User Fee Removal

Togo ranks 166 of 188 on the United Nations Human Development Index, with more than half of its population living on less than $2 per day. Medical costs can quickly create impossible life or death choices for families in need.


Afiya, a young woman living in extreme poverty, was referred to the regional hospital during her ninth month of pregnancy shortly after the Maternal & Child Health program launched. In the days before Integrate Health absorbed the user fees for hospital visits, expenses mounted quickly—transportation to the hospital, an entrance fee, cesarean kit, additional medicine, a night bed fee—totaling around 40USD. For Afiya’s father, this price was beyond his means. In the evening, he and his daughter fled the hospital. Afiya died a short while later from complications related to the pregnancy that could have been prevented if the family had $40. A sum that seems meager by US standards but can be an insurmountable challenge in Togo.

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 long term, these changes shift the entire culture around health.