REPUBLIC OF THE GAMBIA
END-DECADE ASSESSMENT REPORT
ON
FOLLOW-UP TO THE WORLD SUMMIT FOR CHILDREN
December 2000
TABLE OF CONTENTS
LIST OF ACRONYMS
2
EXECUTIVE SUMMARY
3
A.
Introduction and Background
1
B.
Process Established For The End-Decade Review
3
C.
Action at the National & International Levels
4
D.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Specific Actions for Child Survival, Protection & Development
The Convention on the Rights of the Child
Child Health
Food and Nutrition
Role of Women, Maternal Health & Family Planning
Role of the Family
Basic Education & Literacy
Children in Especially Difficult Circumstances
Protection of Children during Armed Conflicts
Children & the Environment
Alleviation of Poverty & Revitalisation of Economic Growth
7
7
9
11
13
14
15
17
19
19
20
b.
Lessons Learnt
Major Factors Enhancing Progress
21
22
E.
F.
Future Action
24
G.
Appendix
25
SELECTED BIBLIOGRAPHY
1
List of Acronyms
ARI
BFCI
Acute Respiratory Infection
Baby Friendly Community Initiative
2
CCA
CEDAW
CHN
CPR
CRC
DoSH
ECD
ECOWAS
EPI
ERP
GER
GRIP
HIPC
HIV/AIDS
ICPD
IDA
IDD
IMR
LIFDC
MCH/FP
MDG
MICS
MRC
NER
NFPP
NHPS
NRC
NYSS
ORT
PAU
PHC
POP/FLE
PRGF
PRSP
PSD
SPA
STI
TBA
U5MR
UNDAF
VAD
WSC
WSG
Common Country Assessment
Convention for the Elimination of discrimination Against Women
Community Health Nurse
Contraceptive Prevalence Rate
Convention on the Rights of the Child
Department of State for Health
Early Childhood Development
Economic Community of West African States
Expanded Programme of Immunisation
Economic Recovery Programme
Gross Enrolment Ratio
Getting Research Into Practice
Highly Indebted Poor Countries
Human Immunodeficiency Virus/Acquired Immune Deficiency
Syndrome
International Conference on Population and Development
Iron Deficiency Anaemia
Iodine Deficiency Disorders
Infant Mortality rate
Low Income Food Deficit Country
Maternal Child Health/family Planning
Mid-Decade Goal
Multiple Indicator Cluster Survey
Medical Research Council
Net Enrolment Ratio
National Family Planning Policy
National Household Poverty Survey
National Rehabilitation Centre
National Youth Service Scheme
Oral Rehydration Therapy
Policy analysis Unit
Primary Health Care
Population and Family Life Education
Poverty Reduction and Growth Facility
Poverty Reduction Strategy Paper
Programme for Sustained Development
Strategy for Poverty Alleviation
Sexually Transmissible Infection
Traditional Birth Attendant
Under Five Mortality Rate
United Nations Development Assistance Framework
Vitamin A Deficiency
World Summit for Children
World Summit Goal
Executive Summary
The End-decade Review Process
The Gambia ratified the Convention on the Rights of the Child (CRC) on 3rd August 1990 and
in September, the same year, the President of the Republic joined other World Leaders in New
3
York for the World Summit for Children (WSC) which adopted the Declaration and Plan of
Action.
To review progress at End-decade, the Policy Analysis Unit (PAU) in the Office of the
President organised a series of meetings in collaboration with the UNICEF Banjul Office in
The Gambia to adopt a joint strategy for launching the review process. A local Consultant with
specific Terms of Reference (TOR) undertook the reviews at the national level and report to a
multi-sectoral Task Force drawn from Government, United Nations Agencies, NGOs, the
private sector, youth groups and members of civil society. The review involved but was not
limited to the analysis of key documents including the Initial Report of The Gambia on the
United Nations Convention on Rights of the Child and the Convention on the Elimination of
Discrimination Against Women (CEDAW); the Joint Government/UNICEF Disability Survey,
Multiple Indicator Cluster Surveys (MICS-1, MICS-2); UNICEF Annual Reviews; the Draft
20/20 Initiative Study; Draft Situation Analysis of Children & Women in The Gambia; the two
Strategies for Poverty Alleviation (SPA-1, SPA-2); Government’s Vision 2020; National
Human Development Reports; Common Country Assessments; and other national and
international data sources.
The major phase of the review process involved a macroscopic research during which a
complete review of available information on the situation of children in The Gambia as well as
the achievements and constraints encountered in meeting the WSC Goals was undertaken. The
findings and recommendations from the review were presented at a two-day national workshop
organised by the PAU on Global Annual Review of the Programme of Co-operation between
the Government of The Gambia and UNICEF. The review which was officially opened by the
HE the Vice President of the Republic of The Gambia and brought together over 94
participants from government departments, Non-governmental Organisations, private sector,
youth organisations, Community-based and other civil society organisations. Members of the
Diplomatic and Consular Corps accredited to were in attendance as observers.
Status of the National Programme of Action for Children
Two years after ratification of the Convention, Government established an Inter-ministerial
Committee, chaired by the Ministry of Health & Social Welfare and backed-up by a multisectoral Technical Working Group with mandate which produced the 1992-2003 National
Programme of Action for the Survival, Protection and Development of Gambian Children
(NPA). The NPA analysed the overall Situation of Children in The Gambia and outlined their
existing unmet needs as well as the challenges they present nationally. The Programme adapted
the WSC Goals and set priorities, which were then phased over three development-planning
periods.
Total resource requirements for implementation of the NPA was estimated at $114 million of
which $86 million would constitute capital expenditure and $28 million in recurrent costs. The
need for funding came at a time when Government’s per capita health expenditures began to
decline largely as a result of reduced donor support, and government’s focus on the tertiary
health care delivery system led to serious pressure building at the top end of the health delivery
system, while leaving resources idle at the Primary Health Care delivery system, the main users
of which are the poor and vulnerable, including women and children. As a result,
communicable diseases such as malaria, diarrhoea, Acute Respiratory Infections (ARIs),
4
Sexually Transmissible Infections (STIs), HIV/AIDS and Tuberculosis continued to account
for the significant increase in the country’s morbidity and mortality rates.
In light of the financial resource constraints, government incorporated the goals and objectives
of the NPA into the National Health Policy to strengthen and sustain service delivery in the
programme areas of Malaria Control; Acute Respiratory Infections (ARI); Safe Motherhood;
EPI; Diarrhoea Control, and Nutrition. Targets and indicators based on the NPA were also set
in these programmes areas for purposes of monitoring. An important mandate of the Interministerial Committee was to focus, at their annual meetings, on strategic issues particularly
those relating to policy directions and budgetary allocations. The Committee would then tabled
a report in Cabinet for discussion and subsequently presented to the Head of State and
Parliament in the form of an Annual Report on the follow-up to the World Summit for
Children.
A major weakness in the NPA is that although it clearly identified the programme components
that would be undertaken, there was very little indication as to how the activities would be
funded including the operations of the Inter-ministerial Committee which, coupled with poor
co-ordination by the then Ministry of Social Welfare, eventually ceased to function as a result.
In the absence of a monitoring body, implementation of the NPA including the timely
submission of periodic reports on progress became difficult if not impossible Thus, apart from
addressing child-specific components within the National Health Policy, the NPA remained
and still remains a static document that needs to be reviewed and operationalised within an
established institutional framework.
Key Measures taken to implement the CRC
Since ratification of the Convention and adoption of the NPA, The Gambia has made
significant progress in meeting the goals of the Convention with the issues of women and
children given prominence in several national development policies, strategies and
programmes. In addition to creating a favourable policy environment, Government also carried
out a number of legislative reforms. The 1997 Constitution was drafted to provide for the
protection of fundamental human rights and the protection of personal liberty, property and
protection against discrimination. It also recognises in general terms the rights of disabled
persons to respect and dignity and non-discrimination. The Criminal Code specifically provides
for the protection and preservation of the Right to Life of children and the unborn foetus and
ensures the child’s right to a name, nationality and for care by both parents.
Despite these legislative reforms, the absence of a corporate body of laws that focuses entirely
on the rights of women and children hampers the harmonisation of Gambian laws with those of
the CRC and CEDAW. Existing legislations tend to focus more on the protective rights of the
child rather than their developmental needs and, although the Courts may be safeguarding the
human and legal rights of all individuals in the country, that may not be enough in the absence
of a national surveillance mechanism to monitor the application of the different provisions of
the CRC and CEDAW.
Government Budgetary Allocations and the CRC
The CRC has not directly influenced national budgetary allocations as such. However,
conscious of the severity of poverty and its impact on the survival, protection and development
5
of children in The Gambia, the Government adopted two Strategies for Poverty Alleviation
(SPA-1 and SPA-2). In line with international development targets the SPA-2 seeks to reduce
by two-thirds the mortality rates for infants and children under the age of Five and a reduction
by three-fourths in maternal mortality by 2015; enforce Universal Primary Education by 2015;
and make substantial progress towards gender equality and empowerment of women by
eliminating gender disparity in primary and secondary education by 2005. But the effective
implementation of the strategy and, by implication, its child-specific components will depend
on substantial debt relief for the country and mobilization of external financial resources.
Major Factors Enhancing Progress
Among the driving forces for The Gambia’s progress towards the World summit Goals
included Government’s strong political commitment to the welfare of children; respect for
fundamental human rights; an impressive economic growth based on a good degree of political
stability; adoption of a preventive primary health care delivery system that has reduced
neonatal deaths; existence of an in-country capability for basic and operational medical
research; government’s involvement in sub-regional peace building, conflict transformation and
dialogue; and the strong and effective financial and technical support from UNICEF which
enable the Government to build capacity in the delivery of quality child-specific programmes in
the country.
Major Constraints
Several factors, however, restrained government’s efforts towards a higher level of programme
delivery in favour of children and therefore need to be minimised. These restraining forces
included the continuing decline in resource flows to the health sector; inadequate institutional
capacity for child-specific programme development and management; deeply rooted sociocultural beliefs and practices; absence of a corporate body of laws that focuses entirely on the
rights of women and children; absence of legislation guaranteeing the rights of children in
armed conflict; dearth of reliable and child-specific data for use in life cycle approaches to
programming; gender inequalities in the access to basic education and literacy for women,
particularly the girl-child; increasing poverty & Debt burden; and inadequate co-ordination and
co-operation among actors involved in the delivery of child-specific programmes resulting in
duplication of efforts and lack of consistency.
Key Challenges for the Future
The adoption by The Gambia of the PHC strategy in 1979 has demonstrated considerable
benefits in combating childhood diseases. But still neonatal deaths continue to account for most
of the deaths of children under-five years of age. Unless the Government is able to make
significant investments in providing preventive and primary health services such as clean
water,
6
waste disposal, health education, primary care to include specialised care for women at high
risk for adverse birth outcomes including death of mothers and young children, this may result
in increased diseases, disabilities and early deaths. Secondly, since the present Gambian legal
system is more concerned with the protective rather than the developmental aspect of children,
there is need, therefore, to review and reinforce these arrangements with the creation of a
National Commission for Children’s Rights and Women whose mandate would be not only to
act as a watchdog for the enforcement of children’s rights but also to monitor the
implementation of The Gambia’s obligations under the CRC and CEDAW. This is one of the
recommendations of the initial report on the CRC submitted to the Child Rights Committee in
Geneva.
Recommendations for Future Action
Taking into account its past experience, existing management capacity and opportunities for
collaboration with both local and international partners, Government will strive to meet a
number of key challenges notably, by the creation of a National Commission and Secretariat on
Women and Children’s Rights; review of the National Programme of Action and incorporating
the Challenges in the New Agenda for Children for the 21st Century; harmonising existing
national legislations with those of the CRC; enacting legislation that protects refugees in The
Gambia and intensify and encourage peace-building, conflict resolution and dialogue both at
home and in the sub-region. Government will also ensure greater involvement of NGOs and the
private sector in the development and implementation of children and women’s rights-based
programmes and mobilising additional resources for their implementation.
7
A. Introduction and Background
The population of The Gambia is estimated at 1,328,814 and is growing at 4.2% per
annum. With a density of 124 persons per square kilometre, The Gambia is one of the
most densely populated countries in Africa with 40% of the population concentrated in
urban and peri-urban areas. The relatively high population growth rate has been
recognised as one of the constraints on the country’s development. Also a small surface
area of 10,689 square kilometres, narrow physical configuration and geographical
