End Preventable Deaths of Women and Kids in Togo

Strengthening Local Government Investments in Community Health: Ma Belle Commune

While Guinea has a strong community health policy in place and the Ministry of Health (MOH) funds core functions including supply chain and health center infrastructure, many Community Health Workers (CHWs) remain unpaid. In 2025, IH tested a new approach in ten municipalities to unlock funding for CHWs at the local level through mayors. All ten mayors committed to paying CHW salaries from their local development budgets in 2026.

“We thought CHW management was only for the State or NGO. Today, we understand it is first our responsibility, because our people benefit from it” - Mayor of Damankania, Guinea

Building on this success, Integrate Health (IH) launched a new initiative in Guinea and Togo this quarter called My Beautiful Municipality (Ma Belle Commune), which leverages local governments to sustainably fund CHW salaries. While continuing to support the original ten mayors in Guinea’s Kindia and Mamou regions to effectively pay their CHWs, IH expanded this work to four municipalities in Kozah, Togo (the first district where IH launched primary care in 2015) and to seven municipalities in Kouroussa, Guinea, where the Integrated Primary Care Program (IPCP) is implemented.

In January 2026, IH and Guinea’s Maférinyah Research Center completed a baseline evaluation in seven Kouroussa district municipalities that identified gaps which IH will work to address. For example, despite a legal mandate for municipalities to allocate 15% of their budgets to health,most communes currently lack dedicated budget lines for community health and face significant gaps in financial monitoring capacity. To address this, IH will train municipal leaders on how to build investment cases for the Ministry of Territorial Administration (MATD), the national-level entity that manages local development. These investment cases will help secure systematic and sustainable funding for CHW salaries in local budgets.

In March 2026, the mayors of the four Kozah municipalities in Togo, Kozah’s Director of Health, a representative of the Kara Regional MOH, and village chiefs visited four sites to see CHWs’ work in action. These visits pave the way for institutional support of including CHW salaries in municipal budgets.

In April 2026, several members of IH's executive team met with Togo's Minister of MATD in charge of local development. The Minister welcomed the initiative and committed to championing it among the council of ministers. These visits demonstrate significant commitment to the initiative at both national and local levels. IH will document and share learnings across both countries.

IH’s ambition is to see all government CHWs paid fairly and consistently for their work so that they can provide lifesaving healthcare with dignity. Over the next three years, IH’s objectives for the 21 municipalities in Ma Belle Commune are: (i) community health activities are included in local development plans, (ii) CHW salaries are included in municipality annual operating budgets, (iii) municipality budgets increase due to mayors’ improved ability to mobilize local financial resources, and (iv) access to quality primary care for women of reproductive age and children under five increases by 10%.

Togo Highlights

Success

CHW Ambassadors Amplify Their Message

In February 2026, CHW Ambassadors across Togo's Kara region went on local radio to raise awareness about their work in the community and to build trust in the health system. Thirteen CHW Ambassadors were trained to discuss health topics such as childhood vaccination schedules and the importance of seeking treatment as soon as possible when a child is sick. The initiative is now being rolled out across five districts and eight local radio stations.

Afi Kpaba, a CHW from Sarakawa in the Kozah district, is one of the ambassadors. For years, she has been a trusted presence in her community through supporting neighbors, sitting with mothers, and guiding families to care. Afi was able to share her message in Kabyè on Al Safar community radio, explaining what CHWs do, why early consultations matter, and why families should trust the health system.

"When I speak on the radio, I think about the mothers I meet every day. If my message can help even one family act in time, then it is worth it." — Afi Kpaba, CHW

From speaking door-to-door to reaching hundreds of households on the airwaves in minutes, CHWs are providing a powerful example of leading advocacy in their own communities and in their own language.

Challenge

Addressing Gender Inequality by Scaling Gender-Transformational Primary Healthcare

Gender inequality in the workplace and gender-based violence are challenges women often face in Togo, including CHWs. In Togo, 96% of IH-supported CHWs are women, and although CHWs are widely respected in their communities, there have still been instances of violence against CHWs, as well as professional development challenges. In December 2025, in an effort to mitigate these challenges, IH conducted surveys to ask them what is working well and what could be improved. In February 2026, results from these interviews were available and findings are now being used to inform interventions in Togo.

