A newly published study in Pediatrics found that Integrate Health’s Integrated Primary Care Program (IPCP) maintained a 29% reduction in child mortality when scaled to four additional districts in northern Togo. The findings replicate the 30% reduction in under-five mortality over five years seen in the pilot study. With results achieved at a cost of only 10.28 USD per person per year, the study provides critical new evidence that the IPCP contributes to meaningful improvements in child survival and can be sustainably scaled at a cost feasible for the national health system.
Integrate Health expanded the IPCP to 21 health centers and four districts in the Kara region of northern Togo, serving more than 200,000 people. The new study was conducted in collaboration with faculty at the Albert Einstein College of Medicine in New York from 2018-2023.
The replicated results at a much larger scale represent a major milestone for the Ministry of Health, district teams, communities, and the Community Health Workers supported by Integrate Health. The findings demonstrate that the IPCP can reduce under-five mortality and be successfully scaled with similar impact.
About the study
Integrate Health expanded the IPCP to serve more than 200,000 people across the districts of Bassar, Dankpen, Kéran, and Binah in collaboration with the Togolese Ministry of Health. The study, led by faculty at the Albert Einstein College of Medicine, together with Togolese partners, used a rigorous stepped-wedge cluster randomized trial design.
Over the five-year study, the research team conducted:
– 50,404 household surveys among women aged 15–49
– Annual assessments in 21 health centers using WHO’s SARA tool
– 79 qualitative interviews with Community Health Workers, nurses, district leaders, and community members
– A detailed costing analysis using UNICEF’s Community Health Planning and Costing Tool.
Child mortality trends are shaped by multiple factors, including economic changes, seasonal variations, and the wider health system. To address this complexity, the study used an inferential model, holding all other factors constant, to estimate what would likely have occurred in the absence of the intervention, rather than attempting to isolate a single causal factor.
Results: Under-five mortality decline confirmed
The study found that the rick of death before age five was 29% lower during periods when districts had launched the Integrated Primary Care Program, compared with periods before launch.
– 45.5 under-five deaths per 1,000 live births predicted during intervention periods.
– 64.5 under-five deaths per 1,000 live births predicted during control periods.
The IPCP maintained effectiveness when implemented at a much larger scale. The replication of these results strengthens confidence in the contribution of the IPCP model to reducing the risk of under-five mortality.
“The results of the study on the Integrated Primary Care Program are particularly compelling: not only do they confirm the sustained reduction in child mortality observed in the Kozah district, but they also demonstrate that the program can be scaled while maintaining the same impact. This study represents hope. It shows the path toward an effective, replicable model to honor our commitment to strengthening community healthcare and ending preventable child deaths by 2030.”
– Dr. Désiré Dabla, Senior Research Manager, Integrate Health
The study observed improvements in system performance that likely support child survival:
– Women were 17% more likely to deliver in a health facility during intervention periods.
– Women were 23% more likely to receive care from a professional Community Health Worker at home.
Qualitative interviews highlighted several factors that made these improvements possible: trust in Community Health Workers, the removal of point-of-care costs, proactive home visits, and strengthened relationships between Community Health Workers, health centers, and communities.
Implications: A viable and scalable path
Making progress toward high-quality healthcare for all requires strong systems and trusted partnerships. The replication of results at scale suggests that Integrate Health’s approach contributes to improved child survival when implemented in close collaboration with the public health system.
A key finding is that the model remains financially sustainable. The study estimates the average yearly complementary cost per capita to be 10.28 USD, a level that could feasibly be integrated into Togo’s national health budget over time.
This study positions the IPCP as a viable and scalable solution for countries seeking to expand professional Community Health Worker programs and strengthen community healthcare as a means to achieve universal health coverage and reduce child mortality. Together, these findings suggest that strengthening both community- and facility-based care can contribute to sustained improvements in child health outcomes, even in remote, resource-limited settings.
For Togo, the results offer a clear, evidence-based pathway for advancing Universal Health Coverage. For other countries, the study adds to a growing body of research demonstrating that integrated primary care systems can save lives at scale.
As Drs. Anabwani-Richter, Thomas, and Haq wrote in their commentary about the study in Pediatrics “The IPCP offers valuable, real-world evidence that integrated primary care can improve child survival in low-resource settings. Its impact reflects key principles of Universal Health Coverage, with primary health care investments acting as a foundational strategy by bringing services closer to families, strengthening quality and continuity of care, fostering trust in health systems, and addressing health system gaps through community-based delivery.”
This study reinforces a fundamental message: when primary care is accessible, free, and delivered by trusted, trained, and salaried Community Health Workers, children have a much greater chance of surviving and thriving.
While child mortality reflects many underlying factors, the consistent results observed in both studies suggest that the IPCP plays a significant role in reducing under-five mortality. Integrate Health is honored to continue partnering with Ministries of Health, district authorities, Community Health Workers, nurses, and community leaders to translate this evidence into lasting health improvements for children and families across francophone West Africa.