Physical Health Togo Project #22946

End Preventable Deaths of Women and Kids in Togo

by Integrate Health

Project Report | Jun 8, 2020
Integrate Health Q3 Impact Report Jan-March 2020

By Jennifer Schechter | CEO

Output Metrics

On January 21, 2020, The World Health Organization indicated that the novel coronavirus was being spread by human-to-human transmission. On March 6, 2020, the first case reached Togo. In response, Integrate Health has taken aggressive and proactive action in an effort to minimize the spread of the virus, while ensuring continuity of primary healthcare and in turn, lessening the impact of the virus in our communities.

As a leading healthcare organization in Togo, it is essential that Integrate Health protect its employees while also working to continue to provide high-quality healthcare to our patients. COVID-19 presents opportunities to demonstrate how Community Health Workers are an essential part of the health system, especially when it is stressed. Integrate Health is deepening our relationship with the government by operating as a responsible partner in support of Ministry of Health efforts, coordinating closely with other technical partners, demonstrating how Community Health Workers can contribute to fighting a pandemic, and modeling how we can strengthen the resiliency of clinics to take on COVID-19 while continuing to fight the major killers in Togo. An effective implementation of our pandemic response is a strategic imperative as well as an opportunity to accelerate and amplifying our goal to strengthen the national primary health system across Togo.

The following report describes additional progress made over the past three months, including successes and challenges, as well as outputs, outcomes, and funding metrics. Please let us know if you have any questions. Thank you for your support.

Successes

After the arrival of COVID-19 in Togo, Integrate Health quickly equipped Community Health Workers with key messaging from The World Health Organization, to disseminate in their communities as a part of communication efforts to dispel rumors and misinformation, and to educate households on the prevention of COVID-19.
In March, Integrate Health placed an immediate, initial order of PPE and infrared thermometers for all Community Health Workers and clinic staff, as well as purchased essential health center equipment. All Community Health Workers already used gloves and hand sanitizer per existing protocols but were quickly equipped with masks for additional protection.

Challenges

With 301 confirmed cases of COVID-19 as of May 18, 2020 and this number consistently growing, IH has postponed the Integrated Primary Care program launch in the Kéran district, originally scheduled for July 2020. IH has developed a revised implementation plan incorporating necessary changes to comply with social distancing mandates in Togo. This revised plan aims for an early October launch date. IH will continue to reassess and revise this plan as necessary, as the situation is still rapidly evolving in Togo.

Expansion Highlights
Successes

In February, a partnership agreement was signed to formalize a research collaboration between Integrate Health, the Ministry of Health, and the Togolese National Research Institute, INSEED. This agreement will formally engage the three parties in Integrate Health research activities including sharing best practices and learning opportunities, as well as provide an external review of research activities in line with national practices for research in Togo.
Since March, Integrate Health has participated in the Ministry of Health’s COVID-19 rapid response task force, which meets twice weekly with key Ministry officials and other partners (UNICEF, GIZ, WHO). In response to our own estimation of needs and detailed requests received from the national and regional Ministry of Health, Integrate Health has procured and is actively working to continue to procure critical equipment and supplies including personal protective equipment.

Challenges

Two important activities planned by the Ministry of Health with support from Integrate Health have been postponed to respect social distancing guidelines. The Mid-Term Review of the National Health Development Plan and the workshop series to utilize the Community Health Worker AIM tool will resume when possible. Planning continues for both activities, which are an important source of collaboration between the Ministry of Health and Integrate Health.

Organizational Highlights

Successes

In January, Integrate Health continued making critical updates to data systems, including developing a new indicator framework, automating data preparation, and improving tools used by Community Health Workers. This comprehensive plan will further align data systems with the Ministry of Health while driving quality improvement. Read more about this exciting work in our latest Medium data series!
Integrate Health is pleased to announce two new team members; Amanda Wheeler Singer, Integrate Health’s new Director of Research and Sahaletou Yelebo Marie, the Development and Operations Assistant.
Integrate Health continues to manage close collaboration with global partners and co-authored a position paper with the Community Health Impact Coalition, “Priorities for the Global COVID-19 Response”.

Challenges

Unfortunately, due to the uncertainty of the COVID-19 pandemic, Integrate Health evacuated most expat staff in the beginning of March, prior to Togo suspending all air travel. All staff across the US and Togo are working remotely until further notice.

Financial Highlights

Successes

This quarter, Integrate Health received one new grant opportunity and one renewal opportunity from an existing partner.

