End Preventable Deaths of Women and Kids in Togo

Integrate Health Gathers for All Staff Retreat

In August, Integrate Health staff joyfully reunited in Kara, Togo for an All Staff Retreat and celebration. This was the first time since 2019 that Integrate Health’s distributed team, based across the country of Togo and across the world, came together in person. The retreat was an opportunity to celebrate our achievements and reorient around Integrate Health’s values, mission, and strategy for the future. The week-long retreat included strategy sessions, cross-team meetings to foster collaboration on current projects, and site visits to observe Integrate Health-supported health centers and shadow Community Health Workers. The retreat made space for fun too—Integrate Health rented the town’s soccer stadium and hosted a staff soccer game. The players, sideline-cheerers, and spectators were equally lively.

The retreat culminated in an all-staff celebration of almost 400 people, including 200 Community Health Workers, staff from Integrate Health’s partner organization Association Espoir Pour Demain-Lidaw, and health sector and community leaders. The celebration included dancing and music, congratulatory words from the district health director and mayor’s office representative, and staff awards based on Integrate Health values. Integrate Health’s CEO, Country Director, and Human Resources Director hosted a townhall-style Q&A session where colleagues had the chance to ask organization leaders anything. The discussion ranged from salary and benefits to the future of government collaboration and country expansion.

The retreat took significant time and resources to plan, yet it was effort well spent to pause and celebrate the work accomplished in order to mobilize more energy and determination to reach our goals ahead.

PROGRAM HIGHLIGHTS

Successes

• Transfer of IPCP in Kozah: This quarter, Integrate Health reached an exciting milestone in transferring ownership of the Integrated Primary Care Program to the government in Togo. The Kozah District Health management team and Integrate Health signed an agreement to officially integrate Clinical Mentors into the district health management team. For now, these key personnel will continue to be paid by Integrate Health; however, they will be directly supervised by the District Health Director, allowing them to be fully integrated into the district team. Clinical Mentors deliver one of the four key pillars of Integrate Health’s approach, and therefore this represents a significant transfer of program implementation ownership to the district-level government.
• Research publication: In August, a new paper written by Integrate Health’s research team and faculty collaborators was published in Global Implementation Research and Applications. The paper, “A Pragmatic Approach to Qualitative Formative Evaluation of an Integrated Primary Care Program in Togo, West Africa,” describes Integrate Health’s process of collecting data through key informant interviews to inform program improvement and implementation. This is an important report that highlights the advantages of including both program implementers and stakeholders in any qualitative evaluation process. Click here to access the full paper.
• Vaccine coverage improvement: In September, a community vaccination campaign was organized at the Kpétab health center in the Dankpen district. This was as a result of a quality improvement initiative led by Integrate Health’s Monitoring, Evaluation, and Quality Improvement (MEQI) team. After a routine review of key performance indicators in Dankpen, the MEQI team discovered Kpétab had especially low vaccination rates in comparison to other health centers in the district. The Clinical Mentor at that site conducted a refresher training with health center staff focused on vaccination coverage, and the health center team carried out a community vaccination campaign, which led to an
  increase in vaccine coverage rates for children in the area from 43% in FY22 Q2 to 178% in FY22 Q4. (Note that the
  over 100% indicates children outside of the catchment area being reached with essential vaccines.)This is an example of how Integrate Health’s MEQI and program teams work together, establishing a feedback loop where data is reviewed and program weaknesses are addressed in a timely manner.

Challenges

• Construction delays: Planned renovations at the Natiponi health center in the Kéran district have been delayed because of severe damage to the road due to heavy rains. The road is under repair, and the Integrate Health team is hopeful that construction equipment and supplies will again be able to access Natiponi in the coming weeks.
• Community feedback: In July, Integrate Health participated in five community townhall meetings across the Binah district, organized by health center staff. These meetings brought together Integrate Health team members, health center staff, community leaders, women's groups, and community members. Community members thanked their nurses, midwives, and Community Health Workers for high-quality care delivery. However, they also raised some challenges they face when seeking care at the health centers, including essential medicine stockouts and poor reception and bedside manner. Community restitution meetings serve a pivotal role in ensuring that the health system is accountable to its community. The Binah district health management team and Integrate Health take this feedback from patients extremely seriously and are co-designing specific quality improvement plans to address the two issues raised.

