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.
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.
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.
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.
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.
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.
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.
This quarter, Integrate Health received renewal funding from three partners, and funding from one new partner.
Two reach applications were not accepted.
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.