Cities & Health

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Challenges of The Gambia’s COVID-19 response

and policy recommendations

Ramatoulie Jallow

To cite this article: Ramatoulie Jallow (2020): Challenges of The Gambia’s COVID-19 response
and policy recommendations, Cities & Health, DOI: 10.1080/23748834.2020.1833596

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CITIES & HEALTH
https://doi.org/10.1080/23748834.2020.1833596

COMMENTARY AND DEBATE

Challenges of The Gambia’s COVID-19 response and policy recommendations

Ramatoulie Jallow
Health of Women, Women’s Economic Imperative (WEI), Maryland, USA; Pan African Women in Health (PAWH), Johannesburg,
South Africa

ABSTRACT ARTICLE HISTORY

On 11 March 2020, the novel coronavirus, COVID-19, was declared a global pandemic. In Received 20 July 2020
response, nations around the globe advocated for social distancing, implemented travel Accepted 3 October 2020
bans, and lockdown measures. This commentary is an analysis of the policy response to KEYWORDS
COVID-19 in The Gambia. While highlighting the challenges faced by women, girls, urban Africa; COVID-19 Lockdown;
and rural communities, and the informal and formal sector as a result of the policy response, COVID-19 response;
this paper also provides recommendations that must be prioritized by policymakers and pandemic; the Gambia;
implementers to effectively combat COVID-19 in The Gambia. women and Girls

Background on The Gambia Medicine 2020) with 3,029 confirmed cases, 1,146 recov­
eries, and 96 deaths recorded to date (Ministry of Health,
The smallest country on mainland Africa, The Gambia,
MoH 2020b). In response to the global pandemic, the
with its population of 2.1 million, is one of the most
government imposed strict public health measures based
densely populated countries on the continent – an esti­
on physical distancing such as a ban on all public gather­
mated 176 inhabitants per square kilometer (The World
ings (including school closures) and travel restrictions for
Bank n.d.) with over 57% of its population centered
21 days (The Republic of The Gambia 2020a, 2020c; U.S.
in urban and peri-urban localities (United States
Embassy in the Gambia 2020b). This was followed by a
Geological Survey | West Africa: Land Use and Land
declaration of a national state of public emergency (SoPE)
Cover Dynamics, n.d.). In rural Gambia, limited access
with more stringent measures and an approval of a
to employment, public transportation, and poor infra­
COVID-19 response emergency fund of Five hundred
structure contribute to the urban sprawl. According to
Million Dalasis (approximately USD$ 9.7 Million) (The
the United Nations Economic Commission for Africa,
Republic of The Gambia 2020b).
approximately 74% of the rural Gambian population
The SoPE response strategy was timely as the
lives on less than USD$1.25 a day in comparison to
declaration came after three confirmed cases and
32.7% of their urban counterparts (Neumueller 2017).
one death. It reassured Gambians that the govern­
Moreover, lack of access to loans – especially for youth
ment’s priority was to safeguard and protect the
and women – limited resources, and low private invest­
health of its citizens through preventing and redu­
ment within rural communities fuel inequities in the
cing transmission. Moreover, it gave authority to the
rural-urban divide. Although Gambia has made signifi­
social distancing messaging from the Ministry of
cant strides in improving access to education, more than
Health. However, the strategy did not take into
84% percent of women and 71% of men do not have
account the potential unintended consequences
formal work arrangements (FAO 2019). Moreover, only
within the context of the Gambia such as hunger
about 14% of women and 29% of men are salaried
and loss of revenue. Additionally, in many cases, it
workers with Gambian women making up 70% of the
was perceived as reactive as opposed to proactive.
unskilled labor force.
The initial SoPE provided no strategies on eco­
nomic support to sustain families and their liveli­
Gambia government COVID-19 response hoods, i.e. those in the informal sector, transport and
strategy tourism industries, and those whose income was
dependent on remittances. For example, approxi­
The Gambia registered its first confirmed case of mately, 22% and 20% of the country’s Gross
COVID-19 a week after the World Health Organization Domestic Product (GDP) is gained from remittances
(WHO) characterized the novel coronavirus, COVID-19, from Gambian migrants (Sawaneh 2017) and the tour­
as a global pandemic (WHO 2020 and MRC Unit the ism industry, respectively (UNCTAD, 2019). Both
Gambia at London School of Hygiene & Tropical remittances from Gambians abroad (Jeffang 2020a)

