End Preventable Deaths of Women and Kids in Togo

Integrate Health Hosts the Minister of Universal Health Coverage in Togo

Integrate Health (IH) was honored to host the Honorable Minister of Universal Health Coverage, Jean Marie Tessi, who was appointed in May. The Minister was promoted from a delegate minister to a full minster with oversight of community health, further cementing universal health coverage as central to the government’s priorities. In June, the Minister visited IH-supported health centers to better understand the impact of our approach and to incorporate key learnings into the national community health reform, under his purview. During the visit, the Minister acknowledged IH’s established partnership with the government and IH-supported Community Health Workers (CHWs) spoke directly with the Minister, advocating for the professionalization of their role.

At the end of his visit, the Minister made an exciting announcement to CHWs and the press. The Minister announced that the government of Togo has committed to expanding its free maternal health program, known as Wezou, to include key prenatal examinations. Women will now benefit from free ultrasound screenings, rhesus factor, and blood count tests, which have been added to the initial package of care, nationwide. This announcement represents a huge policy win that IH and partners have been advocating for since the program was launched in 2021. To learn more about the Minister’s announcement, see the Togolese press coverage of the Minister's visit here.

Togo Highlights

Successes

IH-Supported Sites Added to Wezou: In Togo, as of April 1st, the Ministry of Health has taken the significant step of including the 25 IH-supported health centers in the government's free maternal healthcare national program. Since the program launched in 2021, the government has counted on IH to continue providing free maternal healthcare through its user fee removal model. After continued discussions with the Ministry, the government has agreed to add IH-supported sites to their budget, removing the cost of essential maternal health services from IH’s expenses—approximately $116,000 in annual savings. This is a significant step in government ownership and the achievement of health for all in Togo.

Publication of COVID-19 Study: IH is pleased to share new research published in the journal Advances in Public Health! The comprehensive study evaluated the impact of COVID-19 on healthcare utilization, particularly focusing on essential maternal and child health services. Contrary to early predictions, the study revealed that the disruptions to maternal and child health services were short-lived and did not significantly impact overall service utilization. This was due, in part, to the sustained community care provided by trusted CHWs during the pandemic and the prompt use of infection control prevention measures at health centers. In addition, Togo’s proactive response to the pandemic, characterized by quick government action, extensive community engagement, and the leveraging of existing health infrastructure, played a vital role in mitigating the impact of COVID-19. Although the acute COVID-19 pandemic of 2020 is behind us, this study remains highly relevant as it highlights the importance of preparedness for future health crises. Read more about the study in this IH blog post.

Challenges

National CHW Reform Pilot: IH continues to support Togo’s Ministry of Health (MOH) in implementing the national CHW reform pilot via an embedded project manager serving as CHW reform pilot coordinator, technical assistance from other IH staff, and funding for one of the four districts (Anié) where the pilot will be implemented. Despite delays in the roll-out of the pilot program, some progress was made during the last quarter. A Monitoring and Evaluation (M&E) framework was designed, and in June and July, data collection for a baseline evaluation was conducted. The data analysis is underway, and findings will inform the M&E framework. In addition, training of CHWs is in progress. In June, 180 CHWs were trained in the Anié district on Community Case Management of Childhood Illness. Training on community-based distribution of family planning is also ongoing. The training sessions conducted so far exposed a challenge: that a significant number of the 180 CHWs do not meet requirements for the job (age, ability, etc.). IH is supporting the district to recruit more CHWs and to prioritize women in alignment with the government's objective to increase the proportion of women CHWs from 20% to 40%. Currently, only 17 out of the 180 CHWs in Anié are women.

IH also continues to support the MOH in mobilizing sufficient resources to implement the pilot program. Thanks to IH support, the Global Fund and Gavi, the Vaccine Alliance, have committed to funding the pilot, alongside IH, UNICEF, and the MOH. The MOH is still negotiating to secure government funds to contribute to the pilot. Currently, approximately 76% of the $3.6M budget for the 18-month pilot has been committed, marking significant progress towards full funding.  