IH surveyed 156 CHWs (all women) across five districts in the Kara region using a 30-question anonymous survey administered via mobile phone. Key findings from the study showed that 70% of CHWs agree that women and girls who experience violence do not speak about it due to fear or shame and that 71% of CHWs reported that they face harassment in the community for speaking about contraception and family planning. However, overall, CHWs feel supported in their work, with 85% reporting that they are confident IH would act on a problem if raised, 76% indicating that they are proud of their role, and 88% saying they were open to IH organizing an awareness session on violence in their communities.

Four recommendations will inform our next phase: (1) adapt community awareness models for gender equality and violence prevention proven to work in similar contexts as Kara; (2) work with community leaders on specific, measurable strategies to support and protect CHWs; (3) develop a CHW professional development pathway; and (4) provide CHWs with mental health resources as part of IH's commitment to CHWs’ wellbeing.

Guinea Highlights

Successes

Launch of Gavi Phase II in Kankan Region

On April 8, 2026, IH and Guinea’s MOH, with support from Gavi, the Vaccine Alliance, officially launched Phase II of the IPCP in the Kankan region. The launch ceremony brought together Guinean government health officials, community leaders, health actors, and technical and financial partners.

Phase II, which began in January 2026, aligns with the Government of Guinea's Universal Health Coverage vision. It centers on strengthening the IPCP, scaling the Kendeya digital application for CHWs, and supporting the government's roll-out of the new malaria vaccine, an important component since malaria is a leading cause of death among children and pregnant women.

The launch event was well received with over 300 participants from the MOH, WHO, the World Bank, CHWs and the community at large. Speeches given throughout the event solidified strong institutional commitment to IH’s continued work in the Kankan region and beyond. It also built on IH’s commitment to ensure that all levels of Guinea’s health system, including community members, play an integral role in shaping and implementing the IPCP. To read more about the launch event, visit this blog.

Deepening Impact: Integrating Ten Additional Health Posts in Kouroussa

To overcome geographical barriers and bridge the gap between community-based and facility-based care, IH is deepening its service model in Guinea by integrating health posts into its free-care program. While IH initially focused on supporting health centers, community feedback highlighted health posts as a critical, under-resourced level where CHWs and CRs first refer patients. By adding ten priority health posts in the Kouroussa district this year, IH has reached a milestone of providing free primary care in 20 of the 40 health posts in its catchment area, with plans to expand to the remaining 20 to ensures that high-quality care is accessible closer to home for the 30,000 children and 40,000 women living in IH-supported communities.

Challenges

Scaling Quality Data Systems

Since IH expanded into Guinea in 2023, ensuring that accurate data is collected and that indicators are defined and used consistently across countries has been a central priority. An initial review surfaced discrepancies in how certain CHW visit and activity categories were being recorded in Guinea, pointing to a broader challenge: indicator definitions were not yet fully aligned with national guidelines or with IH's program expectations. This is an ongoing challenge that IH's Monitoring, Evaluation, and Quality Improvement (MEQI) team continues to improve through cross-country exchange missions, bringing together MEQI colleagues in Togo and on the Global Support Team with those in Guinea. These missions focus on the practices, tools, and routines that have made Togo's data system robust over time, including alignment with Togo’s national DHIS2 framework, structured use of Tableau and Alteryx for data cleaning and analysis, and clearly defined indicators.

To learn more about this work and insights from the MEQI team, visit this blog.

Organizational Highlights (Global):

International Women’s Day: Give to Gain

On March 8th, IH marked International Women's Day with a campaign in Togo, Guinea, and at the global level around the theme "Give to Gain." In Togo, community celebrations brought together CHWs and their husbands and were featured in radio and television coverage in Kara. A Togo press article featuring IH’s Country Director, Charlotte Dzamado, offered strong external visibility, and a CHW testimonial publication highlighted the leadership of women on the front lines of community health.