CONTACT Ramatoulie Jallow ramatouliejallow@gmail.com

© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 R. JALLOW
and tourism, which peaks from October to April, have
been heavily impacted by the COVID-19 pandemic
(UNDP 2020, IOM 2020a). For the tourism industry
alone, in addition to the loss of livelihoods and
income, the revenue loss is estimated to be at least
US$ 108.5 Million (United Nations Development
Program, UNDP 2020). With the impact of COVID-
19 on the global economy, many in the diaspora are
facing layoffs and job insecurity, which could lead to a
significant drop in remittances (World Bank 2020).
Given that many Gambians, particularly women,
work in informal sectors and are not salaried workers,
many depend on daily wages and remittances for their
sustenance.
Over time, the government revised the SoPE to
address some of the weaknesses. Businesses received a
2019 tax deferment, food relief package to 84% of
households identified as vulnerable with sugar, rice,
and cooking oil (Jeffang 2020b) and a reduction in
fuel pump prices owed to the dropping of international
market prices for crude oil (Gambiana 2020). While the
government continues to address the weaknesses, some
challenges still remain. For example the rising numbers
of imported cases due to recent travel from Senegal
(Ministry of Health, MoH 2020a). While strategies
have been employed by the government and its partners
to mobilize border communities and raise awareness to
prevent COVID-19 transmission, the extremely porous
borders in rural Gambia and Senegal make surveillance
of mobility at unofficial border points difficult (IOM
2020b). Preventing people from crossing between the
two countries, as required by the SoPE, has not been
easy, putting many rural communities at heightened
risk for COVID-19.
Impact of Gambia’s response strategy (SoPE)
on women
While COVID-19 has impacted all genders, the impact
on women and girls has been exacerbated simply by
virtue of their sex (UN Women 2020). In the Gambia,
which remains a traditional patriarchal society with
social norms and customs that disproportionately
affect women (FAO 2019); women hold majority of
the informal, yet essential jobs and are the predomi­
nant caregivers (unpaid care work). Despite the SoPE
being put in place to curb the spread of COVID-19
and protect the most lives, it did not fully prepare for
the impact on the wellbeing of women and girls. For
example, with schools closed as part of the SoPE,
mothers and daughters are left to care for the children,
a task that impacts their own productivity and work.
Consequently, girls spend less time following remote
learning platforms that the Ministry of Basic and
Secondary Education (MoBSE) have tried to imple­
ment as part of their COVID-19 response strategy
(MoBSE 2020). Mothers – both those working in
informal and formal sectors – divide their attention
between caring for their household and attending to
their workload. Not being able to adequately balance
the two results in either a decline in work performance
or lack of parental monitoring to ensure their children
are following COVID-19 safety precautions.
Impact of Gambia’s response strategy (SoPE)
in urban and rural communities
The rapid urbanization in the Gambia has health, social,
and environmental consequences for the country’s urban
communities (Nshimyumuremyi and Workie 2016).
According to Nshimyumuremyi and Workie (2016),
approximately 34.8% of urban dwellers are living in
close quarters in slums and in informal settlements.
While the urban population accounts for 49% of the
employment income generated (Nshimyumuremyi and
Workie 2016), the majority of Gambians employed in the
informal sector, about 52%, live in urban settings (IOM
2017). Flooding and solid waste pollution impact both the
livelihoods and health of urban residents making them
more susceptible to COVID-19 transmission. The
crowded living conditions coupled with the rapidly grow­
ing population in urban communities make it increas­
ingly difficult to meet the demand for social services and
adhere to COVID-19 risk mitigation precautions.
In rural communities where infrastructure is lack­
ing, students are often unable to access MoBSE televi­
sion, radio, and social media programs. For the girls
who often are forced to drop out of school at an early
age – either for marriage, domestic chores, or to sup­
port income generating activities – being out of school
means little to no time for schoolwork. Additionally,
the closure of non-emergency health services exacer­
bates the already limited access to sexual and repro­
ductive health services that women and girls in rural
communities face, contributing to unintended and
unplanned pregnancies, and consequently leading to
girls not being able to return to school (IPPF 2020)
Proposed solutions to strengthen future
response strategy
Overall, Gambia’s response strategy mainly focused on
curbing the spread of COVID-19 through state of
public emergency shutdown measures that imposed,
rather than facilitated, social and physical distancing.
Some measures that were indeed used to facilitate
social distancing or ease the impact of COVID-19,
such as food relief packages, were disbursed long
after the declaration of a state of emergency. The
COVID-19 state of emergency response has high­
lighted many opportunities and proffered solutions
that could better inform future public health emergen­
cies. These include:

