors, private investment, donor support and other innovative mechanisms.[31]The plan seeks to increase annual NCD funding from USD 6 million to USD 12 million and includes a target of a 2% annual increase in government allocation to health-insurance funding for universal health coverage.[32][31]

Monitoring arrangements include national targets and indicators, an NCD surveillance system, cause-of-death and cancer registration, periodic risk-factor surveys, electronic medical records in NCD clinics, and an electronic monitoring and evaluation dashboard within District Health Information Software 2.[32][33][34]The Ministry of Health and relevant ministries are intended to report annually to the chair of the multisectoral committee, while data-quality teams, quarterly reviews and supervisory visits support routine performance improvement.[32][20][34]

Monitoring & Evaluation

The plan establishes a monitoring, evaluation and surveillance architecture intended to track non-communicable diseases (NCDs), their determinants and progress at national and regional levels, supported by a dedicated monitoring and evaluation framework.[16][13][32]It seeks to address recognised weaknesses in data capture, reporting, research, screening records and routine information systems.[17][35][2]

• Develop national monitoring and evaluation guidelines, targets and indicators aligned with the National Development Plan.[32][33]
• Establish a comprehensive surveillance system incorporating cause-of-death registration, cancer registration, periodic risk-factor data collection and monitoring of the national response.[32]
• Integrate NCD indicators into District Health Information Software 2, introduce electronic medical records in NCD clinics, and establish an electronic monitoring and evaluation dashboard within the Ministry of Health database.[32][33][34]
• Strengthen data-quality assurance through revised data-management guidelines, a national data-quality team, periodic assessments using World Health Organization tools, quarterly review meetings and an annual NCD data-review meeting.[34]
• Improve reporting completeness, accuracy and consistency across public and private facilities, including recording unique patients rather than consultation episodes and investigating discrepancies between data sources.[17][35][36]
• Use annual reports from the Ministry of Health and relevant ministries to the chair of the multisectoral committee, supplemented by routine facility, training, survey, research and programme reports.[32][20][21]

Indicators cover service availability and quality, trained personnel, stock-outs, specialised centres, research outputs, data quality, financing, multisectoral coordination and risk-factor interventions.[32][37][11][20][21]Specified outcome and service targets include reducing premature NCD deaths by one-third by 2027 and reaching at least 50% of people in need with quality NCD services.[3][9]Other reported targets include a 10% reduction in tobacco use, increases in fruit and vegetable consumption and physical activity, reductions in harmful alcohol use and road crashes, vaccination coverage above 90%, and annual medical checks and training for 80% of licensed drivers.[37][11]

Evidence sources include Health Management Information System data, STEPWISE risk-factor surveys, tobacco surveys, eye-health surveys, verbal autopsies, cancer registration, demographic surveys and mortality estimates.[38][39][40][33]Data limitations include incomplete national NCD information, limited diagnostic capacity, under-reporting of stroke and cancer, non-standardised screening records and incomplete private-sector reporting.[38][39][41][42][17][36]

Costing & Financing

The 2022 to 2027 costed action plan estimates that full-scale implementation requires 3.01 billion Gambian dalasi, equivalent to USD 57.8 million.[9]Costing covers interventions by condition and activity, financing arrangements, coverage assumptions and scale-up scenarios, using the OneHealth Tool for demographic and epidemiological modelling, service-need estimation, potential-impact assessment and service-delivery cost estimation.[16][43][21]

• Prioritise cost-effective NCD activities within government allocations while mobilising additional domestic and external resources.[9][32]
• Increase annual funding for NCD prevention and control from a reported baseline of USD 6 million to a target of USD 12 million.[32][6]
• Develop innovative and sustainable financing through health insurance, expanded benefit packages, tax-related allocations for NCD risk factors, private investment, donor support and business plans for specialised services.[13][25][26][31]
• Increase government allocation to health-insurance funding for universal health coverage by 2% annually and fund two specialised NCD services per year from developed proposals.[31]
• Allocate 5% of total tobacco-control tax revenue through a tobacco levy for tobacco-control implementation.[44]

Health-sector allocations have increased but remain limited and are not specifically delineated for NCD prevention and control.[9]Identified constraints include limited programme and operational funding, poor resource tracking, few technical and financial partners, and high out-of-pocket expenditure arising from health-system weaknesses.[2]Investment in prevention is presented as a means of avoiding future expenditure on advanced cancer, diabetes and cardiovascular treatment.[14]

The economic assessment reports incremental cost-effectiveness ratios of USD 567 and USD 1,255, compared with gross domestic product per capita of USD 787; the corresponding ratios to gross domestic product per capita are 0.72 and 1.6.[6]The supplied material does not provide a complete annual expenditure schedule, a quantified funding gap, detailed unit costs or a full breakdown of financing contributions.[9][21][6]