Sep 15, 2021

Integrate Health Q4 (April-June 2021) Report

Q4 FY21 Metrics
Q4 FY21 Metrics

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:

May 21, 2021

Integrate Health FY21 Q3 Report

NATIONAL WORKSHOPS

lay the foundation for community health reform

 

            Universal Health Coverage is at the heart of Togo’s recently released Roadmap 2025 development plan. To achieve Universal Health Coverage, the government has committed to developing a cadre of professionalized Community Health Workers. As a first step in ensuring community health policies are equitable and sustainable, Integrate Health supported the organization of six simultaneous virtual workshops, hosted by the Togolese Ministry of Health, across every region of Togo on February 17th and 18th, 2021.

 

The workshops convened the Ministries of Health and Finance, technical and financial partners, and Community Health Workers to analyze the current community health system using the Community Health Worker Program Assessment and Improvement Matrix (CHW AIM Tool). The result was a baseline assessment of the community health system across multiple, evidence-based dimensions.

 

-       The workshops cultivated a winning coalition to drive Universal Health Coverage: The workshops were hosted by the Ministry of Health, facilitated by Integrate Health and Ministry staff, supported by the Community Health Impact Coalition, with participation from key technical and financial partners. By building buy-in from diverse stakeholders, the workshops cemented a foundation of collaboration for reform.

-       The workshops utilized a participatory approach. From the beginning, Ministry of Health officials committed to involving health practitioners across the district-, regional-, and national-levels in the assessment process. The Ministry of Health utilized videoconferencing to host concurrent sessions in all six regions of Togo.

-       The workshops employed global best practice. In preparation for the workshops, Integrate Health trained the cohort of facilitators in how to use the CHW AIM Tool to guide discussions. Each of the six concurrent sessions worked through the CHW AIM Tool to assess strengths and weaknesses of the current community health system. Using this evidence-based tool at the onset of the reform process is setting the winning coalition up for a successful implementation of future reforms.

 

The workshops demonstrated that the Ministry of Health is committed to reforming community health in Togo, and that Integrate Health is a trusted partner in the government’s journey toward Universal Health Coverage. This is just the first step in achieving a strengthened national community health system. In the coming months, participants will build upon the initial workshops by visiting three Community Health Worker programs across Togo to see diverse Community Health Worker models in action. Integrate Health will facilitate a second set of workshops building off of the baseline assessment from the first workshops and lessons learned from site visits to formulate a proposal of recommendations, emphasizing professionalized Community Health Workers.

 

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 began preparations for the Binah district launch, slated for July 2021. In January, Integrate Health staff met with the Binah District Health Director to present the Integrated Primary Care Program. Community meetings began in February, where Integrate Health staff introduced healthcare services and the selection process for new Community Health Workers. Over the next three months, Integrate Health will hire and train Community Health Workers, train public-sector health center staff, and set up supply chain and monitoring and evaluation systems in preparation for launch in July.

After a year hiatus due to COVID-19, community engagement initiatives have resumed with COVID-19 safety precautions in place. Community meetings serve as a key component of program implementation, ensuring healthcare remains accountable to patients. This quarter, IH engaged with community members in multiple ways:

-       In the Dankpen district, Integrate Health trained over 350 traditional healers on how to spot danger signs and refer patients to the health center or a Community Health Worker.

-       Additionally, in the Dankpen district, Integrate Health launched the Male Peer Educator program, training men from the community on how to talk about family planning with their peers.

-       In the Kéran and Bassar districts, Integrate Health held a series of community meetings across the districts, hosted by each canton Chief. The District Health Directors attended all meetings, demonstrating their support.

Challenges

Due to the ongoing COVID-19 pandemic, Integrate Health has decided not to collect household survey data in 2021 in order to ensure the safety of staff and community members. Given that the Phase I Research study requires annual data collection, adjustments will be made to the study design in order to capture program effectiveness. Integrate Health will share further updates on the revised plan in forthcoming reports.

Expansion Highlights

Successes

In January, the Prime Minister of Togo, Madame Victoire Tomegah Dogbé, visited an Integrate Health-supported health center in the Kozah district. Madame Dogbé said that she was was impressed with the quality of care provided though the Integrated Primary Care Program.