location in the drought stricken Sahelian scrubland, The Gambia has an impoverished
natural resource base. Low rainfall and its poor distribution in the past two decades
resulted in drought conditions that have affected the vegetation cover and food
production potential. Though 95% of the population is Muslim and the population
ethnically diverse, there is a measure of homogeneity in cultural practices.
The Gambian Delegation to the World Summit and Immediate Follow-up Actions
The President of the Public, mandated by Parliament to ratify the Convention on the
Rights of the Child on behalf of The Gambia headed the Gambian delegation to the
World Summit for Children (WSC) in 1990. Two years after ratification of the
Convention, Government established an Inter-ministerial Committee, chaired by the
Ministry of Health & Social Welfare and backed-up by a multi-sectoral Technical
Working Group with mandate to produce a National Programme of Action for the
Survival, Protection and Development of Gambian Children (1992-2003). The
National Programme of Action (NPA) analysed the overall Situation of Children in The
Gambia and outlined their existing unmet needs as well as the challenges they present
nationally. The Programme adapted the WSC Goals and set priorities, which were then
phased over three development-planning periods. Although the total cost of the decadelong plan was estimated at $114 million in 1992 prices of which $86 million and $28
million were for capital and recurrent expenditures, respectively, there was very little
indication as to the sources of the funding over the period and the strategies to mobilise
those resources. Lack of funding and weak co-ordination by the then Ministry of
Health and Social Welfare were therefore the major constraints that affected the
operationalisation of the NPA and by implication the Inter-ministerial Committee and
the Technical Working Group set up to monitor the progress of implementation of the
programme.
Mechanisms for Periodic Reviews of Progress
In order to institutionalise a continuous process of programme supervision, monitoring
and assessment, the NPA envisaged a series of activities that would be pursued on a
regular basis at the grassroots, divisional and national levels. The annual meetings of
the Inter-ministerial Committee being at the national level would focus strategic issues,
particularly those related to policy directions and budgetary allocations. The
Committee’s deliberations would be based on the consolidated reports emanating from
the divisions as well as on inputs from its Secretariat in the form of a national overview
of the changing status of children, progress in the implementation of the NPA and
bottlenecks encountered the previous year. The Report of the Committee would then be
tabled in Cabinet for discussion and subsequently presented to the Head of State and
Parliament in the form of an Annual Report on the follow-up to the World Summit for
Children. Records of meetings of both the Inter-ministerial Committee and the
Technical
2
Working Group indicate that following the initial meetings these bodies did not meet
regularly as planned; and after some time became inactive and finally defunct. In the
absence of a monitoring body, implementation of the National Programme of Action,
including the timely submission of period reports on progress, thus became difficult if
not impossible. This situation was due mainly to the radical political change caused by
the military coup in 1994 and the consequent establishment of the second Republic.
Mid-Decade Review
The Gambia did not carry out a Mid-decade Review. However, a Multiple Indicator
Cluster Survey (MICS-1) was conducted in early 1996 to monitor progress at Middecade in the achievement of the World Summit Goals (WSG). The survey revealed
that many mothers were familiar with Oral Re-hydration Therapy (ORT), knew and
practiced how to treat diarrhoeal diseases, Acute Respiratory Infections (ARI) and
breastfeeding, but detection of symptoms of ARI and seeking appropriate treatment
were found low and far below the Mid-Decade Goal (MDG). An important finding of
the MICS was the existence in the indicators of regional variations that were
significant enough to be considered in future child-related programme development
and implementation. In this regard, the results of the MICS have been recommended as
useful planning tools for policy-makers, managers at various levels of Government,
Non-Governmental Organisations (NGOs), United Nations and donor agencies
involved child welfare activities in The Gambia. The results of the MICS1 were also
used as input to the preparation of the Initial Report of The Gambia on the United
Nations Convention on the Rights of the Child submitted in July 1999 to the
Committee on the Rights of the Child in Geneva as required under Article 44 of the
Convention.
The Initial Report assesses the situation of children in the Gambia and highlights the
relationship between the law and the realities of the country, the progress made so far
towards meeting the goals of the CRC as well as the constraints encountered such as
deeply rooted socio-cultural beliefs and practices, and the absence of a corporate body
of laws that focuses entirely on children. The pre- and full Committee discussions of
the Report are expected to take place in June and September 2001, respectively.
B. Process Established For The End-Decade Review
Organisation of the Review and the Role of Civil Society Organisations
The Policy Analysis Unit (PAU) in the Office of the President organised a series of
meetings with the UNICEF Banjul Office in The Gambia to adopt a joint strategy for
launching the review process. It was agreed to appoint a local Consultant with specific
Terms of Reference (TOR) to undertake the reviews at the national level and report to
a multi-sectoral Task Force drawn from Government, United Nations Agencies, NGOs,
the private sector, youth groups and members of civil society.
3
Principal Source Materials
The review involved but was not limited to the analysis of key documents including the
Initial Report of The Gambia on the United Nations Convention on Rights of the Child
and the Convention on the Elimination of Discrimination Against Women (CEDAW);
the Joint Government/UNICEF Disability Survey, Multiple Indicator Cluster Surveys
(MICS-1, MICS-2); UNICEF Annual Reviews; the Draft 20/20 Initiative Study;
Situation Analysis of Children & Women in The Gambia (October 2000); First and
Second Strategies for Poverty Alleviation (SPA-1, SPA-2); National Human
Development Reports; Common Country Assessments (CCAs); and other national and
international data sources.
Findings
A desk or macroscopic research constituted the major phase of the exercise involving a
comprehensive review of available information on the situation of children in The
Gambia as well as the achievements and constraints encountered in meeting the WSC
Goals set out in Declaration and Plan of Action. This was the factual and analytical
stage, which involved obtaining data and information that exist in evaluation and other
relevant reports dealing with the situation of children in the Gambia. The second phase
involved key person interview the results of which were used as basis for reviewing the
status and impact of interventions in the area of Children’s Rights and assessing the
extent to which progress was made towards the achievement of the WSC Goals, the
driving forces, constraints (political, legal, socio-cultural and institutional etc.) that
restrained progress as well as an assessment of future action to satisfy unmet needs.
The findings and recommendations from the review were presented at a two-day
national meeting organised by the Policy Analysis Unit in The President’s Office on
Global Annual Review of the Programme of Co-operation between the Government of
The Gambia and UNICEF. The meeting which was officially opened by Her
Excellency the Vice President of The Republic of The Gambia, was attended by over
94 participants and observers including government departments, the Diplomatic and
Consular Corps; youth organisations, NGOs, private sector, Community-Based
Organisations (CBOs) and others from civil society. The Permanent Secretaries of the
Departments of State for Foreign Affairs (DoSFA) and Department of State for Health
(DoSH) respectively chaired of the sessions on the Overview of the WSC and the
National Programme of Action, the Findings and Recommendations of the review.
C. Action at the National & International Levels
Policy Environment
Since ratification of the Convention and adoption of the National Programme
of Action, The Gambia has made significant progress in meeting the goals of
the Convention with the issues of women and children given prominence in
several national development policies, strategies and programmes. The policies
so far adopted in support of children and women’s rights have been a
translation at the national level of major Global Conferences in which The
4
Gambia participated fully. Following the 1994 International Conference on
Population and Development (ICPD) in Cairo, the Government adopted the
National Health Policy in which the goals and objectives of the National
Programme for the Survival, Protection, and Development of Gambian
Children were fully incorporated. The Policy on the Advancement of Gambian
Women is in direct response to, inter alia, the Nairobi Forward Looking
Strategies, CEDAW, and the Beijing International Women’s Conference. The
revision of the National Education Policy was carried out in 1998 with a view
to incorporating the Jomtien Goal of ‘Education for All’ whiles the World
Food Conference and the Nutrition Conference have inspired the adoption of a
National Nutrition Policy and the setting up of a National Nutrition Agency
(NaNA). In addition, the goals and objectives of the NPA have been
incorporated in the National Health Policy in order to strengthen and sustain
service delivery in the programme areas of Malaria Control; Acute Respiratory
Infections (ARI); Safe Motherhood; EPI; Diarrhoea Control, and Nutrition.
The 1990 Programme for Sustained Development (PSD) emphasised the increased
allocation of resources for social services, food and horticultural sectors, particularly
those affecting children and women but in absolute terms, those sectors recorded little
growth and in some cases a decline in the level of resources allocated. Therefore,
despite the relative success of the PSD in achieving macro-economic and financial
objectives, the programme had undesirable effects on the social front with aggravation
of poverty among the most vulnerable in the society, notably children and women.
To strengthen community organisations, inculcate civic responsibility; Government has
formulated a National Governance Policy with the full participation of NGOs and civil
society. In coherence with the 1997 constitution that provides a strong foundation for
decentralisation, the government has approved a Strategy and Plan of Action for the
reform of the Local Government system. Government, grassroots organisations and
donor partners were also involved fully in the development of the Strategy and Plan of
Action. The setting of the Commission is an important step in the government’s
decentralisation and participatory process, which could have an important impact on
civil society and grassroots involvement in rights issues throughout the country.
Government’s current national development objectives and priorities are defined in the
Mission Statement of Vision 2020, which expresses The Gambia’s aspirations and
socio-economic strategy for the period 1996-2020. It accords high priority to the social
sectors of Health, Education and other services and calls for a development strategy
that is human-centred and export-oriented. The Vision also gives high priority to
children, and calls for focussed attention on child survival, protection and development
programmes, and emphasises Children’s Rights, particularly to health and education.
Law Reform
5
With regard to legislation, the Constitution (1997) provides for the protection
of Fundamental Rights and the protection of personal liberty, property and
protection against discrimination; the Criminal Code (Cap 10) specifically
provides for the protection and preservation of the Right to Life of children and
the unborn foetus; Sections 197 & 198 prohibit infanticide and child
destruction and imposes a maximum punishment of life imprisonment for both
offences. The child’s right to care and maintenance from both parents is also
guaranteed under several legislations including the Matrimonial Causes Act
(Cap 43), and the Maintenance of Children Act (Cap 44:03). The Public Health
Act (Cap 40:03) includes legislation relating to physical, environmental and
disease control.
Important as these legislations may be, their dispersed nature coupled with the fact that
to a large extent they focus more on the protective rights of children rather than their
developmental needs does not facilitate their harmonisation with the CRC. Further,
although the Courts may be safeguarding the human and legal rights of all individuals
in the country that may not be enough in the absence of a national surveillance
framework to promote and monitor the application of the different provisions of the
CRC. The creation of such an institutional framework will could enable Government to
undertake a structured approach to the dissemination of the Convention and more
important, to co-ordinate and monitor the implementation of the National Programme
of Action once it is reviewed and made fully operational.
Basic and Operational Research Capability
Efforts have also been made in increasing basic and operational research
through close working relationships between the United Kingdom’s Medical
Research Council (MRC) in The Gambia and the Department of State for
Health (DoSH) and many other local partners. The six-monthly Gambia
Government/MRC meetings with the Director of Medical Services, and his
team provide a vital forum for exchanging information and highlighting areas
for collaboration. The central statistics Department is also a National
institution that has the capacity to conduct surveys and studies and Maintain
the Basic reliable information in planning monitoring and evaluation purposes.
Government Budgetary Allocations and the CRC
Although preventive Primary health Care (PHC) strategy adopted by
government in 1979 has contributed significantly in reducing the incidence
some childhood diseases, the strategy nevertheless remains unsustainable due
to over-dependence on external donor financial support. This coupled with the
fact that expenditures in the sector have tended to focus on the tertiary health
care delivery, which is contrary to the stated objectives of the Primary Health
Care (PHC) programme, has led to serious pressure building at the top end of
