Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694249432263.pdf (Gambia)
REPUBLIC OF THE GAMBIA National Assembly, New Assembly Building, Reg.
Pye Lane Banjul, The Gambia THE NATIONAL ASSEMBLY SELECT COMMITTEE ON HEALTH, WOMEN, DISASTER, HUMANITARIAN RELIEF AND REFUGEES REPORT ON THE SECOND OVERSIGHT ENGAGEMENT ON THE NATIONAL RESPONSE TO THE COVID 19 PANDEMIC 11 – 28 MAY 2020 1 Contents ACKNOWLEDGEMENT .................................................................................................................. 4 EXECUTIVE SUMMARY ................................................................................................................. 6 1.
INTRODUCTION ........................................................................................................................ 7 2.

MEMBERS OF THE OVERSIGHT TEAM ........................................................................................ 8 3.

OBJECTIVES .............................................................................................................................. 9 3.1.
General Objective .............................................................................................................. 9 3.2.

Specific Objectives ............................................................................................................. 9 4.

OVERSIGHT VISITS TO QUARANTINE, TESTING AND TREATMENT CENTRES ................................ 9 4,1.

Visit to quarantine centre (Badala Park Hotel ) ..................................................................... 10 4.2.
Visit to Visit to quarantine centre (Bamboo Hotel).

.............................................................. 13 4.3.

Visit to quarantine centre (Golden Beach Hotel) ................................................................... 14 4.4.

Visit to the Medical Research Council Unit ........................................................................... 15 4.5.

Visit to the National Public Health Laboratory ...................................................................... 16 4.6.
Visit to the Epidemiology and Disease Control Unit and Incident Operation Centre Team ...... 17 4.7.

Visit to Edward Francis Small Teaching Hospital ................................................................... 19 4.8.

Visit to the Polyclinic in Banjul ............................................................................................. 20 4.9.

Visit to the Sanatorium Treatment Centre ............................................................................ 21 4.10.
Visit to Ndebaan treatment centre ................................................................................. 22 4.10.
Kanifing General Hospital .................................................................................................. 22 MEETINGS WITH THE NATIONAL DISASTER MANAGEMENT AGENCY AND THE GAMBIA RED CROSS SOCIETY ..................................................................................................................................... 23 5.1 National Disaster Management Agency and the Covid 19 response ............................ 23 5.2 The Gambia Red Cross Society and the Covid 19 response ................................................ 25 6.
MEETING WITH THE MINISTRY OF HEALTH .......................................................................... 26 7.
CONCLUSIONS/RECOMMENDATIONS .................................................................................. 27 7.1 Quarantine centres ............................................................................................................... 27 OBSERVATIONS/CONCLUSIONS .................................................................................................. 27 RECOMMENDATIONS ................................................................................................................. 28 7.2.
Medical Research Council (MRC) Unit, The Gambia .............................................................. 28 OBSERVATIONS /CONCLUSIONS ................................................................................................. 28 RECOMMENDATIONS ................................................................................................................. 28 7.3 National Public Health Laboratory ........................................................................................ 29 RECOMMENDATIONS ................................................................................................................. 29 7.
4.

National Epidemiology and Disease Control Centre ............................................................. 29 OBSERVATIONS/CONCLUSIONS .................................................................................................. 29 RECOMMENDATIONS ................................................................................................................. 29 7.5.
Edward Francis Small Teaching Hospital ............................................................................... 30 OBSERVATIONS/CONCLUSIONS .................................................................................................. 30 RECOMMENDATIONS ................................................................................................................. 30 Banjul Polyclinic ......................................................................................................................... 30 OBSERVATIONS/CONCLUSIONS .................................................................................................. 30 RECOMMENDATIONS ................................................................................................................. 31 Sanatorium ................................................................................................................................ 31 OBSERVATIONS/CONCLUSIONS .................................................................................................. 31 RECOMMENDATIONS ................................................................................................................. 31 7.6 Kanifing General Hospital ..................................................................................................... 32 OBSERVATIONS/CONCLUSIONS .................................................................................................. 32 RECOMMENDATIONS ................................................................................................................. 32 7.7 National Disaster Management Agency ................................................................................. 32 RECOMMENDATIONS: ................................................................................................................ 32 7.8 GAMBIA RED CROSS SOCIETY (GRCS) ..................................................................................... 33 OBSERVATIONS/CONCLUSIONS .................................................................................................. 33 7.9 MINISTRY OF HEALTH ........................................................................................................... 33 OBSERVATIONS/CONCLUSIONS .................................................................................................. 33 Recommendation ...................................................................................................................... 33 Appendices ................................................................................................................................ 35 Annex 1: Responses to the recommendations in the Oversight Report on the state of national preparedness in March 2020 .................................................................................... 35 Responses to the questions from the National Assembly towards Covid-19 national response and budget implementation plan .......................................................................... 36 Q4: Fortnightly detail income and expenditure reports on the COVID-19 funds with explanatory notes.
........................................................................................................................................ 40 Annex 3: Review of issues for the engagement with the Minister and officials of the Ministry of Health on the national response to the Covid 19 pandemic in The Gambia... 46 3 ACKNOWLEDGEMENT The Honourable Members of the Select Committee on Health, Women, Children, Disaster, Humanitarian Relief and Refugees, Secretaries and Subject Matter Specialists wish to express their profound appreciation for the warm reception accorded the Team by all officials during the second oversight visit.
We thank the Directors, Heads of unit and staff who warmly welcomed us in the various health departments, we visited: the Director of the National Public Health Laboratory and his team; the Director of the Epidemiology and Disease Control Unit and Incident Operation Centre Team; and health facilities, the Chief Administrator of the Edward Francis Small Teaching Hospital, the OIC of the Polyclinic, Head of the Covid 19 Treatment Team and Head of the Sanatorium and the Director of Administration and senior management team at Kanifing General Hospital.
We appreciate the time spent with us explaining the operations of their directorates and Units which provided us with a clearer understanding about the current status of the national response to Covid 19 in their respective fields.

We are indebted to the Deputy Executive Director of the National disaster Management and his team and the Secretary General of Gambia Red Cross Society and his staff who shared invaluable insights about their role in the national Covid 19 response.
We thank Professor Umberto D’ Alessandro, Director of the Medical Research Council Unit The Gambia (MRCG) at the London School of Hygiene and Tropical Medicine and his team for the useful information provided regarding the operations of the Unit in the Covid 19 national response.
We also thank the hotel management teams of Badala Park Hotel, Bamboo hotel, Golden Beach hotel, Acting Director of Public Health Services, and the health teams in the quarantine centres for explaining how the quarantine system works and the challenges they face.

We appreciate the efforts of the private sector and the on-going upgrading work at Ndebaan treatment centre coordinated by Mr Mustapha Njie.
We sincerely thank the Minister of Health, Acting Director of Health Services and all the other directors and senior officials at the Ministry for the update given to the Select Committee at the meeting held on 28 May 2020.
The explanations, responses and insights we received were invaluable and have helped us gain a richer understanding of the status of the response to the pandemic We sincerely acknowledge and thank the managements and reporters/crews from the Gambia Radio and Television Services (GRTS), for the media coverage and presentation of the visits in their media outlet.

The timely support of the Office of the Clerk and staff of the National Assembly in facilitating these urgent engagements is noteworthy.
4 ABBREVIATION A & E BCC CMD DHS EDC EFSTH EPI GBA GRCS GRTS IOC IOM KMC MoH MRC NAM NDMA NHEC NPHL PHO PPE SMS WHO Accident and Emergency Banjul City Council Chief Medical Director Director of Health Services Epidemiology and Disease Control Edward Francis Small Teaching Hospital Expanded Programme on Immunisation Greater Banjul Area Gambia Red Cross Society Gambia Radio and Television Services Incident Operation Centre International Office for Migration Kanifing Municipal Council Ministry of Health Medical Research Council National Assembly Member National Disaster Management Agency National Health Emergency Committee National Public Health Laboratory Public Health Officer Personal Protective Equipment Subject Matter Specialist World Health Organisation 5 EXECUTIVE SUMMARY The National Assembly Select Committee on Health, Women, Children, Disaster, Humanitarian Relief and Refugees, conducted a second oversight visit between 11 to 25 May 2020 to follow up on outstanding issues from the first visit and to assess the current state of the national response to the Covid 19 pandemic.
The Select Committee visited quarantine, testing and treatment centres.

They held meetings with the Ministry of Health and agencies responsible for disasters.

The majority of cases are imported highlighting the need to control the borders and curb the influx.

The quarantine centres have largely succeeded in persuading quarantined individual to stay in the hotel with continuing psychosocial support and efforts to address emerging problems.
The positive cases in treatment centres are mainly asymptomatic though there is concern that if social distancing is not observed as is currently the case cases may start to rise.

The country now has two functioning testing laboratories at the MRC and the National Public Health Laboratories.

In most health facilities social distancing was observed in the outpatient departments but staff did not routinely wear face masks.

The only fully functional treatment centres are the Sanatorium and MRC, Fajara.
The Ndeban treatment centre which will have an estimated 100 beds is currently being refurbished.

There is an intensive care unit in the Sanatorium.

Within communities there is denial, stigmatization of positive cases and lack of cooperation within communities during contact tracing.

The overriding concern of frontline health workers is late payment of allowances and lack of incentives.
They are concerned about the risk they face and having to work away from home for weeks which creates an additional financial burden.

The adverse impact of the Covid 19 pandemic on economic livelihoods especially following the declaration of a state of emergency increased the vulnerability of household.

The National Disaster Management Agency has distributed food relief to 84% of households across the country though logistical challenges remain.
Gambia Red Cross Society has supported the national response to Covid 19 in a variety of ways including providing financial and material aid, and supported community sensitisation and surveillance.

The Ministry of Health met with the Committee and provided responses Members noted with concern that there is no social distancing in public places especially in crowded places such as markets increasing the risk that of transmission of the virus.
They were also concerned that even though 70% of cases are imported community surveillance in villages along the border is weak and the monitoring of informal entry points are is ad hoc.

The Committee has provided specific recommendations based on conclusions drawn from their observations and findings.

6 1.
6 1.

INTRODUCTION In March 2020, the Select Committee on Health, Women, Children, Disaster, Humanitarian Relief and Refugees, conducted its first oversight engagement before The Gambia had registered any positive case of Covid 19 infection.

The second oversight visit, between 11 to 25 May 2020, forms the basis of this report.

The purpose of this visit was to follow up on outstanding issues from the first visit and to assess the current state of the national response to the Covid 19 pandemic.
This oversight mission, as was the case with the previous one, was conducted in fulfillment of the Committee’s statutory mandate, in accordance with Section 109 (2) (b) of the Constitution of the Republic and Clauses 97 paragraphs (1) and (2) (b) of the Standing Orders (Revised Edition 2019) of the National Assembly, to perform oversight on the on the areas of health, disaster and humanitarian relief under its purview.
The Committee, during this second oversight engagement, visited health facilities and met with health officials within Banjul and the Kanifing Municipality where all the quarantine, testing and treatment facilities are located.

7 2.

MEMBERS OF THE OVERSIGHT TEAM Honourable Members of the Committee 1.

Hon.

Ousman Sillah - 2.

Hon.

Fatoumata Jawara - 3.

Hon.

Amadou Camara - 4.

Hon.

Musa Amul Nyassi - 5.

Hon.

Saikou Marong - 6.

Hon.

Omar Darboe - 7.

Hon.

Sulayman Saho - 8.

Hon.


Ndey Yassin Secka - 9.

Hon.

Bakary Camara - 10.

Hon.

Kaddy Camara - 11.

Hon.

Momodou L.K.

Sanneh 12.

Hon.

Dawda K Jawara - Chairperson Vice Chairperson Member Member Member Member Member Member Member Member Member Member Secretaries and other support Staff to the Committee 1.

Mrs. Sarata Bojang Secretary 2.

Mr. Matarr Sallah Aide 3.

Mr. Fansu Bojang Driver 4.

Mr. Molefa Colley Driver Subject Matter Specialist to the Committee 1.
Mr. Sekou Omar Dibba 2.

Dr. Ayo Palmer Media Personnel 1.

3.

Mr. Ousman Manneh Mr. Alieu Bojang GRTS GRTS 8 3.

OBJECTIVES 3.1.

General Objective The general objective was to embark on a second fact finding engagement by the Select Committee on Health to assess the state of national response to the Covid 19 pandemic.

