A solution to provide low-income populations with sustainable access to preventive and curative healthcare in Togo

Access to healthcare is very limited in Togo, and the shortcomings of the health system is a major national issue. The lack of healthcare staff in urban health centers undermines their capacity to receive, inform, guide and assist patients. Togo has 7 health workers for every 10,000 inhabitants, and in 2015 only 44% of villages had access to preventive medical care provided by a community health worker. Lack of access to information for people living in poverty hinders their adoption of good health practices.

In addition, only 7.6% of the Togolese population is covered by social welfare, as the main welfare scheme is intended for government workers. Togo's social health system is particularly fragile, resulting in a low take-up of complementary health insurance services within households. Only four of these complementary services are currently able to offer a functional service, with each having less than 2,000 adherents.

The "Innovation for the Health of People in Vulnerable Situations in Africa" program offers a solution called "Mutualized DokitaEyes", which focuses on three aspects:

1. Receiving and attending to the patients' needs: stationary medical facilitators based at the Coursier d'Hôpital International care center and community health workers are sent out to the patients' homes to ensure medical follow-up, check their vital parameters on a regular basis and provide preventive health advice.
2. Providing a digital health record: the digital application developed by DokitaEyes enables users to keep track of the medical records provided by healthcare facilitators in urban areas, and by community health workers in rural areas.
3. Setting up a complementary health insurance scheme: the “Union Des Mutuelles de Santé de l'Archidiocèse de Lomé” will cover 75% of healthcare costs, and will aim to provide fast refunds to its network of healthcare providers

FID’s funding will enable the implementation of a second pilot of this program in collaboration with the International Initiative for Impact Assessment (3ie) to deepen and better evaluate the components that were tested in the first pilot, and include the complementary health insurance component, which has not yet been tested. The aim is to evaluate all of these components together, and their impact on the complementary health insurance’s new memberships.

This pilot aims to:

• Contribute to the reduction of maternal and infant mortality rates by implementing a functional complementary health insurance system.
• Strengthen collaboration between complementary health insurances and healthcare providers.
• Reduce reimbursement difficulties, which are the main reason behind the low take-up of complementary health insurances.