the health delivery system, while leaving resources idle at the PHC level, the
main users of which are the poor and vulnerable, especially women and
children. As a result, communicable diseases such as malaria, diarrhoea, Acute
Respiratory Infections (ARIs), Sexually Transmissible Infections (STIs)
6
including HIV/AIDS and Tuberculosis continue to account for the significant
increase in the country’s morbidity and mortality rates.
D. Specific Actions for Child Survival, Protection &
Development
a) The Convention on the Rights of the Child
Ratification and Dissemination
The Gambia ratified the Convention on the Rights of the Child (CRC) on
3rd August 1990. Since then, a number of activities have been carried out
nationwide to disseminate and implement the CRC and the CEDAW as
well as to advocate for the ratification of the African Charter on the
Welfare and Children’s Rights. Government has also given strong support
to both public and private media houses in their coverage of child rights
and has also been represented at the highest levels in international
conferences on children, including the participation of the Secretary of
State for Justice in the Lome meeting on Children in the 21st Century. In
order to create greater awareness about women and children’s rights,
Committees on Children and Women’s Rights have been set up at both the
national and sub-regional (Divisional) levels.
A Population/Family Life Education (POP/FLE) component was integrated
into the 1988 – 2003 National Education Policy to take account of the
highly youthful nature of the country’s population and the resultant high
rates of adolescent fertility, teenage pregnancies and illegal abortions as
well as infant mortality. But the results of a recent adolescent/youth
reproductive health survey published (September 2000) indicates that that
the POP/FLE intervention has not been very effective in raising awareness
among adolescents/youths on issues of reproductive health, sexual health
and family planning and therefore recommended its review.
The Schools Broadcasting Programme has been revitalised to reinforce the
on-going dialogue on some aspects of the Convention including “free and
compulsory” education, age and sexual consent at marriage, exploitation of
domestic servants, informal skills training for girls and women; greater
male participation in agricultural production; and civil rights and freedoms
in relation to the child’s opinion and parental rights to discipline them.
Efforts in this area are also being complemented by national and
international non-governmental organisations, which sponsor the
participation of children in local competitions and develop suitable
Information, Education & Communication (IEC) materials meant to serve
as constant reminders to the population about children and their rights.
7
A National Parliamentary-Media Task Force on Child Survival and
Development set up in 1992 celebrated The Day of the African Child
during which participants called on the Gambian Government to adopt a
“Programme for the Protection of the Rights of Gambian Children” and to
“make the necessary changes to national legislation aligned with the
provisions of the Convention, propose new legislation that will enable
parents to ensure that their children enjoy the best possible conditions for
their development” and for Parliament to review “national law and practice
as they concern juveniles, to ensure compatibility with the Beijing Rules
on Juvenile Justice.” Since then, celebration of the Day of the African
Child has become an annual event to the extent that in 1999, ten youth
groups came together to launch an umbrella national association for youth
and children. The UNICEF Country Office in The Gambia has since
worked closely with the group on events such as the launching of
UNICEF’s Progress of Nations Report, State of the World’s Children
Report and the International Children’s Day of Broadcasting. The youth
umbrella organisation also participated in the dissemination of The
Gambia’s Initial Report on the United Nations Convention on the Rights of
the Child in collaboration with the Department of State for Social Welfare,
Youth and Sports, Education Women’s Bureau and UNICEF.
Government has regularly undertaken Situation Analyses (SITANs) of
Children in The Gambia. The 1998 SITAN was updated in 2000 to serve as
input to a rights-based approach to the development and implementation of
children and women’s rights programmes in the country. The SITAN is to
be disseminated widely among stakeholders including NGOs and private
sector organisations involved in the promotion and Protection of children's
and women’s rights.
Inadequacy of resources, mainly financial constituted a major constraint to
government’s efforts to carry out effective advocacy on children and
women’s rights in the country. Planned divisional Committee meetings
have been irregular due to lack of local human resources. For the same
reasons, media practitioners, NGOs and youth organisations could not be
trained in the area of children and women’s rights. An important national
seminar aimed at persuading law- and decision-makers to revise existing
national legislations and harmonise them with the CRC and CEDAW could
not be implemented due to insufficient funds. The limited funds available
were instead used to celebrate the 11th Anniversary of the CRC and to
produce and disseminate The Gambia’s Initial Report to members of the
Bar Association of The Gambia, National Assembly members, NGOs and
youth groups. Other major national advocacy initiatives affected by
resource constraints include support to the Attorney General’s Chambers
to promote the harmonisation of existing Gambian legislations with the
CRC and CEDAW; strengthen national capacity for periodic reporting.
8
Monitoring
NPA classified monitoring indicators into three distinct categories – input
indicators such as annual budgetary allocations and actual expenditure;
output indicators such as service coverage attained during the year as a
proportion of the target population; and impact indicators such as mortality
rates. Although the goals and objectives of the NPA were incorporated in
the 1994 – 2000 National Health Policy and the Education Master Plan,
inadequate national capacity for reliable data collection, analysis and
dissemination continues to impede progress in monitoring achievements
and constraints.
In a bid to overcome these constraints, Government intends to set up a
National Commission on Women and Child Rights with mandate to, inter
alia, create and ensure greater awareness of the existence of the CRC as an
instrument of policy; co-ordinate the work of public agencies involved in
Child and Women rights programmes to ensure their compliance with the
CRC; assist in formulating plans and mechanisms for implementing childrelated policies and programmes for monitoring the implementation of the
CRC and CEDAW ; and to seek international support for government and
non-governmental organisations seeking to achieve the aim, goals and
objectives envisaged in the CRC and CEDAW.
b) Child Health
Combating Childhood Diseases
The Infant Mortality Rate (IMR), declined from 127/1000 live births in
1983 to 97/1000 live births by 1998, a decrease of about 23% with a
greater decline of childhood mortality by 54% to 81/1000. The larger
decline of the latter is the major factor for the declining trend of Underfive mortality. The very high coverage of the Expanded Programme of
Immunisation may have been a major factor in the decline. Approximately,
92% of children aged 12-23 months received BCG vaccination by the age
of 12 months and the 1st dose of DPT was given 97% (MICS-2000). The
percentage declines for subsequent doses of DPT to 96% for the 2 nd dose,
and 89% for the third dose. Similarly, 99% of children received Polio 0 by
age 12 months and this declines to 94% by the 4th dose. The coverage for
measles vaccine by 12 months is 90%. Thus the overall proportion of
children who had all eight recommended vaccinations by their 1 st birthday
is 71%. Despite this impressive achievement, the majority of infant deaths
still occur during the neonatal period mainly as a result of malaria, acute
respiratory infections and diarrhoeal diseases.
Malaria, which has proved more difficult to combat, continues to affect
mainly children under the age of 5 years. It is estimated that 60.6% of new
9
admissions in the Paediatric Ward of Royal Victoria Hospital are
diagnosed for malaria, which also accounted for 47% of deaths in the ward
(RVH, Annual Report 1999). Social mobilisation in communities on
proper drainage, environmental control and use of impregnated Bednets
has increased community participation in control activities in several
health divisions. Currently, national impregnated bednet coverage has
reached 44.6% (MICS, 2000) whilst 200 doctors and nurses have been
trained in the management of severe and complicated malaria. The
commitment of government and the international community through the
Abuja Declaration on the Roll Back Malaria Initiative has also been
another very effective strategy for the prevention and management of
malaria in the country with control programmes based on early diagnosis
and proper case management (of which drug availability is a sine-qua-non)
have been developed to combat the disease
Prioritising the Prevention and Treatment of HIV/AIDS
In The Gambia, sexually transmitted infections and their complications are
a major health problem and although the prevalence of HIV-1 in the
country is currently low, it is increasing. Nation-wide, 0.6% of women
have tested positive for HIV1 and 1.1% for HIV2, whilst 0.1% was dually
reactive (HIV-1 and HIV-2). There clear indications that HIV-1 and HIV2
are being transmitted across the country (National AIDS Programme,
1999). However, the level of knowledge of how AIDS is transmitted and
prevented is high among women aged 15-49 years with an overall
proportion of 87% having ever heard of AIDS whiles urban and rural
levels are 90% and 83%, respectively. About 61% believe that having one
uninfected sex partner can prevent HIV transmission; 54% believe that
using a condom every time one has sex can prevent HIV transmission and
48% agree that abstaining from sex prevents transmission. The percentage
that knows all three means of preventing transmission is higher among
women with education and lower among women with no education.
Accurate knowledge of the means of transmission is substantially less
among women in the rural than in the urban areas. In November 2000 the
Head of State launched a major campaign to fight against HIV/AIDS
targeting particularly youths. It is envisaged that a that a national
HIV/AIDS council will be created in 2001 to advocate and support
integrated intervention countrywide.
Access to Safe Drinking Water
The quality of water from sources considered safe is affected by a number
of factors including bacterial contamination (rural wells), salt-water
intrusion and iron content. The use of fertilisers in close proximity to wells
also affects water quality in the country. Distribution of the population by
source of drinking water shows that 42% use drinking water from public
tap and 17% from tube well or borehole with pump. There are regional
disparities in the sources of drinking water. The population using safe
10
drinking water sources are those using any of the following types of supply
– piped water, public tap, borehole/tube well, protected well, and protected
spring or rainwater. Overall, 89% of the population has access to safe
drinking water, of which 98% is urban and 80% rural (source:MICS2).
Major contributory factors to the significant increase in access to safe
drinking water include Donor intervention, Co-ordination of activities
through an established National working group to maximise resource use
and reduce duplication. Also of significance is the Updating of the water
act and appropriate operational policy development which pays particular
attention to the existing urban-rural disparities, especially in the context of
the trend towards privatisation of water services to prevent their further
marginalisation. The establishment at both national and sub-national levels
of water and sanitation sub-committees, with particular emphasis on the
participation of women has also enhanced sub-sector development. The
constraints in accessing safe drinking water include the persistent Sahelian
drought and low budgetary allocations to the sub-sector.
Access to Sanitary Means of Excreta Disposal
Unlike the access to safe drinking water, inadequate access to sanitary
excreta disposal facilities is a serious health problem in the country and
plays a significant role in the high incidence of diarrhoeal diseases and
polio in children under 5 years of age. Sanitary means of excreta disposal
include flush toilets connected to sewage systems or septic tanks; other
flush toilets, improved pit latrines, and traditional pit latrines.
Countrywide, the proportion of the population with access to sanitary
means of excreta disposal is 87%(including traditional pits) of which 98%
is urban and 78% rural(source:MICS2). Too many conflicting priorities
and weak co-ordination among public, NGO and private sector health
service delivery actors have affected the level of programme delivery for
the prevention of childhood diseases. This factor together with the
insufficient allocation of financial resources to the sub-sector has affected
a number of preventive health care activities in this area.
c) Food and Nutrition
Ensuring Household Food Security
Because of its permanent food insecurity status, The Gambia has been
classified as a Low Income Food Deficit Country (LIFDC). The
households that are hardest hit by food insecurity are those in farming
communities and peri-urban areas where unemployment is high. In the
urban areas, household food security depends primarily on the level of
income and the price of food in relation to other consumer goods whiles in
rural areas household food security is most often determined by household
food production and the price of food items in the market, that are
11
commonly related to agricultural production, and by both on-farm and offfarm employment opportunities.
Availability and affordability of basic food commodities are central to the
development of food security in The Gambia. The over concentration on
cash-crop production coupled with smallness of land holdings influenced
by traditional tenure, climatic uncertainties and outmoded land preparation
and crop culture practices as well as poor harvests and post-harvest food
losses, have threatened the food security status of the population.
The removal of government subsidies on and fluctuations of the producer
price for groundnut, present another obstacle to raising the purchasing
power of rural households.
Malnutrition
Malnutrition is a major cause of high infant and maternal mortality and
morbidity in The Gambia with almost two in ten children under the age of
