Remember Togo

When I tell people that our partner works in Togo, I am usually met by confused stares. Some immediately ask where that is, others look unsure for a while, and others get mixed up with Tonga, a small archipelago of islands located in the Pacific Ocean. Whatever the response, I typically explain that Togo is bordered by Ghana to the west, and with that, everyone shakes his or her head in understanding. Why is it that two countries with a common border have such different levels of recognition? Why has the world remembered Ghana, but forgotten about Togo? Before GlobeMed at MIT was partnered with Hope Through Health just over a year ago – I also had never heard of Togo, let alone could pinpoint it on a map. This past year, I’ve learned more about the history of Togo and this past four weeks experienced its culture and worked with local people. And I have often wondered why there is a stark difference when you cross the border from Ghana to Togo, and why Ghana had received so much aid and investment in the past few years, while Togo has received so little. I am not trying to suggest in any way that Ghana doesn’t deserve aid – Ghana needs the investment as well and I only use it as a means of comparison to highlight the differences between two countries that not too long ago were very similar in terms of economic growth and development. Since the early 1990s, they have diverged drastically with Ghana projected to be one of top ten fastest growing economics within the next ten years while Togo has experienced negative GDP growth for the last few years. Driving into Accra this evening on our way to the airport for our flight, we were amazed by the level of infrastructure, the amount of lights dotting the city, and the number of cars crowding the road. Nothing remotely similar exists in Togo. So, why has Togo been forgotten? It has been a relatively peaceful country since the early 1990s, its major exports are agriculture products, it’s francophone, and in the past has failed to uphold democratic institutions. To put it frankly, it is uninteresting in terms of conflict or unrest and has no political advantage to pursue. Maybe you are asking, couldn’t it just be that Ghana is a more productive country, which has led to its growth and investment? From the 1960s to the 1990s, Ghana and Togo experienced similar patterns of growth. In the 1990s, Ghana experienced an injection of foreign aid, while at the same time aid to Togo decreased due to high political instability and stop-and-go market reforms. To give some hard numbers, between 1990 and 2010, Ghana experienced an average growth rate of international aid of 36 million dollars per year while the growth rate of aid to Togo was -.286, or an average decline of 286,000 dollars per year (Source: World Bank, DataBank).

	Growth Rate of International Aid: Ghana (in millions of dollars/year)	Growth Rate of International Aid: Togo (in millions of dollars/year)
1960-1990	23.28524	10.32995
1990-2010	36.07107	-.2864418

It would be wrong to say that aid does not reach Togo at all. I have seen Philadelphia Eagles fans and teenagers sporting their favorite college shirts in small rural villages, as well as TOMS shoes on sale on the side of the road, so obviously American secondhand clothes are making their way across the ocean. The effect of this aid is highly questionable—these cheap, secondhand clothes flood the market and create jobs for the few who are able to procure part of the shipment that comes into the dock at Lomé, but wouldn’t it be more effective if these clothes were made in Togo – making jobs for thousands instead of a few? There are also large funders working in Togo that are doing significant work. Thousands of people are on free antiretrovirals because of the Global Fund, including patients of AED. But compared to the aid received by other countries – is this enough? The World Bank currently has 10 active projects in Togo. Since beginning to work in Togo in Aug. 1962, the Bank has invested $300 million dollars– arguably a large sum. However, compare this to Ghana where the Bank currently has 26 projects worth a total of $1.626 billion dollars. Other funders deter from supporting projects in Togo because it’s not on the scale they desire to get the impact numbers “needed”. This is why the work of Hope Through Health and AED-Lidaw is so critical. In a country where few aid organizations and international NGOs tread, Hope Through Health and AED are challenging the standard of healthcare and pushing for their model to be adopted on a national scale. They’ve shown that even in a country with significant bureaucratic hurdles to maneuver and numerous infrastructure challenges, working with communities can lead to sustainable change. Their Community Health Worker program ensures that even those in the most remote villages have access to high quality healthcare and that all patients receive care indeterminate of their socioeconomic conditions. In a region where secure, well-paid jobs are few and far between, AED invests in the capacity of local community members and hires their own patients to run their programs –more than 50 percent of their staff are living with HIV. Soon, AED will be transitioning from solely HIV care to also providing Maternal and Child Health services, allowing even more people to access the high-quality care they deserve. This is the type of aid and investment that Togo needs. To read more about the work of HTH partner organization, GlobeMed at MIT, please visit: http://globemed.mit.edu/?cat=4