Vaccine rollout has officially begun in Togo. In March, 90% of all health workers across Togo were vaccinated. Community Health Workers have had the lowest relative uptake to date, with only 70% nationally receiving their vaccine. In the Kara region, where Integrate Health works, over 95% of Community Health Workers have chosen to be vaccinated. All eligible Integrate Health staff have been offered the vaccine. Integrate Health is collaborating with the Ministry of Health to support further vaccine rollout, including education campaigns to counter vaccine hesitancy and communicate the benefits of uptake.

Challenges

COVID-19 cases increased this quarter with over 100 new cases per day. With the increased transmission of COVID-19, the Ministry of Health has delayed site visits related to the Community Health Worker AIM Workshops. Integrate Health is closely monitoring COVID-19 cases in the Kara region, and working closely to support the Ministry of Health through this challenging time.

Organizational Highlights

Successes

Integrate Health is pleased to announce the release of our new website. Please take a moment to walk through the Insight Library, Impact pages, and stories throughout.

This quarter, Integrate Health completed a new three-year strategic plan, which envisions how Integrate Health can support the Ministry of Health in their Universal Health Coverage goals. Take a moment to read it here.

Integrate Health’s research paper examining the implementation and effectiveness of the Integrated Primary Care Program in the Kozah district has been accepted for publication in Pediatrics. Integrate Health will share the paper, titled “An Integrated Primary Care Initiative for Child Health in Northern Togo,” when published.

Challenges

Due to COVID-19 travel guidelines, it has been over a year since Integrate Health’s 12-member senior leadership team has been in person together. We have greatly missed the opportunity to dig into key strategic questions around the same table. To bridge this gap, this quarter Integrate Health held our first ever virtual senior leadership retreat, where we built community and worked through big organizational questions together.

Financial Highlights

Successes

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

Challenges

Two reach applications were not accepted.

CHW highlight

Atoume Atampa is a Community Health Worker in the Kéran district. When the vaccine was first available in Togo, her community heard rumors about various side effects, and many people did not want to be vaccinated. Atoume decided to lead by example and received her vaccine in March. While smiling, Atoume noted that after receiving the vaccine, community members wanted to see if she had side effects. She proudly told them no. As a trusted professional in her community, Atoume spreads facts and dispels myths and rumors about the COVID-19 vaccine. By relaying information between the health center and the community, Community Health Workers have a critical role to play in ensuring their neighbors are protected by the vaccine.

Links:

Jan 27, 2021

IH Q2 Report Oct-Dec 2020

Funding Snapshot Q2 FY2021
Funding Snapshot Q2 FY2021

INTEGRATE HEALTH SUPPORTS GOVERNMENT TO MAKE HEALTHCARE FREE

In October, the government of Togo released the Togo Roadmap 2025, an ambitious plan to prioritize health as a key pillar of national development over the coming years. To achieve this, the government of Togo is committing to universal health coverage as the central health priority. With this historic plan, reforms are promised to guarantee access to healthcare for pregnant woman, children under the age of 18, seniors, and vulnerable populations, by reinforcing Togo’s primary healthcare infrastructure, equipment, and personnel, including the creation of a cadre of professionalized Community Health Workers.

Togo Roadmap 2025 is not just aspirational. Within the first two months of publishing the plan, the Ministry of Health asked Integrate Health to assist with the mechanics of providing free care to pregnant women nationally. To date:

- Integrate Health hosted the Deputy Minister for Universal Health Access to observe program implementation including free care.
- In partnership with Financing Alliance and UNFPA, Integrate Health supported the Ministry of Health by costing different program scenarios. The work culminated in a presentation of an essential maternal health package to the senior leaders of the Ministry of Health.

- Integrate Health began a two-week pilot at six sites with the Ministry of Health to test the expansion of an electronic administration platform that could be used to register pregnant women and facilitate payments from government providers.
- The Ministry of Health has suggested free maternal care may roll out nationally in the coming month.

The government of Togo’s commitment to the outlined Togo Roadmap 2025 is a huge step forward. The commitment mirrors Integrate Health’s approach and is a reflection of years of discussion and demonstration. As the government has shown strong political will, Integrate Health is poised to support its efforts as policies are codified, implementation plans are developed, and financing is mobilized.

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.