five classified as severely underweight. 19% of children are stunted or too
short for their age and 8% are wasted or too thin for their height. The
MICS 2000 revealed that children born to mothers with secondary or
higher education are less likely to be underweight and stunted compared to
children of mothers with less education. The age pattern shows that a
higher percentage of children aged 12-23 months are undernourished
compared to children who are younger and older. Only 35% of children
under four months old are exclusively breastfed. At age 6-9 months, 41%
of children are receiving breast milk and solid or semi-solid foods. By age
12-15 months, 95% of children are still being breastfed and by age 20-23
months, 53% are still breastfed. Boys are more likely to be exclusively
breastfed than girls, whilst girls have higher levels than boys for timely
complementary feeding.
The introduction, under the Nutrition Education Programme of an
innovative medium for nutrition education using traditional
communicators, locally known as “kenye-lings” has greatly enhanced
knowledge and awareness about safe motherhood and infant feeding
practices. To promote the practice of exclusive breast-feeding, the National
Nutrition Agency in 1993 successfully piloted a Baby Friendly Community
Initiative (BFCI) in 12 rural villages in the Lower River Division. It is an
integrated approach, which includes immunisation, water and
environmental sanitation, personal hygiene, maternal nutrition,
breastfeeding and literacy. The BFCI operates through village support
groups consisting of five women and two men identified by their
communities to be trained to implement and monitor the initiative. Given
the success of the project, The Gambia in 1999 hosted a regional meeting
on BFCI and is planning to expand the experience countrywide.
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d) Role of Women, Maternal Health & Family Planning
Enhancing the Status of Women
Gambian women constitute the majority of the population and play an
important role as producers; yet, they are relegated to traditional roles that
have in turn disenfranchised and marginalized them. In recognition of their
contribution to national development only began in 1980 when the first
policy statement in this regard was made although not buttressed by the
formulation of a national policy for women. Women thus continue to be
disadvantaged in Gambian society. Their access to education, training,
credit and extension services, and participation in national decision-making
processes remain low and inadequate. The adoption of the National Policy
for the Advancement of Gambian Women (1999-2009) is expected to
provide the basis for the co-ordination that will reduce poverty, promote
sustainable livelihood and ensure sustainable development for women. The
policy is consistent with and complementary to international conventions
to which the Gambia is a party such as CEDAW, CRC, the Nairobi
Forward Strategies and the Beijing Women’s Conference and Global
Platform for Action. The present institutional framework for addressing
women’s issues has proved to be severely limited and inadequate due in
part to its limited mandate, inadequate human resources, and lack of
support and weak horizontal and vertical linkages.
Access to Health Services
The maternal mortality rate estimated to be in excess of 20/1000 live births
in 1983 declined to 10.5/1000 in 1990 with regional variations of 9/1000 in
urban areas and 16/1000 in rural areas ((GMMS, 1990). Rates as low as
6/1000 has been recorded in the main referral hospital. The main causes of
maternal mortality are sepias, haemorrhage and eclampsia. An extensive
MCH Service has ensured that over 83.2% of pregnant women make at
least one antenatal visit to a clinic for review by skilled personnel. The
number of attendances averages 3.8 and 5.3 visits per pregnancy in rural
and urban areas, respectively with 90% of such visits being conducted by
trained midwives. The proportion of mothers with a birth protected against
neonatal tetanus is 70.8%
Family Planning
Government-supported family planning programmes have been in
existence in The Gambia for nearly thirty years, yet the Contraceptive
Prevalence Rate (CPR) is very low among women in the reproductive age
group. The CPR is even lower among the rural population with only 10.6%
of married women of reproductive age (15-49 years) and 11.5% of males
18 years and over in the rural areas have ever used a modern method of
contraception. The discontinuation rate is high as evidenced by the
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proportion of females and males currently using a modern of contraception
(4.3% and 6.9% males and females). About 45% of those who use a
modern method of contraception discontinue use after 5-6 months. A mix
of most modern methods of contraception is available at the primary and
secondary levels of the PHC delivery system while long-term and
permanent methods are provided at the two Government Referral Hospitals
in Banjul and Bansang. According to the MICS 2000, out of the total of
12.2%, the pill ranks as the most popular method (5.5%), followed by
injections (3.7%) and IUCD (2.1%) and condoms (0.1%). Among the
reasons for the low CPR are cultural, lack of knowledge and limited
availability and access to services.
e) Role of the Family
Support to Parents
Gambian women, particularly pregnant and lactating women and their
children are a vulnerable group and as such they need extra support and
care because of their particular needs, even though traditions and social
conditions and circumstances make it difficult for communities to offer
them the necessary care and support. In addition to their role as primary
caretakers of the entire family’s general welfare, which includes nutrition,
women are a major labour force particularly in the agricultural sector
where they account for over 40% of total agricultural production. This is in
addition to their household duties including childcare. Since most of their
time and energy are spent on farming activities during the rainy season,
childcare obviously suffers in both quantitative and qualitative terms.
Communities therefore need more assistance to increase their caring
capacity such as the setting up of Day Care Centres with trained local
human resources to look after children during the rainy season. To this
end, the Department of Social Welfare has initiated policy measures and
programming protocols to define and provide the requisite resources for
optimising childcare and parental support in the country. Essentially, this
involves the examination of the knowledge and traditional belief patterns
of parents and opinion leaders and the identification of alternative
childcare providers and community support mechanisms.
Alternative Family Care
The Gambian has a closely-knit and extended family system. When for
some reason (orphaned, abandoned etc.) parents are unable to care for or
maintain their child, there are relatives to take up the responsibility. This is
a form of informal childcare or guardianship that is considered preferable
to institutional placement. ‘Illegitimate’ children are usually absorbed this
way, particularly into the maternal side of the family. The problem with
this mode of informal adoption in the country is that these customary
practices are not mentioned and are not necessarily carried out in the best
interest of the child. Some of the children or wards may be living under
14
circumstances that directly threaten their emotional and psychological
development.
Like adoption, legal fosterage is not the norm in the Gambia.
Notwithstanding, the Department of Social Welfare and the SOS
Children’s Village in Barkoteh provide alternative institutional support for
orphans and abandoned children. Presently, however, fostering is taking
place in the village in the absence of precise structures and procedures for
doing so, particularly when there is no official monitoring of children once
the SOS Village adopts them. Issues related to child maintenance disputes
represent a significant percentage of cases brought before the Department
of Social Welfare. Several national legislations empower the courts to
make orders for custody and access of either or both parents with
consideration of the best interest of the child. However, it is generally
accepted under customary law in The Gambia that children ‘belong’ to the
man and therefore in the case of divorce, particularly if initiated by the
women, she must leave her children with her husband’s family. The
obvious concerns in these arrangements are that the best interest of the
child is not necessarily taken into consideration.
f) Basic Education & Literacy
The Gambia has made significant progress in the area of education. A
National Education Policy (1988-2003) exists and was revised in 1998 to
address the issues of access, retention and performance as they impinge on
the education of the girl-child and new targets for the Enrolment, Retention
and Quality of education at the basic level were set.
Expansion of Early Childhood Development Activities
The programme for education in the pre-school or Early Childhood
Development (ECD) sub-sector focuses on the personal and social
development of children between 0-6 years. Although the government has
now created the necessary policy environment, ECD has remained a
largely private sector initiative. Accessibility to this level of education and
development has increased significantly with the number of ECD centres
increasing from 125 in 1995 to 265 in 1998 whilst by 2000, the number of
children aged 36-59 months had reached 1,171 (MICS-2000). Based on
increasing partnership between Government and ECD service providers,
more cross-sectoral and integrated approaches to Early Childhood Care are
being developed and implemented, including the re-design of the Early
Childcare Pre-service Training Programme at the Gambia College, which
is aimed at increasing the number and quality of polyvalent community
workers with skills and competencies relevant to community and family
support
Universal Access to Basic Education
15
As a result of government’s increasing commitment to promoting the
education of the girls child, the Gross Enrolment Rate (GER) at the
primary level increased at a much faster rate from 47.9% in 1991/92 to
65.6% in 1998/99, an increase of 37% while over the same period, the
GER for boys only increased by about 11%, that is, from 70% to 77.7%
(EFA 2000). This positive trend in the GER for is however affected by the
high dropout rates among girls at the secondary school level. The trend in
Net Enrolment Ratio (NER) is very similar to that of the Gross Enrolment
Ratio (GER). Between 1991/92 and 1998/99, total NER for the whole
country increased from 46.3% to 59.8%, respectively with male NER for
the same period increasing from 54.2% to 64.2%, while female NER grew
from 38.5% to 55.4%. The female to male ratio in primary school grew
from 0.71% in 1991/92 to 0.86% in 1998/99. This is an indication that
there has been some improvements in terms of enrolment and retention of
girls during the last decade, but that there is still more room for
improvement. Among the factors responsible for the low enrolment rates
for girls compared to boys are the direct and indirect costs of education,
the perceived relevance of education; the perceived erosion of moral
values attributed to Western type education and fear of pregnancy for girls.
Reduction of Adult Illiteracy
About 75% of the Gambian population is illiterate, of which 68% are
women and girls (UNDP, April 1991). Under the country’s 1994 Strategy
for Poverty Alleviation (SPA), therefore, an Integrated Functional Literacy
component specifically targeting women and girls was included in the
Strategy. This component is largely compatible with the overall goal of the
National Education Policy, which is to attain the Jomtien Goal of
‘Education for All.’ Currently, there are 152 literacy centres with a total
enrolment of 6,810 participants.
Vocational Training and Preparation for Employment
Considerable efforts have also been made to provide opportunities to
adults to acquire functional literacy skills although the effectiveness of
implementation of the existing Government-sponsored Rural Vocational
Training Programme is constrained by short supply of staff, facilities and
materials. Inadequate co-ordination and co-operation among the many
actors involved in the sector results in duplication of efforts and lack of
consistency whiles inadequate monitoring reduces the opportunity to use
evaluative information to strengthen programme development and
implementation.
Opportunities for vocational and skills training for girls and young women
who have dropped out of school, also exist in the country. One such
channel is the National Youth Service Scheme (NYSS) the purpose of
which is to fill the gap created by the educational system, especially the
academically biased educational curriculum. Adolescent school-leavers
16
who are denied the opportunity for self-development are special
beneficiaries of the scheme. It also serves to strengthen the civicmindedness of young Gambians and to inculcate the virtues of hard work,
self-reliance, and patriotism and moral up-rightness. In addition to the
NYSS, the President’s Award Scheme created in the late 1980s to develop
the values of self-reliance and discipline in young people currently caters
for the needs of young people aged 12 to 21 years, with no formal
education, and primary junior and secondary school dropouts.
g) Children in Especially Difficult Circumstances
Certain categories of children in The Gambia are particularly vulnerable or
susceptible to non-respect of their rights to physical, emotional and
cognitive development. They include but are not limited to the girl-child,
disabled children, children from extremely poor families and those with no
families (e.g. orphans) and increasingly, refugee children. By virtue of
belonging to a particular social category these children are often victims of
discrimination or practices such as child labour, which inhibit the full
development of their potential.
Child Labour
The issue of child labour constitutes a serious obstacle to the achievement
of the goal of universal and equal access to education for all children in
The Gambia, where children in especially difficult circumstances include
those commonly referred to as Street Children as well as the girl-child who
is often kept at home to assist with household duties and care of younger
siblings. Overall, 29.0% of children aged 5-14 years are currently engaged
in paid and unpaid work (MICS 2000). There is virtually no differential in
the proportion of male and female children engaged in paid work (1.9%
each) and those engaged in unpaid work (4.4%, 4.5%). The proportion of
children working four hours and more varies for males (3.9%) and females
(5.1%). There are currently no specific procedures, programmes or
