The Edward Francis Small Centre for Rights and Justice has learned with deep concern and disappointment that fees for medical services have reportedly been increased across public health facilities in the Gambia. While the Government has yet to make an official public announcement detailing the revised fee structure, information circulating on social media and reports from citizens indicate that a wide range of healthcare services, including medical consultations, have been subjected to significant increases.
EFSCRJ strongly opposes this decision. We find these fee increases unjustified, unreasonable, and insensitive to the prevailing economic realities facing Gambians. At a time when the cost of living continues to rise and poverty remains widespread, increasing the cost of accessing healthcare places an additional burden on citizens and threatens to exclude the most vulnerable from essential medical services.
We have noted media reports in which the Chief Medical Director of the Edward Francis Small Teaching Hospital Dr. Mustapha Bittaye argued that fees at public health facilities remain lower than those charged by private healthcare providers and facilities in neighbouring countries. We reject this rationale as fundamentally flawed.
Public healthcare cannot and should not be assessed through the lens of commercial profitability or regional price comparisons. The primary obligation of government is not to compete with private institutions or mirror practices elsewhere, but to guarantee the health and well-being of its citizens. Healthcare is a public good and a fundamental human right, not a commodity to be priced according to market considerations.
Gambians already contribute to the financing of public services through taxation and other public revenues. In addition, the health sector receives substantial support from development partners, international agencies, and donors. Given the volume of public resources and external assistance directed toward healthcare, EFSCRJ maintains that the Gambia has the capacity to progressively provide universal, high-quality healthcare free of charge for all citizens.
Access to healthcare should not depend on one’s ability to pay. When citizens are unable to afford medical services, the result is delayed treatment, worsening illness, unnecessary suffering, preventable disability, and, in many cases, avoidable death. Denying healthcare because of cost effectively undermines the right to health and violates the principle of equality in access to public services.
We are particularly concerned that these fee increases are being imposed in an environment where serious concerns persist regarding financial accountability and management within the public sector, including the health sector. Recent audits by the National Audit Office have revealed cases of missing and unaccounted-for public funds, some of which were referred for police investigation. Yet meaningful accountability remains elusive.
Beyond the health sector, billions of dalasi continue to be lost through waste, inefficiency, mismanagement, corruption, and weak financial controls. These are resources that should be invested in strengthening healthcare infrastructure, procuring medicines, retaining health professionals, and expanding access to quality services. The burden of financing governance failures must not be shifted onto ordinary citizens through increased user fees.
As a State Party to numerous regional and international human rights instruments, including the African Charter on Human and Peoplesโ Rights and the International Covenant on Economic, Social and Cultural Rights, the Gambia has a legal and moral obligation to progressively realize the right to health for all persons within its jurisdiction. This obligation requires the State to ensure that healthcare is available, accessible, affordable, acceptable, and of good quality. EFSCRJ therefore calls on the Government to immediately suspend and review all increases in public healthcare fees and engage citizens in a transparent national discussion on the financing and future of healthcare in the Gambia.
Furthermore, we urge the Government and the National Assembly to undertake comprehensive legal reforms aimed at guaranteeing healthcare as a justiciable constitutional right. In particular, Chapter IV of the Constitution should be amended to explicitly recognize and protect the right to health as an enforceable fundamental right. We also call for a review of the Public Health Act and related legislation to establish a clear legal framework for universal access to free public healthcare.
EFSCRJ remains firmly convinced that healthcare and education are not expenditures but investments. They are the foundations of human development, economic productivity, social stability, national security, and sustainable growth. A healthy and educated population is the greatest asset of any nation. We therefore strongly oppose any increase in public healthcare fees and demand that healthcare and education, two critical social services, be made free in the Gambia. Providing high quality, free education and healthcare is an investment in the peace, security, and future of our country.
The future prosperity of the Gambia depends on ensuring that every citizen, regardless of income, social status, or place of residence, can access quality healthcare and education without financial barriers. We therefore reiterate our opposition to any increase in public healthcare fees and call on the Government to work towards a system where healthcare is free, accessible, equitable, and of the highest attainable standard for all.
2026: The Year of Empowerment โ Empowered Citizens. Accountable Leadership.
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