Guinea Highlights

Successes

Forum on Community Health Financing: In April, IH co-hosted a national forum on community health financing in Guinea. The forum gathered 250 participants from the Ministries of Health, Administration, and Finance; technical and financial partners; and health workers. The forum’s agenda was to map financing flows to community health in an effort to coordinate sufficient and sustained funding. Representatives from Burkina Faso and Rwanda presented case studies on their experience in funding robust community health systems including salaries for CHWs. After advocacy from forum participants, the Ministry of Administration and the Ministry of Finance agreed to include Community Relay (equivalent of CHWs in Guinea) salaries in local investment plans. This is a huge step forward in securing fair pay for health workers by systematically ensuring a budget line for this essential investment. The forum was a key deliverable in IH’s Global Fund-funded grant to provide technical assistance to the government to strengthen community health funding nationwide. As a next step, IH will partner with the Ministry of Administration to pilot how to create the budget line and fund it.

Community Townhall Meetings: In April, IH held community townhall-style meetings for the first time, creating a space for community members to ask questions and provide feedback about the program to date. Five community townhall meetings were held in each of the five IH-support communities with a total of 161 participants. Community members shared their feedback on the Integrated Primary Care Program and communicated their happiness with IH providing free access to care and lifesaving referral services to patients such as pregnant women with complications. They also noted that fellow community members are beginning to get in the habit of taking their children to health centers for care. A few recommendations made during these meetings were for IH to create a plan to recruit Community Relays (CRs) in remote communities that currently do not have one (see challenge section below), IHand to consider constructing a pavilion at the Kansereya health center to keep patients cool while waiting to be seen for care.

Community Action Groups: In May, IH facilitated the formation of five Community Action Groups (CAGs) composed of approximately eight community leaders (imams, traditional healers, chiefs). The groups are tasked with endorsing CRs, giving credibility to their work, and sharing information on vaccination and other primary care topics within their communities. Through the CAG creation process, IH staff engaged with over 150 community leaders, sharing primary health educational messages and gaining buy-in for the program. This initiative meets patients where they are and speaks to IH’s mission of providing accessible health information to the communities we serve.

Challenges

Recruitment of Community Relays (CRs): Based on population estimates and geography, IH and the Kouroussa district health team determined that 150 CRs were needed to provide home-based care to IH-supported catchment areas. However, IH has struggled with recruiting CRs, and recruiting women has been particularly difficult due to socio-cultural norms about the roles of women. To date, IH supports 129 CRs in Kouroussa district. Villages that currently do not have CRs are in some of most remote locations, making the need for additional CRs even more acute. Despite engaging communities in the recruitment process, IH and MOH partners have struggled to identify community members who meet some important job requirements: live in the community to be served and demonstrate literacy in French. IH continues to work closely with communities to recruit more CRs, including more women. IH hopes to recruit 24 additional CRs in the coming months (including three replacement CRs) and is working towards meeting the goal of employing 150 CRs.

Organizational Highlights

Successes

Clinton Global Initiative: IH, Last Mile Health, Co-Impact, and the Clinton Global Initiative co-hosted a closed-door online event to discuss progress towards our Commitment to Action to integrate gender equity into community health systems. The event solicited feedback on a Global Framework for Action that is in development and will be launched at events surrounding the United Nations General Assembly in September. Please contact Chief Partnership officer Emily Bensen at ebensen@integratehealth.org if you are interested in joining the conversation.

Organizational Restructuring: IH has launched an organizational restructuring designed to position our organization for continued growth. Operating in two countries in West Africa and supported by staff spread across the globe, we are a global organization. We also maintain a strong commitment, that we have held since our founding nearly 20 years ago, to remain locally led and to continually shift resources, decision-making power, and authority closer to the communities we serve. We need a scalable structure that relies on our greatest strength: the expertise of our teammates. Read more about our new organizational structure and the critical objectives it accomplishes here.

Challenges

Departure of Assietou Diouf: As we announce an exciting new organizational restructure, we also share the bittersweet news that our Global Managing Director, Assietou Diouf, has been called by her home country, Senegal, to serve as CEO of the new national entity created following the launch of the African Vaccine Manufacturing Accelerator Initiative. We are incredibly proud of the important role Assietou will be taking on and are delighted to announce that she has agreed to join the Board of Directors of IH. In this new capacity, she will continue to serve as a mentor, advisor, and champion for our mission.

