End Preventable Deaths of Women and Kids in Togo

As COVID-19 brought the global economy to a halt, the team at Integrate Health ratcheted up their efforts. In early March, as the first case was detected in Togo, the team rapidly and seamlessly pivoted to emergency response mode, proactively procuring personal protective equipment and other essential supplies, conducting facility readiness assessments, and communicating directly and regularly with the community, through multiple channels and in local languages, to disseminate timely and accurate health information.

As cases have continued to climb in Togo slowly but steadily, the team has pivoted again, accepting that the COVID-19 pandemic will be present in Togo for the foreseeable future. As a result, the team has redesigned both pandemic response and routine service delivery activities to permit all activities to continue under new social distancing and infection control guidelines. Trainings continue, redesigned and delivered in new ways. Procurement of personal protective equipment and supplies is now routine and ongoing. Most importantly, all health service delivery, both in health centers and by Community Health Workers, continues. Integrate Health is committed to doing everything we can to minimize disruptions to routine primary healthcare as the pandemic endures. As a result, we are proceeding with expansion plans and are on track to expand to serve an additional 39,531 people through five health centers and their communities in the Kéran district beginning in October 2020. Strong primary healthcare is now more important then ever.

The following report describes progress made over the past three months in Integrate Health’s pandemic response and routine primary care activities, including successes and challenges as well as outputs, outcomes, and funding metrics. Please let us know if you have any questions or suggestions. We welcome your feedback and thank you for your support.

Program Highlights

Successes

-        This quarter, Integrate Health was able to procure an initial order of personal protective equipment (PPE) to equip Community Health Workers and health center staff, as well as critical equipment such as isolation tents, hand washing stations, and ventilators. While Integrate Health Community Health Workers have always used gloves and hand sanitizer, Integrate Health procured surgical masks and face shields, including some made in Togo, per COVID-19 protocols.

• To further support Community Health Workers who are on the frontline of the pandemic, Integrate Health offered all Community Health Workers the option to opt out with full paid leave for any reason. All 95 Community Health Workers elected to continue working. Additionally, the team collaborated with the Ministry of Health to organize stress management training for Community Health Workers. This training, led by mental health professionals, covered topics including how to identify signs of stress, understand stress, and manage stress. Furthermore, Community Health Workers were trained on the use of infrared thermometers to permit temperatures to be taken with no-touch protocols.

Challenges

-        Integrate Health is learning how to adapt to new conditions created by COVID-19. Because of social gathering restrictions, Integrate Health had to postpone biannual community meetings indefinitely. We are exploring alternate ways to secure community feedback. To continue Community Health Worker and health center provider training, Integrate Health has redesigned trainings for smaller groups, supplemented by clinical practicum. Although this adaptation enables training to continue, it will now take longer to complete due to the restrictions on number of participants.

Expansion Highlights

Successes

-        During this quarter, Integrate Health, with the support of our partners from the Ministry of Health, Construction for Change, and the 30/30 Project, completed renovation of four health centers in the Bassar district. Newly equipped with essentials like running water and electricity, these buildings now reflect the dignity of the patients and care afforded inside their walls.

-        Integrate Health Country Director, Christophe Sesso Gbeleou, and Integrate Health Board Member, Dr. Meskerem Grunitzky Bekele, were invited to meet with the Minister of Health in Lomé. The Minister expressed his appreciation for Integrate Health’s support of the Ministry’s COVID-19 response and reiterated his commitment to ongoing work to optimize Togo's Community Health Program and strengthen the delivery of primary healthcare nationwide. 

-         The Ministry of Health's Director of Maternal and Child Health conducted a very productive visit to Integrate Health-supported sites in June to learn about Integrate Health’s approach. This visit, which included detailed presentations on Integrate Health's Costing and national Investment Case projections, will support the Director's ongoing work to inform national policy. 

Challenges

-        Integrate Health made the difficult choice to delay the planned expansion into the Kéran district from July to a tentative date of October 2020. In May, as national restrictions were eased, Integrate Health proceeded with preparation activities under new guidelines to respect social distancing and limit the size of in-person gatherings. In June, all CHW candidates underwent screening exams, and the top 50 CHW candidates were presented to village chiefs (via photos on a tablet) in partnership with Kéran district health officials.

Organizational Highlights

Successes

• Integrate Health is pleased to announce that Anita Kouvahey-Eklu has joined Integrate Health as Deputy Country Director, based in Lomé. Anita brings extensive experience from a long career with the Ministry of Health and other NGOs across Togo, including most recently overseeing the national Community-Based Family Planning Program of ATBEF (local affiliate of International Planned Parenthood Federation).

-        This quarter, Integrate Health made exciting progress on a large-scale effort to strengthen data management systems. The first step has included revising and updating all key performance indicators to ensure alignment with Ministry of Health definitions and calculation methodology. Integrate Health completed a review of all existing Integrate Health and national Ministry of Health indicators and finalized an updated and aligned indicator list to be implemented in July 2020.

Challenges

-        In May, Integrate Health was the victim of a phishing scam. After being alerted to the scam, Integrate Health worked with a technology consultant to strengthen internal email, technology, and communication systems. All employees have completed a professional training to enhance cybersecurity moving forward. 

Financial Highlights

Successes

-        This quarter, Integrate Health received COVID-19 funding from ten existing partners, renewal funding from five existing partners, and new funding from one partner.

Challenges

-        An application to USAID Development Innovation Ventures was not accepted this quarter.

Funding Snapshot:

Three-year funding Need

$24M

FY20 Projected Expenses

$6M

Current Funding Runway

9 Months (6 months operating + 3 months reserve)

Spotlight

Nika bikes to work every morning as one of the two Community Health Worker Supervisors in the Bassar district. As a Supervisor, Nika oversees and supports 19 Community Health Workers. In his role, he helps to reinforce the link between the health center staff and Community Health Workers. This role has become even more vital with the introduction of COVID-19 in Togo; Nika now supports Community Health Workers as they refocus to ensure the community learns about and understands COVID-19 prevention. Although his priorities have shifted with the COVID-19 pandemic, Nika is learning how to cope. Nika reflected on the recent Integrate Health stress management training, organized in collaboration with the Ministry of Health Regional Health Director. He said, “I was inspired by Community Health Workers, Supervisors, Clinical Mentors, Head Nurses, and Maternity Officers coming together to learn about stress management. It was a very important training and has helped us cope with every situation we come across and how to manage our stress.” Nika is motivated to continue his important role in bringing together Community Health Workers and health center staff, especially now during this critical time.

Links:

• Integrate Health website