CHW Profile:

Essodam Patawalo, an Integrate Health Community Health Worker in the Bassar district, was recently asked about how her work has changed since COVID-19. She said, “Since community meetings are not allowed, we no longer have the opportunity to bring people together to hold educational talks to tell them about this pandemic, so we are doing door-to-door outreach to talk to people in the community about prevention measures to avoid the spread of the virus. This is a big job in addition to our usual work. But we're trying as much as we can to get it done. We make sure that mothers and children always have access to care and to the information and practices necessary for their well-being. We therefore take every opportunity to better explain to them the hygiene precautions and measures necessary to prevent the spread of this virus.” When asked what advice she would give to her fellow Community Health Workers, Patawalo responded: “The work we do in the field is great and noble. And it is time for us to take on a great challenge in front of our people, our country, and the world that is watching us.”

Funding Snapshot Q3 2020

Links:

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Feb 10, 2020
Integrate Health Q2 Impact Report (Oct-Dec 2019)

By Jennifer Schechter | CEO

Funing Snapshot FY20 Q2

Program Highlights

Successes

- This quarter 33 Community Health Workers from the Dankpen district were newly trained in family planning. With the aim of transitioning program implementation to local ownership, for the first time this training was led by the District Health Office of the Ministry of Health with the Integrate Health program team providing support. Following the training, the Community Health Workers completed a month-long internship under the supervision of healthcare providers at each health center. Integrate Health was pleased with the success of the training and plans to incorporate these changes into all trainings moving forward.

- Renovations of four clinics in the Bassar district began, in partnership with Construction for Change and the 30/30 Project. The Construction for Change team alongside engineers from the Ministry of Health, visited each site to solidify construction plans. After hiring a contractor, the construction officially launched across all sites in December.

Challenges

- Integrate Health has noticed a high rate of home-based deliveries since launching in the Dankpen district in July 2019. Upon investigation, the program team discovered that to visit the clinics, pregnant women needed to cross a river, that by traditional customs is thought to cause harm to pregnant women. To address this concern, Integrate Health trained Community Health Workers, in partnership with health center staff and community leaders, to share key messages with pregnant women and their partners to help explain the risk of home-based deliveries. We are exploring additional options to make the journey easier.

Expansion Highlights
Successes

- The Togolese Ministry of Health (MOH) validated a new National Health Quality Assurance Policy in November. A few weeks later Dr. Baba, Director of Health Facilities within the MOH, conducted a site visit to Kara to learn about Integrate Health’s clinical mentorship approach and explore adaptation of this approach and the tools used for quality assurance. Integrate Health continues to support the Ministry of Health on development of the implementation plan for the new national policy.

- Integrate Health is pleased to announce that the Kéran district was randomly selected to be the next district for implementation of the expansion of the Integrated Primary Care Program! The Integrate Health program team will now begin preparations for a July 2020 program launch in the Kéran district, which will bring the total population served to 200,000 across 18 clinics with 142 Community Health Workers.

Challenges

The Togolese Ministry of Health is currently supporting multiple mHealth pilots with various funders and partners that use competing technologies. Integrate Health is working to understand the vision of the Ministry of Health and its partners. We hope to help facilitate a process where the mHealth strategy and tool selection is clearly articulated. We will align our efforts in the mHealth space with that of the Ministry of Health and key partners.

Organizational Highlights

Successes

- The 2018 990 and Independent Financial Audit of Integrate Health have been finalized. The auditors found no weaknesses or deficiencies, and only noted a few observations for improvement. Integrate Health’s CEO, COO, and Finance Manager will address any observations immediately.

- Integrate Health published a protocol manuscript for its Phase Two study in the journal Implementation Science. Entitled “Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol,” this study will generate knowledge to improve delivery of high-quality healthcare services to our current population of over 140,000 in northern Togo and ultimately help inform national-scale strategies.

- This quarter, Integrate Health is happy to welcome two new team members: a new Communications Associate (US) and MEQI Associate (Togo). Integrate Health is still recruiting for a Deputy Country Director and Logistics Assistant, both to be based in Togo.

Challenges

- Although 70% of Integrate Health staff are women, it has been difficult to improve recruitment of women for in-country positions, especially senior positions. Integrate Health is working on a strategy to address this challenge and hopes to be able to both recruit and promote more women into leadership positions.

Financial Highlights

Successes

- Integrate Health received renewal funding from 13 existing partners, new funding from two partners, and has pending applications for three new funding partners this quarter.

Challenges

- An application to Conservation, Food, and Health Foundation was not accepted.

Patient Profile:

Bidipoumè, a Dankpen Community Health Worker, was conducting home visits when she met Bilere, a 20-year-old pregnant woman. Bilere, was nearly full term, and could not stand due to pains she felt in her ribs and chest. Bidipoumè expressed the importance of visiting the health center, and Bilere agreed. On the following day, Bidipoumè visited Bilere, and realized she did not go to the health center. Concerned for her health, Bidipoumè decided to bring her to the clinic herself. After they arrived together at the health center, Bilere was diagnosed with anemia, which was successfully treated. Bilere decided to deliver her baby at the health center, and on December 27^th, she gave birth to a healthy baby. After her delivery, she called her Community Health Worker, Bidipoumè, and was thankful for the knowledge and care provided. Proactive case visits and regular follow up by Community Health Workers, integrated with improved care at health centers, help ensure women like Bilere receive the care they need and deserve.

