By Aminata Kuyateh
Few weeks following the significant expansion of the National Health Insurance Scheme (NHIS) to 67 health facilities across the country, the National Health Insurance Authority (NHIA) has taken another pivotal step in the ongoing reform of Gambia’s healthcare landscape.
On Wednesday, the Authority officially launched a roll-out provider tariff negotiation and consensus building workshops, aimed at fostering dialogue with healthcare service providers under the expanding national scheme.
Held at Kombo Beach Hotel, the workshop brought together public and private sector stakeholders, ranging from hospital administrators, clinic managers, independent practitioners and health economists. The central objective is to collaboratively define and agree on fair and sustainable tariff structures for services delivered within the NHIA provider network.
In 2021, government introduced the National Health Insurance Scheme, an initiative that seeks to reduce out-pocket expenditure for middle and low income earners when accessing basic health care service.
The NHIS, spearheaded by the National Health Insurance Authority in collaboration with the ministry of health, is a crucial step toward ensuring that all Gambians have access to health care without financial barriers.
A milestone toward quality healthcare delivery
According to the NHIA, these workshops represent a broader commitment to ensuring that quality healthcare is accessible, equitable, and sustainable for all Gambians.
In his opening remarks, Bai Mass Saine, CEO at NHIA emphasised the importance of building a strong partnership with healthcare providers, stating that “negotiating fair tariffs is not only a matter of financial logistics, but also, a matter of public trust and health equity.
“When we talk about health insurance, we are not just talking about figures and frameworks. We are talking about the peace of mind a family feels knowing help is available when illness strikes; the dignity every citizen deserves when walking into a health facility, and ensuring no one is left behind because of financial limitations”, CEO Saine stated.
He added: “Our mandate goes beyond policy. It includes building trust between service providers, government, and most importantly, the people we serve. But that trust can only exist if the foundation we lay today is both fair and sustainable”.
“The days ahead are designed not for speeches, but for real and hard conversations that must be honest, sometimes tough, but always respectful, because at the centre of this dialogue is a shared belief that healthcare should not be a privilege, but a right”.
CEO Saine urged the participants to fully engage, challenge perspectives and contribute their unique experience to the process, noting that the success of the NHIS depends on the consensus built at these workshops and the spirit of partnership carried forward beyond the workshops.
“Let’s make this workshop a turning point in how healthcare is valued and delivered across The Gambia,” Mr Saine said.
Yaya Barjo, also of the NHIA, highlighted the overview of the development of the health insurance package. “With the NHIS membership card beneficiaries can enjoy delivery services covered by the scheme, for a mother presenting a delivery,” he said.
Mr Barjo added that one of the objectives of these workshops is to outline the mechanisms through which the population of the Gambia can receive basic essential health services without suffering financial hardship as well as provide a framework for the allocation of benefits and resources based on three principles.
According to officials, the tariff negotiation process, while technical, is central to the sustainability of the NHIS. They added that well-balanced tariff system ensures that providers are compensated fairly for services rendered while preventing the overburdening of the insurance fund, which is still in its formative years.
From expansion to implementation
The NHIA’s recent expansion of the scheme to 67 health facilities, spanning all regions of the country, marked a bold stride in the Authority’s mission to universalised healthcare coverage. But experts note that expansion without harmonised service standards and reimbursement models can lead to systemic inefficiencies.
Nonetheless, the NHIA assured stakeholders that their inputs would form the basis of a transparent and adaptive tariff model, with periodic reviews built into the system.
As The Gambia continues its journey toward universal health coverage, the NHIA’s workshop signals a deliberate and necessary shift toward building a health system that is not only more inclusive, but also more accountable and efficient.
The NHIA expressed gratitude to all participants and thanked Professor Chola Lumwe, the consultant for his expert guidance.
