This was highlighted during a recent press conference held at SDKJ Conference Center at the weekend, where senior officials provided updates on the progress and future plans of the National Health Insurance Scheme (NHIS).
In his welcoming remarks, Bai Mass Saine, Chief Executive Officer of National Health Insurance Authority (NHIA), who underscored the significance of the gathering, said the National Health Insurance Scheme (NHIS) is designed to protect residents from the financial burden of accessing essential healthcare services.
The initiative ensures that “no one is left behind”, regardless of background or status, he said, emphasising that collective effort is required to achieve universal health coverage.
The CEO acknowledged the Ministry of Health's strategic leadership and the World Bank’s crucial financial and technical support to establishing the NHIA.
Dr Hassan Njie, Director of Services, NHIA, outlined the scheme’s rollout process. The initiative, he said, began with a pilot program at Bundung Maternal and Child Hospital in July 2023, initially focusing on maternal and child health services. Based on lessons learned, the scheme has since expanded to 12 additional public health facilities, covering general and specialist hospitals as well as key district and health centers except Sheikh Zayed Eye Care Center.
“As of now, we have contracted 13 public health facilities, and preparations are underway to roll out the scheme to the remaining 54 facilities by March 2025,” Dr Njie confirmed, adding that the NHIA is currently utilizing a fee-for-service reimbursement model, ensuring that healthcare providers receive compensation for services rendered. A performance-based financing (PBF) component is also in place to improve service quality across contracted facilities.
Dr Njie further highlighted that while the NHIS benefits package includes 19 essential health interventions, the initial rollout is prioritizing maternal and newborn health services. “Under this scheme, medical expenses related to childbirth, including postnatal care, are fully covered for a specified period up to seven days for normal delivery and ten days for cesarean section births,” he said.
Njie mentioned several opportunities for NHRA, including strong political support, with the initiative being backed by the president, and the Ministry of Health. International partners, notably the World Bank, are also providing financial and technical assistance.
Additionally, he asserted that NHIA has established a strong digital foundation for managing healthcare services efficiently. However, he said challenges remain: frequent shortages of essential medicines and medical consumables continue to impact service delivery, despite government efforts by allocating a budget line of 50M for NHIA in the 2025 national budget. The heavy reliance on external funding, particularly from the World Bank, he said raises sustainability concerns.
Another challenge, he stated, is the limited digitization of public healthcare facilities, which contrasts with NHRA’s modern systems. Additionally, despite NHRA’s goal of reducing out-of-pocket healthcare spending, some patients continue to pay for medicines and diagnostic services due to supply shortages.
“A recent assessment of The Gambia’s imaging and diagnostic services revealed significant gaps, with the private sector currently filling much of the demand,” he said.
For his part, Alieu Sowe, NHIS membership manager, explained that the National Health Insurance Scheme is governed by the NHIS Act 2021, which mandates that membership is open to all residents of The Gambia who are not part of a private health insurance scheme.
However, he said, a gap in the legislation currently allows individuals to opt out, which could place a financial strain on the scheme by leaving only lower-income individuals enrolled. To address this, he said, the NHIS legal team is working on amendments to make membership mandatory for all residents.
Sowe pointed out that the National Health Insurance Scheme will not be entirely free for all members, as contributions will be required from those who do not fall under exempted categories such as the vulnerable groups, including children under five, pregnant women, mentally ill individuals, indigents, pensioners, and persons above 65 years of age.
To properly identify exempt individuals, he disclosed that the NHIS is collaborating with key agencies such as the Ministry of Gender and Social Welfare, the Social Protection Agency, the Ministry of Health, and the Mental Health Hospital. “To access NHIS services, individuals must present a National Health Insurance Card or an electronic birth certificate,” he stated.
“The NHIS system is integrated with the Birth and Death Registry for automatic enrollment but does not issue these documents itself.”
Mr Sowe further said training for healthcare providers has begun in 13 facilities to support enrollments. “Currently, services are limited to women admitted for delivery, with plans to expand,” he said, adding: “Those without an NHIS card must visit designated locations for enrollment.”
