Community Health Care for Women & Children in Togo, West Africa

World Centric + Integrate Health

$124,927 from profits from fiscal year 2020

In Togo, 368 women die for every 100,000 live births, and nearly 1 in 10 children will not live to see their fifth birthday. That’s 15X the rate for developed countries. The majority of these deaths are from diseases that are entirely treatable at very low costs, like malaria, diarrhea, and pneumonia. Unfortunately, Togo lacks the functioning healthcare system required to deliver effective treatments to women and children in need. Essential healthcare systems, including personnel, supplies, and training, are currently absent or insufficient throughout much of the country. As a result, 70% of Togo’s population, nearly six million people, lives without access to adequate healthcare.

The mission of Integrate Health is to make quality primary healthcare accessible to all. IH works alongside governments and the local community to implement and study an integrated approach to strengthening primary healthcare delivery in order to achieve universal health coverage. By integrating professional Community Health Workers with improved care in public clinics, IH creates a patient-centered health system that is accountable to the community and dramatically reduces mortality in resource-limited settings. This system includes four key components:

• Clinical Capacity-Building. Ensuring high-quality care by providing ongoing training and continuing medical education to nurses and midwives.
• Community Health Workers. Community Health Workers (CHWs) are frontline healthcare providers, predominantly women, recruited from the community they serve. They are trained, equipped, supervised, salaried, and fiercely passionate, combining a lifetime of local knowledge with an ongoing medical education.
• Supply Chain and Infrastructure. Integrate Health’s approach to improving supply chain management and basic infrastructure ensures that providers have high-quality facilities to work in and the tools they need to adequately care for their patients. Clinical mentors coach pharmacy managers to ensure proper supply, equipment, reporting, and ordering so that the right medication is in the right place at the right time.
• User Fee Removal. Research shows that even very small fees sharply limit access to healthcare. The pay-for-service nature of Togo’s healthcare system creates a vicious cycle where low utilization rates leave the health center with little investments while the community receives little care. By removing financial barriers, specifically costs at the point of care, use of lifesaving healthcare services increases dramatically. Clinics see more patients, and patients get the care they need.

Over the last four years, IH and World Centric have created long-lasting impact for women and children in Togo by expanding to a new district each year. In July 2021, IH will expand to the final district in the Phase II expansion, the Binah district.

The Impact

World Centric funding helps sustain Integrate Health's current services across the Kozah, Bassar, Dankpen, Kéran districts and to launch services in Binah district. Through all their sites, Integrate Health intends to have the following impact:

• Serve a total population of 205,000
• Employ 179 CHWs (40 new hires for Binah district):
  For many individuals, this will be their first formal employment. Many worked as small-holder farmers or were self-employed as hairdressers or seamstresses. Having formal employment gives them access to a reliable and consistent monthly salary for the first time. Anecdotally, CHWs report using these funds to send their daughters to school, to buy clothing and school supplies for their children, and to cover healthcare costs (that are not covered through IH’s program). Many CHWs have also independently formed savings and loans groups to pool their salaries and provide rotating loans to enable investments in additional income-generating activities.
• 121,092 consultations of children under-five
• 183,924 home visits
• 85% facility-based delivery rate
• 35% contraceptive coverage rate
• 85% of childhood illness treated within 72 hours of symptom onset

Indirect impact:

• Health improvements from access to quality health care
• Increased access to education about the benefits of family planning
• Wages for Community Health Workers
• Wages for 8 nurses
• 50% reduction in child mortality at the sites
• Increased community cohesion
  IH holds over 700 community meetings each year to involve the community in every step of the planning, implementation, and evaluation processes for all of its programs. Community meetings provide invaluable community feedback, reinforce accountability, and ensure that IH is fulfilling their commitment to meet the expressed needs of the communities they serve.

Healthcare & Climate Change

To counter climate change, IH actively works to promote health-related solutions including increasing access to and education about the benefits of family planning. Addressing population growth is one of the most important steps to addressing climate change and is a core component of our approach. In addition to promoting family planning, IH has partnered with the Climate Accountability Initiative, an alliance of NGOs committed to measuring and reducing carbon footprints. Although this process has just begun in 2021, IH will continue working with the Initiative to measure IH’s current carbon footprint, establish emissions reduction targets, and commit to reducing and offsetting IH’s footprint.

About Integrate Health (Santé Intégrée)

A World Centric partner since 2017.

Integrate Health (Santé Intégrée) provides HIV care and treatment services in northern Togo, West Africa, where these services were previously not available. The organization is one of the most effective healthcare delivery services operating in the country. They focus on involving community members in the dynamics of the organization, ensuring that the programs are responding directly to patient priorities.

Integrate Health was founded in 2004 in an effort to support individuals living with HIV who were fighting for their right to healthcare. This work contributed to the creation of the most effective HIV care programs in Togo. This effort led to their current work to integrate health into every community and clinic.