By Aminata Kuyateh
The National Health Insurance Authority (NHIA) on Monday started a two -day convergence of its stakeholders at Sir Dawda Jawara International Conference Centre. It brought together government officials, health sector actors and development partners to take stock of the National Health Insurance Scheme (NHIS) and outline priorities for the year ahead.
In 2021, the government introduced the National Health Insurance Scheme, that seeks to reduce out-of-pocket expenditure for middle and low earners to access basic health care services.
Since then, the National Health Insurance Authority, the body mandated by the Act, has been leading the charge to license and regulate all private insurance schemes.
Speaking at the meeting, Bai Mass Saine, CEO of NHIA said the convergence was meant to create space for honest reflection on progress made so far and the work that still lies ahead in building a sustainable and inclusive health insurance system for The Gambia.
CEO Saine reported that since its launch, the NHIS has recorded steady growth, expanding from just 13 contracted health facilities to 70 facilities nationwide, now covering all regions of the country.
He noted that the scheme is already making a tangible difference, with more than 50,000 women and newborns having accessed services under the NHIS, helping to ease financial barriers to care and improve maternal and newborn health outcomes.
Despite these gains, Saine acknowledged that challenges remain and stressed the importance of continued collaboration.
He outlined the NHIS strategic priorities for 2026, which include expanding services to reach more people, especially those in rural and hard-to-reach communities, securing predictable and sustainable financing, and ensuring the passage and effective implementation of the amended National Health Insurance Act 2021.
He also highlighted the need to remove administrative bottlenecks, particularly the link between NHIS registration and birth certification, which he said has limited access for many eligible Gambians.
Presenting a detailed overview of the scheme, Dr Hassan Njie, Director of Services at NHIA, traced the origins of the NHIS to broader health financing reforms initiated around 2017.
He explained that the scheme was built on the establishment of a Health Financing Technical Committee, which later produced a National Health Financing Policy and Strategy aligned with the National Development Plan and the global Universal Health Coverage agenda under the Sustainable Development Goals.
Dr Njie said the passage of the National Health Insurance Act in September 2021 provided the legal backbone for the system, establishing the NHIA, the NHIS and the National Health Insurance Fund, which is domiciled at the Central Bank. Together, he said, these structures are designed to move the country steadily towards universal health coverage by 2030, with a focus on equity, access to quality service and financial protection, particularly for vulnerable groups.
He described the NHIS as a prepayment system that combines contributory and non-contributory financing, noting that while those who can afford to pay are expected to contribute, government subsidies are intended to cover exempted groups.
Dr Njie acknowledged that the scheme is still in its early stages and is being implemented in phases due to fiscal constraints, adding that nearly half of the population falls under exemption categories, placing pressure on sustainability.
He stressed that the gradual approach is meant to balance ambition with financial reality while keeping the long-term goal of universal coverage in sight.
Njie presented an overview of the NHIS implementation journey, highlighting key milestones achieved since the pilot phase. He recalled that the scheme was first tested in July 2023 at the Bundung Maternal and Child Hospital, serving as a learning ground for refining systems, processes, and service delivery arrangements.
He noted that lessons from the pilot informed the expansion of the scheme in April 2024 to additional public health facilities and later to most public hospitals and major health centres across the country.
According to him, community clinics have been integrated through a mapping system that links them to parent facilities, ensuring wider inclusion and continuity of care under the NHIS.
Also addressing the convergence, Baba Njie, Senior Quality Assurance and Benefits Manager at NHIA, shared lessons learned from implementation, pointing to the importance of strong service agreements, verification systems and timely reimbursements to maintain provider confidence and service quality.
He said these experiences will guide further improvements as the scheme scales up, adding that continued stakeholder engagement remains critical to strengthening the NHIS and delivering on its promise to Gambians.