strategies to adequately address the perennial problem of “Street Children”
and the general issue of child labour and economic exploitation but a
significant step was taken in November 2000 when The Gambia signed the
ILO Convention on the Worst Forms of Child Labour.
Another category of disadvantaged children in The Gambia is the disabled.
In 1998, the Government of The Gambia, in collaboration with UNICEF,
carried out a national survey on Disabled Children in Mainstream schools.
The survey provides information on the type of disability among children
in mainstream schools, their coping strategies and issues of normalisation.
The survey reveals that 25.7% of disabled children in the mainstream
schools are partially sighted; 12.3% and 8.9%, respectively, have
significant speaking and mobile problems; 5.4% are hard of hearing and
3.7% have significant manipulation and fits problems. The major
17
constraints affecting the mainstreaming of disabled children are lack of
technical aid, games, financial resources and scholarships; access to
physical facilities such as toilets/classrooms; and teachers training.
18
Drug Abuse
Drug abuse among adolescents is becoming a major concern to
government. The Drug Control Act, 1993 and the Drug control Decree
(Decree No. 80/1996) prescribe punitive measures in the form of heavy
fines for possession, distribution or sale. Forfeiture of assets such as
vehicles, bank deposits, real property of convicted offenders are other
preventive measures in the anti-drug efforts of the Government. The major
weakness in government’s efforts in the ant-drug campaign is that the
dispensing of medicinal drugs in chemist shops is not effectively
monitored. The abuse of tranquillisers and barbiturates by young addicts is
due to the laxity of the distribution outlets rather than legislative measures.
Consequently, drug related offences are on the rise among juveniles.
Violent assault cases, housebreaking and stealing tend to have a direct
linkage to the financial needs of the young addicts.
h) Protection of Children during Armed Conflicts
Protection of Refugees in The Gambia
Refugee statistics indicate that despite the deteriorating economic and
social conditions in The Gambia, the influx of refugees continues. Records
from the United Nations High Commission for Refugees (UNHCR) in The
Gambia show that as at 31st December 1998, there were 10,300 refugees in
The Gambia with refugees from Sierra Leone constituting 53%, followed
by Senegalese (35%) and Bissau-Guineans (11%). About 60% of the total
refugee population is female. While the Government has been increasingly
sympathetic to the refugees in the country, there is as yet no legislation that
guarantees the rights of refugees within its national borders.
Peace, Tolerance, Understanding and Dialogue
Within the context of armed conflict, The Gambia has played an active role
in brokering peace in Senegal, Guinea-Bissau, Liberia and Sierra Leone.
These efforts have been internationally recognised and commended and
there are indications that the country is to be provide with support through
the Economic Community of West African States (ECOWAS) for the
establishment of a Sub-regional Conflict Prevention Office in The Gambia
(Daily Observer, August 2000).
i) Children & the Environment
Environmental sanitation, which was a largely neglected sector in the
country until recently has become a priority with the introduction of a Pilot
Rural Environmental Sanitation Project in 18 PHC Villages as part of the
revitalised PHC delivery systems. The project has succeeded in raising
high interest and demand among rural communities and latrines are
increasingly seen as essential for good health and hygiene. A Primary
19
Environmental Care Strategy has also been launched in communities in the
North Bank Division of the country using 8 schools as entry points to
strengthen existing projects in those schools and to increase environmental
awareness and knowledge among children through provision of hydrometeorological equipment and other instruments for demonstration and
training. As a result of these efforts, many Gambians have become more
aware of the need for sustainable management of the environment although
poor farming practices based on short-term objectives, such as food and
cash crop production continue. The alarming rate of environmental
degradation caused by the growing imbalance between population and the
country's natural resource base threatens the quality of life for the large
majority of the Gambian population, especially children and women.
j) Alleviation of Poverty & Revitalisation of Economic Growth
Poverty
The Gambia is classified among the Least Developed Countries (LDCs).
Poverty is wide spread with an estimated 40% of the population falling
below the Food Poverty Line (FPL). Figures from the National Household
Poverty Survey (NHPS 1998) and the Participatory Poverty Assessment
(PPA 1999) wet season and 2000 dry season indicate a rise in the overall
poverty situation over a two-year period. In 1998, the NHPS showed that
18% of the population was poor and that 37% were living in extreme
poverty. During the 1999 wet season, the figures had risen to 39% poor
and 53% extremely poor. This is a deepening of the poverty situation in
The Gambia as the wet season is normally regarded as the hungry season
when food stocks are depleted and the purchasing power for food is
limited. Because of the severity of poverty and its implications on human
resource development, a three-year Second Strategy for Poverty
Alleviation (SPA-II) was launched in September 2000. The strategy seeks
to reduce poverty by 8% in the short Term, by 13% in the medium term
and by 29% subsequently.
Debt Relief
But the burden of repayment of the country’s external debt will constitute a
serious drag on the achievements of the development goals of the strategy
although the country’s debt sustainability ratios have not yet reached the
critical thresholds established by the Breton Woods institutions for Heavily
Indebted Poor Countries (HIPC). Because The Gambia has had an
impressive record of creditworthiness in terms of honouring its external
obligations on time, it is eligible for HIPC under the export and fiscal
criteria thresholds of 150% and 250%, respectively. The debt presents an
opportunity for mobilising additional resources for investment in priority
areas of the economy such as the social sectors of health and education
with emphasis on greater access to these facilities for women and children.
20
E. Lessons Learnt
a. Major Constraints
High Infant and Maternal Mortality Rates
While the health status of the Gambian population has improved
significantly since the country’s adoption of a community-focused
PHC strategy as indicated by lower rates of infant and maternal
mortality, improved child survival rates, serious health problems
remain the majority of which are still caused by infectious and
parasitic diseases, resulting from persistent weaknesses in the public
health services, environmental hygiene, health education and basic
primary care.
Decline in resource flows to the health sector
Government per capita health expenditures, which peaked in 1992/93,
have since been on the decline as a result of reduced donor support.
Consequently, preventable diseases continue to account for the
significant increase in the country’s morbidity and mortality rates.
Absence of an established institutional framework for child rights
The inadequacy of existing institutional capacity for monitoring child
and women’s rights in the country hindered progress in areas critical to
the well being of children such as the capacity for programme
development, management and evaluation. The problem is
compounded by the absence of an institutional framework such as a
National Commission and Secretariat to co-ordinate national rightsbased programmes for women and children.
Deeply rooted socio-cultural beliefs and practices
Gambian society has deeply rooted socio-cultural beliefs and practices,
which are influenced by Islamic principles. Often the understanding of
the role of and status of children and women in the society seriously
demands an awareness of entrenched social attitudes and values.
Absence of a corporate body of laws on Women and Children’s Rights
The absence of a corporate body of laws that focuses entirely on the
rights of women and children hampered the harmonisation of Gambian
laws with those of the CRC and CEDAW.
Absence of legislation guaranteeing the rights of children in armed
conflict
Despite the present economic difficulties of The Gambia the country
continued to be a pole of attraction for refuges from the West Africa
Sub-region. In spite of these difficulties, it was widely recognised that
the Government was sympathetic to refugees in the country. However,
21
the Government did enact laws guaranteeing the rights of refuges in
the country the majority of who are women and children.
Dearth of reliable and child-specific data
The capacity to plan requires the availability of reliable data. There is
dearth of child-specific data, which highlights the need to promote
inter-agency collaboration in quantitative and qualitative data
collection, analysis and dissemination on children and for use in the
life cycle approaches to programming.
Gender Inequalities
The continuing low status of women in the society resulted in
inequalities in the access to basic education and literacy for women,
particularly the girl-child.
Increasing Poverty & Debt burden
Although the government is committed to the reduction of poverty
external indebtedness and the burden of repayment continued to short
shrift its ability to meet set targets, particularly in programmes which
give priority to children and call for focussed attention on child
survival, protection and development.
Weak Inter-agency Collaboration and Co-ordination
Weak inter-agency co-ordination and co-operation among actors
involved in the delivery of child-specific programmes results in
duplication of efforts and lack of consistency, particularly with respect
to other UN agencies’ programmes.
b. Major Factors Enhancing Progress
Although the above factors to a large extent impeded government’s
efforts towards greater progress the WSC Goals, a number of factors,
however, contributed to part of the progress made at End-decade.
These forces need to be maximised and sustained for increased levels
of programme delivery in favour of women and children in The
Gambia:
Strong Political Commitment
The Gambia ratified the CRC and was represented at the highest level
of Government at the World Summit for Children. With a fairly
impressive economic growth based on a good degree of political
stability have enabled Government to develop national policies,
strategies and development programmes in which child-and womenspecific rights have been incorporated
22
Law Reform
Respect for fundamental human rights is entrenched in the
Constitution while several legislations such as the Criminal Code,
Maintenance of Children’s Act, and the Matrimonial Causes Act,
among others, specifically provide for the protection and preservation
of the Right to Life of children and the unborn foetus; and ensure the
child’s right to care and maintenance.
Existence of in-country Basic and Operational Research Capability
The existence of an in-country capability for basic and operational
medical research has enabled the Government, in collaboration with
the Medical Research Council, in Getting Research into Practice
(GRIP) in areas affecting morbidity and mortality. The Central
Statistics Department also has the capacity to conduct surveys and
studies to get reliable data.
Involvement in Sub-regional Peace Building, Conflict resolution and
Dialogue
The Gambia’s involvement in peace building, conflict transformation
and dialogue in the West Africa Sub-region has enabled many
refugees, mostly women and children to find refuge in The Gambia
despite difficult economic conditions. The presence of these refugees
drew government’s attention to the urgent need for legislation to
protect the rights of children during armed conflicts.
Government/UNICEF Technical Co-operation
Strong and effective financial and technical support from UNICEF as
the lead agency for children’s rights and welfare in the Gambia
enabled government to build capacity in the delivery of quality childspecific programmes.
c. Major Challenges and Key Issues
The Gambia’s preventive Primary Health Care Strategy focus in recent
years has already demonstrated benefits, as evidenced by the decrease
in neonatal deaths and the overall maternal death rates. Yet, the
leading causes of death among children other than neonatal problems
remain acute respiratory infections and malaria. Still, neonatal deaths
continue to account for most of the deaths of children under-five years
of age, with HIVAIDS as major threat to development. Unless the
Government is able to make significant investments in preventive and
primary health services to the populations at risk for these conditions,
this may result in increased diseases, disabilities and early deaths.
Clearly, however, the extent of the increase in health service
requirements will be determined by the Government’s success in
23
providing preventive and primary health services such as clean water,
waste disposal, health education, primary care to include specialised
care for women at high risk for adverse birth outcomes including death
to mothers and young children.
There is urgent need for law reform with respect to the rights of
women and children because the present Gambian legal system is more
concerned with the protective rather than the developmental aspect of
children. This imbalance is reflected in the concentration of the system
on traditional civic rights and freedoms as well as protecting the
physical and moral integrity of children. There are no legislative
provisions concerned with promoting the overall development of
children. There is need, therefore, to review and reinforce these
arrangements with the creation of a National Commission for
Children’s Rights whose mandate would be not only to act as a
watchdog for the enforcement of children’s rights but also to monitor
the implementation of The Gambia’s obligations under the CRC and
CEDAW.
F. Future Action
The Gambia is committed to the respect of Fundamental Human Rights both
nationally and internationally. With the national Constitution serving as a basis
and source of inspiration Government will, in collaboration with its partners
and other stakeholders, intensify its efforts at both the national and
international levels towards ensuring the survival, protection, development and
participation rights of children and women as set out in the CRC and CEDAW.
Considering the constraints encountered and the progress made so far towards
the World Summit Goals, Government commits itself to undertake the
following strategic actions:
a. National Action