Significant progress has been achieved in the short three months of Assietou’s tenure. With Assietou’s support and contributions, we defined the vision for and launched the organizational restructure announced above. We identified high capacity in our Togo Director of Finance and announced his promotion into the role of Senior Director of Finance and Operations. We are designing a new financial report package and metrics presentation that will be piloted with senior management and the Finance Committee of the Board of Directors. Read more on the progress achieved and hear from Assietou in her own words here.

Departure of Olivier Fabre: This quarter, we also said goodbye to Business Analyst, Olivier Fabre, who transitioned to a new role with another international development organization. Olivier worked with IH for two years, analyzing financial and operational data to improve efficiencies across the organization. We wish him all the best in his future endeavors.

Community Health Worker Highlight: Djariétou Aboubakare

Djariétou Aboubakare is a CHW in the village of Koundoum, in the district of Bassar. Djariétou connects families who live far from the health center, sometimes more than 10km away, to health services. Every day, she makes rounds to households in her community, raising awareness of issues like malnutrition and promoting healthy eating practices. She also checks in on the women and children in her community. During the rainy season, when malaria is more prevalent, Djariétou increases her vigilance to ensure she detects all malaria cases. One such case was that of Keliba Amidou, a four-year-old boy. She discovered the boy ill at his home. His parents believed the illness was caused by witchcraft and had been treating him with herbal remedies. On examination, Djariétou explained to Keliba’s parents that the illness was not from a mysterious source but was acute malaria. Fortunately, the family listened to Djariétou's advice and accepted the referral to the Koundoum health center for better care. Two weeks later, Amidou was back to his full health. Djariétou is grateful for the Integrated Primary Care Program in Bassar and believes that the program, and her role in it, has helped to reduce child deaths in the area.

Financial Highlights

• This quarter, IH received generous new and renewal funding from five partners. We remain grateful for your continued support.
• IH’s Board of Directors met in May for the annual meeting. The board approved the FY25 (July 2024–June 2025) budget of $11,814,157. Board Chair Bob Heine concluded his six years of service as chair, and Nafeesa Remtilla was voted in as our new board chair. We also thanked Casey Whitsett for his many years of service as he retired from the board, and enthusiastically welcomed new Finance Committee Chair and Treasurer Marieme Niang Camara, and new Trustee Lolem Ngong.
• This quarter, a new payroll system was selected for use in Togo and Guinea. IH replaced the previous Payspace system because of usage challenges, mainly around language. The Guinea and Togo HR teams worked together to recruit a new francophone provider. The Sage payroll system has been selected and will be launched across both countries in the first quarter of FY25.  

Links:

• Integrate Health Website

Integrate Health welcomes Assietou Sylla Diouf as Global Managing Director As Integrate Health continues to grow and evolve, we find ourselves embracing new challenges and opportunities with open arms. In response to our expanding services in Guinea and our strengthened presence in Togo, the complexity of our mission has increased: Delivering high-quality healthcare and supporting national policies and implementations has never been more demanding. To meet these evolving needs with vision, authenticity, and integrity, we are thrilled to announce the appointment of Assietou Sylla Diouf as our Global Managing Director.

Assietou brings a wealth of experience and a spirit of dynamic leadership from her extensive career in the financial sector, including transformative roles at prestigious international organizations such as Gavi, the Vaccine Alliance. There, she contributed to Gavi’s objectives to enhance primary healthcare systems across more than 70 countries through innovative public-private partnerships. Her seasoned leadership also spans roles at the African Union, Barclays Bank, Crédit Agricole, and the Central Bank of West Africa, where she has proven her ability to guide diverse and geographically dispersed teams through complex financial landscapes.

In her new role with us, Assietou will focus on enhancing our operational efficiencies, defining and achieving organizational goals, and steering the execution of our strategic plan. Operating from Lomé, Togo, she will work intimately with our Country Directors and alongside our US-based CEO to ensure that our global support services are seamlessly integrated with our on-the-ground efforts, enhancing our overall impact.

