Letter from Leadership
Dear friends,
We are excited to present you this report that outlines our success during an incredibly challenging year. This year, we launched in the district of Kéran, bringing care to more than 160,000 people across four districts, and began the preparations for the launch of our final district. We aim to draw useful lessons to help the health system move forward in its policy orientations and in its service delivery practices.
We were not spared the restrictions imposed by the COVID-19 pandemic. Although we had originally planned to launch in July, we halted our preparations of the launch due to the pandemic. But during that time, we remained flexible, alert, and insistent. With the launch on pause, we started to hear from the community that they wanted us to continue: they wanted the Integrated Primary Care Program to launch in their communities. That is when we went back to the drawing board and created a plan. With safety measures in place, we started the preparation activities again, with a planned launch date in October to account for smaller group trainings. And on October 14th, we officially launched in our fourth district. These lessons were used to inform the preparation of the launch in our final district in July 2021.
It was around the time of the launch that the government announced an ambitious new plan for Universal Health Coverage and appointed a Delegate Minister of Universal Health Access. In just three months, Integrate Health supported critical initiatives that have helped pave the country’s path towards high-quality, accessible, primary care for all. Our team, with the indispensable support of partners including the Community Health Impact Coalition, initiated a series of workshops, in dialogue with the Ministry of Health and its partners, to optimize the practices of community health workers (CHWs), including benchmarking the professionalization of CHWs and efforts to move toward policy harmonization in the country, based on best practices. We have also supported the costing and roll-out of a maternal health user fee removal program, with the support of the Financing Alliance for Health, to bring free care for pregnant women across the country.
Despite the challenges that this year brought, we have experienced incredible progress. Our team has remained flexible, and our vision has remained clear: make quality primary healthcare accessible to all. Through our actions, we have shown the government of Togo that our commitment to Universal Health Coverage is unrelenting.
Our achievements have been made in a variety of challenging contexts. Our team has matured over the years, gaining experience in the face of these challenges. The clashes of our initiatives with health policy directions in the early years gave way to progressive collaboration and integration into a single system in the later years. As we prepare for the launch of our final district, and as we begin to discuss what is next, we cannot help but reflect on how your support has played a pivotal role in helping us pave the way.
With gratitude,
Sesso Christophe Gbeleou, Country Director
Jennifer Schechter, CEO & Co-Founder
Kevin Fiori, Senior Advisor & Co-Founder
Half of the world’s population, 3.8 billion people, lacks access to essential health services.
This shortage has deadly consequences.
Globally, 15,000 children under age five and 810 women die each day from preventable causes.
In Togo, one in fifteen children die before their fifth birthday. The maternal mortality rate is
than in high-income countries.
“My two-year-old daughter was burning with a fever. I couldn’t get to the health center because I had just given birth and was very tired. I had no idea what to do. That day, an Integrate Health-supported Community Health Worker came to our house during her home visits. I immediately told her about my child. She checked on him and gave him the necessary medication. That afternoon, my child felt much better, and his fever disappeared. I now feel more relieved because I know there is someone in my community, close to home, who can provide care and all the necessary medications to treat my children.”
— Céline Natta on how her child was cared for by a Community Health Worker
Health for all is within our reach
A primary care model that works
In the communities where Integrate Health works, we observed a
decrease in under-five mortality over five years.
Integrated Primary Care Program
The Integrated Primary Care Program delivers key innovations designed to address the major barriers to seeking care in Togo and ensure high-quality, accessible, and patient-centered primary healthcare delivery.
“The challenge we face right now is to silence the fear within us so that we can continue to care for the communities around us.”
— Justine Takeda, Integrate Health-supported Community Health Worker
Maintaining High-quality Service Delivery
While the COVID-19 pandemic intensified around the world, healthcare delivery continued at all Integrate Health-supported sites. Integrate Health-supported Community Health Workers have maintained their presence in the community using personal protective equipment. Although vaccine accessibility remains a challenge, 90% of health workers across Togo are vaccinated, including 100% of Integrate Health-supported Community Health Workers. Integrate Health is focused on providing information to health center staff, Community Health Workers, and communities so that they can continue to keep each other safe.