Creation of a National Commission and Secretariat on Women
and Children’s Rights as a matter of priority and provided with
the necessary resources for its operations
Review of the 1992-2003 National Programme of Action using
relevant social indicators relating to the well being of children
and which will incorporate the Challenges in the New Agenda
for Children for the 21st Century
Harmonisation of existing national legislations on the Rights
of the Child with those of the CRC
Enacting legislation that protects children in armed conflicts,
particularly refugees in The Gambia and intensifies and
encourage peace-building, conflict transformation and
dialogue at home and in the sub-region.
24



Ensuring greater involvement of NGOs and the private sector
in the development and implementation of children and
women’s rights-based programmes.
Mobilising additional resources at the international level for
implementation of programmes in favour of women and
children, using the UNDAF and Round Table Conferences
Converting debt relief under the HIPC facility for investment
in the social sector as matter of priority to provide for and
protect the physical and intellectual well-being of children,
ensure universal access to good quality basic services for every
child and create the national legal, policy and budgetary
framework to facilitate and promote the full realisation of
children’s rights.
b. International Targets









Reduction by two-thirds in the mortality rates for infants and
children under the age of five and a reduction by three-fourths
in maternal mortality by 2015
Enabling all individuals of appropriate age to access
reproductive health services and rights through the Primary
Health Care system as soon as possible and no later than 2015
Enforce Universal Primary Education by 2015
Making substantial progress towards gender equality and
empowerment of women by eliminating gender disparity in
primary and secondary education by 2005
Fighting against HIV/AIDS through awareness creation on
HIV/AIDS prevention and management of atleast 90% of the
Population by the year 2005
Implementing a national strategy for sustainable development so as to
ensure that current trends in the loss of environmental and natural
resources are effectively reversed by 2015
Reduction by one-half in the proportion of people living in extreme
poverty by 2015
Creating economic opportunities for the poor to substantially reduce
income and food poverty and the general feeling of insecurity related
to food and income poverty through the implementation of Vision
20/20
Developing a full-fledged participatory government based on the
consent of the citizenry.
G. Appendix
25
Selected Bibliography
UNICEF, World Declaration & Plan of Action from the World Summit/Convention on the
Rights of the Child
1999 Annual Global Review Report
Annual Report 1999
The Gambia Common Country Assessment Report
Conformity of Gambian Laws with the Convention on the Rights of the Child, November 1995
Equality, Development and Peace, Beijing +5
Children in Jeopardy, September 1999
Conformity of Gambian Laws with the Convention on the Rights of the Child
GOTG, Initial Report of the Gambia on the United Nations Convention on the Rights of the
Child

