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The Gambia’s Public Health Emergency Operations Center: building responsive, sustainable institutions for Covid-19 and beyond

To address the current health crisis and better prepare the country for the future, Dalberg is working alongside senior Gambian government officials to set a new vision for the development of the country’s public health emergency management capacity.  

During a crisis, Public Health Emergency Operations Centers (PHEOCs) help save lives and minimize socioeconomic losses. The Rockefeller Foundation has awarded a grant to Dalberg to help strengthen PHEOC work in five West-African countries: The Gambia, Guinea-Bissau, Mali, Mauritania, and Senegal. Working closely with governments, Dalberg aims to increase sub-regional coordination for the prevention and detection of Covid-19 and future public health emergencies.


Covid-19 in The Gambia: An Overview

The Gambia is a West African country of 2.4 million people, located on the continent’s West Atlantic coast. During the 2013-2016 West Africa Ebola epidemic, the Gambia put in place a public health emergency management structure to prepare for and respond to the disease.

When Covid-19 began to make international headlines, The Gambia reactivated many of these Ebola-era structures. Authorities began screening for Covid at the international airport in Banjul, the Gambian capital, and instituted a 14-day self-isolation period for incoming international travelers, before closing its air, sea, and land borders. The country further closed schools and banned public gatherings to limit the spread of the virus.

As of December 14 2020, The Gambia has reported 3,782 confirmed cases of Covid and 123 total deaths.

The central role of Public Health Emergency Operations Centers

A PHEOC is a central command facility designed to coordinate operational information and resources for strategic management of health emergencies.1 The Gambia established a PHEOC in 2016 following the Ebola epidemic, recognizing its value-add to the country’s public health emergency management system. The Gambian Covid-19 response has been steered by the multi-hazard emergencies operations agency (the National Disaster Management Agency – NDMA), under which the Gambian PHEOC has managed the public health dimensions of the response. While in its early stages of development, the Gambian PHEOC has played a central role in coordinating the response to Covid-19, including conducting risk evaluation and diagnosis, response preparation and planning, surveillance, and monitoring.

The Gambian PHEOC’s operational limitations have been offset by unsustainable levels of personal commitment from the Ministry of Health personnel, which threatens the efficiency of the response, particularly for a crisis managed over an extended period of time rather than the short-term.

In order to address this challenge and strengthen the response to the current health crisis, senior Gambian officials are now working alongside Dalberg Advisors to set a new vision for the development of Gambian public health emergency management capacity, focused on the PHEOC.  

Anchoring emergency response systems in effective institutions

The Gambia recently underwent a significant political transition (2016-2017) and has started to implement a number of initiatives and reforms. Many of the country’s institutions suffered under years of authoritarian leadership, slowing their development. But the present day is different: As a young democracy with a need to rebuild institutional capacities, there is a clear political will to strengthen democratic institutions.

This project involves collaboration with the Gambian government – and this collaboration is key to the inter-agency coordination required to develop such an institution. As a result, government staff that are leading PHEOC development can draw on the collective authority behind the initiative to ascertain quick and decisive national leadership in the matter – a key need for institutions involved in managing a crisis over an extended period of time.

To help achieve alignment across actors involved in The Gambia’s PHEOC, a series of high-level workshops have been organized by the government with support from Dalberg Advisors. The aim of the workshops is to generate consensus across all stakeholders, laying the groundwork for a course of action that is specifically aimed at improving public health and socioeconomic outcomes. The co-created vision, strategic pillars, and operational objectives established in the workshops go on to serve as the roadmap for a fully operational PHEOC. 

The thin line: Securing a tailored technical crisis response space within political environments

Through the workshops and in its overall crisis-response approach, The Gambia has made important efforts to guard against political appropriation. The country has also taken steps to avoid creating ad hoc interim bodies, which often lack the proper expertise to steer the response. These actions and others – which are happening against the overall development and maturation of The Gambia’s democratic institutions overall – demonstrate the need to build the strongest institutional tools for the country. In addition, there is now more space to invent, design, and build the most innovative solutions to complex problems such as the Covid-19 pandemic.

Organizations including the World Health Organization (WHO), the Africa Centres for Disease Control and Prevention (Africa CDC), and leading actors such as the U.S. Centers for Disease Control and Prevention (CDC) and the West African Health Organization (WAHO) have already done extensive work in public health emergencies management, meaning The Gambia does not need to create the solutions to manage public health emergencies from scratch. The responsibility of the current Gambian administration lies in absorbing the principles already developed by the aforementioned development partners, then adapting them for the Gambian context.

Solutions suitable for Europe, Asia, the United States, or even other African countries might not be the most fitting for The Gambia. The country understands that it needs to find inspiration in these public health emergencies management models, but that the Gambian model needs to be firmly grounded in national institutional and cultural specific aspects. The Gambia cannot import such solutions; it needs to design models that work for its specific context and, where need be, invent them; unapologetically adjusting any technical matter to its specific environment.


1 WHO, Public Health Emergency Operations Centre Network (EOC-NET)

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