“I am delighted to join a team of exceptional individuals dedicated to improving primary healthcare by pioneering an effective model anchored in community-led and integrated solutions. Coming from my role as CFO at Gavi, I’m very excited to join an organization that will take me closer to patients and communities. I look forward to leveraging my experience to further enhance the impactful healthcare programs this team delivers in Togo and Guinea.” Assietou Sylla Diouf, Global Managing Director

We are excited to welcome Assietou into the Integrate Health family. Her leadership is expected to enrich our organizational dynamics significantly and foster stronger collaboration across our teams. Together, we will continue to push forward, striving to make quality primary healthcare accessible to all.

Togo Highlights

Successes

Determinants of Mortality Study: In February, an IH-led paper, "Identifying determinants of under-five child mortality in northern Togo," was published in the Journal of Global Health. The findings highlight factors that influence higher under-five mortality rates in Togo as compared to other low- and middle-income countries. These include prior death of a sibling and access to high-quality prenatal care. We used Demographic and Health Survey (DHS) data and a World Health Organization framework in our analyses. The findings highlight intervention targets to improve child health outcomes including promoting high-quality prenatal care and paying special attention to children who have experienced a sibling death. We also found that ethnicity is a driver of under-five mortality, with some ethnic groups in Togo experiencing higher rates than others. Read more about the study here.

Community Health Worker Ambassador Program: In March, Integrate Health launched its Community Health Worker Ambassador program to strengthen leadership skills and professional development for CHWs. Thirteen CHWs, nominated as the first Ambassadors, participated in a ten-day comprehensive training that included advocacy modules created by the Community Health Impact Coalition as well as public speaking, persuasive writing, and gender equity. The training, led by in-house experts, produced enthusiastic and motivated CHWs, ready to champion their colleagues’ and communities’ interests at national, regional, and global levels. IH continues to work with the CHW advocates to provide networking opportunities with other CHWs and other professional development opportunities.

Guinea Highlights

Successes

Program Data: In February, IH’s Togo Director of Monitoring and Evaluation (M&E) as well as IH’s Senior Director of Monitoring, Evaluation, and Quality Improvement (MEQI) completed a joint trip to Guinea. The trip included site visits with Community Relays (the Guinean equivalent of CHWs in Togo), CHWs (equivalent to CHW supervisors in Togo) and Clinical Mentors to better understand the flow of data among community workers and clinic staff in the Kouroussa district. In addition, a working session was held with the Integrate Health team in Guinea to review and align the Key Performance Indicators with the DHIS2 data from the government. As a result, key programmatic indicators with targets and quarterly actuals from Guinea are included in this quarterly report alongside Togo data for the first time. (Note: The Guinea team is not yet measuring the Timeliness indicator but is planning on building functionality into the digital health solution for Community Relays [CRs] in the coming months.)

Digital Health:

Two developers form IH’s Togo team are supporting IH Guinea and Guinea’s MOH to digitize community health and immunization data collection forms for CRs. A ten-day working session was held in Guinea in March 2024, and the developers have produced a first draft of all the forms to be used in the health application. They are adapting the digital application created by IH Togo, built using the Community Health Toolkit, Medic’s open-source technology. After a two-month planning phase (April–May 2024), the developers will meet again in Guinea to present a first draft of the application. The Guinea team aims to roll out the digital tool for CRs after July 2024.

This project is an example of the close collaboration between IH’s country teams and how our expertise of nearly 20 years in Togo is informing our work in Guinea. It is also an example of how IH is able to pilot innovative solutions for potential scale-up through government, as the director of the division of community health in particular is following the project closely to assess its success and scalability.

Training of Traditional Healers: In March, Integrate Health organized a weeklong training course for traditional healers and traditional birth attendants from five communities in the Kouroussa district. Participants were trained to recognize danger signs in pregnant women and children under five, building a referral network to Community Health Workers and health centers. Engaging traditional medicine practitioners in program implementation is a longstanding component of IH’s approach in Togo and has been replicated and adapted by the Guinean team. To read more about the inclusion of traditional healers in healthcare delivery, see this blog post on the Integrate Health website.

Challenges

Vaccine Stockouts: This quarter, the Integrated Primary Care Program in Guinea faced the impacts of national stockouts of the pentavalent vaccine for children and the tetanus diphtheria vaccine for pregnant women. IH is working closely with Ministry colleagues and Gavi partners to identify both immediate and long-term solutions.

