Integrate Health

Since 2004, Integrate Health has worked alongside community leaders, government officials, and public health experts, first to build and scale one of the most effective HIV care programs in Togo and then to reduce maternal and child mortality through the Integrated Primary Care Program (IPCP). The IPCP demonstrates the key innovations necessary to strengthen primary healthcare delivery at scale. This approach integrates professional Community Health Workers with improved care in public clinics. This powerful combination transforms how primary healthcare is delivered and saves lives.
The IPCP delivers key innovations designed to address the major barriers to seeking care in Togo and ensure high-quality, accessible, and patient-centered primary healthcare delivery. These innovations are delivered using a learning health system approach whereby rigorous data is collected and used to drive continuous quality improvement as well as to share with policy-makers to inform national scale. This package includes:

1. Community Health Workers. Trained, equipped, supervised, and salaried Community Health Workers (CHWs) conduct proactive case-finding and provide home-based care to ensure population-level coverage.
2. Clinical Capacity-Building. A trained peer coach provides clinical mentorship to nurses and midwives in public clinics to ensure competent care providers and effective care.
3. Supply Chain and Infrastructure. Pharmacy managers are trained in improved supply chain management, and basic infrastructure improvements are made to ensure that providers have the tools they need.
4. User Fee Removal. Point-of-care fees for pregnant women and children under five are removed to eliminate financial barriers.

Together this package of services creates a seamless system of healthcare delivery that ensures access to high-quality care, supporting government’s UHC targets, at a replication cost of roughly $10 per capita.
This approach is currently being implemented in 18 public clinics serving a population of over 160,000 in the northern Kara region of Togo. Integrate Health has demonstrated the effectiveness of this model. Preliminary data revealed a 30% reduction in under-five mortality in the pilot communities where Integrate Health works, from 51.1 per 1000 at baseline to 35.8 per 1000 after six years. These results have been submitted for publication in collaboration with Togolese public sector partners and are currently under review by a peer-reviewed scientific journal.

IH envisions a world where everyone, everywhere has access to high-quality healthcare, without suffering financial hardship, regardless of where they were born. The mission of IH is to make quality primary healthcare accessible to all.
Ensuring access to high-quality healthcare for women and children left out of the current healthcare system has always been and will always be IH’s first priority. IH believes that the best way to ensure quality primary healthcare for the greatest number of people is to work directly with governments who hold the mandate for national healthcare. IH aims to reinforce the public system, rather than build a parallel solution. As IH approaches 200,000 people directly served by the IPCP, the organization is looking to ensure quality primary healthcare for all six million people living without access to care across rural Togo. In order to achieve the goal of strengthened national primary healthcare for all in Togo, Integrate Health has established four strategic priorities for the next three years described in the table below.

1. Implementation: Continue to demonstrate key innovations in quality primary healthcare delivery through direct implementation of the Integrated Primary Care Program (IPCP) with data systems to monitor progress and implementation science research to evaluate impact and document lessons for national scale.
2. Mandate: Identify gaps in existing policy relative to evidence-based global best practice and align stakeholders around the inclusion of key design elements in national policy and implementation plans.
3. Financial Ownership: Define clear costs associated with key design elements and map existing and future revenue streams to demonstrate a sustainable funding pathway for Togo’s government to move toward UHC.
4. Sustain IH: Ensure IH has sufficient resources to meet scale targets and strong internal systems to remain an exceptional place to work.

IH requires $24 million dollars over the next three years to accomplish our vision. We project these resources will come predominantly from philanthropic capital in the form of grants from family and corporate foundations as well as charitable contributions from key individuals. IH will look to current partners to sustain and increase their investments, as well as work to bring on new funders at catalytic, mezzanine levels. IH also is developing resource mobilization capacity in our Lomé office to mobilize additional funds flowing directly into the country office. To measure progress towards our three-year funding goal, IH aims to maintain a nine-month funding runway, with six months of expenses available on the operating account and three months in the reserve account. IH tracks retention rates year on year, with the goal of retaining 75% of funders, with 25% of funders increasing their gift amount. IH invites impact-oriented investors to make grant-based investments to achieve this vision.

IH’s projected expenses for fiscal year 2021 of $6,082,657 represent a 64% increase from fiscal year 2020 actual expenditure. IH projects annual budget increases of 30% in fiscal year 2022 and 26% in fiscal year 2023, respectively. IH administrative and fundraising costs represented 16% of total expenditure in fiscal year 2020, and IH anticipates this cost category will remain under 15% of total expenditure moving forward. IH will continue to deepen the organization’s budgetary analysis to ensure spending aligns to the organization’s strategy and values.

Integrate Health (formerly Hope Through Health) was initially founded in response to an acute need for HIV/AIDS care and treatment in northern Togo. In 2004, a group of United States Peace Corps Volunteers, including Chief Executive Officer Jennifer Schechter and Chief Science Officer Kevin Fiori, began working with a community-based association of individuals living with HIV/AIDS, known as Association Espoir pour Demain (AED-Lidaw). The members of AED-Lidaw had come together to advocate for access to HIV/AIDS treatment, which was not yet available in northern Togo. The group of Peace Corps Volunteers refused to accept that people were dying from AIDS simply because of where they lived, and, as a result of this crisis, Integrate Health was founded.
Since 2004, Integrate Health and AED-Lidaw have built and scaled one of the most effective HIV treatment programs in Togo using the Integrate Health approach. Community Health Workers (CHWs) provide adherence and psychosocial support to patients in their homes, and the quality of clinical care is improved through training and mentoring for physicians, nurses, and midwives. Thanks in part to this work, HIV is no longer a death sentence in Togo, but instead is a manageable chronic condition. Since its founding, Integrate Health’s HIV program has directly saved thousands of lives. In 2020, Integrate Health served 2,000 individuals living with HIV through five district hospitals.
IH is on track to launch the final step in the four-year IPCP replication phase in the Binah district in July 2021. Further expansion of direct program implementation will be designed in close collaboration with the MOH to align to the national rollout of the strengthened community health strategy and could include implementing the national community health strategy across the entire Kara region, as requested by the MOH. Additional implementation could also serve to answer new questions that will undoubtedly emerge from the national policy development process. IH will work with government partners to identify the ideal implementation and research strategies to answer key questions and support national rollout, further leveraging IH’s role as an innovation center designed to help the government achieve its UHC goals. IH won’t stop delivering healthcare to people who need it until everyone across Togo has access to high-quality healthcare.