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Healthcare service provision in the Gambia

Working with the private sector to deliver public policy goals


Mike Naylor

This project has provided crucial evidence into the feasibility of large-scale, international-standard healthcare facilities in the Gambia and across west Africa more generally. The demand for high quality health services in the region has grown rapidly, especially amongst the burgeoning consumer classes. We were contracted by the African Development Bank to conduct an evaluation of the health market and service provision dynamics in the Gambia and neighbouring countries and assess the feasibility of a proposed new healthcare facility in Banjul.

This turn-key, Build, Own, and Operate (BOO) project included the design and construction of a facility providing diagnostic, surgical, and medical in-and out-patient services for both privately- and non-privately-funded patients. The team used both primary and secondary research to evaluate the sector and assess the financial viability of the proposed new facility. Extensive documentation reviews were complemented by key informant interviews covering key government, public, and private sector actors in the Gambia and Senegal. The team used these data to develop a full market study including strategic recommendations for maximising healthcare service opportunities in line with wider development goals for the region. Based on these recommendations, the African Development Bank has now approved plans to establish the proposed facility, supporting improved healthcare service delivery across the region.


The demand for high-quality health services across west Africa is growing rapidly, in line with the burgeoning consumer classes across the region. In order to address this growing demand, the African Development Bank is planning to establish an international-standard, state-of-the-art facility in Banjul.

Our approach

We conducted an extensive, independent market study, combining primary and secondary research to evaluate the healthcare business in the Gambia and neighbouring countries and assess the financial viability of the proposed new facility.

Work was based around verifying and expanding an initial health market study carried out in 2012, including financial and geopolitical assumptions, a financial plan and risk assessment for the proposed new facility. The team used both primary and secondary research methods including extensive literature reviews complemented by key informant interviews in both the Gambia and Senegal. Stakeholder mapping was used to identify key actors including officials from a number of government ministries and units, public and private healthcare systems, the business community, and development institutions.

The data gathered were analysed through assessment of a number of dimensions, including the current size of the market for a particular service, existing provision in that service area, and the potential for growth and sales within the next ten years. Based on these market insights, the team made a number of recommendations around the feasibility of a large-scale, all-encompassing health facility in the Gambia.

Specific activities undertaken by the team included:

  • reviewing project documentation and wider national policy plans including the Gambia National Development Strategy (2012-2015);
  • carrying out stakeholder mapping to determine key actors from government, public and private healthcare systems, financial and development institutions;
  • conducting key informant interviews and quasi-focus group discussions in the Gambia and Senegal; and
  • designing and implementing sampling of business sector institutions based on a semi-structured questionnaires.

The success of the facility - notably how well it meets the needs of potential patients - will depend upon an extensive understanding of the dynamics of the healthcare sector in the Gambia and other parts of western Africa. This project was established to provide this evidence through an independent feasibility assessment, highlighting current and potential future challenges and opportunities in the sector.


This study has helped improve evidence around the feasibility of large-scale healthcare projects in west Africa. By independently highlighting the challenges and opportunities within the Gambia’s healthcare sector, our report has contributed to a greater understanding of the financial viability of a proposed new health facility serving the country and its neighbours.

Based on our recommendations, the African Development Bank has now approved plans to establish the facility and fill the gap in the market for high quality healthcare including upper-income private medical services. As well as positively impacting healthcare systems across the region, such a facility - if managed effectively - could contribute to increasing investment and tourism, supporting wider socio-economic development outcomes.


Areas of expertise