Interview with Lieutenant-Colonel Prof. Bagny Aklesso, National Coordinator of the « Quality Essential Health Services for Universal Health Coverage » (SSEQCU) project

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Extract from the article: At a time when access to healthcare is crucial to people's well-being, the SSEQCU project (Services de Santé Essentiels de Qualité pour une Couverture Sanitaire Universelle - Quality Essential Health Services for Universal Health Coverage) is positio

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«Currently, 86 new health facilities are being completed, and 60 others have already been renovated»

At a time when access to healthcare is crucial to people's well-being, the SSEQCU project (Services de Santé Essentiels de Qualité pour une Couverture Sanitaire Universelle - Quality Essential Health Services for Universal Health Coverage) is positioning itself as an essential lever for the implementation of Universal Health Insurance (UHI) in Togo. The project aims to improve access to healthcare and the quality of health services in communities. To find out more about the mission of this project, its national co-ordinator, Doctor Lieutenant-Colonel, Professor. Bagny Aklesso sheds light on the project's activities, the link between the SSEQCU project and the implementation of the AMU, and the importance of community participation for the successful implementation of the project. The SSEQCU project is funded by the World Bank (WB) to the tune of 70 million dollars, with the WB acting as technical and financial partner for its implementation.

Health & Education: What are the main reasons behind the SSEQCU project?

Lieutenant-Colonel Prof. Bagny Aklesso: This project was born out of the commitment of the Head of State and his government to building a robust, efficient and resilient healthcare system. The aim is to enable all Togolese to access healthcare wherever they are and whenever they need it. It is this fundamental commitment that motivated the creation of this project.

What are the different components of this project?

The SSEQCU project is structured around five key components:

Component 1: Increasing the demand for and supply of quality health and nutrition services: This component aims to increase access to healthcare for households, women, children and vulnerable people.The aim is to ensure that every Togolese has access to healthcare, particularly in disadvantaged areas, and to strengthen the health workforce. To this end, a competition to recruit medical staff was recently organised.

Component 2: Bringing health facilities and services closer to households: The project provides for the construction of 200 new health facilities and the renovation of 300 others throughout the country. Currently, 86 new facilities are being completed, and 60 have already been renovated in the Savanes region.

At the same time, a complete technical platform is planned for each new facility.The equipment for 100 new training courses has already been received and is ready to be installed as soon as the hospitals have been delivered.

Component 3: Strengthening the national social health insurance scheme: The project is supporting the implementation of universal health coverage (UHC) by providing assistance to health insurance management bodies. Since 1 January, all Togolese have been entitled to this insurance, and the SSEQCU project is contributing to this process by providing technical, communication and human resources support.

Component 4: Improved stewardship, monitoring and management: This component concerns the overall management and coordination of the project, to ensure its effectiveness and monitoring.

Component 5: Emergency response component: This last component enables project funds to be redirected in the event of a crisis or disaster, as was the case with the COVID-19 pandemic.This ensures the flexibility to respond rapidly to emergency situations while maintaining the project's long-term objectives.

What does the project provide in concrete terms to retain healthcare staff in vulnerable areas?

The project includes a number of concrete actions to retain medical staff in vulnerable areas, combining financial and non-financial motivation strategies. Here are the main measures:

Financial motivation: Specific allowances or bonuses will be granted to staff working in vulnerable areas, with per diems linked to the conditions in these areas. A relocation allowance will be granted to staff moving from their home area to a disadvantaged area.

Non-financial support: Staff will be supported in sending their children to school to ease the burden in remote areas. Accommodation will be systematically provided for medical staff in newly built health facilities, often close to hospitals. Motorbikes and other means of transport will be provided to staff to facilitate their daily travel and emergency interventions.Basic medical kits will be provided, in particular for young doctors, to guarantee the quality of care offered.

Ongoing training: Staff will be supported to attend post-graduate training courses to maintain and improve their professional skills.

Infrastructures and essential services: The government is making an effort to guarantee internet access in these areas in order to encourage staff development. Improving roads and rural tracks will improve mobility, thereby reducing the isolation of vulnerable areas.

 The first component of the SSEQCU project aims to increase the supply of healthcare, strengthen medical staff, particularly in underserved areas, and ensure the continuous availability of medicines in health facilities. To encourage this improvement, financial incentives are provided for health facilities that achieve the targets set.