Links:

Integrate Health website

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Nov 13, 2019
Integrate Health Q1 Impact Report (July - Sept 2019)

By Jennifer Schechter | CEO

Funding Snapshot

Integrate Health Launches in Third District

Integrate Health’s Integrated Primary Care Program launched in four clinics and their surrounding communities in the Dankpen district on July 8^th. With this expansion, Integrate Health’s Integrate Primary Care Program, implemented in partnership with the Ministry of Health, now serves a total population of over 142,000 in 13 clinics with 95 Community Health Workers across three districts. Within the last two months, all 33 new Community Health Workers in the Dankpen district successfully completed four weeks of intensive supervision from Integrate Health staff and have been providing high-quality, proactive care to their communities. Integrate Health is pleased to have received extremely positive feedback on program deployment and quality of services in the first few months in this new district. The launch of services in the Dankpen district marks the halfway point of Integrate Health’s planned four-year expansion to serve a population of 240,000 over five districts in northern Togo by 2021.

Program Highlights

Successes

1. Community Health Workers in the Kozah district have gone paperless! We are excited to announce that our Community Health Workers in all pilot sites have stopped using paper backup and use only the smart phone application co-designed with Medic Mobile. Our team will assess all data from October to December and will use this experience to inform a scale-up of mobile tools to other districts planned for 2020.

2. The Integrate Health program team held bi-annual community town hall meetings in the Bassar district in September. During the meetings, Integrate Health staff discussed program results from the last six months, addressed community feedback, and celebrated recent successes. Over 100 community members and stakeholders were present at each meeting, including clinic staff, Ministry of Health representatives, and village chiefs. During the meetings, chiefs expressed their gratitude for the Integrated Primary Care Program, and the District Health Director reiterated the Ministry of Health’s commitment to this program and partnership.

Challenges

1. In August, the Community Health Worker Supervisor in the Kozah district and the Clinical Mentor in the Dankpen district were recruited to join the public sector through an annual recruitment process. Both decided to leave Integrate Health to work within the government system. While sad to lose talented staff, Integrate Health is pleased to contribute to training strong public sector employees. Although new candidates were hired in September, some activities were postponed to afford new staff adequate time to be properly trained.

Expansion Highlights
Successes

1. Integrate Health was proud to join Togo’s Minister of Health, Dr. Moustafa Mijiyawa, and the Director-General of the Ministry of Health, Dr. Bertrand Beweli, in NYC for events around the UN General Assembly in September. Both Minister Mijiyawa and Dr. Beweli had the opportunity to meet with Integrate Health partners and learn from their experiences scaling professional Community Health Worker programs in other West African countries. The Minister and Dr. Beweli have pledged to continue these action-oriented conversations in Togo.

2. In September, Integrate Health embedded a new position, Quality Assurance Officer, in the Regional Health Management team to oversee ongoing implementation of the Integrated Primary Care Program. Reporting directly to the Regional Health Director, this position is designed to accelerate integration and facilitate local ownership of program implementation.

Challenges

1. In the first few months of launching services in the Dankpen district, Integrate Health staff have noticed that the new district has higher levels of under-five malnutrition compared to other districts. Furthermore, due to the rainy season and rough terrain in the Dankpen district, there have been transportation problems in getting severe malnutrition cases to the hospital. The Integrate Health program team is analyzing the possibility of expanding the rural ambulance program, while the Community Health Workers will be attentive to follow up on all malnutrition cases.

Organizational Highlights

Successes

The Integrate Health operations and HR staff rolled out two new exciting organizational tools this quarter. First, all staff have completed the new performance management system adapted from our friends at Last Mile Health, which includes annual goal setting, updated performance plans, and professional development. Second, the Integrate Health finance team has created an internal finance manual with updated policies and procedures. Both tools will be guides and resources for Integrate Health operations.

Challenges

Analysis of the data collected through Integrate Health’s repeated cross-sectional study is behind schedule. To address this challenge, Integrate Health has contracted a researcher to conduct the analysis and has opened recruitment for a new full-time position: Deputy Director of the Community Health Systems Lab . Integrate Health hopes that the analysis will be complete by the end of the calendar year.

Financial Highlights

Successes

1. Integrate Health received renewal funding from two existing partners and has submitted applications to two new funding partners this quarter.

Challenges

1. An application to USAID Health Systems Prize for $25,000 was not accepted.

Quarter 1 metrics

Links:

IH Website

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