3.2.
Specific Objectives The specific objectives were to: assess the nature and quality of the facilities and the services offered to 1. suspected cases under observation in the quarantine centres; acquaint Select Committee members with the work and services available in 2. the designated testing laboratories to respond to the demand; appraise the measures put in place for rapid response, contact tracing and 3. sample collection in response to Covid 19; assess the measures in place and services available in hospitals, isolation and 4. treatment facilities for confirmed cases of Covid 19 infections; find out about operational, technical, human resources challenges and their 5. remedies; learn about the needs for a strengthened and robust national system for the 6. tracing, isolation, testing and treatment of the Covid 19 cases; assess the state in national preparedness for the prevention, management and 7. containment of the Covid 19 outbreak and other public health emergencies; review the nature, method and outcome of distribution of relief package of 8. the government; assess the role of partners 9. management; in disaster preparedness, response and collect information on the current situation so that recommendations can be 10. made to improve the national response to the Covid 19 pandemic; and, use the findings of the visit to improve legislative, budgetary, policy and 11. advocacy processes to respond to public health emergencies in general.
4.

OVERSIGHT VISITS TO QUARANTINE, TESTING AND TREATMENT CENTRES The oversight engagements commenced on Monday, 11 May 2020, with visits to the three designated quarantine centres situated at various hotels in the Greater Banjul Area (GBA) namely Badala Park, Bambo and Golden Beach.

9 4,1.
9 4,1.

Visit to quarantine centre (Badala Park Hotel ) The Team first visited Badala Park Hotel in Kotu and were met on arrival around 10.15 am by a team of health officials, hotel management staff and security stationed at the facility.

Hon.
Hon.

Ousman Sillah, Chairperson of the Select Committee on Health, in a brief introductory session at the courtyard of the hotel, thanked the team on the ground for the warm reception accorded to the visiting National Assembly delegation and explained the purpose of the mission.

The Chairperson indicated that the Select Committee on Health, in its exercise of its oversight mandate, embarked on the fact finding mission to assess the current state of the national response to the Covid 19 pandemic.
In particular the Team wanted to find out what measures were in place for screening, isolating, quarantining, testing and treating confirmed cases to present a report with recommendations to the National Assembly.

He further stated that the tour was also a follow up to assess the state of implementation of the recommendations in the report presented by the Committee after the first oversight engagement on the pandemic which was adopted by the plenary on 17 March 2020.
The Chairperson further explained that the Committee was interested to know the range and quality of services being provided such as the food, rooms, access to information and communication and other basic facilities.

He added that the principle and standard was to ensure that the place was comfortable for the individuals who were quarantined so that they would be willing to stay in the quarantine facility.
The Chairperson informed the gathering that the Committee had formally written to the Ministry of Health requesting that an official accompany the Team during the period of the visits to the identified facilities.

He concluded by urging those present to share their concerns to enable the Committee to recommend solutions to address them.
Dr. Buba Manjang, the Acting Director of Public Health Services who is also the Head of Surveillance, Rapid Response and Quarantine Teams welcomed the visiting parliamentary delegation.

He thanked the Committee for their interest and for taking time to visit the quarantine centres which are under his charge.
He noted the importance of the Select Committee on Health and the National Assembly in national efforts to control the spread of Covid 19 and thanked them for taking the lead as demonstrated by visits to quarantine facilities.

Dr. Manjang explained that quarantine centers are not places to imprison individuals but the aim is to isolate people suspected to be infected with Covid 19 virus before their test results are out to avoid any spread of the disease.
He said they keep suspected cases in quarantine as a preventive measure.

He also informed the Committee that the suspects in quarantine are monitored for 14 days during which period they conduct two or more tests, including one on day twelve.

Suspected persons who are found to be negative are released to go home but the contact tracing team still follows them for another two weeks.
He said 10 individuals found to be positive are transferred to a treatment center using a special ambulance after which the room is immediately fumigated or disinfected.

Dr. Manjang described frontline workers who make up the Rapid Response Team (RRT) responsible for services during the course of quarantine at the centres: 1.

Public Health Oﬃcers who conduct screening through temperature testing.
Psycho-Social Workers interact with the people in quarantine and enquire 2. about their social situation and provide counseling.

3.

Clinical Team, comprising the medical doctors and nurses, examine quarantined individuals to check for underlying conditions and give advice accordingly.

4.

Laboratory technicians collect samples and test them.

5.
5.

Fumigation or Wash Team disinfects places and go into the community to distribute sanitary materials with the support of UNICEF, IOM, WHO, Red Cross and other partners.

Security, including the police and immigration, provide protection at facilities 6. and escort the surveillance teams on community engagements.
In addition he highlighted the role of the media in publicizing Covid 19 issues and National Assembly Members (NAMs) who engage in community sensitisation activities within their constituencies.

Dr. Manjang indicated that frontline workers have challenges that need to be addressed.

He urged the government to consider the welfare of frontline workers who, he said, are risking their lives in serving their country.

Hon.
Hon.

Fatoumata Jawara, Vice Chairperson of the Health Committee, asked whether the security personnel posted at the quarantine centres are provided with accommodation, food, etc.

Hon.

Musa Amul Nyassi added that he had been to this quarantine centre some days previously following an invitation to encourage the family members of a positive case to stay but the security personnel on guard night duty did not have repellants to protect themselves from mosquito bites.
He asked whether this has been addressed.

In response, the head of surveillance said the security personnel were part of them and receive the same treatment as other members of the frontline team.

They were provided with changing rooms at the hotel, food, personal protective equipment (PPE), mosquito repellants, etc.

This was confirmed by the head of the security who added that they work closely with and coordinate their efforts as the Rapid Response Team (RRT).
The Committee members were then taken round on a conducted tour of the hotel by Mr. Jarga Mboge, Manager of Badala Park, to see firsthand the condition of the rooms.

He told the members of the Committee that he was given short notice about the government’s interest to use his hotel as a quarantine centre for suspected cases of Covid 19.
He said some of his key staff, who were at home due to the closure of the tourist season because of the Covid 19 pandemic, had to be recalled and that they 11 were providing normal hotel services, including food, for those in quarantine.

The Team visited a room and found it to be in a good condition with a clean bedsheets, a plasma television, an air conditioner, access to wifi connection and an adjoining toilet.
Dr Manjang informed the Committee that quarantine persons who test negative are allowed to receive family visits from 11am to 13:00pm daily.

He disclosed that at the time of the visit the facility was holding 36 persons in quarantine.

He explained that if a suspected case is confirmed positive a contact tracing teams is sent their homes and communities.

This is done to try and break the chain of transmission.
He said a 1025 team and call centre were established to receive and process information, enquiries and complaints from the public regarding Covid 19 and related issues.

He also informed the Committee that his team collaborates with their Senegalese counterparts to combat Covid 19 through information sharing and cross- border community sensitisation and surveillance.
The public health officials informed the Committee that they are well equipped with adequate supplies of Personal Protective Equipment (PPE) such as barrier or face masks, gowns, gloves, etc.

to enable them to work safely.

The frontline workers were concerned that they were paid D5000 at the end of March and are unclear if this is a one-off payment.

They explained that having to work away from home for weeks creates an additional financial burden.
Mr. Jim Jobe, a member of the Mental Health and Psycho-Social Support Unit, told the Committee that they segregate those in quarantine based on their need for counseling and support to children, women, the heads of households, physically challenged, etc.

He explained the challenges they sometimes experience when people are picked up for quarantine who arrive without personal effects such as additional clothes, and toiletries a situation made even more difficult when whole families are quarantined.
He further explained that there is currently no budget to cover transport fares for those discharged from quarantine without money.

Another challenge facing the breadwinners in quarantine is their concern about who would take care of their families at home.

Hon.

Ndey Yassin Secka asked whether the psychosocial teams accompanies persons discharged from quarantine to talk to their families to address the issue of stigma and discrimination.
He responded that they do and also follow up two weeks after discharge visits for further counselling and contact tracing.

Clinical Team Dr. Lamin Nyassi, head of the Clinical Team, informed the Committee that the clinicians are part of the Rapid Response Team (RRT) that conducts screening and contact tracing.
He explained that after a suspect is quarantined the individual is 12 screened to find out if there are any underlying health complication such as hypertension, diabetes, and epilepsy so that treatment can be provided.

Mr. Bakary Sanneh, Principal Laboratory Scientist at the National Public Health Laboratory (NPHL), explained the importance of the laboratory section in conducting sample testing to identify positive and negative cases.
He said the staff of National Public Health Laboratory (NPHL) were trained by MRC Gambia Unit on Covid 19 testing.

He added that quarantined individuals who test positive are immediately evacuated to a treatment centre while those who are negative are placed in quarantine to complete the 14 days period for monitoring and further testing.

He said the Rapid Response Team would then embark on contact tracing of those who tested positive.
He informed the Committee that the biggest challenge being faced in the country is denial by some members of the public including some asymptomatic cases who test positive claiming that they do not have the virus in their bodies.

Other challenges included financial constraints and lack of cooperation within communities during contact tracing.

4.2.

Visit to Visit to quarantine centre (Bamboo Hotel).
The Select Committee, accompanied by Dr. Buba Manjang and senior security officers, proceeded from Badala Park to the second quarantine centre at Bambo Beach Hotel in Kololi.

Mr. Modou Jallow, Administrator of the Bamboo Hotel quarantine centre, together with his team of health officials, mental health and psychosocial workers and security personnel met the touring party.

He informed the Committee that they had adequate stocks of PPE and coordinated their work as a team.
At the time of the visit there were seven suspected cases in quarantine.

He said some of the suspected cases were collected from their homes while others were picked up immediately after entering the country at the borders and brought for quarantine often empty handed without adequate clothing and money.

He explained that it is difficult to confine a person, especially a family head, as the absence of some of the people who are bread winners affected families they had left behind.
He added that a head of household who is quarantine can become traumatized and worried about his household which makes their work at the quarantine centre difficult.

Mr. Cherno Jallow, a Public Health Officer, informed the Committee that they also provide health care services to those in quarantine if the need arises.

He recognised the efforts of the security personnel in supporting their work at the quarantine centre.
Another health official, Mr. Lamin Suwaneh, also explained how they treat those in quarantine.

They informed the Committee that among the seven people in quarantine at the facility, six were men and a woman.

The Hon.

Chair, Hon.

Amadou Camara, Hon.

Musa Amul Nyassi and Hon.

Bakary Camara raised questions that were responded to by the health personnel.

13 4.3.

Visit to quarantine centre (Golden Beach Hotel) Golden Beach Hotel was the third and last quarantine centre that was visited.
Mr. Kawsu Bayo, the supervisor of the frontline workers, welcomed the Committee.

The Chairperson of the Select Committee on Health gave introductory remarks.

Mr. Bayo thanked the Committee for the visit and explained that the frontline workers consisted of seven health workers, two social welfare officers and attached security personnel.

At the time of the visit forty four people were quarantined but two had been discharged home.
The Committee was informed that they had adequate stocks of PPE and other sanitary materials to safely do their work.

He informed the Committee in response to questions the facility had confirmed seven positive cases since they started quarantining individuals.

He added that samples were taken on the first and eleventh day from quarantined individuals.

Currently there were forty four suspected cases including eleven females, three of whom are pregnant and four children.
Mr. Lamarana Bah, a Nurse, explained officials from the Department of Social Welfare now team up with health officials to provide mental health and psycho- social support and counseling to both staff and quarantined individuals.

They usually assess the mood concerning how they feel about the hotel and services provided, for example, the quality of the food, the cleanliness of bed-sheets, condition of the rooms, room hygiene, etc.
They also ensure that hand washing facilities are made available and exclude visitors to the hotel.

Mr Bayo complained that even though they had appealed to the hotel management team, the rooms still had no television sets or access to wifi for information or news.

They also had no vehicle assigned to them which made it difficult to do outreach visits.

Mr. Sheriff Marong, the propriety of the hotel, in response to the concerns voiced by health workers pleaded for more time to provide these facilities.
He claimed that there were some challenges with the service provider but gave assurance that each of the rooms will soon be provided with a television set and access to wifi connection.

Ms. Hannah Bass from the Ministry of Women, Children and Social Welfare indicated Covid 19 was more than a health issue given its impacts on other aspects of the lives of people.
She reiterated the challenges facing some people brought to the quarantine centres as previously highlighted by frontline workers at other quarantine centres such as the lack of clothes, money, toiletries as well as the problem facing breadwinners disconnected from their families who depend on them for survival.

She was also concerned about children with their mothers who had no baby food or diapers.
Dr. Manjang reported that UNICEF was informed and has agreed to support them to provide some items for the children.

