This article delves into the aforementioned challenges and pivotal role that initiatives such as the recently announced Horizons Clinic play in reshaping healthcare paradigms in The Gambia.
While many have heralded the Horizons Clinic transaction as a “beacon of hope”, which it is, this article endeavors to establish the reasons why. Moreover, it will explore the replicable lessons and financial innovations that can be applied to further catalyze positive transformations in Gambia’s healthcare sector and beyond.
The Healthcare Landscape in The Gambia
The Gambia faces significant healthcare challenges, including high maternal and neonatal mortality rates, limited access to essential medicines, and substantial out-of-pocket healthcare costs. These issues underscore the urgent need for interventions to improve healthcare access and outcomes.
According to WorldBankData, The Gambia only has 1 doctor per 10,000 people, whereas OECD countries average 34; maternal mortality stands at 458 deaths per 100,000 live births, nearly double the global average; limited access to essential medicines; and 60% of healthcare costs covered by out-of-pocket payments. In other words, access to quality healthcare and medicines is far too scarce, and their cost is far too expensive.
Further retarding improvement in these areas is the fact that would-be catalytic patients typically travel abroad for medical treatment. According to the World Bank, Africa loses an estimated $1 billion annually through outbound medical tourism.
Poverty's Role in Healthcare Challenges
While there are many secondary reasons that hamstring Africa and its healthcare – such as corruption, medical tourism, brain drain, lack of innovation, macroeconomic policy, low insurance coverage – poverty is arguably the primary contributing factor.
“Poverty amplifies healthcare needs while limiting African countries' ability to fund healthcare”, says Dr. Ola Brown, Founding Partner, Healthcare Capital Africa, an Africa and healthcare focused investment firm.
In The Gambia, fiscal constraints loom large, with a substantial portion of the budget allocated to debt servicing and recurring expenses like salaries. Approximately 60-70% of the national budget goes towards debt servicing and recurring expenses such as salaries, leaving limited resources for crucial sectors like healthcare.
New Solutions on the Horizon
Backed by a $16.8 million Afreximbank financing facility, the Horizons Clinic will be the first international standard 60-bed hospital in The Gambia and offer a range of secondary & tertiary specialist services that are not available at present. Currently, patients needing specialist care either do not receive it or travel abroad at significant cost. The Horizons Clinic therefore will be complementary to the current healthcare provision in The Gambia.
For the first time, existing healthcare providers in The Gambia will have the option to refer patients needing specialist care to a high quality hospital locally. The 60-bed Horizons Clinic will feature a comprehensive outpatients department and diagnostic service. Horizons will also offer local healthcare workers opportunities for continuing professional development (CPD) to further strengthen the health system.
“We are thrilled that this agreement has now been finalised…The Horizons Clinic will offer a range of outstanding specialist medical services and save lives. All patients will be treated in our clinic – including those who can afford to pay and less well-off people – because of our social enterprise corporate structure design. Thank you to all our stakeholders for making this dream a reality, including Afreximbank, Horizons Trust Gambia, our legal teams in the UK and The Gambia, GICEC Gambia and Bloom Bank”, says Professor James N'Dow OBE DL, renowned Gambian urologist, Founder and Director of Horizons Clinic Gambia Limited.
Government Strategic Interventions
One of the pivotal aspects of Horizons Clinic is the bold step reportedly taken by the Government of The Gambia to facilitate this project. According to Sources, the Government strategically leveraged its balance sheet and influence to help bridge financing gaps and provide critical support for the project.
This strategic intervention marks a departure from the primary reliance upon traditional donor-driven approach to development, showcasing the potential of public finance in unlocking opportunities and tackling significant challenges. If this is in fact the case, then the Government and its financial team led by H.E. President Adama Barrow, Minister of Finance & Economic Affairs Seedy Keita, and Central Bank Governor Buah Saidy should be lauded and empowered to take further actions in this vein.
Development Through Financial Innovation
"Addressing fiscal challenges to funding health care solutions is critical, and I believe that impact investing, ESG finance, blended finance strategies, and concessionary finance are key. These innovative structures like SDG bonds can attract international and private investors, ensuring a balanced mix of capital for impactful projects", says Dr. Brown.
Dr Brown goes on to add that “to a certain extent, this notion is exemplified by Horizon Clinics’ capital structure and all parties involved should be applauded for such an innovative solution, especially in a challenging funding environment as The Gambia”.
Reversing Brain Drain and Harnessing Diaspora Power
Horizons Clinic represents a reversal of medical brain drain by offering incentives for local healthcare professionals. The collaboration between Gambian professionals and diaspora members highlights the potential for impactful projects driven by visionary leadership.
Much like other recently launched, visionary-led healthcare ventures – such as, Innovarx Global Health led by Dr Ismail Badjie, Karamies Health led by Dr. Baboucarr Sanyang, and EFSTH’s Department of Surgery led by Dr Kebba Marena – the Horizons Clinic led by Professor James N'Dow’s OBE DL represents a reversal in this trend by offering attractive incentives for local healthcare professionals.
"The actualization of the Horizon Clinic stands as a beacon of hope for The Gambia, particularly in the area of Foreign Direct Investment (FDI) supported by the government but channeled through private sector health entities that can significantly add value. It sends the right signal to both investors about The Gambia's readiness to create a conducive environment for value creation, and, most importantly, it encourages Gambian healthcare professionals across all specialties to start thinking about being partners in development", say Dr Ismail Badjie, Founder & CEO, Innovarx Global Health.
Sustaining Momentum Beyond the Headlines
As we forge ahead, the sustained backing of the government, international financial institutions, and the diaspora emerges as a linchpin in upholding this influx of Foreign Direct Investment (FDI), especially in catalyzing sectors like healthcare.
Moreover, the impact of innovative financial solutions – and its role in unlocking the Horizons Clinic opportunity – underscores the compelling rationale for establishing a parastatal fund in The Gambia. Drawing inspiration from successful models like Ethiopia Investment Holdings (EIH) and Lesotho National Development Corporation (LNDC), the fund would be empowered with a formidable balance sheet and tasked to execute the nation's industrial development policies, thereby positioning the country as an appealing investment destination for both local and international investors. substantial progress in their respective nations.
By embracing these visionary strategies and fostering strategic collaborations, the nation can surmount obstacles and pave the path toward sustainable advancements in healthcare and beyond, heralding a new era of transformative growth and prosperity.
