End Preventable Deaths of Women and Kids in Togo

Integrate Health Completes Four-Year Plan to Reach 200,000

In 2015, a group of Togolese women approached Integrate Health, and expressed fear that their babies were at a great risk from dying of treatable diseases like malaria, pneumonia, and diarrhea. To respond to their plea, Integrate Health launched the Integrated Primary Care Program pilot in the Kozah district, combining proactive Community Health Workers with improved care in public clinics. Over a three-year period, the Integrated Primary Care Program dramatically improved access to and quality of primary healthcare services to 40,000 people in the Kozah district. The Ministry of Health took note, and in 2018 approached Integrate Health to expand to more communities across northern Togo.

From 2018 to 2021, Integrate Health, in partnership with the Ministry of Health, implemented a four-year replication of the Integrated Primary Care Program, launching services in a new district each year. Year after year, our team worked relentlessly to replicate our approach and deliver on our four-year commitment. This month marked a momentous milestone for Integrate Health: the final district of the replication plan launched successfully in the Binah district.

As of July 2021, Integrate Health now serves a population of over 204,000 across 25 health centers in five districts. Integrate Health employs 145 Community Health Workers (92% of whom are women), all recruited from their communities to be a trusted resource for healthcare. These Community Health Workers, alongside public health center staff, care for 51,202 women and 38,197 children under-five in northern Togo, providing family planning, maternal and neonatal care, and treatment of the leading causes of death in children.

While we are taking a moment to celebrate our achievement, we are not letting up. Integrate Health is positioned to help the government of Togo achieve their commitment to Universal Health Coverage while maintaining quality and advancing equity. Integrate Health will continue to serve communities in Togo, while learning key lessons to help the government understand how to scale effective primary healthcare nationally. This moment of reflection gives us hope and inspiration to continue our work. 

The following report describes 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 or suggestions. We welcome your feedback and thank you for your support.

Program highlights

Successes

• To kick off the launch of the Integrated Primary Care Program in the Binah district, Integrate Health hosted community meetings across the seven IH-supported communities in the district. At each meeting, new Community Health Workers were presented with certificates and their backpacks full of supplies, giving community members the chance to see their new Community Health Workers in uniform. All new Community Health Workers will receive a month-long intensive supervision following the successful launch.
• Kéran district Community Health Workers received training in home-based family planning provision this quarter. The training comprised of a week-long classroom-based training followed by a month-long clinical internship at their respective health centers to solidify skills. In May, all 44 Kéran district Community Health Workers began providing oral and injectable contraceptives in their community members’ homes.

Challenges

• Peak malaria season runs from June to September in Togo. To prepare for the increase in malaria cases, the Integrate Health Operations team has been working to ensure there are sufficient commodities including malaria treatment courses and rapid diagnostic tests. Integrate Health has engaged conversations with the national pharmaceutical supplier to improve the availability of quality-assured products and ensure that the supply chain is ready for an increased caseload. To read more about the nuance of malaria season, read Integrate Health’s data series here.

Expansion Highlights

Successes

• In April, the Ministry of Health hosted community meetings in the Kozah district. As part of the ongoing plan to transition elements of the Integrated Primary Care Program to the Ministry of Health, Integrate Health attended the first ever public-sector hosted bi-annual community meeting. In preparations for the meetings, the health center head nurse developed the agenda, the District Health Director approved the plan, and the Integrate Health program team reviewed all materials. The meetings were a crucial first step in transitioning ownership of the Integrated Primary Care program to the district and regional ministry of health.
• This quarter, Integrate Health progressed on its eHealth strategy. In May, the Integrate Health eHealth team completed an internal two-week training on District Health Information Software (DHIS2), the health information system used by the Togolese Ministry of Health. After the training, Integrate Health created our own instance of DHIS2, and learned how to use the software to analyze Integrate Health data, and sync it with public sector health data. Following the successful training, Integrate Health met with officials in the Division of Health Information within the Ministry of Health. The meeting was a first step towards defining how Integrate Health can support the Ministry of Health in the development and rollout of national digital tools.

• The Ministry of Health continues to lay the groundwork for community health reforms. In June, the Ministry of Health requested assistance in researching best practices for national Community Health Worker programs and policies. Integrate Health was thrilled to support the Ministry of Health, and spent the month gathering resources and drafting case studies.

Challenges

-          Last quarter, Integrate Health facilitated the Community Health Worker Harmonization workshops with the Ministry of Health and other key partners in Togo. Although hosting the workshops was a huge step forward towards defining a national Community Health Worker definition, site visits and further workshops are paused due to COVID-19 restrictions. Integrate Health is hopeful that activities will resume in the coming months to progress on this key policy initiative.

Organizational

Successes

• This quarter, in partnership with the Gould Family Foundation, Joseph Kokou Atsou Sogbo began his role as our new Biomedical Technician. To date, he has already repaired and maintained multiple portable scales and one radiant warmer.
• This quarter, Integrate Health progressed on implementing a new payroll software, XX. Integrate Health is confident that the new software will be critical in eliminating redundancies for the Operations team and provide additional bandwidth across the team.

Challenges

-          Integrate Health is saying goodbye to our integral team member, Michelle Thompson. Michelle has served IH as Development and Communications Manager for the last two and a half years, cultivating donor relationships and professionalizing our internal systems to support our growth. As we work to bring new development team members on, please direct all development queries to Emily Bensen, Chief Partnerships Officer at ebensen@integratehealth.org. Best of luck in your future endeavors, Michelle!

Financial highlights

Successes

-          This quarter, Integrate Health received renewal funding from seven partners, and funding from one new partner.

Challenges

-          One reach application was not accepted

The community plays an important role in the success of the Integrated Primary Care Program. To launch in the Binah district, Integrate Health held over fifty meetings across the seven communities in the Binah district. Key stakeholders, clinic staff, traditional leaders, women’s groups, and community members attend computer meetings to communicate their needs and help recruit who will become healthcare providers in their communities, including Community Health Workers and Clinical Mentors. Kodabalo Tonde, the village chief of Kachira in the Binah district knows that the success of the program relies equally with the community who will use services, and Integrate Health who adapts services to fit their needs. In reflecting about the future of the Integrated Primary Care Program, Kodabalo stated on behalf of his community, “…we will take good care of this initiative.”

Links:

• Integrate Health website