Mr. Boubacar T. Jallow, a Clinician/Nurse, and Ms. Ramatoulie Secka, Public Health Nurse, both explained the work they do and the challenges they face with regards to in the quarantine facility.

The Committee could not visit any of the hotel rooms to assess the condition because they were all occupied.

14 The health officials responded to some follow-up questions raised by Hon.
Ousman Sillah, Chair, Hon.

Fatoumata Jawara, Hon.

Ndey Yassin Secka and Hon.

Amadou Camara.

4.4.

Visit to the Medical Research Council Unit On Tuesday, 12 May, 2020, the second day of the oversight engagements, the Select Committee started with a visit to the Medical Research Council Unit The Gambia (MRCG) at the London School of Hygiene and Tropical Medicine (LSHTM).

Hon.
Hon.

Ousman Sillah, the Chairperson of the Select Committee, in his introductory remarks, explained that the Unit Director of MRC had invited the Select Committee.

He further stated that they had wanted to pay a visit given the role of the MRCG in providing testing and treatment of Covid 19 cases in the country.

Immunisation the Expanded Programme on Professor Umberto D’ Alessandro, the MRCG Unit Director, explained that MRCG has 1400 members of staff which includes 26 nationalities.
He highlighted historical partnerships with (EPI) and interventions leading to the development of the Hepatitis B vaccine and the huge decrease of malaria to the point of exterminating it in the Gambia.
Dr. D’Alessandro enumerated some of the contributions of the MRCG in response to the Covid 19 pandemic in the country which includes membership of Committees (EOC, NHEC, Expert Advisory Committee, Communication, and Case Management); providing diagnostic tests which was done in collaboration with NPHL; setting up a diagnostic testing at the NPHL; providing treatment of positive cases; training on PPE; donation of five motorbikes, ten hospital beds and PPEs to Ministry of Health; an, capacity building on a variety of issues.
The statistical model or projections indicate that The Gambia may be registering new Covid 19 cases for a long time.

On the projections of a surge in infections, Professor D’ Alessandro said that in a worst case scenario, without social distancing being practiced by the people, The Gambia may register up to 2000 cases or more per week, and need 600 hospital beds per week.
The Unit Director indicated that in preparation for any possible surge, the MRCG Unit had started with two isolation rooms where some of the first Covid 19 positive cases were treated and now they have forty two (42) beds available for the treatment of patients, including ten beds at MRC Keneba, in readiness for any surge in the number of infections in the country.

He added that they were engaged in 3D printing of essential supplies such as face shields, and research.
The MRCG Unit Director informed the Committee that if the people do not maintain or observe social or physical distancing, there is the possibility of seeing cases increasing exponentially in the country.

Dr. Abdul Karim Sesay made a presentation on setting up of a genomic hub/platform and a standard laboratory at the NPHL by MRCG.

He explained the importance of sequencing the virus to know the strain for the purpose of developing a vaccine.

He noted that this work was also important for contact tracing.
He informed the Committee that they have completed the training of the staff of NPHL to enable the facility to commence testing Covid 19 samples.

15 Ms. Jama Jack of MRCG also elaborated on the issue of communication and what they are doing in collaboration with the ministry of health.

The decision of the Ministry of Health to do a swab on corpses to determine if the cause of death was due to Covid 19 related was also noted.
The Unit is encouraging the expansion of treatment and testing centres at facilities in other parts of the country.

The Honourable Chair, Hon.

Fatoumata Jawara, Vice Chair, Hon.

Amadou Camara, Hon.

Momodou L.K.

Sanneh, Deputy Speaker, Hon.

Sulayman Saho, Hon.

Kaddy Camara, Hon.

Ndey Yassin Secka, Hon.

Bakary Camara, Hon.

Musa Amul Nyassi and Mr. Sekou Omar Dibba raised questions.
Following the briefing, the members of the Select Committee were led on a conducted tour of the state-of-the-art laboratory that is conducting the tests forCCovid 19.

This is the only laboratory in the country conducting a range of tests on Covid 19.
The Committee also visited the centre where the MRCG is doing 3D printing to produce essential parts such as face shields and other materials and equipment needed to contain Covid 19 in response to the worldwide restrictions on imports imposed by the pandemic.

The visiting party was also taken to two wards where the first cases were treated and the additional two new wards which MRCG is making available for the treatment of an additional 30 Covid 19 positive cases.

4.5.
4.5.

Visit to the National Public Health Laboratory The Select Committee, after visiting the MRC, proceeded to the National Public Health Laboratory (NPHL) at Central Medical Stores in Kotu, the 1025 Call Centre and the Centre for Epidemiology Disease Control.

The Chairperson invited the Director of the NPHL to explain the work being done in response to the Covid 19 pandemic, the challenges and what they intended to do to address these concerns.
Mr. Ignatius Baldeh, Director of the NPHL, provide an overview of the state of laboratory services in the country.

He explained that because the laboratory services have been neglected over the years national diagnostic services are limited leading to external referrals.

The NPHL Director indicated that public hospitals and health centres deliver a limited set of laboratory services because testing machines and consumables are unavailable.
He stressed the need to strengthen laboratory services in public facilities and saw Covid 19 as an opportunity to do so.

He said the NPHL conducts microbiology, haematology and biochemistry investigations with support from the Global Fund in a state-of-the-art BSL3 laboratory that was currently being upgraded for the testing of Covid 19, adding that the MRCG is training its staff so that the Unit can serve as the national platform for Covid 19 diagnostics.
He said MRCG also offered to conduct molecular tests in Keneba and Basse.

Mr. Modou Lamin Jarju, Senior Lab Scientist, informed the committee that they are currently working with two medical doctors from MRCG, namely Dr. Abdoukarim Ceesay and Dr. Ousman Secka, who are training their staff on molecular diagnostics and health and safety processes respectively.

He said the laboratory platforms and sample testing were working well when compared with test results from the MRCG.
He noted that staff had been trained on collecting samples from suspected Covid 19 cases and that they will soon be ready to start running samples to test for Covid 19.

16 The NPHL director had arranged for the Committee to meet with the staff to share their concerns with regards to their work in response to the Covid 19 pandemic.

Mrs. Maimuna Jammeh explained that there were 35 members of staff and three teams of nine members each engaged in sample collection and testing daily.
She was concerned about the lack of formal training for those engaged in sample collection, adding that training is needed for all the staff including step down training.

She also talked about the need for adequate PPEs and complained about inadequate office space as they are all in one small room.

Mr. Alieu Faal, another staff member, was pleased the parliamentarians had visited.

He emphasized the need support NPHL to conduct research in this area.
He said the Ministry also needs to address the issue of motivation and allowances for frontline workers in response to Covid 19.Alphonse Mendy reiterated the need for more appropriate PPE, the replacement of the short sizes of the protective gowns from China, adequate disinfectants, more staff and transport.

The director and senior NPHL officials took the members of the touring party on a conducted tour to the newly built state-of-the-art BSL3 Lab and the other labs at the Kotu premises.
Mr. Modou Jallow and the other scientists and lab technicians explained the work and purpose of the machines and equipment in the labs.

The Committee met a team that had just returned from a sample collection mission in the community.
The sample collection team highlighted challenges include adequate and fit for purpose PPE such as protective gowns that are knee length, as donated Chinese protective gowns they are using are short; more training; public sensitisation to make their sample collection work easier in communities; food for the staff as they stay at work the whole day and the fulfillment of other necessary occupational incentives and work related financial dues.

4.6.
4.6.

Visit to the Epidemiology and Disease Control Unit and Incident Operation Centre Team The Select Committee on Health then visited the Epidemiology and Disease Control Unit of the Ministry of Health based in Kotu.

Mr. Sanna M Sambou, Director of the Unit and the Manager of the Incident Operation Centre (IOC) on Covid 19 Response said the IOC is the Unit where the Covid 19 response and recovery activities are coordinated at the national level.
He clarified that the work involves detecting people infected with the virus whether or not they have symptoms based on their travel history or after receiving information from the 1025 Call Centre or the health facilities.

He added that they also conduct tests on people who wish to know their status due to their exposure and also on corpses.
He explained that whenever the 1025 hotline receives a call a message is immediately sent to the Rapid Response Team (RRT) which would then investigate the situation and engage contact tracers.

He said their work also includes transferring suspected cases to the quarantine centres for testing which is done by laboratory staff.

He mentioned the need to decentralize the RRT in each region and for all regional staff to be trained on Covid 19.
17 He complained that the team had submitted a budget for the routine operations of the security personnel which has been approved but has not yet been disbursed.

Commissioner Bojang of the Gambia Police Force (GPF), who is Safety and Security officer in IOC, said coordination is in place but that there were challenges concerning logistics which is affecting the enforcement of physical distancing and border control.
Dr. Anna Jammeh, the head of the contact tracing team, listed challenges such as the lack of transport, the need to buy motorbikes for health workers involved in contact tracing in the communities and the lack of communication allowance to buy credit for phone calls in contact tracing.
Mr. Mustapha Sanneh, Head of the Rapid Response Team, reiterated the need for provision of funds for communication as the staff always ends up using their own phone credits to make calls when tracing contacts in the communities.

He also raised the issue of providing food for the staff who spend the whole day attending to cases.

Mr. Camara noted that coordination at the national level is a challenge and that systems were not followed.
Mr. Nget stressed the need for the cooperation of the public which sometimes is lacking.

He called for more decentralisation and the need to use schools in the regions as quarantine centres especially in the event of a surge.

He also commented on the need to provide food for the staff on duty.
Mr. Serigne Modou Joof, Deputy Executive Director of the National disaster Management (NDMA) who is the deputy Incident Operation Manager, emphasized the importance of the implementation of the strategic plan developed for the management of the pandemic.

He called on the National Assembly Members to encourage their constituencies to cooperate with the Rapid Response Teams during community contact tracing missions.

He also encouraged the government to consider motivating frontline workers.
All the Honourable Members of the Committee and SMS raised concerns and questions during the interaction with the members of the IOC.

Before concluding the engagement the Members of the Select Committee visited and met with the members of staff in the 1025 Call Centre who were busy attending to and returning calls.

The staff of the Incident Operations Cemtre identified their main challenges as: • • • • • • • • Late or no response to calls to 1025 Late response to messages from 1025 to respective units.
Inadequate human resources for capacity building.

Quarantine challenges.

Isolation challenges.

Communication cost from various units Transportation for contact tracers especially motor bikes and fuel.

Lack of proper addresses for identification and location of suspects.

18 • • • • • • • Denial, refusal and rejection of patients and suspects by the general public.

No food or refreshment for the field and office staff.

Reception from central coordination is very poor and challenging.
Lack of motivation for health staff in terms of providing allowances.

Abuse of calls to 1025.

Knowledge gap of communities and coordination .

Mass screening of people for early detection of Covid 19 .

4.7.

Visit to Edward Francis Small Teaching Hospital On the third day of the Tour on Wednesday, 13 May, 2020, the Select Committee on Health visited the Edward Francis Small Teaching Hospital (EFSTH) in Banjul.

Hon.
Hon.

Sillah, Chairperson of the Committee, explained the purpose of the visit as a follow-up on the recommendations in the Report of the Committee following the first oversight engagement in March 2020 on the state of national preparedness for Covid 19.

He clarified that the Committee was there to assess the state of implementation of these recommendations for EFSTH contained in the report circulated by the Ministry of Health.
In his response, Mr. Malang Ndong, Director of Administration of EFSTH, deputising for the Deputy Chief Medical Director, welcomed the Committee and indicated that the Hospital was fully prepared to combat Covid 19.

He informed the Committee that the current workforce of the EFSTH stands at 1273 comprising professional, administrative and ancillary staff in addition to 70 Cuban medical corps and 8 Chinese consultants and Interpreters.
He informed the Committee that the measures indicated in the Report such as temperature checking, hand washing and sanitisation at all the entrances, disinfection as well as physical distancing were in place.

In addition to these measures, social distancing was also being practiced in the staff bus and that visitors are not allowed in the hospital.

He added that they also have a functional holding/isolation centre with 2 beds and that training had been conducted for their staff.
The Committee members asked the Director of Administration to explain what has been done by the Hospital in terms of implementation on the following recommendations: provide more PPEs, protective materials, gloves, M95 face masks detergents 1.
(bleach), fumigators; 2. replicate a safer reception area for patients to minimize transmission of Covid 19 disease in Banjul Polyclinic similar to what exists at the reception in the Accident and Unit in the EFSTH; 19 organize training on the Covid 19 disease for doctors, nurses, auxiliaries, 3. orderlies, drivers, cleaners, and all the others hospital staff at the EFSTH, Polyclinic and the Tanka Tanka Psychiatric Unit; and, provide special risk allowances and other incentives to the workers managing 4.
Covid 19 cases.