National Disability Survey, 1998

Country Report on the Republic of The Gambia, World Summit for Social
Development, Denmark, 1995

National Programme of Action for the Survival, Protection and Development of
Gambian Children 1992-2003

CEDAW Report (Draft)

National Nutrition Policy 2000-2004

National AIDS Control Programme, HIV/AIDS Situation in The Gambia, June 2000

Social Dimensions of Adjustment, 1993-94 Community Education Survey Report,
CSD, 1995

EFA 2000 assessment Report, The Gambia

1998 National Household Survey Report, June 2000

The Multiple Indicator Cluster Survey Report – 1996, CSD, July 1998

Multiple Indicator Cluster Survey Report (Draft), 2000

The Gambia’s National Report on Women for the Beijing Fourth World Conference
and Beyond, 1995

Disabled Children in Mainstream Schools, May 2000

Report of the 1990 Maternal Mortality Survey, September 1991

Country Report for the Technical Committee for the Regional Conference on Women,
Addis Ababa,

Department of Social Welfare, Policy Document, February 2000

Interim Strategy for Poverty Alleviation, 2000

Updating the Situation of Women & Children in The Gambia, Draft Report, October
2000

/UNICEF Draft Strategy for the Country Programme 2002-2006

Nationwide Survey on the Prevalence of Vitamin A and Iron Deficiency in Women and
Children in The Gambia (Preliminary Draft, September 2000)

Meeting the Development & Protection Needs of the Girl Child in the Gambia,
September 1999
-UNICEF State of the World children report 2000
-UNICEF Progress of Nations report 2000
UNDP, The Gambia Development Co-operation Report, 1998