EXPANSION HIGHLIGHTS

Successes

• MOU in Guinea: Integrate Health has officially signed a partnership agreement with the Ministry of Health (MOH) in Guinea to solve critical challenges in the implementation of the national community health strategy. Further, Integrate Health kicked off the district selection process for direct service delivery. Integrate Health and the MOH have co-developed terms of reference for the selection process, which is anticipated to be completed by January 2023.
• Wezou implementation update: Over a year ago, in August 2021, the Togolese government launched a new initiative to provide free healthcare for pregnant women across Togo. The initiative, called "Wezou," increased access to healthcare for women by removing the cost of care for many services—a key barrier to accessing lifesaving care. Integrate Health is excited to report that during the first nine months of the program, over 206,000 pregnant women have been enrolled. In addition, the Wezou program has supported close to 100,000 deliveries and subsidized more than 206,000 prenatal consultations. At the launch of the program, the government announced an envelope of $5M for program implementation and has spent close to $2M to date. This is a great step that demonstrates the Togolese government’s commitment to universal health coverage.

Challenges

• Delays in Togo expansion prep: Integrate Health is currently awaiting official authorization to begin the co-design process for government-led implementation of the Integrated Primary Care Program in a new district in the plateau region of Togo. Once official authorization is obtained, a co-design committee will be formed with a first task of district selection. Integrate Health will remain very flexible in managing timelines for this critical expansion, given the constraints of working through government. With this new district implementation, we are piloting a new approach to have implementation co-led with the Ministry of Health from the beginning. We knew that this strategy would have greater risks, given that many decisions are outside of our control. However, we believe that this approach is essential to drive our ultimate national scale goals to ensure quality primary care reaches all eight million Togolese people.

ORGANIZATIONAL HIGHLIGHTS

Successes

• Annual Report 2022 published: Integrate Health is pleased to share its 2022 Annual Report. Please explore our digital snapshot, and download the full report here.
• IH Global Support Team Renaming: This quarter, Integrate Health reflected on changing the name of our "US team" to more accurately illustrate that our teams outside of West Africa exist to support, assist, and serve with the teams based in Togo and Guinea. Integrate Health conducted an internal survey, giving all staff an opportunity to participate in the process. By an overwhelming vote, Integrate Health staff decided that the term “Global Support Team” better communicates an identity that clearly demonstrates our framework for cross-country partnership and centering the leadership of our country teams in providing strategic direction for the organization.
• Integrate Health and Togo UNGA Participation: Integrate Health was excited to join the events surrounding the UN General Assembly in New York. We are grateful to our funders and partners who made the time to meet with our team during the busy week. Togo was also well represented in New York. Integrate Health’s CEO and Chief Partnership Officer met with the Minister of Health and discussed furthering our partnership. In addition, Togo’s Foreign Minister, Robert Dussey, spoke at the UN General Assembly and stressed the importance of climate justice and equity. As part of his speech, the foreign minister said: “Africa expects more equality, respect, equity, and justice in its relations and partnerships with other powers, regardless of who they may be.” To read more about Minister Dussey’s statement, please click here. Integrate Health is committed to addressing the intersection of health and climate justice and looks forward to partnering with the government of Togo on this important initiative.
• Lightful Academy Bridger Program: For the past six months, Integrate Health’s communications team participated in the Lightful Academy's BRIDGE program, an online training with one-on-one support aimed at building skills to improve an organization’s online presence. The Lightful courses and our dedicated coach provided key insights that will inform a revamp of our organizational communications strategy, currently in development.  

FINANCIAL HIGHLIGHTS

• This quarter, Integrate Health received generous funding from two new partners and three renewed partners. We remain grateful for your continued support and are excited to be able to continue providing lifesaving primary care to communities in need in Togo and Guinea.
• In August, IH launched an international tender to support the purchase of vehicles for both Togo and Guinea. The tender process utilized procurement best practices, and eight bidders responded to the request. As a result, we were able to save approximately $40,000 (25% of the total purchase cost).
• Integrate Health continues to benefit from a strong dollar, which has appreciated by nearly 20% versus the CFA over the last year. Our finance team is exploring avenues to lock in the current exchange rate and improve management of foreign currencies in our accounting and budgeting systems.
• After many months of negotiations and waiting, Integrate Health received a letter from the Togolese Office of Taxation and Revenue confirming our Value-Added Tax exemption for projects with clear benefits to local communities. This will facilitate the importation process of needed equipment and supplies and will reduce costs for Integrate Health.