(1) Inclusion of social and economic support
in state of emergency policy: With many
Gambians in both urban and rural commu­
nities earning less than 1.25 USD/day and
holding non-salaried jobs, the closure of busi­
nesses and non-essential enterprises has
greatly impacted livelihoods. Accompanying
future SoPE policies with social and economic
support can serve as incentives to encourage
and afford people the ability to adhere to stay-
at-home directives. The Gambia can learn
from other countries in Africa who have
introduced measures to lessen the economic
impact of the coronavirus restrictions and
incentivize distancing. Such measures include
food assistance and emergency cash payments
to the recently unemployed in Namibia
and Cabo Verde (Kaneda and Ashford 2020)
and national stimulus support in Ghana,
Mauritius, and Kenya (Monga 2020).
(2) Specific recommendations to alleviate the dis­
proportionate impact of COVID-19 on
women and girls: In an aim to mitigate the
disproportionate burden women and girls
already experience due to social and gender
norms in the Gambia, steps must be taken to
ensure that progress made towards improving
gender equality is not lost. The inclusion of
women and girls from diverse socioeconomic
backgrounds as key leaders in emergency policy
decisions will ensure gender and age represen­
tation for more inclusive policies that take in to
account the social, health, and economic chal­
lenges girls and women are currently facing
(UN Global Compact 2020). Moreover, provid­
ing flexible work arrangements for working
parents and economic grants to those working
in the informal sector could disrupt gender
stereotypes which leave the bulk of unpaid
labor and childcare on women. By assuring
uninterrupted access to sexual and reproduc­
tive health commodities and ensuring that back
to school measures put focus on the improve­
ment and retention of girls in school, more girls
will be able to return once schools are reopened
(Malala Fund 2020). By so doing, the Gambia
could continue to stay on course in the strides it
has made towards gender equality.
(3) Intensify Community Engagement and Sensi-
tization by leveraging key community leaders:
Policies about and for the communities are less
effective if they do not engage concerned com­
munities in decision-making. Lessons learned
from the Ebola epidemic highlight that faith
leaders, for example, played a great role in sup­
porting the Ebola response; however, they were
engaged very late in the epidemic. Engaging
CITIES & HEALTH 3
them earlier in the response could have
averted significant loss of life (CAFOD 2015).
Government should have consulted commu­
nities before the first confirmed case in order to
identify mitigation strategies on the social and
economic impact of COVID-19-related lock­
downs. Future strategies should consult and
gain buy-in from community stakeholders such
as religious leaders, women, and youth leaders,
before implementation.
(4) Engage lay community health workers (CHWs)
to bolster community alert systems in border
communities: Drawing from the Ebola Virus
Disease response in Guinea, Liberia, and Sierra
Leone lessons, the government should engage
CHWs to mobilize communities, monitor, and
support surveillance at unofficial border points
(Miller et al. 2018). Moreover, CHWs can contact
the Quarantine team to facilitate the transporta­
tion of travelers to designated quarantine facilities.
(5) Partnerships with the government: The
COVID-19 response also saw the benevolence
of Gambian citizens and business owners.
Gambians, both in country and the diaspora,
launched fundraisers and donated their time,
money, food items, cleaning supplies, and reu­
sable face masks to those in need (Gofundme.
Com 2020). Youth and entrepreneurs came
together to produce personal protective equip­
ment (PPE) and reusable facemasks, make acces­
sible portable wash stations, print 3D face
