HSS-BC in the north of Togo: a 29% reduction in the risk of mortality for children under 5 years of age

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Extract from the article: On 28 February 2025 in Lomé, the international NGO Integrated Health presented the results of the phase II study on the implementation of its programme to strengthen community-based health systems (RSS-BC). The study covered 21 health centres and the

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On 28 February 2025 in Lomé, the international NGO Integrated Health presented the results of the phase II study on the implementation of its programme to strengthen community-based health systems (RSS-BC). The study covered 21 health centres and their catchment areas in the Kara region in northern Togo. According to the results of the study conducted between 2018 and 2023, a 29% reduction in the risk of infant and child mortality was observed in the areas covered by the RSS-BC programme. These results are associated with an improvement in the quality of and access to health centres, an increase in institutional deliveries, and regular home visits by professional Community Health Workers (CHWs). The workshop was opened by Dr Mahamouda Teouri, Director of the National Health Information System, in the presence of the Country Director of Santé Intégrée, Sesso Gbeleou, and Prof. Kévin Fiori, Scientific Advisor to Integrated Health. 

To improve access to healthcare for women of childbearing age and children under 5, Integrated Health (SI) began a pilot phase of the RSS-BC programme in four health centres in the Kozah district in 2015. The convincing results of this programme led to its extension to twenty-one (21) other health centres in the districts of Bassar, Dankpen, Kéran and Binah, with gradual implementation at the rate of one district per year.  It is in the context of this extension that the present study was initiated to evaluate the effectiveness and results of the implementation of this model through household surveys carried out at regular intervals.

The study methodology, which included surveys based on the Demographic and Health Survey (DHS), health centre assessments and qualitative surveys, focused on key measures such as the coverage of maternal and child health services, mortality rates for children under 5, and factors facilitating or limiting access to health services, in order to provide critical data for measuring the impact of the HSS-BC model on improving access to care.

To this end, the results of the HSS-BC interventions were presented to the health authorities and local partners, in order to understand the impact of the intervention and inform potential strategies for improving healthcare for women of childbearing age and children aged 0-5.  During the workshop, participants analysed changes in maternal and child health outcomes, health service utilisation rates, and uptake of HSS-BC interventions, and discussed recommendations for improving community health systems based on the results of the study.

According to Sesso Gbeleou, Country Director of Integrated Health, the results showed a significant increase in paediatric and prenatal consultations, family planning and assisted deliveries in the various health centres supported by Santé Intégrée. The NGO Santé Intégrée remains faithful to its objective of strengthening the community-based health system.

Significant and encouraging results

The ‘Effectiveness of an integrated primary care model in reducing infant and child mortality’ study was carried out in 21 health facilities in the Kara region and their coverage area. Between 2018 and 2023, Integrated Health gradually extended the programme to strengthen community-based healthcare (RSS-BC) to four districts, covering more than 200,000 people and 21 health facilities. The associated study carried out in collaboration with the Albert Einstein College of Medicine confirms an additional 29% reduction in the risk of death among children under five in the intervention zones. In a study published in 2021, Integrated Health already demonstrated that the HSS-BC programme had helped to reduce under-five mortality by 30% in the areas covered by four health facilities in the Kozah district.  The latest estimates for 2013 show that the infant mortality rate in the northern region of Kara is 62 per 1,000 live births, and the under-five mortality rate is 130 per 1,000 live births, compared with national rates of 49 per 1,000 live births, and 88 per 1,000 live births).

For the Head of Research, Dr Desiré Dabla, ‘the implementation of the Integrated Health (HSS-BC) programme has led to a reduction of around 29% in infant and child mortality in the intervention zones. Alongside this reduction in mortality, we have also seen an increase in access to healthcare for the population, particularly women aged 15 to 49 and children aged 0 to 5.We also salute the effectiveness of the CHWs who are proactively seeking out cases of illness in the community.  Many women and children were reached in a relatively short time by the CHWs and referred to the health centers’.

Today, the results of the study show that, even on this scale, the programme has maintained its effectiveness, with a significant reduction in under-five mortality.This success reinforces the idea that the HSS-BC model is not only effective, but also replicable on a large scale, offering a sustainable solution for improving child health in rural communities.

The CHWs' experience of BC-HSS has been very positive.Assia Makouya can testify to this. This CHW from Bandjeli (Bassar) covers 04 villages with 389 households, including 720 children under the age of 5, and 1,315 women of childbearing age. ‘We've really noticed a gradual change.  Pregnant women now go to the health centre to start their antenatal check-ups. And just after giving birth, we do the follow-up too. People in our community are proud,’ she confided.

A viable and replicable solution

With an estimated additional cost of FCFA 5,895 per person per year, the model for strengthening integrated primary care represents an effective and sustainable solution. The lasting impact of the RSS-BC and its affordable cost make it a model to be explored by policy-makers to improve the health of women and children on a large scale.

William O.