In Guinea, a roundtable on inclusive leadership provided a productive forum for IH and local partners. The campaign highlighted IH’s presence across Togo and Guinea around a shared theme and reaffirmed the central role that women play at IH.

Launch of ECOWAS Regional Community Health Policy

In March 2026, the West African Health Organization, the specialized regional health institution of the Economic Community of West African States (ECOWAS), convened the launch of the ECOWAS’ Regional Community Health Policy in Cotonou, Benin. The policy aims to provide a structured framework to harmonize community health approaches across the 15 member states in the region. The regional community health policy is closely aligned with WHO best practices and advocates for the professionalization and remuneration of CHWs, a clear package of preventative and curative services, standardized competency-based training, continuous supportive supervision, and career pathways for CHWs to transition to other health roles.

IH was represented by Director of Programs Émile Bobozi and Director of Technical Assistance Dr. Tcheou Dadou Pikèdina, who participated in the workshop and contributed IH's experience to discussions on operationalizing community health at decentralized levels.

Task-Shifting Ultrasounds: IH on the Global Stage in Nairobi

In March 2026, Senior Director of Programs Dr. Tiguida Sissoko was invited to speak on the DAK International Network’s (DIN) panel "Building Systems for Equitable Access to Obstetric Ultrasound Through Task Sharing" at the International Maternal Newborn & Child Health Conference in Nairobi. Since 2024, IH has been an active member of DIN's Community of Practice, collaborating with six other organizations to strengthen ultrasound task-sharing globally.

Dr. Sissoko presented IH's obstetric ultrasound task-shifting model in Togo's Kara region, which has been implemented since May 2022 in partnership with Kara's MOH.

IH's task-shifting model trains midwives and nurses to deliver basic obstetric ultrasound in rural communities at no cost to patients, addressing maternal and infant mortality in Togo (399 maternal deaths per 100,000 live births and 27 neonatal deaths per 1,000 live births). Results from the Kara region (May 2022–December 2025) include 36,394 pregnant women served across 7 districts and 101 health centers, with 30 ultrasound machines deployed. The intervention costs $8 per patient.

Community Spotlight:

Mamadou : The Face of Hope in Babila

In many rural areas of Guinea, distance remains a major barrier to accessing healthcare. In Babila in the Kouroussa district, this reality has long affected the lives of local communities.

But today, things are beginning to change.

At the heart of this transformation is Mamadou Keita, a man in his fifties and a CHW supported by Integrate Health. Every day, he looks after the health and wellbeing of 122 households.

Before 2024, access to healthcare in Babila was extremely limited. Many children were either unvaccinated or were only partially vaccinated. Families struggled to afford consultations and treatment, especially for pregnant women and children. Malaria was widespread, and many children were malnourished. CHWs themselves lacked regular training and sufficient resources to carry out their work effectively.

Since the launch of IH’s IPCP in late 2023 in collaboration with Guinea’s MOH, Mamadou has become a central figure in his community.

Affectionately known as “Kenda Kenda,” he walks from household to household each day, monitoring the health of pregnant women, new mothers, and children under five. He raises awareness, provides guidance, and connects families to care.

Mamadou’s work goes far beyond screening. He takes time to explain, reassure, and sometimes persuade—especially when certain practices are deeply rooted in tradition.

“At first, it’s not always easy. But with patience and conversations, families eventually begin to trust in this work,” he says.

Thanks to his dedication, children who once suffered from malnutrition are gradually regaining their health, mothers are adopting better hygiene and nutrition practices, and pregnant women are now more willing to attend healthcare consultations.

Today, Mamadou is much more than a health worker. He is a trusted neighbor, a counselor, and someone people turn to in their time of need.

“Here, no one should face illness alone,” he says with conviction.

Through his commitment, an entire community is slowly transforming—step by step—toward a healthier future.

Financial Highlights

This quarter, IH was awarded a new grant from an anonymous donor, as well as generous renewal funding from two longtime partners. We remain grateful for your continued support.

Links:

• Integrate Health website