In response, the Director of Administration told the Committee that the first three recommendations were implemented whilst the fourth one concerning the payment of allowances for health workers managing the Covid 19 cases is still not addressed due to financial constraints.

He said the hospital management had submitted its budget to the Ministry and was waiting for a response.
On the Sanatorium which is under the management of the EFSTH, the Administrative Director informed the Committee that the patients who were admitted there prior to the Covid 19 outbreak have now been moved to Farafenni General Hospital as per the recommendations but adding that smoke coming from the nearby dumpsite is still a challenge.

He identified other challenges as inadequate mobility, motivation and more training for all the hospital staff.
The Committee members were finally taken to the Accident and Emergency Department of the Hospital where it was observed that all the preventive measures such as screening for temperature, hand washing and physical distancing were maintained or enforced.

A planned visit to the holding ward could not materialise as a suspected case that confirmed negative was discharged a little earlier and the ward had not yet been disinfected.

4.8.
4.8.

Visit to the Polyclinic in Banjul The Polyclinic in Banjul, under the management of the Edward Francis Small Teaching Hospital (EFSTH), was the next facility on the itinerary.

On arrival, Mr. Sillaba Drammeh, Officer-In-Charge (OIC) and Dr. Bekai Camara received the Team.

The health officials were informed that the purpose of the visit was to follow-up on the recommendations made in March 2020 and to appreciate what procedures, materials and equipment were available in response to Covid 19.
The OIC welcomed the visiting members of the Select Committee on Health.

He explained that they were supplied with PPEs and other materials and equipment to prevent Covid 19 infection, adding that some staff were trained on the response to Covid 19.
The Committee members informed the health team that they were concerned given the highly infectious nature of the virus that even though preventive measures such as hand washing and infrared screening were in place physical distancing was not being observed by the patients in all the consultation and treatment sections at the facility.
The management was urged to take the necessary measures and maximum precautions to avoid allowing the treatment facility to be a source of transmission of the Covid 19 disease.

It was recommended that they consider erecting a shed in the courtyard to allow for physical distancing to be observed at all times with some members of staff assigned to enforce this measure.
It was also recommended that the facility should regularly be disinfected 20 to avoid the transmission of Covid 19 and other communicable diseases.

In response, the management assured the Committee that the concerns and recommendations were noted and would be acted upon in consultation with the EFSTH management.

4.9.

Visit to the Sanatorium Treatment Centre From the Polyclinic, the touring party proceeded to the government managed treatment centre at the Sanatorium on the outskirts of Banjul.
They met Dr. Abubacar Jagne, Head of the Covid 19 Treatment Team, Dr. Kalilu Jagne, the Head of the facility, Mr. Ababa Gibba, the Matron, Mr. Kebba Jammeh, the Nurse, and support staff.

Hon.

Sillah, the Chairperson of the Select Committee, introduced the purpose of this second visit as a fact finding mission on the current state of the Sanatorium in response to Covid 19 and to follow-up on the state of implementation of the Committee’s recommendations following the first visit in March 2020.
He noted that at the time of the earlier visit the facility was not ready or operational to handle Covid 19 cases but was being prepared for such a function.

He added that some observations were made concerning the operations, structure of the wards and the environment, among others, which led to recommendations to address them.

Dr. Jagne, in responding to the issues raised, said that 90% of what is supposed to be done has been realised and that they are using the whole facility apart from the laboratory.
The head of the treatment team informed the Committee that the newly constructed treatment block has 10 rooms.

Each room is fully furnished and fitted with a television set, telephone line, access to internet and an air conditioner.

He said all the ten rooms were fully occupied, at the time of the visit, with twelve patients, including a seven moth old baby and a four year child admitted with their mothers.

The patients are all recovering and the mother with the seven month old baby is also doing well.
The four year old child and mother, who initially tested positive, both tested negative and were discharged home earlier in the day.

The refurbished existing main building has two wards with one designated for the moderately sick Covid 19 patients: one ward has 16 beds while the second ward, the intensive care unit (ICU) for the critically ill has 8 beds fitted with life supporting equipment e.g.

oxygen canisters, ventilators, etc.


The laboratory is not yet functional because the equipment has not arrived due to the Covid 19 imposed travel restrictions but that arrangements are being made to get them into the country as soon as possible.

The Committee was also informed that the nurses change shift every 6 hours while the doctors and securities change every 8 hours.

There are 45 support staff, security personnel and technicians working at the Sanatorium.
The Covid 19 treatment team consists of 15 doctors, 32 nurses, 10 orderlies, 10 ancillaries and 12 biomedical staff.

The head of the treatment team noted that out of every 100 persons infected with Covid 19, 80 of them are asymptomatic with no manifested signs of the illness.

Dr. Kalilu Jagne, Mental Health and Psycho-Social specialists, informed the Committee that most of the patients receiving treatment at the facility are Senegalese nationals.
He emphasised the need to control the borders and curb the influx.

He 21 said they want the authorities to address the following issues: the nearby dumpsite at Mile 2 with its intermittent smoke emission which is posing a real health hazard to both the patients and workers at the facility; provide more oxygen machines and ventilators for the ICU; provide laundry machines and transport for staff.
Mr. Kebba Jammeh, Nurse, also made a similar appeal, adding that the laboratory needs to be equipped to conduct investigations.

The staff from EFSTH accompanying the parliamentarians to the Sanatorium, Mr. Mbye, identified the need to build a guard room and toilet facility at the entrance for security personnel.

Mr. Gibba, Matron of the Sanatorium, showed the Committee members the wards, laboratory, staff room, standby generator room, security tent and the incinerator.
The health officials responded to the questions raised by Hon.

Sillah, Chairperson, Hon.

Jawara, Vice Chair, Hon.

Marong and Sekou Omar Dibba, SMS.

4.10.

Visit to Ndebaan treatment centre The team was received on arrival by Mr. Mustapha Njie, the CEO of Taf Africa Foundation, who took the members round to visit the on-going rehabilitation and construction works at the Ndebaan Hospital situated at the entrance of Bakau from Stink Corner.
Mr. Njie told the members of the Committee that he was contacted to come on board to support government in rehabilitating this former hospital to serve as the biggest treatment centre for Covid 19 to take up to 100 patients.
He said they had initially committed to contribute two million dalasi for the construction of the treatment centre and to ask the government and other interested parties in the private sector to come up with the balance, adding that they had now exceeded the two million dalasi that was committed for the completion of the administrative block and had spent D2.5 million.
Mr. Njie explained that the centre comprises two buildings, namely the Administration Block which was modified and refurbished to hold up to 15 patients and is ready for use and the Main Building which can hold up to 85 patients when completed.

He added that the Ministry of Works and Infrastructure was involved.

He mentioned other partners that have made commitments to support the undertaking: Ministry of health, Social Security and Housing Finance Corporation, UNDP, UNICEF, and UNFPA.

4.10.
4.10.

Kanifing General Hospital The last visit on the second day was to the Kanifing General Hospital which was held in the Conference room and attended by some members of the Hospital Management Team.

The Chairperson of the Select Committee explained that this was a fact finding mission on understand the measures put in place by the hospital to respond to the Covid 19 pandemic.
Mr. Baboucar Saine, Director of Administration, listed Covid 19 activities He told the Committee that the hospital started the fight against Covid 19 well before the 22 Gambia recorded its first case by constituting Task Force or Preparedness Response Committee and developing a Hospital Emergency Response Plan and Terms of Reference (ToR) in January 2020.
In addition, he said the management also undertook the following actions: conducted training for the clinicians, doctors and support staff; placed hand washing stations at every entrance for every person entering to wash their hands with chlorinated water; conduct temperature check for everyone entering the hospital; prepared an isolation room to hold a suspected case before transfer to the treatment centre; developed a protocol on the handling of a suspected case; scaled down non-essential services on elective surgeries or non- emergency services; reduced staff to prevent exposure; enforced physical distancing in the clinics and in the wards; and, trained mortuary attendants on handling of corpses under the supervision of doctors.
The Director of Administration identified the main challenges as the absence of a dedicated budget for Covid 19 responses; transport for operations and staff and allowances for the frontline workers.

Mr. Sankung Jaiteh, Human Resource Manager, also emphasised the need for on-going capacity building for the support staff, particularly the nurses, on the pandemic and infectious diseases.
The Committee members later visited the emergency ward and the isolation ward for the holding of any suspected Covid 19 case.

It was observed that the hospital management had put in place prevention measures such as hand washing stations; temperature checking at the entrances, physical distancing, face masks for staff and hand sanitisation gels at offices and wards.
MEETINGS WITH THE NATIONAL DISASTER MANAGEMENT AGENCY AND THE GAMBIA RED CROSS SOCIETY In the exercise of its statutory mandate to perform oversight on matters relating to disaster and humanitarian relief, the Select Committee invited the National Disaster Management Agency (NDMA) and Gambia Red Cross Society (GRCS) to provide updates on the work of the two institutions in response to the Covid 19 pandemic.
The management of the two institutions appeared before the Committee on Thursday, 14 May, 2020, and made presentations on their interventions.
5.1 National Disaster Management Agency and the Covid 19 response The NDMA management was invited to make a presentation on its role in the coordination and management of the food relief being undertaken by Government to support vulnerable households to stay at home to break the chain of transmission of the Covid 19 disease and mitigate the impact of the emergency regulations on livelihoods.
Mr. Sanna Dahaba, Executive Director of NDMA, informed the Committee that the Government of the Gambia had appointed Mr. Alasan Senghore, the Secretary 23 General of the Gambia Red Cross Society (GRCS) as the National Coordinator for the Covid 19 Preparedness and Response Programme.

The NDMA Executive Director described the coordination framework.
He first explained the membership of the Inter-ministerial Committee headed by the Vice- President of the Gambia and assisted by a Technical Committee comprising Permanent Secretaries, Director Generals, Executive Directors and Coordinators of relevant ministries, departments and agencies.

In addition to these structures, he said there were other multi- sectorial sub-committees in specific areas such as procurement, logistics, monitoring, grievance and communication.
Mr Kawsu Barrow, the Monitoring and Evaluation Officer at NDMA, in a power- point presentation, summarised the activities of NDMA and other technical committees since the declaration of a State of Public Emergency on 27 March 2020.

He indicated that immediately after the declaration, NDMA convened an internal meeting to discuss the next steps in terms of the coordination role to be played by the institution in accordance with the NDMA Act especially given the broad multi- sectoral impact of the pandemic.
A Technical Committee was established under the leadership of the NDMA, with technical support from the World Food Programme (WFP), that is working with Government structures.

He summarised the objectives of the food response from the Government as follows: • .

• • To build resilience of the vulnerable population during the emergency period To reduce the spread of the virus in the country.

To encourage economic stimulus in the households and the macro economy.

Technical committees were created: 1.


Procurement committee headed by the Ministry of Trade and Employment.

Logistic committee which is the most important committee.

It provides the 2. data to inform decision-making by the larger committee headed by NDMA.

Monitoring sub-committee headed by Ministry of Finance and Economic 3.

Affairs.

4.

Grievance and Redress Committee headed by MoLRG.

Communication Committee headed by Ministry of Communication and also 5.
Communication experts with the Ministry that are involved.

He noted that in addition to these committees, they were are also working with regional governors, mayors and local authorities.

Mr. Barrow also informed the Select Committee that 17 trucks have been identified for the distribution of the food relief to over 300 distribution points across the country.

On the distribution of the relief, they have recommended to central Government to provide for universal coverage.
So far 99,548 households had been reached in the provinces.

He added that households in some parts of the West Coast Region such as 24 Foni, Kombo East and Kombo South have received 100 %, while Kombo North and Kombo Central will receive 60% and Kanifing Municipal Council (KMC) and Banjul City Council (BCC) 50%.

He indicated that a total of 235, 767 or 84% of households across the country have received the relief package with 97,508 in West Coast, 38,711 in KMC and BCC and 99,548 in the provinces.
He said the required stock is a total of 229, 845 bags of rice, 229,845 bags of sugar and 147, 494 gallons of cooking oil.

NDMA identified the challenges as logistical, lack of household data and having to deal with a large number of distribution points.

In response to questions and comments from Honourable Members of the Select Committee, Mr. Barrow indicated that they will be working on the following: Setting up a call centre and number to receive complaints from members of 1. the public.
Reserve a stock to serve as buffer to address those in targeted areas who are 2. left out in the distribution 3.

