The Gambia is a small West African country with a population of approximately 900 000. In 1989 over half of the 48 physicians registered in the public sector were working in the country's main hospital. Nurses are thus responsible for most drug prescribing in the public health care system. At the primary care level, village health workers, most of them illiterate, are trained to prescribe a limited number of drugs.

Faced by numerous difficulties in this field the Gambia requested assistance from WHO's Drug Action Programme in reviewing the pharmaceutical sector and formulating a national drug policy. The problems identified in the private sector were related to ineffective drug legislation and regulation, resulting in an uncontrolled pharmaceutical market. The pharmaceutical supply system in the public sector was hampered by poor management and logistics, insufficient financial resources and manpower constraints. When the Essential Drugs Programme was introduced in 1984 the main objectives were to achieve regulatory control of drugs in the private sector and the availability of safe, effective and affordable drugs in the public sector. The impact and progress of the programme have been assessed. A review was conducted of the national drug policy by interviewing health authorities and examining documents issued by WHO and the Gambia. An evaluation of the Gambian essential drugs list of 1984, highlighting the therapeutic classes and level of use, included comparison with the WHO model list of 1983. A survey of the pharmaceutical supply system in the public sector dealt with:

• The general situation, with reference to manpower, functions and management;
• Specific indicators: drug financing, unit costs, drug consumption patterns, drugs listed for secondary-level facilities before and after the Essential Drugs Programme began, and the average availability of drugs;
• The situation in the private sector before and after the new drug law;
• The first year experiences of the drug revolving funds project.