Like many other African countries, Togo has ratified the resolution on the Sustainable Development Goals (SDGs) adopted by the United Nations in September 2015. Goal 3.8 is dedicated to achieving Universal Health Coverage (UHC) by 2030. The goal is to ensure that everyone has access to health coverage, including protection against financial risks and access to quality essential health services and safe, effective, quality, and affordable essential medicines and vaccines.
Indeed, the country’s health context is still marked by high maternal and neonatal deaths. In 2013, there were already 401 maternal deaths per 100,000 live births, and in 2017, 89 infant and child deaths per 1,000 live births. In addition to the COVID-19 pandemic, the first case of which appeared on 7 March 2020, the health context is also marked by communicable diseases such as malaria, HIV/AIDS, tuberculosis, and viral hepatitis, and non-communicable diseases such as cardiovascular diseases, hypertension, and cancer.
Thus, to improve all these health indicators to move towards UHC, a National Health Policy was drawn up, the vision of which is to “ensure the highest possible level of health for the entire population by doing everything possible to develop a system based on public and private, individual and collective initiatives, which is accessible and equitable, and which is capable of satisfying the right to health of all, in particular the most vulnerable.”
There have also been other initiatives or developments that have been made in Togo toward advancing UHC. These include:
- Development of a National Health Development Plan (PNDS) covering the period 2017-2022, the objective of which is the “Acceleration of the reduction of maternal, neonatal, infant and child mortality and strengthening family planning and adolescent health”
- Development of a 2020-2025 roadmap to guarantee health coverage and access to basic services for all by strengthening access and improving the quality of the health system
- The signing in May 2012 of a national Compact between the Government and several multi- and bilateral technical and financial partners working in the sector (World Bank, WHO, UNICEF, UNFPA, UNAIDS, French, German and American cooperation, NGOs and international associations, etc.) to benefit from the support of the Government and its partners.) and benefit from technical and financial support.
Further, a strong political commitment has been materialized with free health care for pregnant women and newborns with the launch of the WEZOU programme. The program’s official launch took place on 12 August 2021 at the Centre Hospitalier Préfectoral de Sotouboua, a locality located in the northern part of the country.
At the start of the programme, only the public health facilities, numbering six hundred and sixty-four (664), were eligible. The programme has been implemented throughout the country since its launch covering 100% of the health facilities in Togo.
The principle of the programme is simple. Health facilities are obliged to provide free care for pregnant women and newborns. Thus, these women pay neither for the services nor the medicines required for their condition, and the government fully compensates the costs incurred by the health facility. This is done for several services, which are as follows.
- The enrolment kit, i.e., the booklet
- The four antenatal consultations (CPN)
- The simple delivery
- Cesarean section
- Post-natal consultations.
The programme covers a range of care, with benefits divided into capped sub-headings. Thus, normal childbirth is reimbursed at 14,265 FCFA (~$21.32), consisting of prenatal consultations at 3,640 FCFA (~$5.44), simple childbirth at 9,470 FCFA (~$14.15), and postnatal consultations at 1,155 FCFA (~$1.73). Cesarean delivery is reimbursed at CFAF 3,540 (~$5.29). In 2021, a total amount of 1,991,420,448 FCFA, or approximately $2,976,356, was transferred to health facilities under the programme.
As soon as the state of pregnancy is confirmed at the health center, every pregnant woman is enrolled in the programme using a telephone kit; she is given a registration number which will be used throughout her journey.
Since the program’s implementation, the number of women registered as of 30 September 2022 is 235,022 out of an estimated target of 264,014 pregnant women. On average, 19,585 pregnant women are enrolled per month, 56.72% of whom are between 18-28. Approximately 66% of the beneficiaries live in rural areas, and 34% are registered in urban areas (34%).
Testimonies from some beneficiaries indicate that the programme is an asset in breaking down financial barriers to accessing health facilities. Community health workers contribute to the programme by informing and sensitizing households to take advantage of the free medical services under the programme.
“The arrival of WEZOU has made our tasks as community health workers much easier for nursing mothers and pregnant women. With WEZOU in place, referring a pregnant woman is not as difficult as before. They have all understood the program’s benefits so well and are now quick to make decisions pertaining to them and their children, matters of health. Previously, we faced challenges convincing expectant women to visit health facilities as they had to pay for medical care.” Mr. M. MAKIYE Poziyoufey CHW of the USP of Konna
The programme has been immensely successful, and there still are some bottlenecks that need to be overcome, such as:
- The slowness of the invoice transmission and validation circuits, such as the collection of invoices, transmission to the manager, validation by the manager, and transmission to the Ministry of Health and Universal Access to Health Care
- Rejection of several invoices sent by the health facilities for services not registered on the platform or failure to comply with the service rates.
- Losses of telephones and kits meant for care.
- The instability or absence of the Togocom network in certain localities does not favor the fluidity in implementing certain activities relating to the Programme.
Financing Alliance for Health, in addition to having participated in the technical feasibility study for the implementation of this free health care in 2021, is currently contributing to the monitoring of the implementation of the programme and, in particular, contributing to the development of the M&E indicators that will ensure that the programme is tracked effectively. FAH is also weighing in on providing guidance and support on unlocking some of the challenges the programme is currently facing to ensure its efficient implementation.