Organizational Highlights

Successes

Global Advocacy with the World Health Organization (WHO): Integrate Health is excited to have made progress with global advocacy goals as outlined in the FY24-FY28 strategic plan. The recently published WHO benchmarks for capacity building in health emergencies include feedback provided by Integrate Health via the Community Health Impact Coalition. The benchmarks include our recommendations to ensure that CHWs influence decision-making in early planning for health emergencies. In addition, the annual meeting of the WHO Civil Society Organizations Commission in March marked an important milestone for Integrate Health, who officially joined the commission in 2023. As part of the coalition, earlier this year Integrate Health contributed to the development of WHO's 2025-2028 strategy, advocating for the inclusion of professional CHWs, gender equity, and climate justice as indispensable elements of strong health systems. In 2024, Integrate Health will continue active participation in the commission as part of our efforts to amplify the voices of African women and leaders in global decision-making.

Diversity, Equity, and Inclusion (DEI) Council: Integrate Health’s Diversity, Equity, and Inclusion Council, founded in 2022, is a representative, rotating committee of staff members committed to moving DEI initiatives forward within the organization (read more here). The council’s first 10-month cohort launched a Culture Code, Statement Against Racial Injustice, and a Resource Mobilization Code of Ethics, all housed on a dedicated web page. This month, cohort 2 wrapped up their ten-month council service by launching an internal Complaints Management Committee. The committee and accompanying reporting mechanism collect and process complaints concerning fraud, corruption, abuse, and human rights violations, centering respect and confidentiality of the complainant. Improving internal reporting mechanisms was a key recommendation from our DEI consultant Dr. Angela Bruce Raeburn, and it’s exciting to see the DEI Council making significant progress in ensuring a safe, equitable, and empowering work environment for all Integrate Health team members. Cohort 3, beginning their term in May, will be tasked with continuing to operationalize the new reporting mechanism. 

Challenges

Resignations: In February, Human Resources Manager in Guinea, Moriba Traoré, resigned. Moriba joined Integrate Health in January 2023 and in his year-long tenure, recruited and onboarded a highly qualified and motivated team. We wish him the best of luck in his future endeavors. The Guinea team is updating the HR job description and began recruitment for Moriba’s replacement in March.

Electricity and Internet Connectivity: Internet connectivity and power outages in both Guinea and Togo have had a significant impact on cross-team collaboration. We’re working to identify potential solutions and getting creative on ways to continue to work together.

Male Peer Educator Highlight

Anloko Makpente is a male peer educator (MPE) and a traditional healer in the village of Sarakawa in the Kozah district. MPEs facilitate conversations in their communities to promote healthy sexual behavior and family planning.

Men like Anloko continue to be important agents of change in their communities. Anloko recalls his proudest achievement as one where he convinced a village chief who was opposed to family planning. The chief's wife, tired of giving birth multiple times, wanted to explore family planning options. Her husband refused, and Anloko was called in to mediate the resulting conflict between the couple. After a few days, Anloko was able to make the husband understand his wife’s needs. Today, the chief is one of Anloko’s supporters in raising awareness about family planning.

Anloko is proud of helping almost a hundred couples in Sarakawa acquire the knowledge they need to make informed decisions about reproductive health and birth spacing. He also involves his fellow traditional healers in awareness-raising activities in order to achieve improved maternal, newborn, and child health in his community.

"People are often surprised that I tackle these subjects. They ask me how it concerns me, that it's their private life, their married life. So, I explain to them that we're all concerned and that if someone suffers in a home, if there's an avoidable death in a house, it's the whole community that suffers. Of course, there are always naysayers, but I want to open the way, show that it's possible and that we all have a role to play. We used to do things that were pointless, and that made people suffer because we weren't well informed. But today it's different. And since Integrate Health arrived in Sarakawa, we've noticed that things are changing. In any case, in Sarakawa, our women are less and less exposed to death."

Financial Highlights

• In February, the finance team completed a mid-year evaluation of the FY24 budget resulting in a revision of the annual proposed expenditure from 11.5M to 9.4M. Major changes resulted from delays in partner programming in Togo (Saving Lives and Livelihoods vaccination program and government CHW reform pilot), unfilled positions, and reduction in planned travel. This budget revision informs the FY25 budgeting process, which began in early March.

Links:

• IH Website