Human Development Report 2000

The Gambia 2000, Quarterly Report Vol. 1, May 2000

Jokkoo Vol.9, 1999

Institutional Mechanisms in The Gambia for the Monitoring of United Nations Global
Conferences, 1999
Abdou Rahman et al, 20/20 Initiative Country Study for the Gambia (Draft)
Prof. Jeffrey Sachs et al, Implementing Debt Relief for the HIPCs, Centre for international
Development, Harvard University, August 1999
Bledsoe CH et al., Constructing natural fertility: The use of western contraceptive
technologies in rural Gambia, 1994
2
G. APPENDIX
INDICATORS FOR MONITORING PROGRESS AT END-DECADE
WSC GOALS
Goal 1: Between 1990 and the Year 2000, reduction of infant and under-five child mortality rate by one-third or to 50
and 70 per 1,000 live births, whichever is less.
1990
1993
Under-five mortality
129
82
Infant mortality rate
92
84
Goal 2: Between 1990 and the Year 2000, reduction of infant and under-five child mortality rate by one-third or to 50
and 70 per 1,000 live births, whichever is less.
Estimate
Gambia Maternal
Comments
from
Mortality Survey
Health
1990
Maternal mortality ratio
Dept.
20.0/1000
10.5/1000
Goal 3: Between 1990 and the Year 2000, reduction of severe and moderate malnutrition among under-five children
by half.
MICS -2
Moderate
Severe
%
%
Underweight prevalence
17.0
3.5
Stunting prevalence
18.7
5.9
Wasting prevalence
8.6
1.2
k) WSC Goal 4: Universal access to Safe Drinking Water
SOURCE OF WATER SUPPLY
Public Tap
Own Tap
Pumped Well
MICS-1
%
38.2
12.1
20.9
River or Lake
Traditional Well
Other
0.3
26.1
2.4
Piped water to household
Public standpipe/tap
Borehole/pump
Protected well
Rainwater
Piped into yard or plot
Bottled Water
Pond, River or stream
Tanker Truck Vendor
MICS-2
%
39.7
16.9
Comments
7.2
39.7
18.7
8.5
9.7
0.0
0.1
0.0
The sources vary from region to region with 94.6% and
77.1% for urban and rural areas, respectively. Overall
84.0% of the population has access to Safe Drinking Water
Public tap, Own tap, and Pumped Well are defined as
‘safe’. On premises and less than 100 metres as well
as less than 30 minutes and from 30 minutes to 1
hour were defined as “convenient”. Overall 69% of the
Gambian population had access to Safe and
‘Convenient’ Water by 1996
l) WSC Goal 4: Universal access to Sanitary Means of Excreta Disposal
TYPE OF SANITATION FACILITY
WC
Private Pit/Pan/Pail
Public Pit
Private Pit
Other
Flush to sewage system/septic tank
Pour Flush Latrine
Improved Pit Latrine
Traditional Pit Latrine
Open Pit
Bucket
Other
No Facilities
MICS-1
%
9.1
0.6
0.8
77.6
12.0
MICS-2
%
Comments
Under MICS-1, the definition of type and quality
of private pit and others were vague. This
caused difficulty in distinguishing sanitary
household latrines from unsanitary ones
7.9
5.4
10.7
64.0
3.7
0.2
0.3
7.9
Goal 6: Universal access to basic education, and achievement of primary education by at least 80% of primary
school-age children, through formal schooling or non-formal education of comparable learning standard, with
emphasis on reducing the current disparities between boys and girls.
1997/98
Male
73.2
64.3
Female
% Children reaching grade 5
74.8
Net Primary School Enrolment Ratio
54.0
% Net Primary School attendance Rate
Goal 7: Reduction of adult illiteracy rate (the appropriate age group to be determined in each country) to at least half
its 1990 level, with emphasis on female literacy
EFA 2000
1991
1992
1993
1994
1995
1996
1997
LITERACY
1998
MICS2
RATES
OVERALL (MF)
37.2
37.2
37.2
37.2
37.1
37.1
37.1
37.1
36.4
Male
53.5
52.8
52.0
51.3
50.6
49.9
49.2
48.5
48.4
Female
21.3
21.8
22.3
22.8
23.3
23.8
24.4
25.0
24.8
Goal 8: Provide improved protection of children in especially difficult circumstances and tackle the root causes
leading to such situations.
Disability Survey
TYPE OF
DISABILITY
Children in
Mainstream
Schools
(5-19 years)
Children in
Households
Comments
(2-18 years)
Partially sighted
25.7%
4.5%
1998, Government of The Gambia/UNICEF Disability
Survey of Children in Mainstream Schools and
Significant speaking
Households. The overall child disability (2-14 years) rate is
problems
12.3%
18.4%
8.9 per 1, 000 with gender differentials of 10.2 and 7.7 per
Significant Mobility
8.9%
15.6%
1, 000 for males and females respectively.
problems
Hard of hearing
5.4%
9.8%
Significant fits
problems
3.7%
11.4%
Goal 9: Special attention to the health and nutrition of the female child and to pregnant and lactating women
Under-five mortality
Between 1983-1990
Probability of dying between birth and
Rate
122
exactly five years of age per 1000 Female
Male
144
live births – disaggregated by gender
Underweight
17.6%
Proportion of under-five who fall Female
prevalence
16.4%
below minus 2 standard deviation Male
female/male
from median weight for age of
(MICS-2)
NCHS/WHO reference population –
disaggregated by gender
Antenatal Care
MICS-2
Proportion of women aged 15-49
86.0%
attended at least once during Overall:
pregnancy by skilled health personnel
Cases of HIV
MRC/National AIDS Programme
Proportion of cumulative total of HIV
1999
cases aged 15-49 years by total and
gender
Total
0.6%
Female
54.6%
Male
45.4%
HIV Prevalence
Proportion of population aged 15-49
a) Tot 2.2% (MRC & Gambia
Government, 1992)
years who are HIV positive by total
al
3.5-4% (MRC & GGov't. 2000)
Total
2
Anaemia
Proportion of women aged 15-49
years with haemoglobin levels below
b) Pre
gna
nt
wo
men
(MRC, 1999)
73%
5%
56%
2%
Moderate
Severe
c) Lac
tati
ng
Wo
men
Moderate anaemia
Severe anaemia
Goal 10: Access by all couples to information and services to prevent pregnancies that are too early, too closely
spaced, too late or too many
Contraceptive prevalence
9.8%
Proportion of women aged 15-49 who are Overall:
12.8%
(Source: MICS 2000)
using (or whose partner is using) a Urban:
8.1%
contraceptive method (either modern or Rural:
traditional)
Note: Overall CPR declined from
Modern
8.9%
12% in 1990 to about 10% in 2000
Traditional:
0.8%
1983
1993
% Decline
Fertility rate doe women 15-19
200
167
16.4
Number of live births to women aged 15-19
per 1000 women aged 15-19
Overall fertility rate
Average number of live births per woman 6.4 (1983 Census)
who has reached the end of her 6.0 (1993 Census)
childbearing period.
Figures from MICS-2 showing further
decline awaited.
Goal 11: Access by all pregnant women to prenatal care, trained attendants during childbirth and referral facilities for
high-risk pregnancies and obstetric emergencies
MICS-2
Antenatal Care
86.0%
Proportion of women aged 15-49 attended once during Overall:
pregnancy by skilled health personnel
:
Childbirth care E. Proportion of births attended by
Overall:
51.3%
Urban:
71.6%
skilled health personnel
Rural:
39.9%
Obstetric care
Number of facilities providing basic essential obstetric care per Not available
500,000 population
m) Goal 12: Reduction of low birth weights (less than 2.5kg) to less than 10%
MICS-2
Overall:
14%
Urban
12%
Rural:
16%
Goal 13: Reduction of iron-deficiency anaemia in women by one-third of the 1990 levels.
Vitamin A & Iron Deficiency Survey
(Preliminary Draft, September 2000)
Anaemi
Proportion of women aged 15-49 years with haemoglobin levels below Pregnant
a
26%
12-grams/100 ml blood for non-pregnant women, and below 11- women:
grams/100 ml blood for pregnant women.
Lactating
20%
women:
Birth weight below 2.5 kg
Proportion of live births that weigh below 2,500 grams
Goal 14: Virtual elimination of iodine deficiency disorders.
MICS-2
3
Iodised salt consumption
Low urinary iodine
Proportion of households
consuming adequately iodised
salt
Proportion of population (school age children
or general population) with urinary iodine
levels below 10 micrograms/100ml urine
Overall:
Urban:
Rural:
7.5%
4.8%
9.9%
Average for the country of urinary
iodine excreted by the body is 4.2 ug/dl
(National vitamin and iodine deficiency
survey)
Goal 15: Virtual elimination of Vitamin A Deficiency and its consequences, including blindness.
MICS-2
Children receiving Vitamin A
Overall:
3.7%
Proportion of children 6-59
supplements
months of age who have
Urban
2.2%
received a high dose of vitamin
Rural:
4.6%
A supplement in the last 6
months
Mothers receiving Vitamin A
Overall:
16.8%
Proportion of mothers who
supplements
received a high dose vitamin A
Urban
9.0%
supplement before infant was 8
Rural:
13.4%
weeks old
Low Vitamin A
Although clinical vitamin A deficiency is not evident,
Proportion of children 6-59
serum retinol levels are very low. 64% of children
months of age with serum retinol
surveyed showed moderate vitamin A deficiency
below 20 micrograms/100 ml
(<0.7um/L whiles 9% were found to be severely
vitamin A deficient (<0.35um/L)
Goal 16: Empowerment of all women to breastfeed their children exclusively for four to six months and continue
breastfeeding, with complementary food, well into the second year.
1998 Dept. Health survey
MICS-2
Exclusive breastfeeding
17.4%
Overall:
35.3%
Proportion of infants less Overall:
Urban
36.8%
than 4 months (120 days)
Rural
34.1%
of age who are exclusively
breastfed
Timely complementary feeding
8.1% (MICS1)
Overall:
36.5%
Proportion of infants 6-9 Overall:
rate
months (180-299 days) of
25.0% MICS1
Urban
52.0%
age who are receiving Urban
3.9% (MICS1)
Rural
28.3%
breast
milk
and Rural
complementary food
12-15 Months
Continued breastfeeding rate
92.2% MICS1
Overall:
96.9%%
Proportion of children 12- Overall:
15 months and 20-23
87.0% MICS1
Urban
96.2%
months of age who are Urban
Rural:
93.8% MICS1
Rural:
97.2%
breastfeeding
20-23 Months
Overall:
57.9% MICS1
Overall:
53.5%
Urban
46.4% MICS1
Urban
46.2%
Rural
62.0% MICS1
Rural:
57.5%
Number of Baby-Friendly
Number of hospitals and A Baby Friendly Hospital Initiative (BFHI) was introduced in
Facilities
maternity facilities which 1993 in 12 rural villages in the Lower River Division, which
are designated as baby- will be replicated in 10 additional villages by 2000
friendly according to BFHI
criteria
4
Goal 17: Growth promotion and its regular monitoring to be institutionalised in all countries by the end of the
1990s.
Comments
No indicators
All children whose births are registered in the Gambia receive an Infant Welfare Card
with a Road-to-Health Chart on which to chart growth from 0-5 years of age. The
weighing and recording is done when the child attends MCH clinic.
Goal 18: Dissemination of knowledge and supporting services to increase food production to ensure household
food security.
Comments
No indicators
Because of its permanent food insecurity status, The Gambia has been classified as
a Low Income Food Deficit Country (LIFDC). The households that are hardest hit by
food insecurity are those in farming communities and peri-urban areas where
unemployment is high. In the urban areas, household food security depends primarily
on the level of income and the price of food in relation to other consumer goods
whiles in rural areas household food security is most often determined by household
food production and the price of food items in the market, that are commonly related
to agricultural production, and by both on-farm and off-farm employment
opportunities.
Availability and affordability of basic food commodities are central to the development
of food security in The Gambia. The over concentration on cash-crop production
coupled with smallness of land holdings influenced by traditional tenure, climatic
uncertainties and outmoded land preparation and crop culture practices as well as
poor harvests and post-harvest food losses, have threatened the food security status
of the population. The removal of government subsidies on and fluctuations of the
producer price for groundnut, present another obstacle to raising the purchasing
power of rural households.
Goal 19: Global eradication of poliomyelitis by the year 2000
Comments
Polio cases
Annual number of cases
of polio
Not available
Goal 20: Elimination of neonatal tetanus by 1995
Neonatal tetanus cases
Annual number of cases
of neonatal tetanus
Comments
Not available (see goal 22 below)
Goal 21: Reduction by 95% in measles deaths and reduction by 90% of measles cases compared to preimmunisation levels by 1995, as a major step to the global eradication of measles in the longer run.
Comments
Under-five deaths from
Not available
Annual number of
measles
under-five deaths due to
measles
5
Measles cases
Not available
Annual number of cases of
measles in children under five
years of age
Goal 22: Maintenance of a high level of immunisation coverage (at least 90% of children under one year of age
by the year 2000) against diphtheria, pertussis, tetanus, measles, poliomyelitis, tuberculosis and against tetanus
for women of childbearing age.
MICS-2000
DPT immunisation
Proportion of one year old DPT 1:
97.2%
children immunised
DPT 2:
95.3%
against diphtheria,
DPT 3:
90.1%
pertussis, and tetanus
(DPT)
Measles immunisation
coverage
Proportion of one year old
immunised against measles
Polio immunisation coverage
Overall:
88.4%
Urban:
Rural:
Polio 1
Polio 2:
Polio 3:
93.2%
86.3%
89.7%
94.2%
91.5%
81.2%
Proportion of one year old
children immunised against
poliomyelitis
Tuberculosis immunisation
Proportion of one year old
coverage (BCG)
children immunised against
tuberculosis
Children protected against
Proportion of one-year-old
73.0%
neonatal tetanus
children protected against
neonatal tetanus through
immunisation of their mother.
Goal 23: Reduction by 50 per cent in the deaths due to diarrhoea in children under the age of five years and 25
per cent reduction in the diarrhoea incidence rate l
MICS-2
Under-five deaths from
Annual number of under-five deaths due to Not Available
diarrhoea
diarrhoea
Diarrhoea cases
Average number of episodes of diarrhoea per child Not available
under five years of age
ORT use
33.3%
Proportion of children 0-59 months of age who had Overall:
36.5%
diarrhoea in the last two weeks who were treated Urban
31.7%
with oral Rehydration salts or an appropriate Rural:
household solution (ORT)
Home management of
44.6%
Proportion of children 0-59 months of age who had Drinking more:
diarrhoea
36.2%
diarrhoea in the last two weeks and received Drinking
increased fluids and continued feeding during the same/less:
period.
Eating somewhat
53.5%
less/same/more:
Eating much
36.2%
less/none:
Goal 24: Reduction by one-third in the deaths due to acute respiratory infections (ARI)
MICS-2000
Under-five deaths from acute
Annual number of under-five deaths due to acute Not available but 6.9% had
respiratory infections
acute respiratory infection in
respiratory infections (ARI)
last two weeks
Care seeking for acute
63.5%
Proportion of children 0-59 months of age who had Overall
respiratory infections
ARI in the last two weeks and were taken to an
Urban:
75.7%
appropriate health provider
Rural:
60.0%
Goal 25: Elimination of guinea-worm (dracunculiasis) by the year 2000
Dracunculiasis cases
Number of cases of dracunculiasis (guinea-worm)
in the total population
6
Not available
Goal 26: Expansion of early childhood development activities, including appropriate low-cost family and
community-based interventions
Pre-school development
Underweight prevalence
Proportion of children aged 36-59 months
who are attending some form of organised
early childhood education programme
Proportion of under-fives who fall below
minus 2 standard deviations from median
weight for age NCHS/WHO reference
population.
17.7% (EFA 2000)
15.1% (MICS2)
Overall:
17.0%
Urban
Rural:
9.8%
20.9%
(MICS-2)
Goal 27: Increased acquisition by individuals and families of the knowledge, skills and values required for better
living, made available through all educational channels, including the mass media, other forms of modern and
traditional communication and social action, with effectiveness measured in terms of behavioural change.
No indicators
At the community level exist traditional drama and dance groups, praise singers and
musicians; public radio and television as well as IEC specialists located within
government, NGOs and Donor institutions. The Agricultural Communications Unit with its
network of village-level extension workers is responsible for a range of rural developmentrelated communication and education functions while the Health Education Unit and the
Population Communication Support Unit similarly work at regional and village levels.
Additional Indicators for monitoring Children’s Rights
Indicator
Birth registration
Children’s living
arrangements
Orphans in households
Child labour
Description
Proportion of children aged 0-59 months whose
births are reported registered
Proportion of children in households aged 0-14
years not living with biological parent
Proportion of children in households aged 0-14
years who are orphans
Proportion of children in households aged 5-14
years who are currently working (paid or unpaid;
inside or outside home)
Percentage
32.8%
72.6%
7.9%
Working: 26.9%
Paid work: 2.0%
Unpaid work: 4.1%
Domestic Work:
Less than four hours/day: 42.9%
More than four hours/day: 3.9%
Additional Indicators for monitoring IMCI Initiative and Malaria
Indicator
Description
n) Percentage
MICS2
7
Home management of
illness
Care-seeking knowledge
Bednets
Malaria treatment
Proportion of children aged 0-59 months who
were ill during the last two weeks and received
increased fluids and continued feeding.
Proportion of caretakers of children aged 0-59
months who know at least two of the following
signs for seeking care immediately: child
develops a fever, child has fast breathing, child
has difficult breathing, child blood in the stools,
child is drinking poorly.
Proportion of children aged 0-59 months who
slept under an insecticide-impregnated bednet
during the previous night.
Proportion of children aged 0-59 months who fell
ill with fever in the last two weeks and received
anti-malarial drugs
24.3%
Child develops fever: 72.0%
Child has fast breathing: 16.7%
Difficult breathing: 17.7%
Blood in stool: 24.9%
Drinking poorly: 12.7
Know at least two signs: 42.5%
35.3%
Fell ill with fever: 14.8%
Received anti-malaria drug: 55.2%
Additional indicators for monitoring HIV/AIDS
Indicator
Knowledge of preventing
HIV/AIDS
Knowledge of misconceptions
about HIV/AIDS
Knowledge of mother-to-child
transmission of HIV
Attitude to people with
HIV/AIDS
Women who know where to be
tested for HIV
Women who have been tested
for HIV
Attitude toward condom use
Adolescent sexual behaviour
Description
Proportion of women who correctly state the
three main ways of avoiding HIV infection
Proportion of women who correctly identify
three misconceptions about HIV/AIDS
Proportion of women who correctly identify
means of transmission of HIV from mother
to child
Proportion of women expressing a
discriminatory attitude towards people with
HIV/AIDS
Proportion of women who know where to get
an HIV test
Proportion of women who have been tested
for HIV
Proportion of women who state that it is
acceptable for women in their area to ask a
man to use a condom.
Median age of girls/women at first
pregnancy.
8
Comments
34.3%
19.8%
36.5%
24.3%
25.5%
7.3%
N/A
16.9 Years (UNFPA-Gambia Government
Survey, 1998)
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