THE REPUBLIC OF THE GAMBIA’S COMBINED REPORT ON THE AFRICAN CHARTER ON HUMAN & PEOPLES’ RIGHTS & INITIAL REPORT ON THE PROTOCOL TO THE AFRICAN CHARTER ON THE RIGHTS OF WOMEN IN AFRICA Reproductive Health Policy, National HIV/AIDS Policy, the National Nutrition Policy and the National Population Policy and Plan of Action. Provision of primary and secondary health care has expanded significantly with increased immunization reducing mortality rates. Works to improve physical access continues with the upgrading and building of new facilities, staffed with qualified health personnel. This has increased geographical coverage and reduced the distance to the nearest health facility. The 2007 PRSP Progress Report indicated that over 85% and 97% of the population are within 3 km and 5 km of a basic health facility and primary health care post respectively. Antenatal care coverage countrywide is as high as 96% as well as the RCH awareness of 96%.15 The cost of public health care services remains relatively cheap, as Reproductive and Child Health Services including family planning are provided free of charge. A minimum user charge fee of D5.00 (US$0.20) is paid for outpatient consultations and treatment at all public health facilities. Micronutrient deficiencies, which are a major cause of morbidity and mortality, are being addressed through a nutrition supplementation programme. Insecticide treated bed-nets are provided free of charge particularly to pregnant and lactating mothers and children under 5 and IPT. 4.2 Reproductive health services, including the reduction of maternal mortality (article 14 (1) (a) & (b)) Sexual and Reproductive Health (SRH) issues have been among the top priorities of The Gambian Government’s agenda for many decades. These have been reflected by the adoption of the Alma-Ata Declaration on Primary Health Care (PHC, 1978), the International Conference on Population and Development (ICPD-PA, 1994) and The Millennium Development Goals (MDGs, 1990-2015). Despite these efforts, The Gambia remains a country with a relatively high Maternal Mortality Ratio (MMR) (433 deaths per 100,000 live births). The neonatal (22 per 1000 live births), infant (34 per 1000 live births) and child mortality (54 per 1000 live births) rates are also high. (GBOS, 2014).16 15 16 Paper presented by Ramou Cole Ceesay as the health contribution to the BPFA + 15 Report. National Reproductive, maternal, Neonatal, Child and Adolescent Health (RMNCAH) POLICY (2017 -2026) 144