Supervise the distribution in KMC and Banjul.

4.

Work towards putting up a data system as one of the lessons learnt 5.

Expedite the process of distribution in view of the looming rains.
5.2 The Gambia Red Cross Society and the Covid 19 response Mr. Alasan Senghore, Secretary General of Gambia Red Cross Society (GRCS), thanked the Select Committee for all the encouragement and support it has given his institution over the years.

He said GRCS was established by an Act of Parliament in 1966.
He informed the Committee that GRCS has always been prepared for pandemics and other disasters which is part of its core mandate and function as a humanitarian organisation, adding that GRCS has developed a National Preparedness Plan.

The GRCS Secretary General noted that the Covid 19 pandemic has health, social and humanitarian implications.
He said the Red Cross had built a number of isolation centres across the country as part of its investments in preparedness and that the focus now was to ensure the continuity of humanitarian services in a safe environment for the volunteers.

Mr. Abdoulie Faye, a staff member, highlighted the activities being undertaken by GRCS in response to the Covid 19 pandemic.
He listed the key actions, activities and decisions taken which include the development of standard procedures on the safe management and transfer of suspects and patients from their homes to treatment centres; training on safe handling and dignified burial of Covid 19 patients; distribution of 250 bags of rice and cash; radio programs; caravan and community talk shows; TV shows; distribution of posters; school sensitisation reaching over 67, 000 people; distribution of 1,627 hand wash materials; training of 20 GRCS personnel on psychosocial support and volunteers posted at seven border posts around the country to support the public health officials in the screening and temperature checking of persons; and, the disinfection of public places and institutions, including 25 the National Assembly.
He said GRCS focuses on infection prevention, risk communication, psychosocial support for SDB team members and ambulance service.

He identified key challenges as human resource, administrative and logistical issues; inadequate finances at their disposal; and, limited vehicles and ambulances; no subvention from central government; and, inadequate resources for the training of their staff.
The funds received by GRCS for its Covid 19 responses were mainly from local donors and international partners and not from central government.

The GRCS had received some materials donated by Government.
Elaborating on the possible strategies to defeat Covid 19, he stressed the need of having in place effective and efficient coordination, widepsread sample collection and testing, well equipped treatment centre, strengthening of regulations, recovery strategies, dedication of a standard Covid 19 hour on all radio and television stations, community sensitisation and hand washing among others.
In their interventions, the Honourable members enquired whether the Red Cross has the capacity to fumigate public places and institutions around the country if it is asked to do such a task.

6.

MEETING WITH THE MINISTRY OF HEALTH The five days oversight engagements of the Select Committee on Health, Women, Children, Disaster, Humanitarian Relief and Refugees culminated on Thursday, 28 May, 2020, in a high level meeting with the Minister and senior officials of the Ministry of Health.
The team of officials was headed by Hon.
Ahmadou Lamin Samateh, Minister of Health, and included, Mr. Muhamed Lamin Jaiteh, Permanent Secretary, Mr. Karamba Keita, Deputy Permanent Secretary Technical, Dr. Mustapha Bittaye, Acting Director of Health Services, Mr. Momodou Njie, Director of Health Promotion and Education, Dr, Buba Manjang, Acting Director of Public Health Services, Dr. Charles Roberts, Deputy Chief Medical Director of the Edward Francis Small Teaching Hospital (EFSTH), and Mr. Babanding Sabally, Director of Pharmaceutical Services.
In a three hour long engagement, the session started with introduction by the Chairperson, followed by a statement from the Minister of Health, presentations by the respective health ministry officials and then the questions and comments by honourable members and Subject Matter Specialists (SMSs) of the Committee.

Hon.
Hon.

Ousman Sillah, the Chairperson, asked for the observance of a minute of silence to pay tribute to all frontline workers, who continue to serve as buffer between the virus and the population, for their sacrifice and patriotism.
On behalf the Committee, he commended all the health workers, including the minister, National Health Emergency Committee, hospital workers, the officials taking care of surveillance, quarantine, testing and treatment, risk communication and community engagement, the Red Cross, border officials and security personnel.
26 The Chairperson indicated that this second oversight engagement was a fact finding on the state of national response to the Covid 19 pandemic and a follow-up on the recommendations of the report of the first oversight on the state of national preparedness conducted in March 2020.

The Minister was invited to make a statement in which he started by commending the Committee for its usual oversight engagements that helps the Ministry in the discharge of its mandate.
He highlighted efforts being made and the challenges and called for more support from the Government, partners and the population in the fight against the Covid 19 pandemic.

After the presentations by the officials of the health ministry, the following honourable members namely Honourable Fatoumata Jawara, Hon.

Saikou Marong, Hon.

Amadou Camara, Honourable Musa Amul Nyassi, Hon.

Ndey Yassin Secka, Hon.

Omar Darboe, Hon.

Kaddy Camara and Hon.


Ousman Sillah, the Chairperson, as well as Dr. Ayo Palmer and Mr. Sekou Omar Dibba, the SMSs, asked questions, made comments and suggestions for consideration by the Ministry.

7.
7.

CONCLUSIONS/RECOMMENDATIONS The Select Committee on Health, Women, Children, Disaster, Humanitarian Relief and Refugees met to review their findings after they visited quarantine, testing and treatment centres and met with officials responsible for the implementation of the national response to the Covid 19 pandemic.

The key conclusions reached and recommendations are based on the information received and observations made by members of the Committee.
The Select Committee on Health submits the following observations/conclusions and for consideration and implementation by the relevant stakeholders from government and partners: the National Assembly recommendations to 7.1 Quarantine centres OBSERVATIONS/CONCLUSIONS The Committee Members observed during the visits that not all the three hotels being used as quarantine centres had standard room services that included a television and access to wi-fi.
Given that quarantined individuals are being subjected to mandatory confinement, it is important that the State ensures that all those in quarantine for the purpose of public health and safety are accorded the necessary comfort to enable them to comply and stay in the facility.

The Committee was equally concerned about the rational utilisation of resources and the sustainability of the continued use of hotels as places of quarantine for suspected cases.
This issue was raised during the session with the officials of the Ministry of Health.

The health officials identified some difficulties that certain persons face when they are picked up and brought directly to quarantine centres as they come empty handed apart from the clothes they are putting on and are unable to buy toiletries 27 and pay their taxi fare when discharged.

This situation is especially difficult for heads of households who have left their families without money.
RECOMMENDATIONS The Ministry of Health should ensure that hotels to be contracted as 1. quarantine centres can provide a standard list of amenities.

2.

The Ministry of Health should consider looking for alternative facilities with standard basic services to substitute the hotels and cut down on the massive sums being spent for the quarantine of suspected cases.

This could include Government owned facilities that are currently not in use.

3.
3.

The Ministry of Health to request from the Office of the President to provide the multi-purpose tent at state house to be transferred and temporarily used as a quarantine facility.

4.

The Ministry of Health should expedite the process for the timely payment of allowances to the frontline workers at the quarantine centres, including the health officials, support and ancillary staff and security personnel.

5.
5.

The Ministry of Health to look into the welfare and upkeep of persons while under quarantine such as providing them with toiletries, baby food, sanitary materials, clothes and taxi fares to facilitate the transportation of persons discharged from quarantine to their respective final destinations.

6.

The Ministry of Health and the National Disaster Management Agency should set up a support mechanism for vulnerable households where the head of household is quarantined.

7.2.
7.2.

Medical Research Council (MRC) Unit, The Gambia OBSERVATIONS /CONCLUSIONS The Committee concludes that the institution has the capacity to continue testing for Covid 19 and treating Covid 19 positive cases which is on-going.
The Committee acknowledges the timely and critical support being given by the MRC Unit The Gambia in pioneering the testing and treatment of Covid 19 patients in The Gambia, training personnel and building the national capacity for testing as well as its plans to decentralise the services in the other parts of the country.

RECOMMENDATIONS 1.

MRCG to continue supporting the national efforts in response to the pandemic through the provision of Covid 19 related clinical, testing and treatment services.

2.
2.

MRCG to continue its existing collaboration with the Ministry of Health in the areas of information sharing, professional exchanges, capacity building or training and technical support in response to the pandemic 28 7.3 National Public Health Laboratory OBSERVATIONS/CONCLUSIONS The teams on rapid response, contact tracing and sample collection are working together under the coordination of the NPHL and the Directorate of Public Health.
The NPHL with the support being given by the MRC Unit The Gambia has built its capacity to start testing Covid 19 samples.

The staff is also advocating for the expansion of treatment and testing centres at health facilities in other parts of the country.

The staff of the NPHL was, however, concerned about the need for more training, adequate and appropriate personal protective equipment, staff motivation and a spacious or conducive working environment.
RECOMMENDATIONS Ministry of Health to expedite the process of enhancing the capacity of NPHL 1. to start testing Covid 19 samples with the necessary equipment and materials.

Ministry to provide appropriate PPE to the rapid response or contact tracing 2. team.

Ministry to expedite the process for the timely payment of allowances to the 3. frontline workers in the laboratories, surveillance and contact tracing.
Ministry of Health to consider upgrading or equipping the labs in some major 4. health facilities in the other parts of the country to test Covid 19 samples.

Ministry of Health to conduct formal training for the officials who are 5. engaged in sample collection.

The rapid response, contact tracing and sample collection teams to be 6. provided with a more spacious office to accommodate them.

7.

4.

National Epidemiology and Disease Control Centre OBSERVATIONS/CONCLUSIONS 1.
Incident Operation Committee (IOC) During the discussion with the Committee, the Honourable Members raised the concern of the public at the slow or lack of response to calls about suspected cases in the communities made to the emergency hotline.

The Select Committee was also concerned that the reported non-availability of financial resources is affecting the ability of the IOC to implement the response programme and to enforce physical distancing and border control.
The issue of mobility to facilitate contact tracing and staff motivation in the form of allowances were also highlighted.

RECOMMENDATIONS 1.

Ministry of Health to ensure that all the necessary arrangements and support in terms of resources (material and financial) are in place for the proper coordination and implementation of the national response or strategic plan on Covid 19.

29 Ministry of Health to expedite the process for the timely payment of 2. allowances to the frontline workers.

3.
3.

Ministry of Health to increase and decentralise the number of 1025 Emergency Call Centre numbers.

Volunteers from other agencies such as the Gambia Red Cross can be trained to man the call Centres.

The number of Rapid Response Teams especially in regions with high population densities should be increased to ensure the timely response to reports.

7.5.
7.5.

Edward Francis Small Teaching Hospital OBSERVATIONS/CONCLUSIONS The hospital was found to be compliant with the physical distancing, temperature screening and hand washing or sanitising requirements as observed by the members of the Select Committee at the main entrances and the visit to the Out-Patient Department (OPD) or Accident and Emergency (A&E).

However, not all the members of both the hospital and Polyclinic staff were found to wear face masks.
There are adequate stocks of PPEs and other materials and equipment.

RECOMMENDATIONS Immediately The EFSTH Management should make it mandatory for all staff to wear face 1. masks in the hospital.

2.
2.

The EFSTH Management should assist the administration at the Polyclinic to replicate the arrangements at the OPD of the apex hospital by erecting outside reception tents to ensure that patients and their escorts who come to the facility, as the first port of call, do observe the physical distancing requirement .

3.
3.

The EFSTH Management to follow-up with the Ministry of Health to engage the Inspector General of Police and the Banjul City Council to provide a 24 hour watch at the dumpsite near the Sanatorium to prevent scavengers from burning the trash which emits toxic fumes (smoke).

Long term 4.
Long term 4.

To relate either the Sanatorium or the dump site Banjul Polyclinic OBSERVATIONS/CONCLUSIONS The EFSTH Polyclinic in Banjul is a facility which serves as the first port of call for many people who need clinical services for different ailments.

Since they are coming from places beyond Banjul, the place is always full of patients needing medical attention and their escorts.
The Committee members were alarmed by the fact that the patients were found sitting close to each other and not observing any form of 30 physical distancing while waiting for their turn at the various clinics or departments in the facility.

RECOMMENDATIONS The EFSTH Management to erect a temporally tent or shed in the court-yard 1. of the Polyclinic for the purpose of seating people to observe physical distancing.

The EFSTH Management to engage in the regular disinfection of the 2.

Polyclinic.

3.
Polyclinic.

3.

The staff of the Polyclinic should wear face masks when in the facility.

