How The Gambia’s Only Teaching Hospital Became a Cashbox for Its Managers.
For half a century, the Edward Francis Small Teaching Hospital (EFSTH) has stood at the heart of The Gambia’s public health system. In this place, people experiencing poverty seek care, where students learn to heal, and where public money was intended to save lives.
However, the National Audit Office (NAO) Management Letter, April 2024, reveals that the same hospital, meant to heal the nation, has itself become a patient, bleeding from within.
Between 2021 and 2024, millions of dalasis meant for wards, drugs, and salaries were converted into rent refunds, allowances, and favours for insiders.
The Setting: A Hospital on Life Support
EFSTH is the country’s sole teaching hospital, the training ground for doctors and nurses, and the last referral point for the poor.
Yet its financial records read like a corporate crime novel: falsified allowances, personal rent payments, ghost workers, and collusion between management, with missing drugs (medications), tickets, and suppliers, among other irregularities.
Auditors began their report with a warning few citizens have seen in official language:
“The audit identified suspected fraudulent activities within the operations of EFSTH… Funds were used for personal purposes by senior management.” NAO EFSTH Management Letter 2024, p. 6
The CMD’s House of Rents — Finding 3.8
At the centre is Dr MHD Ammar Al Jafari, the then Chief Medical Director.
Audit records show repeated payments made in his name for “rent refunds” and “CMD apartment rental fees.”
The table lists transactions such as:
• “Ammar Aljafari — refund of two-month rental fees for CMD apartment … D15 000”
• “MHD Ammar Al Jafari — monthly rental fee for February 2023 … D15 000”
• “Adama Mbye — refund of payment of house rent for Dr Muhammed Al Jafari … D20 000”
These payments continued for months, totalling D648 000.
The catch? The CMD was already living in a hospital-funded residence.
EFSTH was literally paying its own head to occupy its own property, with no approval from the Ministry of Health or the Board.
“The CMD continued to draw rental allowances while occupying accommodation fully funded by EFSTH.” — Finding 3.8
The then Finance Director, Lamin Ceesay, processed these transactions without supporting documents or ministerial clearance, thereby breaching the Public Finance Act 2014 directly.
Finding 3.1 — Allowances for the Unqualified
Elsewhere in the books, the audit found D1.8 million paid as “Call Allowance” to non-medical staff, including drivers, clerks, typists, and procurement officers.
Among them was Nyima Jatta, the then Senior Procurement Officer, who received D120,000 as a “Call Allowance,” even though she was never on any medical duty roster.
Over a dozen other administrative staff benefited the same way.
The Auditor General summed it up bluntly:
“Call allowances amounting to GMD 1 805 500 were paid to unqualified staff without due process.” Finding 3.1
This was money intended for surgeons and nurses who work through the night, not for office staff on day shifts.
A Pattern of Collusion
The findings suggest a coordinated scheme: the CMD authorises, the Finance Director pays, the Procurement Officer benefits.
Together, they turned EFSTH into an ATM for insiders.
In total, over D2.4 million was lost through rent and fake allowances between 2021 and 2023 alone.
The Auditor General recommended that the Ministry of Health and the Inspector General of Police launch an immediate investigation and recover all funds from the officers named.
Months later, no public action has been reported.
The Laws They Violated
• Public Finance Act 2014 §§ 43 & 46 — failure to safeguard public resources
• Public Procurement Act 2022 § 52 — conflict of interest in payments and approvals
• 1997 Constitution § 222 — breach of public trust and duty of honesty
The People’s Questions for FPAC & the Ministry of Health
- Why was Dr Ammar Al Jafari collecting rent while living in a hospital house?
- Why did the then Finance Director, Lamin Ceesay, authorise these payments without approval?
- Why was Nyima Jatta paid D120 000 as a medical call officer?
- Where was the Board of Governors when these frauds occurred?
- When will Parliament debate and act on this audit report?
The People’s Verdict
A hospital that cannot heal its own corruption cannot cure its patients.
When those entrusted to save lives choose to save their pockets instead, every citizen becomes the patient.
Until every dalasi is recovered and every official faces justice,
Edward Francis Small Teaching Hospital remains a monument to impunity, not to medicine.
By Jallow Modou, Washington D.C.
Financial Analyst | Making the Audit Speak for the People.