PROGRAM HIGHLIGHTS

Successes

  • On October 14, 2020, the Integrated Primary Care program officially launched in the Kéran district of northern Togo! All 44 new Community Health Workers received intensive supervision this quarter, and the Kéran district community members have been pleased with their new access to healthcare.
  • Anita Kouvahey-Eklu, Deputy Country Director, trained ten Integrate Health Clinical Mentors and Community Health Worker Supervisors in adult learning theory in December. The five-day training covered topics including creating a positive learning environment, evaluating skill levels, and using audiovisual support. This training was a key effort in ensuring that mentors and supervisors have the tools and skills they need to support frontline health workers in delivering high-quality care.
  • This quarter, the District Health Department conducted end-of-the-year personnel evaluations as part of the Integrated Primary Care Program. Having the evaluations be conducted by local government staff was critical to not only strengthen the collaboration between the district government and Integrate Health, but also to serve as a step in the continuation of handing over program components to the Ministry of Health.

Challenges

  • Integrate Health launched a pilot of the mHealth application, ThinkMD, in October to 68 Community Health Workers in the Bassar and Dankpen districts. After the pilot launched, Integrate Health experienced difficulties with real-time data collection in rural communities. Integrate Health and ThinkMD are troubleshooting various challenges and hope to resolve all issues over the coming months.

EXPANSION HIGHLIGHTS

Successes

  • In December, Integrate Health hosted a press conference in Lomé, focused on the COVID-19 Action Fund for Africa personal protective equipment distribution and Integrate Health’s COVID-19 assistance to the Ministry of Health. The press conference was successful with national news coverage and support from the Ministry of Health and WHO.
  • Integrate Health began a collaboration with UNICEF and the Ministry of Health in the Bassar district. As a result of the collaboration, professional Community Health Workers will support UNICEF’s Child Friendly Communities initiative and assist volunteer Community Health Workers in creating a population registry and coordinating care for pregnant women and children under- five. This will be a great learning opportunity for Integrate Health and partners.

Challenges

  • The Quality Assurance Manager, a dual-hire role serving as part of both the Integrate Health and Ministry of Health teams, began a six-month leave in November to pursue continued education. A newly hired, Community Coordinator, will help to backfill this position during the Quality Assurance Manager’s leave.

ORGANIZATIONAL HIGHLIGHTS

Successes

  • After months of recruitment, Integrate Health has officially launched a Research Advisory Board Committee, which includes two Togolese researchers. The committee will guide the Integrate Health research team and will assist in answering key research questions.
  • This quarter, Integrate Health filled two critical positions: Digital Health Manager and Resource Mobilization Officer. Dawkin’s Kamara joins the Integrate Health team as the new Digital Health Manager, and Lucien Lia as the Resource Mobilization Officer. Both positions are based in Lomé and will support Integrate Health and the Ministry of Health’s joint efforts.

Challenges

  • Recruitment has taken longer than anticipated over the last year. The amount of work to accomplish on both daily implementation and strategic levels has grown to be too large for one Human Resource Manager. To increase capacity and efficiency, last quarter Integrate Health hired a Human Resource Assistant. This quarter, Integrate Health has opened recruitment for a senior-level Human Resource Director.

FINANCIAL HIGHLIGHTS

Successes

  • This quarter, Integrate Health received renewal funding from nine partners, and new funding from one new partner.

Challenges

  • One reach application was not accepted.

 

CHW Profile: Meet Mariette

Over the last few years, Mariette was a seamstress and a farmer, struggling to provide for herself and her family. Although she could not pay school fees, Mariette worked hard to ensure her children were taken care of. When Integrate Health posted the Community Health Worker job in her community in the Kéran district, Mariette was the first person to write her name down. After excelling in the interviews and trainings, Mariette officially passed the Community Health Worker test and began providing care in October in her community. For the first time, Mariette receives a monthly salary. With her first two months of salary, Mariette’s children have started school again, outfitted with new school supplies and dresses. When asked how she feels that her children are back in school, Mariette said, “in the past, I could not have imagined that myself, but I did it, and it is such a pride for me.” By employing mostly women as Community Health Workers, Integrate Health has watched communities transform with high quality healthcare and Community Health Workers reinvesting in their communities.

Links:

 
WARNING: Javascript is currently disabled or is not available in your browser. GlobalGiving makes extensive use of Javascript and will not function properly with Javascript disabled. Please enable Javascript and refresh this page.