Sanatorium OBSERVATIONS/CONCLUSIONS The Sanatorium is a highly secured place with all the necessary restrictions on movements considering the critical state of facility with patients suffering from a highly infectious and deadly disease.
However, while being received on arrival by the head and officials of the facility in the courtyard, the Committee Members found it very difficult to stay outside even for a very short period as the place was covered in thick heavy smoke coming from the nearby Mile 2 dumpsite which made visibility and breathing very difficult.
The health officials indicated the urgency to address the issue of the dumpsite with its intermittent smoke emission which is posing a real health hazard to both the patients and workers at the facility.

RECOMMENDATIONS 1.

The EFSTH Management to follow-up with the Ministry of Health to engage the Inspector General of Police and the Banjul City Council to provide a 24 hour watch at the dumpsite near the Sanatorium to prevent scavengers from burning the trash which emits toxic fumes (smoke).

2.
2.

The Ministry of Health and EFSTH management to continue with the efforts to expedite the process of shipment, instalment and provision of the necessary equipment and materials for the laboratory at the facility.

The Ministry of Health to provide more equipment such as oxygen machines 3. and ventilators for the ICU, laundry machines and mobility for staff.

The EFSTH Management should consider building a guard room and toilet 4. facility at the entrance for the security.
31 7.6 Kanifing General Hospital OBSERVATIONS/CONCLUSIONS It was observed that the hospital management has put in place the prevention measures such as hand washing stations and temperature checking at the main entrance, physical distancing at the Accident and Emergency Unit and face masks by some members of staff.

RECOMMENDATIONS 1.
RECOMMENDATIONS 1.

The Hospital Management to enforce its Covid 19 prevention polices 7.7 National Disaster Management Agency Although 85% of households have reportedly received the relief packages there are still pockets of vulnerable households in the urban areas that are yet to receive the package.

It is likely that the adverse impact of the Covid 19 pandemic on economic livelihoods will linger into the future.

There is an urgent need.


RECOMMENDATIONS: Develop long term strategies for vulnerable households to mitigate the impact 1. of continuing Covid 19 pandemic on livelihoods.

Set up call centre and number to receive complaints from members of the 2. public.

Reserve a stock of food relief to serve as buffer to address those in targeted 3. areas who are left out in the distribution.

4.

Supervise the distribution in Kanifing Municipality and the City of Banjul.

5.
5.

Work towards putting up a data system as one of the lessons learnt.

6.

Establish transparent and accountable procedures that ensure fair and equitable distribution of the relief which should not be dictated by any partisan political considerations or favouritism.

Ensure the strict observance of physical distancing at all the distribution 7. points.

8.

Expedite the process of distribution in view of the looming rains.
32 7.8 GAMBIA RED CROSS SOCIETY (GRCS) OBSERVATIONS/CONCLUSIONS Given that the core mandate and function of the GRCS is to respond to emergency and other disasters, the GRCS is well placed through its network of volunteers to improve community engagement and mobilisation.

The Ministry of Health should rely on this comparative advantage for its outreach strategies.

RECOMMENDATIONS 1.
RECOMMENDATIONS 1.

The Ministry of Health should contract Red Cross volunteers to participate in the contact tracing process, mass testing and community surveillance and psychosocial support The Ministry of Health should outsource the fumigation of public offices, 2. markets, public places, car parks to the GRCS.

The GRCS should participant in the risk communication activities within 3. communities.
The state should consider a subvention for the GRCS to augment its efforts to respond to Covid 19 pandemic in the country.

7.9 MINISTRY OF HEALTH OBSERVATIONS/CONCLUSIONS The Committee is concerned about the quality of documentation submitted by the Ministry and the late submission of responses to queries raised by the Committee prevents Honourable Members from adequately scrutinising the details of submission thereby compromising the quality of our oversight function.
Members have noted with concern that there is no social distancing in public places especially in crowded places such as markets thus increasing the risk of transmission of the virus.

Given that 70% of cases are imported there is concern that community surveillance in villages along the border is still not well established.
Recommendation The Ministry of Health should prepare and submit 1. in advance a comprehensive report to the Select Committee before any scheduled meeting to give Honourable members adequate time to reflect on the issues presented in the report.

Ministry of Health is requested to provide guidance on whether the use of 2. masks should become mandatory in public places.

33 3.
33 3.

Ministry of Health is requested to develop strategies for more enhanced community surveillance system linked to incentives to increase reporting in border villages/towns.

4.

Ministry of Health to ensure that this Covid 19 pandemic serves as an opportunity to invest and improve on the health infrastructure and services by committing more resources for the health facilities around the country.

.
.

34 Appendices Annex 1: Responses to the recommendations in the Oversight Report on the state of national preparedness in March 2020 2.

Which health facilities are going to have sentinel surveillance systems in place?

The sentinel surveillance sites will target growth areas in western1 and western2.

Targeting EFSTH, Kanifing G. Hospital, Bundung Maternal and Child Health Hospital, Faji Kunda Major Health centre, Brikama District Hospital, Bwiam General Hospital and Sibanor.
It will gradually be rolled out to Essau, Farafenni, Soma, Kaur, Kuntaur, Bansang and Basse.

All these are dictated by available laboratory capacities for testing 3.

What proportion of border communities have community surveillance systems in place and where are these communities located?

These are proposed strategies to increase awareness and ensure communities are involved in covid-19 surveillance.

The sites are NBE, NBW CRR North and South, LRR, URR North and South, Western Region.
There are approximately 250 settlements in these locations without community surveillance due lack of funding.

4.

How many sample collectors are there by region?

There are networks of labs in all the regions.

The minimum capacity to collect samples is available in all the 7 health regions and they can be strengthened from the NPHL if the need arises.

5.

How many rapid response teams are there per region?
The entire Health Regions each have been strengthened with rapid response teams and contact tracers.

The number depends on available potential staff to do contact tracing.

They have been trained and now working in their respective regions.

Plans are in place to increase their numbers including the district levels using CHNs and community volunteers through support of partners 6.

Can MoH provide data on the average time taken to respond to 1025 calls in the following locations?
Banjul, About one hour Kanifing, Between thirty to forty-five minutes Brikama, About one hour to one hour thirty minutes Kombo North, About two hours Kombo Central, About two hours and Kombo South, About two hours 7.

What criteria will MoH advise the Executive to use to remove or reduce the restrictions in the state of emergency?
There have recently been a virtual meeting of Health Ministers in the ECOWAS Region and at the end of the meeting Ministers agreed that West African Health Organization (WAHO), as the technical body for ECOWAS on health matters, to develop protocols or guidelines to advice governments in the scaling down of restrictions.
However, as the Government recently eased the restrictions on Mosques, Churches and Markets; the advices given for adherence are as follows: • Social Distancing • Wear face mask 35 • • • • • • Regular hand washing Application of hand sanitizer Temperature screening Ablution should be performed at home Quick dispersal after prayer Call toll free number 1025 8.

What is the perceived relationship between the National Covid Coordinator and MoH?
The fight against COVID-19 is multi-sectoral and multi-dimensional and as such the National Coordinator will perform the overall coordination in bringing all the players, including MoH, to enable the smooth implementation of all the planned activities.

Responses to the questions from the National Assembly towards Covid-19 national response and budget implementation plan Q1: A detail work plan and programme of activities with cost relating to the handling of COVID-19 pandemic in The Gambia.
In respect of question one, please refer to the attached document; The Gambia COVID-19 Plan Q2: A periodic update on the data regarding cases, treatment and deaths associated with the COVID-19 pandemic.

There is a team of experts based in the Public Health Emergency Centre that provides the daily update of the situation.

Below is the latest update as of the 18th May, 2020.
See the detail report below: SITUATION IN NUMBERS Globally Confirmed Case(s): 4,715,388 • Recovery (ies): 1,809,805 Death (s): 312,317 Senegal • • Confirmed Case(s): 2,429 Recovery (ies):949 Death (s): 25 The Gambia • Recovery (ies): 13 Death (s):1 Confirmed Case(s): 24 II.

EPIDEMIOLOGICAL DESCRIPTION Tables 1, 2, and 3 show the line list of confirmed cases, the epi-classification of casesand the summary of outputs on the various public health activities undertaken.
Figures 1 and 2 are the age-sex distribution of confirmed cases and the Epi-curve of confirmed cases by reported date.

