Background: Infertility poses a significant global reproductive health challenge, disproportionately affecting regions within the Global South, particularly sub-Saharan Africa. Understanding the current landscape of diagnostic and treatment services is crucial for health systems aiming to enhance access to fertility care. This study investigates the availability and integration of infertility services within the health systems of sub-Saharan Africa, with a specific focus on The Gambia, West Africa, and the role of Private Health Care Diagnosis in accessing these services. This quantitative research provides the first detailed examination of infertility service availability across both public and private health facilities in The Gambia, contributing to broader efforts to improve fertility care policy and practice nationwide.
Methods: A cross-sectional survey was conducted across 38 health facilities in The Gambia between March and August 2021. Utilizing Qualtrics, the survey employed closed-ended questions to gather data on service availability. The data collected from these facilities, encompassing both public and private sectors, underwent descriptive statistical analysis and t-tests using SPSS version 26 to determine the patterns in private health care diagnosis and treatment offerings.
Results: Out of the surveyed facilities, 25 (66%) reported offering infertility services. This was almost evenly split between public (13 facilities, 52%) and private (12 facilities, 47%) institutions. While basic screening tests for infertility were similarly available across both sectors, the study revealed a significant disparity in the provision of advanced diagnostic and treatment services. Notably, the majority of these specialized services were concentrated within the private health care diagnosis sector. Treatment options available, predominantly in private facilities, included: ovarian stimulation (n=16, 42%), surgical interventions such as reversal of tubal ligation or blockage (tuboplasty) (n=4, 11%), and intrauterine insemination (IUI) (n=3, 8%). Advanced Assisted Reproductive Technologies (ART) like In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) were found to be unavailable in both public and private health care diagnosis settings within The Gambia. Furthermore, the national health management information system in The Gambia lacks a dedicated framework for collecting specific data on infertility, hindering comprehensive tracking and service planning. Barriers to integrating infertility services within existing reproductive health frameworks were identified as: a lack of specialized training for healthcare providers, the absence of national guidelines for infertility management, and shortages of essential equipment, supplies, and medications across both public and private health care diagnosis sectors, though more acutely impacting public services.
Conclusions: The landscape of infertility services in The Gambia mirrors trends observed in other sub-Saharan African nations, where access is largely mediated through the private health care diagnosis sector. This reliance on private care creates substantial barriers due to cost and geographical limitations, thereby exacerbating inequalities in access to essential fertility care for all Gambians. To improve the provision of infertility services within the public sector, systematic data collection on infertility prevalence and service needs is essential. Crucially, investment in a comprehensive fertility care package within the public health system is required to ensure equitable access and reduce the current over-reliance on private health care diagnosis for these vital services.
