An Integrated Primary Care Initiative for Child Health in Northern Togo

Abstract

OBJECTIVES:To determine if the Integrated Community-Based Health Systems-Strengthening (ICBHSS) initiative was effective in expanding health coverage, improving care quality, and reducing child mortality in Togo.METHODS: Population-representative cross-sectional household surveys adapted from the Demographic Household Survey and Multiple Indicator Cluster Surveys were conducted at baseline ( 2015) and then annually (2016-2020) in 4 ICBHSS catchment sites in Kara, Togo. The primary outcome was under-5 mortality, with health service coverage and health-seeking behavior as secondary outcomes. Costing analyses were calculated by using "top-down" methodology with audited financial statements and programmatic data.RESULTS: There were 10 022 household surveys completed from 2015 to 2020. At baseline (2015), under-5 mortality was 51.1 per 1000 live births (95% confidence interval [CI]: 35.5-66.8), and at the study end period (2020), under-5 mortality was 35.8 (95% CI: 23.4-48.2). From 2015 to 2020, home-based treatment by a community health worker increased from 24.1% (95% CI: 21.9%-26.4%) to 45.7% (95% CI: 43.3%-48.2%), and respondents reporting prenatal care in the first trimester likewise increased (37.5% to 50.1%). Among respondents who sought care for a child with fever, presenting for care within 1 day increased from 51.9% (95% CI: 47.1%-56.6%) in 2015 to 80.3% (95% CI: 74.6%-85.0%) in 2020. The estimated annual additional intervention cost was $8.84 per person.CONCLUSIONS: Our findings suggest that the ICBHSS initiative, a bundle of evidence-based interventions implemented with a community-based strategy, improves care access and quality and was associated with reduction in child mortality.

Under-five mortality before and after implementation of the Liberia National Community Health Assistant (NCHA) program: A study protocol

“…Prior studies have demonstrated improvement in process measures from implementation of small scale governmental CHW programs in similar settings including Liberia [18,19]. Whereas Nyqvist, Guariso [11] were able to randomize program exposure across communities, the program was different from our evaluation in that it is was operated by a non-governmental organization.…”

Implementation of the Liberia National Community Health Assistant (NCHA) Program and Under-five Mortality: A study protocol

“…Prior studies have demonstrated improvement in process measures from implementation of small scale governmental CHW programs in similar settings including Liberia (Fiori et al, 2021; White et al, 2018). Whereas Nyqvist et al (2019) were able to randomize program exposure across communities, the program was different from our evaluation in that it is was operated by a non-governmental organization.…”

A Pragmatic Approach to Qualitative Formative Evaluation of an Integrated Primary Care Program in Togo, West Africa

“…Building on successful implementation of an effective HIV care program (Dubois et al, 2020;Fiori et al, 2016Fiori et al, , 2020, Integrate Health now focuses on reducing mortality and improving health through the Integrated Primary Care Program (Arnold et al, 2016;Lauria et al, 2019). The Integrated Primary Care Program uses a community engagement approach to implement a bundle of evidence-based interventions consistent with global health best practices that has been published previously (Fiori et al, 2021). Together this package of components creates a system of healthcare delivery that expands access to high-quality care, supporting the Togolese government's universal health coverage targets (Ministère de la Santé et de la Protection Sociale, 2017).…”