These incentives are now enabling health facilities to improve their services and the quality of their care. The SSEQCU project focuses mainly on peripheral care units (type 1 or 2).

Is the SSEQCU project being implemented in every part of Togo?

The SSEQCU project covers the whole of Togo. However, when it was launched in 2021, difficulties were already present in the Savanes region, which led to the initial actions being concentrated in this area.The initial objective was to relieve the population of health problems by renovating dilapidated health facilities. Subsequently, construction work was also undertaken in this region.

SSEQCU's activities were then extended to the other regions of Togo. Renovations and a second phase of construction in all regions of the country are planned in the near future.

What has the project already achieved?

The SSEQCU project has supported health facilities in improving the provision of care and the availability of medicines.It has completely renovated health facilities, particularly in the Savanes region.Some of these facilities are already finished, ready to be handed over and equipped with medical staff and equipment.

Equipment has also been acquired for the first 100 new health facilities to be built. In addition, under the project to strengthen Togo's health and primary healthcare system (RESPRU), additional medical equipment has been purchased and is currently being deployed in recently built or renovated health facilities.

The project has also contributed to the introduction of universal health insurance, which is now effective throughout the country.

How does the SSEQCU project contribute to achieving Universal Health Insurance (UHI)?

The aim of the SSEQCU project is to ensure the successful implementation of UHI so that it lasts for future generations.

We have participated in national communication on this insurance, notably through traditional events and awareness campaigns. Our communication on access to healthcare and universal health insurance is ongoing, both on our online platform and in the press, including the written press. This has enabled Togolese people to gain a better understanding of what health insurance is, their rights and duties as insured persons, and the benefits they can derive from it. This communication is ongoing and evolving, adapted to the context and needs of the population.

On a technical level, the SSEQCU project is also supporting the managing bodies by helping them to acquire the equipment they need to implement AMU effectively, such as IT equipment.An interoperable information system is crucial for managing data efficiently and processing insurance claims diligently, especially with the expected increase in demand for care.

The SSEQCU project is currently working on setting up a pilot project to digitise processes within health insurance management organisations in health facilities.

This system will enable better interaction between health facilities and insurance managers. This will facilitate patient care and payment management.This pilot phase will serve as a basis for wider deployment throughout the country, ensuring more efficient and rapid management of health insurance claims.

In addition, we are supporting the managing bodies in the implementation of universal health insurance, by bringing these services closer to the people who need them.

We are currently setting up local points throughout the country, with decentralised kiosks run by the managing bodies, in particular INAM and CNSS, located inside hospitals. A team is currently on the ground to monitor the progress of work on these outreach points, and we are making good progress in this phase.

What is the role of communities in implementing and achieving the objectives of this project?

Participation is not only solicited, but also required by the guidelines for projects financed by the World Bank.Here are the main aspects of community participation:

Site identification: When it comes to setting up new health infrastructures, communities are closely involved in the choice of sites.Their knowledge of local needs makes it possible to determine the cantons and villages where the presence of a hospital is essential.

Monitoring work: The communities are actively involved in monitoring the construction or renovation of healthcare facilities. 

Helping to respect customs and traditions: Working with the communities helps to respect the cultural practices specific to each locality. This includes site selection, construction management and infrastructure maintenance, thereby minimising the risk of conflict.

Management of healthcare services: During periods of renovation, it is essential that healthcare services are not interrupted. Communities are involved in the temporary relocation of hospitals, in coordination with the health facility management committees (COGES).

Awareness-raising and maintenance: Once the infrastructure has been built or renovated, communities are made aware of the importance of maintaining and using the facilities properly. This includes maintaining the premises, preventing inappropriate behaviour and encouraging people to use the facilities.

Monitoring role: Members of the community play a monitoring role, alerting project managers to the progress of work, the behaviour of workers and any other aspect relevant to ensuring that the project is properly implemented.

Use of health facilities: Communities are also encouraged to use the services offered by hospitals.Their involvement is essential to ensure the sustainability of the health facilities, as a hospital can only survive if people use it regularly.

By involving the communities, the project promotes an inclusive and sustainable approach, ensuring that the objectives of universal health coverage are achieved effectively.

Interview by Gamé KOKO & Raymond DZAKPATA