Since July 1, 2020, Integrate Health has completed…
Adapting Our Research
The COVID-19 pandemic forced Integrate Health to change the way we do research. Before the pandemic, Integrate Health’s research team visited more than 10,000 households each year to gather information on health behavior, access to care, and outcomes from community members themselves. In 2020, due to COVID-19 safety precautions, Integrate Health paused household survey data collection. Our effectiveness study is being adjusted to account for this gap in data collection but will still be able to evaluate both effectiveness and implementation of the Integrated Primary Care Program. Despite the challenges in conducting research presented by the COVID-19 pandemic, the team has accomplished much over the last year. Click the blue circles to read more about their achievements.
“This pandemic teaches us the need to accelerate the strengthening of the health system here in Togo as elsewhere in the world, and the importance of mobilizing and involving communities in the management of public health and epidemics.”
— Integrate Health Country Director, Christophe Sesso Gbeleou
Reinforcing Government Partnership
This year, Integrate Health has strengthened our collaboration with the government of Togo to support the response to the COVID-19 pandemic and expand our impact. Integrate Health continues to attend weekly Ministry of Health COVID-19 task force meetings to discuss the current situation in the country and provide support when solicited. Integrate Health has also played a key role in procuring protective equipment for 11,000 Community Health Workers throughout Togo via an ongoing partnership with the COVID-19 Action Fund for Africa. Integrate Health has become a key partner to the Ministry of Health in Togo’s pandemic response.
The Year in Numbers
The Year in Numbers
In October 2020, the Government of Togo unveiled a national development plan, Togo Roadmap 2025, with a central focus on achieving Universal Health Coverage for all eight million Togolese. The government of Togo is on the brink of Universal Health Coverage. Our role is to help them get there.
The challenge is no longer “what” but “how.”
Click here to read more.
The Big Shift
To help governments optimize primary healthcare delivery and make progress towards Universal Health Coverage, Integrate Health focuses on three key levers of change.
Implementation of the Integrated Primary Care Program within government systems is critical to show the efficacy of key health system innovations. Integrate Health demonstrates and documents the impact of its innovative approach, delivering lifesaving care to a population of over 166,000 across some of the hardest-to-reach communities in Togo.
“I always wanted to be a healthcare worker which is why I applied to be a Community Health Worker. Too many women and children do not have access to healthcare in my community, and I wanted to change that.” – Tchéké Timarakou, Community Health Worker in Kokou-temberma in the district of Kéran
For Tchéké, starting her role as a Community Health Worker during the COVID-19 pandemic wasn’t easy. Social distancing made her feel less connected to the other Community Health Workers and to her community. Despite these challenges, Tchéké remained committed to her new role and to providing high-quality healthcare to mothers and children.
Launching in the Kéran District
This year, Integrate Health worked relentlessly with community members and government partners to launch the Integrated Primary Care Program in the district of Kéran. The launch was initially planned for July 2020, but the COVID-19 pandemic created restrictions across Togo during the critical preparation phase from February to May 2020. To address safety concerns, Integrate Health proposed a new extended timeline that accounted for more training to allow for smaller groups. In October 2020, the Integrated Primary Care Program officially launched in five clinics and their surrounding communities, now serving over 166,000 people.
At Integrate Health, women lead health system design and delivery.
“I felt more effective and confident in the diagnosis and treatment I provided because I used the new assessment tool from my phone. I learned a lot during the Community Health Worker training, but it’s helpful to have this simple application as another resource to do my job well.”
— Tado Mougni N’Dolighin, a Community Health Worker in the Dankpen district
Integrate Health-supported Community Health Workers like those pictured below use mHealth tools to guide their decision-making during home visits.
Aligning with the Government
Integrate Health strengthened our ability to capture the right data needed to improve care and guide policymakers. This year, Integrate Health aligned our indicators with the Ministry of Health, piloted a cutting-edge mobile health technology to guide Community Health Worker decision-making, and reinforced staff’s data analysis capabilities. Through these efforts, we are able to provide staff, partners, and community members with timely access to data to continuously improve healthcare delivery.
We continuously collect, analyze, and utilize data to inform service delivery.
At every step of the way, Integrate Health has partnered with the Government of Togo as a key ally at the district, regional, and national levels. By identifying gaps in existing policy relative to global best practices and aligning stakeholders around the inclusion of effective design elements in national policy and implementation plans, Integrate Health is helping the government achieve their ambitious Universal Health Coverage goals.
