The Vital Signs Profile (VSP) exercise provides an opportunity to assess the state of the primary care system in The Gambia. This report presents the findings of the VSP exercise conducted by the Primary Health Care Performance Initiative (PHCPI) of the WB in collaboration with The Gambia Ministry of Health (MOH). The assessment highlights areas of strength and challenges through the lens of the PHCPI framework, which organizes five domains of primary care service through a logic model approach. The PHCPI methodology encompasses the traditional inputs and outputs of primary care systems but also places a strong focus on the processes of service delivery and performance of the primary health care (PHC) system (1). PHCPI recognises the role of social determinants of health and intersectoral health promotion and prevention efforts as chief factors influencing population health, although the VSP is primarily focused on aspects of health service delivery. Although The Gambia’s PHC system has experienced significant improvements, many challenges persist. Geographic and financial access to care is a persistent problem for the population, as 26 percent of women face barriers to receiving care when in need because of distance, and 27 percent face barriers due to a lack of funds (2). These barriers are greater for more vulnerable populations as evidenced by large disparities in access to services by wealth quintile: forty-six percent of women in the lowest wealth quintile report facing financial barriers to access compared to only 13 percent of women in the highest wealth quintile. Barriers to accessing PHC are compounded by gaps in coverage for infectious disease, reproductive, maternal, newborn, and child health (RMNCH), and noncommunicable disease (NCD) services, despite significant improvements in coverage indicators from 2013–2020. Notably, for infectious diseases, the percentage of TB cases detected and treated with success declined by 12 percentage points from 62 percent in 2013 to 50 percent in 2019. Other declines in infectious diseases include a 15-percentage point decrease in children under 5 with diarrhea receiving ORS, while the percent of people living with HIV receiving anti-retroviral treatment and the population sleeping under 11 Executive Summary