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

Objectives

The 2022 to 2027 National Multi-Sectoral Strategy and Costed Action Plan for Non-Communicable Disease prevention and control seeks a Gambia free from the avoidable burden of non-communicable diseases, using a multisectoral response to reduce premature mortality and support a healthier population. Its overarching goal is to reduce premature deaths from non-communicable diseases by one-third by 2027, contributing to Sustainable Development Goal 3.4 and universal health coverage.[1][2]

• Raise the national and regional priority of non-communicable disease prevention and control through advocacy, cooperation, stakeholder engagement and public-private partnerships.[3][4]
• Strengthen national capacity, leadership, governance, multisectoral action and partnerships for prevention and control.[3][5]
• Reduce behavioural, metabolic, environmental and social risk factors through health promotion, education and population-based, cost-effective interventions.[6][7]
• Address tobacco use, unhealthy diets, physical inactivity, harmful alcohol use, household air pollution, vaccine-preventable infections and road-traffic injuries.[8][9]
• Strengthen people-centred primary health care and universal health coverage by expanding prevention, screening, diagnosis, treatment, rehabilitation, palliative care and referral services.[10][11]
• Expand quality services to reach at least 50% of people requiring non-communicable disease care, with continuous access to affordable supplies and technologies.[6]
• Promote high-quality national research and development and improve surveillance, monitoring, evaluation, data quality and evidence-informed decision-making.[12][13]

The strategy applies life-course, human-rights, equity, empowerment, evidence-based, integrated and universal-health-coverage principles. It covers cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, alongside prioritised conditions including mental health, oral, ear and eye health, injuries and disabilities.[2][14][15]

Implementation

Implementation combines coordinated multisectoral governance, strengthened primary and specialised care, community engagement, workforce development, supply-chain improvement, research and a structured monitoring framework. The Ministry of Health leads the response through its Non-Communicable Disease Programme Unit, working with government ministries, regional health structures, communities, civil society, development partners, academia and private-sector actors.[16][1][17]

• Establish a National Multi-sectoral Steering Committee chaired by the Office of the President and supported by a Multi-sectoral Technical Working Group with defined terms of reference and regular meetings.[2][5]
• Integrate non-communicable disease prevention and management across primary, secondary and tertiary care, using the World Health Organization Package of Essential Noncommunicable Disease Interventions and complementary PEN-Plus services for severe chronic conditions.[18][19]
• Deliver health education, promotion and demand creation alongside screening, treatment and care through communities, health facilities, home visits and two-way referral pathways.[18][10]
• Train health workers, village health workers, community groups and peer educators; use clinical mentorship, updated curricula, integrated treatment guidance and electronic learning modules to improve early detection, management and continuity of care.[20][21][22]
• Strengthen supply systems for essential medicines, laboratory commodities, diagnostic technologies and equipment through improved forecasting, procurement, distribution, inventory management and digital stock systems.[10][23]
• Establish specialised diagnostic and treatment centres, including cancer, cardiac, renal, trauma, rehabilitation and other services, using business plans to attract public and private investment.[12][24]
• Develop integrated electronic medical records or referral documentation, strengthen cause-of-death and cancer registration, collect periodic risk-factor data, and establish a monitoring and evaluation dashboard in the District Health Information Software 2 platform.[10][12][25]

The implementation framework assigns roles to institutions including the Ministry of Health, Ministry of Finance and Economic Affairs, Ministry of Transport, Ministry of Environment, Ministry of Youth and Sport, Ministry of Education, police, the World Health Organization, World Bank, Medical Research Council, University of The Gambia, civil society and private-sector partners.[7][26][24][27]

Monitoring includes annual reporting to the chair of the multisectoral committee, with indicators covering risk factors, service availability and quality, workforce capacity, commodity stock-outs, research outputs, funding, data quality, vaccination, road safety and governance performance.[28][7][26][13]The plan targets an 80% improvement in data quality for decision-making, five non-communicable disease research projects annually, and strengthened national targets and indicators linked to the National Development Plan.[13][12]