36 Table 1: Line List of Laboratory-Confirmed Cases, COVID-19 Pandemic, The Gambia, 2020 Nationality Cas e No.
001 Gambian 002 Bangladeshi 003 Gambian 004 Gambian 005 Gambian 006 Gambian 007 Gambian 008 Gambian 009 Gambian 010 Gambian 011 Senegalese 012 Gambian 013 Gambian 014 Gambian 015 Senegalese 016 Gambian 017 Gambian 018 Senegalese 019 Senegalese 020 Senegalese 021 Senegalese 022 Dual (Senegalese, Gambian) Age (Years) Sex Date Reporte d Transmiss ion Classificat ion Imported Current Status 28 70 71 53 20 40 28 62 28 26 39 23 22 7 Month s 35 31 21 41 21 23 84 51 Femal e Male Male Male Male Femal e Femal e Male Femal e Femal e Male Femal e Femal e Male Male Male Male Male Male Male Male Femal e Local Local Imported Imported Imported Imported Recovered and Discharged Died 16/03/2 020 19/03/2 020 Recovered and 20/03/2 Discharged 020 Recovered and 26/03/2 Discharged 020 Recovered and 29/03/2 Discharged 020 Recovered and 29/03/2 Discharged 020 Recovered and 20/03/2 Discharged 020 Recovered and 21/03/2 Discharged 020 Recovered and 20/03/2 Discharged 020 Recovered and 20/03/2 Discharged 020 Currently 26/04/2 Hospitalized 020 Recovered and 27/04/2 Discharged 020 Currently 28/04/2 Hospitalized 020 Currently 28/04/2 Hospitalized 020 Imported Imported Imported Imported Local Local Local 29/04/2 020 29/04/2 020 28/0420 20 04/05/2 020 20/04/2 020 03/05/2 020 25/04/2 020 26/04/2 020 Imported Local Local Local Imported Local Imported Imported Recovered and Dischared Currently Hospitalized Recovered and Discharged Recovered Currently Hospitalized Currently Hospitalized Currently Hospitalized Currently Hospitalized 37 Nationality
 Cas e No.
023 Gambian 024 Guinea Bissau 003 Senegalese Age (Years) Sex Date Reporte d 30/04/2 020 14/05/2 020 Transmiss ion Classificat ion Imported Imported Current Status Currently Hospitalized Currently Hospitalized Male Male Probable Cases Femal e 25/04/2 020 Imported In Quarantine 34 47 6 Case 024 is a 47 year old male from Guinea Bissau He is a driver at the Nigerian Consulate in Guinea Bissau He came with the consul who was to receive treatment at Medicare Clinic Gambia Brief Description of Newly Confirmed Case • • • but were both intercepted at the border and taken into quarantine • locations with ongoing community transmission • the Southern Senegalese region of Casamance • out the following day (16th May) • for COVID-19 IV.
Gaps/Challenges: He was taken into quarantine on the 14th May for entering the country after being in En route to The Gambia from Bissau, the duo spent 3 nights in Ziguinchor – a city in Both travellers had their samples collected on the 15th Mayand the test results came While the test result of his travelling companion returned negative, he tested positive Delay in setting up an e-surveillance system that would ensure the availability of • real-time response data • • Tumana, Wuli East, Wuli West and Sandu Districts • efforts Delay in the release ofperiodic imprests to support basic response efforts Inadequate border patrol especially in undesignated PoEs around Jimara, Kantora, No motor cycles at Fatoto Health Centre and NyamanarrPoE to support response V. Next Steps/Recommendations: Orientation of regional governors and district chiefs on COVID-19 Security to open a post at Kerr Ardo as it is becoming a major route of entry into the To consider testing low risk contacts (contacts of contacts) before discharge upon • • Gambia • completion of mandatory follow-up • All SoPs to be revised in order to cater for gender and the differently abled 38 Inclusion of immigration in the RRT to facilitate the deportation of non-Gambians Enforcement of the letter and spirit of the restriction orders contained in the State of Strengthen surveillance at all points of entry (including the undesignated ones) Engage private pharmacies to report clients presenting flu-like symptoms to the • sneaking into the country • Emergency declared • • RRTs • Strengthen RRT and contact tracing teams at all regions Q3: A list of other isolation facilities and the rationale for their selection.
Below are the identified isolation centres country wide and the rationale behind the selection is that ideally we would want every health facility to have isolation room, so that when a suspected patient visits that facility, he/she is immediately isolated from the rest of the patients.
However this is a challenge, so all the hospitals and some major health centers are targeted to cover the length and breadth of the country • Edward Francis Small Teaching Hospital • Kanifing General Hospital • Essau District Hospital • SibanorWec Clinic • Bwiam General Hospital • Soma District Hospital • Bansang General Hospital • Basse District Hospital • Farafenni General Hospital • Brikama District Hospital • Kaur Major Health Center • FajiKunda Health Center • Bundung Maternal and Child Health Hospital 39 Q4: Fortnightly detail income and expenditure reports on the COVID-19 funds with explanatory notes.
EXPENDITURE FROM THE D500 MILLION COVID-19 FUND AS AT 30TH JUNE 2020 Date Atlantic Friendship Badala Bambo West African Golden HOTELS 1,980,300.00 77,350.00 3,124,800.00 2,259,200.00 4,572,400.00 2,860,000.00 1,980,300.00 2,832,500.00 1,392,200.00 4,911,305.00 360,000.00 2,163,000.00 1,866,200.00 1,723,800.00 3,649,800.00 2,544,800.00 Sub-Totals 6,123,600.00 77,350.00 11,473,300.00 3,651,400.00 9,483,705.00 7,488,600.00 38,297,955.00 Grand Totals GOOD Amount VEHICLES 12,800,000 SHYBEN A. MADI AND SONS Marr Bantang 70L Plastic buckets 1,300,000.00 HALI’S TRADING Sanitary materials 52,800.00 40 Atlas Trading Face masks/Gloves 89,440.00 Dicko Enterprise Hand Sanitizers 1,978,500.00 Sadia Trading Hand Sanitizers 244,000.00 Standard Solution Hand Sanitizers 57,000.00 Mbowe Ngala Hand Sanitizers 66,000.00 Banna's Trading Privisions 136,200.00 Makunyam a Office Equipment 111,700.00 Paseedia Gassama Catering for media 106,850.00.00 Dembo Spring Roll Kaira Catering Service Catering 107,500.00 Catering 33,500.00 Liza Transport Covid Product 2,217,987.87 Major suppliers ventilators 359,850.00 Havana Catering 123,000.00 41 Sub-Total 19,677,477.87 19,677,477.87 FUEL RFH Operations 600,001.87 GNPC Security 165,450.00 GNPC Security 2,489,249.93 Sub-Total 3,254,701.80 3,254,710.80 Allowance s Treks 84,000.00 24,000.00 8,000.00 42 40,000.00 Frontline Workers Frontline Workers 1st Batch 5,795,000.00 2nd batch 5,750,000.00 Sub-Total 11,701,000.00 11,701,000.00 IMPRESTS Team Leads Team Leads 1,300,000.00 300,000.00 Security
 2,490,000.00 Sub-Total GRAND TOTALS 4,090,000.00 4,090,000.00 77,021,143.67 The funds that is pledged by the Government for the fight against COVID-19 is being deposited in a special account called COVID-19 response account which is governed by a dedicated accountant different from the Ministry of Health’s accounting system.
TREATMENT CENTERS • • • • • • • • Sanatorium, EFSTH – WR1 Ndemban – WR1 MRC - WR1 Sukuta – WR1 Kafuta – WR2 Kanuma – NBW NjabaKunda – NBE Land adjacent to Soma District Hospital – LRR 43 Bansang General Hospital – CRR (S) Pallang – CRR (N) Basse CREN facility – URR (S) Yorobawol – URR (N) • • • • The idea here is to have at least one treatment facility in each health region, to avoid movement of patients, and thus lessen the risk to drivers and staff.
Criteria for selection of treatment centers: • • • • Accessible by road Access to water and electricity Proximity to a major health facility for laboratory support Possibility of getting accommodation for staff available LIST OF TREATMENT CENTERS IN THE REGIONS NO REGIONS LOCATION West Coast Region 2 LRR CRR - SOUTH CRR - NORTH NBR NBW URR - NORTH URR - SOUTH Kafuta H/C Soma District Hospital Bansang General Hospital Wassu – Pallang village NjabaKunda Health Center Kanuma - Essau YorroBawol H/C Basse District Hospital CREN NUMBER OF BEDS 40 40 40 40 40 40 40 40 40 TYPE OF WORK New construction New construction New construction & Refurbishment New construction New construction & Refurbishment New construction New construction New construction Refurbishment SCOPE FOR NEW CONSTRUCTION 44 • • • • • • Construct 40 admission bed capacity with doctor’s duty room Construct staff quarters The environment shall have pavement The center shall have boundary fence and security post The center shall have water supply and sanitary fittings The center shall have electricity connection and backup system (solar/generator) Need to refurbish the existing structures in the health facility Replace the existing door.
Replace the existing windows with sliding windows.

Provide adequate cooling system in the rooms.

Construct collapsed fence.

Replace the existing plumbing and electrical fittings.

Replace the existing ceiling and the leaking roof sheets.

Paint the existing building structures.

REFURBISHMENT KAFUTA HEALTH CENTER • o o o o o o o BANSANG GENERAL HOSPITAL -EYE UNIT • • • • • • TREATMENT CENTER NEEDS (CREN) • • • existing ceiling.
• • • • • Replace the existing plumbing fittings in both buildings Replace existing louver windows with aluminum sliding windows Provide an apron concrete to the other side of the building Provide and replace the existing ceiling fans Provide an adequate air conditioning system in the required rooms Provide perimeter fencing for the proposed building Need to improve the condition of the existing access road to the facility Create an internal toilet for the single rooms in the residential area Provide beds and office furniture in the required rooms Upgrade the wiring system Provide water connection to the existing toilets Replace the existing plumbing fitting (toilet, showers, wash hand basins and etc) Repaint the existing building structure.
Provide ceiling to the rooms without ceilings and replace the damage portion of the 45 Annex 3: Review of issues for the engagement with the Minister and officials of the Ministry of Health on the national response to the Covid 19 pandemic in The Gambia Below are the relevant recommendations directed to the Ministry of Health as contained in chapter 5 of the Oversight Report of the Committee adopted by plenary on 17 March 2020 and needing response regarding implementation: 5.1.
Banjul Seaport The office space provided to the Public Health officials by the GPA management to accommodate all of them is small.

However, it was noted by the GPA officials that space is a challenge even for the Authority which also needs to physically expand.

When vessels dock at the harbor, the Committee was informed that the health officials are the first to meet with the crew in order to perform the obligatory internationally accepted screening protocols and procedures.
Recommendations GPA management Identify and provide space for the health officials to use as a holding centre for any suspected case before evacuation to the Edward Francis Small Teaching Hospital (EFSTH).

Response: Holding center at Banjul Seaport has not yet been provided however there is a standby ambulance that can immediately evacuate any suspected individual to EFSTH.
Provide a more spacious office for the Public Health Officers who have a critical role to play in terms of the health of the population.

Response: This issue of a more spacious office for Public Health Officers at the Seaport is still being looked at but not yet materialized.
In situations of public health emergencies, as is currently the case, it should be a policy for not only the health officers to wear protective masks but for all other workers coming on board the vessels to do so for their own safety and that of their co-workers and the larger society, including their families.

Response: It is already a policy for everyone to be in face mask especially while conducting such duties.
Ministry of Health Provide more protective materials such as face masks, gloves, temperature testing equipment, detergents and antiseptics.

Response: face masks, gloves, temperature testing equipment, detergents and antiseptics have been supplied and are being supplied routinely based on request.

Review and amend the Public Health Act to address gaps and empower, protect and enhance the inspection work of public health officials.
46 Response: The review of the Public Health Act is in progress however due to the advent of COVID-19, the issue of social distancing has deterred the already established task force to function effectively.

However, we plan to proceed with the activity by observing physical distancing.

Place a ban on the importation of old/used newspapers which are used for wrapping food e.g.

bread and other foodstuff thus posing a public health concern.
Response: This is being looked into to determine what potential risk exist.

As part of the process, we would push towards us, as a country, looking at the alternatives first.

Provide mobility for the public health staff at the Banjul ports.

Response: There is no Motorcycle provided to the staff of Banjul seaport as the number of motorcycles received were prioritized to Airport, Nyamanarr, Kuntaya and Brikamaba.
However, the Ministry has received another batch of motorcycles and the other stations including the Banjul Seaport will be considered.

The motorbikes are received from MRC and UNDP.

5.2.

Banjul International Airport Recommendations GCAA Provide transport for the staff on duty to facilitate timely reporting to work and to enable them to return home.

Response: this is being looked at for them to be incorporated into the covid response transport system.
A Motorcycle has been provided to the staff of Banjul International Airport Response: Protective materials and temperature testing equipment have been provided and the stock is replenish on demand.

GCAA and the MoH should work together to develop a questionnaire to be filled out by visitors to collect information on previous travel within the last 30 days prior to arriving in The Gambia and not rely on the landing cards.
Response: The Ministry of Health has developed a form called arrival form which is completed by all arrival passengers and it collects all relevant information required.

5.3.

Giboro Border Post Recommendations Ministry of Health Deploy a minimum of 3 Public Health Officers to be stationed at the border and work on a shift basis.

Response: Giboro border post has now 3 public health officers Provide more protective materials like protective masks, gloves, detergents and antiseptics.
Response: Protective materials like protective masks, gloves, detergents and antiseptics have been provided and stocks are replenish based on request.

Erect a temporary holding facility, away from the hot sun, in front of the immigration office for health officials to first screen travelers entering the country before the travelers meet any other official.
47 Response: A holding centre will soon be built at the Goboro border post Ensure that chlorinated running water is available in front of the temporary holding facility for travelers to wash their hands with soap or detergent before being seen by a health officials.

Response: Chlorinated running water is available in front of the temporary holding facility for travelers to wash their hands with soap or detergent.

This is done before being seen by the public health official.
Provide a special ambulance on standby.

Response: A special standby ambulance is provided and is located in Brikama Provide transport for the staff.

Response: The Giboro border post has two motorcycles for use by the staff.

Upgrade holding centre or ‘Ebola’ house for suspected cases and include solar energy and running water.

Response: The holding centre or ‘Ebola’ house for suspected cases in Giboro is upgraded and connected to NAWEC with running water.

5.4.
5.4.

Amdalai Border Post Recommendations Ministry of Health Erect a temporary holding facility for the health desk as the first port of call for every traveler entering the country.

This should be done immediately after the border line mark on the tarmac road separating the two countries.

Response: Such an action has been erected.

Deploy more Public Health Officers to boost the capacities of the three who are already posted there, in view of the current public health emergency situation.
Response: An additional public health officer has been deployed there bringing the number to four.

Allocate a special ambulance on standby to be stationed either in Amdalai or the Regional Health Directorate in Essau.

Response: A special ambulance on standby is available and located at the Regional Health Directorate in Essau.

Renovate the existing holding facility at the ‘Ebola’ House to accommodate any suspected case waiting for evacuation.
Response: The building has been renovated and is now ready for use.

5.5.

Edward Francis Small Teaching Hospital (EFSTH) Recommendations Ministry of Health Provide more PPEs, protective materials, gloves, N95 face masks, detergents (bleach), fumigators.

Response: The said items have been distributed and stocks at various points are replenished as requested.
48 Replicate a safer reception area for patients to minimize transmission of COVID 19 disease in the Banjul Polyclinic similar to the reception in the Accident and Emergency Unit in the Edward Francis Small Teaching Hospital.

Response: A system is put in place to see all cases through the Accident and Emergency Unit.
Organize training on the COVID-19 disease for doctors, nurses, auxiliaries, orderlies, drivers, cleaners and all the other hospital staff at the EFSTH, Polyclinic, and the Tanka Tanka Psychiatric Unit.

Response: Training has been conducted for staff from all the different categories of health service providers .

The training is ongoing to cover the entire health workforce.

Provide special risk allowances and other incentives to the workers managing COVID-19 cases.
Response: A special risk allowance is being provided to all Health Workers and many have been paid already and the payment for the rest is in progress.

5.6.

Sanatorium Recommendations Ministry of Health Short term.

- Sanatorium Urgent attention should be given to finalizing the refurbishment at the Sanatorium immediately to be able to admit cases.

Also other facilities in Greater Banjul and the regions must be identified to manage COVID 19 cases.
Response: The refurbishment at the Sanatorium has been completed and has been used for admission of cases.There are works ongoing on providing oxygen piping systems to up to 20 points.

Work is ongoing at other treatment sites.

The two wards in the Sanatorium for critical and recovering patients need a more airtight separation, with aluminum and glass partitions rather than the plywood and mesh that currently divide the rooms.

Response: This work has already been done.


TB patients should be transferred to another facility for treatment given that they are at high risk of contracting COVID-19 due to their low immunity and their underlying respiratory infection.