“Integrate Health is doing incredible work in Togo… Today, Integrate Health is in 18 health facilities in the Kara region, but we believe it should be extended throughout the country.”
— Dr. Essotoma Beweli, Director General Ministry of Health
Dr. Beweli (pictured below) has been a trusted partner from the Ministry of Health for the last five years. His leadership has been key in ensuring that the Community Health Harmonization Workshops moved forward this year.
Laying the Foundation for Universal Health Coverage
In February 2021, Integrate Health, in partnership with the Ministry of Health and the Community Health Impact Coalition, organized the national Community Health Harmonization Workshops, which brought together participants from the government and technical and financial partners across Togo to evaluate the current community health system using the Community Health Worker Program Assessment and Improvement Matrix. By building buy-in from diverse stakeholders, the workshops cemented a foundation of collaboration for reform.
The workshops utilized a participatory approach to cultivate a winning coalition to drive Universal Health Coverage.
The Integrated Primary Care Program is replicable at a low cost with a 10:1 economic return on investment. Scaled across Togo, this approach would save over 100,000 lives and create thousands of jobs. Integrate Health is helping the Government of Togo map existing and future revenue streams to ensure a sustainable funding pathway to move toward Universal Health Coverage.
“After several months of preparations, my country has given the guarantee to pregnant women that they can give birth without cost. I am even prouder because Integrate Health has played a determining role in this process. From the study of the feasibility of this program to its implementation, Integrate Health was a key actor who accompanied the Ministry of Health and helped determine the package of care offered by the new maternal health reform called ‘WEZOU,’ blood of life.” – Anita Kouvahey-Eklu, Deputy Country Director
Informing the National Maternal User Fee Removal Program
In November, the Government of Togo asked Integrate Health to model the costs of an essential package of maternal health services. This analysis was used to inform the national user fee removal program for pregnant women, called Wezou. Through this work, the government was given a clearer understanding of the costs associated with removing user fees for pregnant women and were provided with an implementation plan to put the policy in place. Integrate Health is continuing to support the roll-out of the program.
To succeed in catalyzing the transformation of national health systems, Integrate Health remains a highly efficient, well-resourced, and values-driven organization where people love to work.
Racial Justice and Equity
Integrate Health recognizes that racism, sexism, and neo-colonialism exist. We live and work in the context of deep power imbalances. Far too often our efforts to “solve” social problems reinforce those power dynamics. Integrate Health is committed to changing that.
This year, Integrate Health published our Culture Code, which outlines how we aim to live our values as we work to dismantle systems of opression.
This year also marks the first year that we developed a racial justice and equity checklist to guide all decision-making across the organization.
“Stopping our lifesaving work is not an option, and ignoring the climate emergency isn’t possible either. We’re committed to holding ourselves accountable to address both as best as possible.” — Emily Bensen, Chief Partnership Officer
Emily has joined the Climate Accountability in Development steering committee to lead the way as the coalition launched this year.
The climate crisis is a reality in Togo. Integrate Health joined Climate Accountability in Development, a coalition of six organizations, to hold ourselves accountable to measuring and reducing our emissions.
“Integrate Health has given me the opportunity to manage the research team. It is both an honor to serve on this new team in this position of responsibility but at the same time, a huge challenge that I am ready to take on with the support of my colleagues.”
— Désiré Dabla, Research Manager
In his new role, Désiré (pictured on the right below) will lead the research team through the challenges presented by COVID-19 and ensure the timely implementation of activities. He will also support Integrate Health’s dissemination of research results to national government partners to share proven initiatives that can contribute to improving healthcare delivery for millions of Togolese.
Opportunities for Growth
Integrate Health’s greatest asset is our people. Our goal is to keep staff engaged in their work and provide opportunities for growth.
Désiré Dabla joined Integrate Health in 2017 as the Executive Assistant to the Partnerships team. The same year, he enrolled in a PhD program at the University of Lomé. Désiré was drawn to Integrate Health because of his interest in how mobile health can improve the effectiveness of Community Health Workers.
Simultaneously, he began his research for his thesis on the same topic, and how Information and Communication Technology can elevate health systems in low- and middle-income countries. This year, Désiré finished his PhD program and was promoted to Research Manager at Integrate Health.