Gambians Endorse Universal Health Coverage As Medical Care Remains Elusive for Many

Source: Afrobarometer

Overwhelming majority of citizens say they worry about being unable to obtain or afford medical care when they need it.

Key findings

• Only one in 10 Gambians (11%) say they have medical aid coverage.
• Among those who don't have health insurance, more than half (53%) say it's because they are not aware of any available health insurance schemes.
• An overwhelming majority (85%) of Gambians say they worry "a little," "somewhat," or "a lot" about obtaining or affording medical care when they need it.
• About seven in 10 survey participants (69%) say the government should ensure universal access to health care, even if it means higher taxes.
• Health ranks as the most important problem that Gambians want their government to address.
• Among the 75% of respondents who had contact with a public clinic or hospital during the year preceding the survey: o Fewer than three in 10 (28%) say it was easy to obtain the medical assistance they needed, while one-quarter (24%) say they had to pay a bribe to be helped. o Vast majorities report encountering inadequate medical supplies (92%), long wait times (88%), facilities in poor condition (79%), and unaffordable care or medicines (76%), while 60% say they found absent medical staff.
• Three-fourths (75%) of citizens say they or a family member went without medicine or medical treatment at least once during the preceding 12 months, including 35% who say this happened "many times" or "always."
• Four-fifths (79%) of citizens think the government is doing a poor job of improving basic health services.
• About one-third (32%) of survey participants say they trust the Ministry of Health "somewhat" or "a lot."

The World Health Organization and World Bank (2025) jointly track global progress toward the Sustainable Development Goal of achieving universal health coverage (UHC) by 2030. Coverage is considered universal if all individuals can receive quality health care "without incurring financial hardship." According to the most recent global monitoring data, about 4.6 billion people worldwide still lack full coverage of essential health services, while an estimated 2.1 billion experienced financial hardship due to out-of-pocket health expenditures. Although coverage has expanded over the past two decades in 73 of 138 countries, only 42 reduced "catastrophic" out-of-pocket health spending (defined as more than 10% of a household budget) (World Health Organization & World Bank, 2025).

In the Gambia, access to affordable and high-quality health care has been a long-standing challenge. While the country recorded modest improvements under the previous national development plan, including expanded community health outreach and progress on maternal and child health indicators, recent assessments point to widening service-delivery gaps (Ministry of Finance and Economic Affairs, 2024). Limited infrastructure, frequent stockouts of essential medicines, and shortages of skilled health workers have all contributed to lessening the availability and quality of primary health care, especially in rural areas (Ministry of Health, 2022; World Health Organization, 2024). Between 2005 and 2023, health spending per capita declined from U.S. $33 to U.S. $26, yet the share of out-of-pocket spending by households tripled, from 11.5% of overall health expenditure to 33.8% (World Health Organization, 2025).

In 2019-2020, the Gambia had a maternal mortality ratio of 289 deaths per 100,000 live births, a neonatal mortality rate of 29 per 1,000, and an under-5 mortality rate of 56 per 1,000, underscoring ongoing fragility in maternal and child health outcomes (Bureau of Statistics & Ministry of Health, 2020). The National Health Policy (2021-2030) notes that both communicable and non-communicable diseases challenge the health-care system, with cancer and cardiovascular disease causing increasing proportions of deaths (Ministry of Health, 2022).

The Ministry of Health (2022) underscores the need to ensure that no one is left behind in accessing essential health services. In the National Health Policy, the ministry outlines several reform priorities aimed at revitalising primary health care and advancing progress toward UHC. Key measures include strengthening community-level service delivery through the expansion of village health services, increasing the availability of essential medicines, and upgrading infrastructure in primary and secondary facilities. The plan also calls for enhanced training programmes and targeted recruitment to address persistent shortages of health care professionals.

This dispatch reports on an Afrobarometer Round 10 survey module focusing on health care. Findings show that health ranks as the most important problem that Gambians want their government to address, ahead of the increasing cost of living and crime/insecurity.

Only one in 10 citizens report having medical aid coverage. Among those who lack health insurance, more than half say they are unaware of any existing schemes available to them.

More than eight in 10 respondents worry about being unable to afford medical care when needed, while more than two-thirds say the government should ensure universal access to health care, even at the cost of higher taxes.

Three-fourths of Gambians say they or a family member went without needed care in the past year. Among citizens who had contact with a public health facility, overwhelming majorities report encountering inadequate medical supplies, long wait times, facilities in poor condition, and/or unaffordable medicines.

Mariama Davies Mariama Davies is programme manager for the Center for Research and Policy Development.

Bill Clinton Alex Bill Clinton Alex is a technical specialist at the Center for Research and Policy Development in the Gambia.