shields, and creatively use social media to raise
awareness (MarketScreener 2020). By leveraging
these partnerships, the country can empower
Gambians to develop context-specific tools and
resources that can address current and future
health concerns on a grand scale. This will be
particularly important once the country transi­
tions from its response to recovery phase.
(6) Improve access to functional infrastructure,
particularly for those living in urban slums
and in rural communities: While a lot of
COVID-19 health messaging includes encoura­
ging people to wash their hands, water shortages
and reliable access to adequate water supply
continues to be a challenge. Safety precautions
such as physical and social distancing have also
been difficult to operationalize due to limited or
lack of access to electricity and internet.
Increasing investments and improving the
reach of infrastructure to tackle water quality
and shortages, unstable electricity, and expensive
or absent telecommunication can strengthen
adherence to social distancing policies by allow­
ing students to stay engaged with their education
and providing an option for people to work
remotely where possible.
4 R. JALLOW
Conclusion
The State of Public Emergency which was first declared
on 27 March is still in effect; however, there have been
some relaxations to the restrictions, chiefly, the reopen­
ing of all places of worship during prayer times and non-
food business outlets for limited operating hours. Schools
remain closed, except for students sitting for their school
leaving exams, as well as the airspace and land borders.
New mandatory measures including nightly curfews and
mandatory wearing of facemasks in public settings have
been instituted in an attempt to curb the existence of
community transmission of COVID-19 in the country
(U.S. Embassy in the Gambia 2020a).
The COVID-19 pandemic response has under­
scored, however, that by approaching community
health strategies and solutions, both in emergency
and normal conditions, through one lens alone with­
out the involvement of diverse stakeholders, the lives
and lived experiences of the most vulnerable – parti­
cularly women and girls – will continue to be left out
of the conversation. As aptly highlighted by Dr.
Tedros during his opening remarks at the World
Health National Assembly, ‘ . . . There is no silver
bullet. There is no simple solution. There is no pana­
cea. There is no one-size-fits-all approach. It takes
hard work, fidelity to science, learning and adapting
as you go, and difficult decisions, of course . . . ’
(Ghebreyesus 2020). The generosity of Gambians to
mobilize and provide urgent support to the most
vulnerable in a time of urgent need has filled in
gaps where the slower bureaucratic system needed
time to organize. Leveraging existing social resources
and engaging youth entrepreneurs, private enter­
prises, and community anchors can strengthen future
response strategies.
Disclosure statement
The view(s) expressed in this article are those of the author
and do not necessarily represent the views of the Pan-
African Women in Health (PAWH).
Notes on contributor
Ramatoulie is a Public Health Consultant. She holds an
MPH in Community Health Promotion from the
University of Minnesota. Ramatoulie is a co-lead in
subSaharan African affairs for the Health of Women team
at the Women’s Economic Imperative. Previously, she
served as an Epidemiologist with the US Centers for
Disease Control and Prevention, supporting surveillance of
the Ebola outbreak in Guinea. Prior to CDC, she conducted
HIV/AIDS research in Rwanda as a Global Health Corps
fellow. She has worked on women’s empowerment and the
demographic dividend in the Sahel as well as on youth
access to family planning services.
ORCID
Ramatoulie Jallow http://orcid.org/0000-0002-7880-7539
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