Full-scale implementation requires Gambia dalasi 3.01 billion, equivalent to United States dollars 57.8 million, over 2022 to 2027.[6]Financing measures include increased government allocation, health-insurance benefit packages, public subsidies for vulnerable patients, private investment, proposals to allocate 5% of tobacco-tax revenue to control activities, and taxes on sugar-sweetened beverages.[12][29][30]The strategy is intended to remain adaptable to emerging evidence, research findings and changing circumstances during its five-year lifespan.[6]

Monitoring & Evaluation

The plan establishes a monitoring and evaluation system centred on national targets, routine surveillance, data-quality improvement and annual reporting to the chair of the non-communicable disease multi-sectoral committee. It aims to reduce premature non-communicable disease mortality by one-third by 2027.[2]

• Develop and disseminate non-communicable disease monitoring and evaluation guidelines, national indicators linked to the National Development Plan, and a monitoring dashboard within the District Health Information Software 2 platform.[12][25][31]
• Integrate surveillance into the national information system, strengthen cause-of-death and cancer registration, collect periodic risk-factor data, and improve verbal autopsy protocols.[12][25]
• Introduce electronic medical records in non-communicable disease clinics and interoperable referral documentation to support continuity of care and more complete patient-level data.[10][12]
• Conduct quarterly integrated surveillance monitoring, supportive supervision, surveillance and data-quality meetings, alongside an annual national non-communicable disease data review.[25][31]
• Report annually on indicators, research outputs, funding, partnerships, committee activity, service delivery and risk-factor interventions through the Ministry of Health, Ministry of Finance and Economic Affairs, and other responsible institutions.[28][13][17][24][32][27]
• Measure risk factors, service quality, workforce capacity, medicines availability, insurance coverage, vaccination, road safety and prevention interventions through surveys, administrative reports and facility data.[7][26][33][34][19][23]

Priority data constraints include manual and incomplete reporting, weak private-sector reporting, non-standardised screening records, data-source discrepancies and limited diagnostic capacity.[18][35][36][37]The plan therefore provides for data-quality assurance, core data teams, capacity building and routine reporting, although the supplied material does not specify an independent accountability mechanism.[12][25][31]

Costing & Financing

Full implementation of the 2022-2027 costed action plan requires Gambia dalasi 3.01 billion, equivalent to United States dollars 57.8 million.[6]Costing used the World Health Organization OneHealth Tool, combining demographic, epidemiological, service-delivery and financial modelling with activity-based costing, coverage assumptions, medicine prices and stakeholder validation.[13][38]

• Prioritise cost-effective interventions within government budgets, mobilise new funders and develop innovative financing with government, private-sector, community and development-partner participation.[6]
• Increase domestic and external funding for non-communicable disease prevention and control from an annual baseline of United States dollars 6 million to a target of United States dollars 12 million.[28]
• Allocate 5% of tobacco-tax revenue and introduce comparable sugar-sweetened beverage taxation to help finance the prioritised scenario.[39][30][29]
• Expand health-insurance benefits, subsidise specialised services for vulnerable patients, attract private investment through business plans and mobilise resources from taxes on non-communicable disease risk factors.[12][24][32]

Financing conditions are constrained by limited and non-delineated budget allocations, operational funding barriers, high household out-of-pocket expenditure and reliance on donors.[6][40][36][37]Households funded 46% of non-communicable disease expenditure in 2017, compared with 28% from government, 17% from employers and 9% from donors.[41]

The financing model assumes annual gross domestic product growth of 5.5% and an increase in the non-communicable disease share of health expenditure from 7.46% in 2020 to 10% by 2026.[41]Under the proposed tax mechanism, the prioritised scenario’s projected funding gap is eliminated, while the ambitious scenario retains a gap of approximately United States dollars 4 million by 2026/27.[39][30]