Response: This was part of the plan and has been executed The wards need a well-functioning air-conditioning system once they become air tight and admit patients.

Response: Air conditioners have been fixed and will be utilized when necessary.
However, under the circumstances, free air ventilation is preferable.

The facility should be provided with a well-equipped ambulance on stand-by for the purpose of evacuating patients from the other facilities to the isolation centre.

Response: Since this is a treatment centre and the patients should be moved to this facility.

However an ambulance will be stationed there for any possible referral.
The workers on shift duties at the hospital need to be provided with a utility vehicle to be transporting them to and from work.

49 Response: There are (2 vehicles) to provide transport for the staff whenever needed.

More trained staff need to be deployed to the facility to compliment the few that are posted there before the facility starts admitting confirmed.
Response: Staff are now provided to cover all shift Given the highly contagious nature of the disease and the risk of infection medical workers and support staff should be given special risk allowances and other incentives when they start managing COVID-19 cases.

Response: This is being worked out at Ministry level but they have received their first disbursement of D5000.00 More protective materials such as N-95 masks, disposable gloves, gowns, PPEs, detergents e.g.

bleach antiseptics, etc.


need to be provided in sufficient quantities.

Response: These are provided and are being provided as per request.

The water supply (6000L tank) and ventilation system needs to be improved for sanitary and health purposes.

Response: these have been sorted out and are working well.

A waste management policy needs to be in place to handle highly contaminated medical waste.
For example a high temperature modern fire-brick incinerator needs to be built for waste materials Response: The World Bank is procuring 2 industrial scale waste management equipment for Ministry of Health.

All the handle doors in the building leading to the wards and toilets should be changed to revolving doors to reduce transmission of the virus.
Response: these doors have been changed Medium/Long term If the dumpsite cannot be relocated from where it is situated now in the outskirts of Banjul, the Committee is recommending for the eventual relocation of the Sanatorium to a more ideal and environmentally friendly area with a fit for purpose building for the treatment of communicable or contagious diseases that need isolation.
This is an urgent matter for the Ministry of Health, Ministry of the Environment and the Ministry of Lands to look into and find a permanent solution.

Response: It would be more prudent to move the dumpsite and all stakeholders should work towards this.

With the worlbank incinerators it may be more feasible.

5.7.
5.7.

Ministry of Health Recommendations Short Term The Ministry of Health should take the lead, at all times, in the coordination and implementation of the national preparedness and response to the COVID-19 pandemic.

The Ministry should ensure that public health officials, hospital and all the other frontline workers, who are at risk, are given priority in terms of their protection against infection of this highly contagious virus.
Response: Protection to frontline Health Workers has been provided by way of PPEs and cleansing items like hand sanitizers.

50 The Ministry should ensure additional resources to be given to hospitals and public health officers at the points of entry for the provision of protective and screening materials and equipment, training for doctors, nurses, auxiliaries and public health workers.
Response: Hospitals and public health offices at the points of entry have now been provided with protective and screening materials and equipment, trainings have been carried out for doctors, nurses, auxiliaries and public health officers The Ministry should intensify its risk communication, social mobilization and community engagement activities by utilizing various mediums to create public awareness for the prevention and containment of the coronavirus pandemic in both the urban and rural communities.
Response: The Ministry have established a risk communication and community engagement committee which is multi sectoral in nature.

The committee is tasked to plan, coordinate and mobilize resources for the implementation of public awareness, media community engagement on COVID-19.

A similar committee was established in all the Regions across the country.

The implementation is anchored on the use of both traditional and mainstream media.
This includes the use of Television, Radio, News papers and social media as well as using traditional structures to reach a larger population.

In addition public information sharing was greatly enhanced with the establishment of a Public information centre called the “Called Center”.
The Ministry should engage in providing updates on a daily or every other day basis, based on its own compiled reports and the WHO and other credible sources on the state of the COVID-19 pandemic at the national, regional and international levels.

Response: The Ministry has been very committed and consistent in providing the daily situational report which include national, regional and international.
This report is being provided to the public through daily press briefings ( excluding Sundays except when required).

The National Health Emergency Committee (NHEC) should be enlarged, if necessary, to include all the health related statutory bodies (councils and agencies) and other non-technical (health) stakeholders to enhance its coordination and implementation capacities.
NHEC can even constitute a Standing Consultative or Advisory Forum comprising retired medical workers, former officials of the ministry e.g.

former ministers, permanent secretaries and directors of health, the private doctors/consultants, clinics, pharmacies, NGOs, civil society, media, etc.

The Ministry of Health should also include Veterinary Services, the government institution responsible for animal health in the NHEC.
RESPONSE: The NHEC is very inclusive The Ministry of Health should provide one standby ambulance in every health region for the purpose of evacuating suspected cases to EFSTH.

Response: At the moment Regions have not yet been provided with a standby ambulance for the evacuation of patients to EFSTH.

However, plans are on the way to providing ambulance to each region as soon as the ambulances arrive.
The Ministry of Health should issue a circular advising all public and private institutions or workplaces, including schools to provide facilities for hand washing.
Response: A press release to the general publicincluding schools to provide facilities for hand washing was made 51 The Ministry of Health should develop and implement a protocol on measures for the screening of travelers entering the country through the airport, seaport and land borders laying particular emphasis on residence and travel in the 30 days prior to arrival in The Gambia.

Response: A protocol is in place and being implemented which is backed by the International Health Regulation (2005).
The Ministry of Health, in consultation with the Ministry of Foreign Affairs, International Relations and Gambians Abroad, should consider taking timely and appropriate control measures to quarantine travelers on arrival and any other interventions necessary to save the people living in The Gambia from imported cases of the COVID-19 pandemic.

Response: This is in place and strictly been enforced by the officials.
The Ministry of Health should closely work with the Ministry of Foreign Affairs, International Relations and Gambians Abroad to get in touch with Gambians, through our foreign missions or by any possible means, in COVID-19 affected countries to know their situation and, where appropriate, advise them on travel restrictions to avoid the risk of infection or being carriers for transmission.

Response: This is in place and also being enforced.
The Ministry of Health should strengthen the already existing collaboration with other State agencies operating at the international entry points i.e.

GID, GRA, Police, Animal Health (Veterinary) and Food Safety.

Response: The Ministry of Health has strengthened the already existing collaboration with other State agencies operating at the international entry points i.e.

GID, GRA, Police, Animal Health (Veterinary) and Food Safety.
The Ministry of Health should involve the Ministries of Basic and Secondary Education and Higher Education to include educational institutions in the national public sensitization campaign.

Response: The Ministries of Basic and Secondary Education and Higher Education are members of the Risk communication and Community Engagement committee.

The RCCE plan includes the sensitization campaigns in the schools even though the schools are closed for now.
The TV programs for schools are potential tools to be used.

The Ministry, in addition to the Medical Research Council (MRC), should identify and enhance the capacities of public laboratories to test for COVID-19 disease.

Response: This process has been ongoing the last six weeks and we are almost complete with the activity.

Various levels of the operation have been conducted at NPHL in Kotu to establish Covid-19 testing platform.
Everything, from sample inactivation to PCR has been conducted successfully.

This was done with samples already processed at MRCG.

Parallel testing of the same samples has been conducted by both institutions and the results are similar.

The lab is now ready for use.


The Ministry of Health should advice the Executive to establish an Inter-Ministerial Committee on COVID-19 comprising the Ministry of Health, Ministry of Finance and Economic Affairs, Ministry of Justice, Ministry of Foreign Affairs, International Relations and Gambians Abroad, Ministry of Basic and Secondary Education, Ministry of Higher Education, Ministry of Transport and Ministry of Tourism to advise on policy matters, among other responsibilities.
52 Response: This committee is in place and functional.

This committee is Chairpersoned by the vice president and members are ministries of Local Government and Lands, Finance, Health, Tourism, Trade, Interior, Foreign Affairs, Defense, Transport, women’s affairs and Agriculture The Ministry of Health should deploy health personnel at unmanned border entry points, ferry crossings and the Trans-Gambia Bridge to screen travelers.
Response: Health Officers in Banjul ports have trained officials of the GPA to carry out temperature taking under supervision and there are plans to roll out to other crossing points.

The Ministry should identify and establish quarantine facilities for people referred for more observation of their conditions.

Response: Quarantine facilities are available especially for contacts of confirmed cases or people returning from area of confirmed community transmission.
Medium Term The Ministry of Health to formulate a National Emergency Strategy and establish a National Emergency Centre for all health emergencies.

Response: There is a Health Sector emergency preparedness and response plan 2017 -2019 which has expired and is in the process of being reviewed and updated with funding from World Bank.

Long Term The Ministry of Health to commence the process toward establishing a Disease Observatory Centre for the treatment of infectious disease.
Response: There is a functional Public Health Emergency Operations Center (PHEOC) where all the response are coordinated.

However the legal frame work is yet to be enacted.There is plan by world Bank to build an infectious disease Hospital 5.8.

Ministry of Finance and Economic Affairs Recommendation The Select Committee is recommending the Ministry of Finance and Economic Affairs to support the Ministry of Health in its requests for resources to respond to the pandemic.
The Select Committee is recommending the Ministry of Finance and Economic Affairs to liaise with the Attorney General Chambers and Ministry of Justice to start the process toward giving effect to Section 154 (1) of the Constitution of the Republic by tabling before the National Assembly a Bill for the enactment of this provision which states thus “An Act of the National Assembly may make provision for the establishment of a Contingencies Fund …”.
The purpose of this Fund is for unforeseen and urgent need for expenditure that would cater for emergencies such as the Covid 19 disease pandemic.

The Honourable Members of the National Assembly, including the Members of this Select Committee which has health, disaster, humanitarian relief and refugees under its purview, will give full support to the enactment of an Emergency Fund Act.

5.9.
5.9.

National Assembly Recommendation The National Assembly should provide the necessary legislative, budgetary and advocacy support in terms of public health emergencies and continue to support the National Assembly Select Committee on Health, Women, Children, Disaster, Humanitarian Relief and Refugees to continue performing its oversight on the health sector.
53 The National Assembly Members to be fully sensitized on the COVID-19 pandemic and related issues to enable them to assist in the dissemination of appropriate and evidence based information or messages at the level of their constituencies.

Response: There are plans to continue to sensitize National Assembly Members, however in cognizance of social distancing protocols the Ministry is planning to conduct a virtual sensitization with support from UNDP.
5.10 Partners Recommendation The Select Committee is calling on development partners from the UN system such as the WHO, UNICEF, UNFPA, WFP, FAO, IOM, the MRC Unit of The Gambia, Gambia Red Cross Society (GRCS), CCM of the Global Fund, Action Aid International The Gambia, Embassies, media outlets (print, electronic and online), civil society, the private sector, among others, to provide support to the national preparedness and response efforts under the leadership and coordination of the Ministry of Health.
Response: These interventions from the partners may come in varied forms such as the provision of PPEs, equipment and other essential materials, medicaments, publicity through newspapers, radio and television stations, posters, billboards, drama, jingles or songs, among others.

Response: The Ministry concurs with the statement as partners have been supporting in various ways in support of the fight against COVID-19.
The Committee is recommending that all public spaces such as schools, offices, car parks, bank halls, be adorned with sensitization messages on the COVID-19 pandemic on billboards, posters, cartoon sketches, flyers, etc.

Response: All public spaces such as schools, offices, car parks, bank halls, have been adorned with sensitization messages on the COVID-19 pandemic on billboards, posters, and flyers, etc.
Partners such as local councils, Non-Governmental Organizations and Civil Society are also supporting and undertaking activities aimed at sensitizing the population on the COVID-19 disease.

However, the Committee advises that all such efforts or undertakings must be done through or in consultation with the Ministry of Health which is responsible for the national coordination of all the preparedness and response activities.
Response: All efforts or undertakings that executed by Partners such as local councils, Non- Governmental Organizations and Civil Society are in consultation with the Ministry of Health which is responsible for the national coordination of all the preparedness and response activities 54 AT THE QUARANTING CENTRES At the Badala Quarantine Centre At Bamboo Quarantine Sample of the quarantine rooms at the Golden Beach Hotel 55 At the MRCG The new Isolation Centre at the MRCG At the MRCG LAB Meeting with the Management of NPHL 56 National Public Health Laboratory Lab At EFSTH The Sanatorium the Intensive Care Unit 57 Hon.Members with the Management of Serrekunds General Hospital Committee’s Meeting with NDMA and GRCS Meeting with the Ministry of Health and Team Oxygen Machine 58 59