Innovation pour la Santé des Mères et des Enfants du Togo (ISME-Togo)

The ISME-Togo project aims to combat the problems of access to medical care and follow-up for the target populations:

Problem of access to qualified health personnel and provision of essential care due to: long distance between targets and health centres; impassable roads in the rainy season; lack of financial means to travel, pay for consultations and care;
The consequences: Absence and delay of medical follow-up; limited access to medicines; lack of medical history for target populations; high infant and maternal mortality rates.

This project aims to improve the quality and accessibility of care and services adapted to pregnant women and children under five in remote areas of the Maritime region through the digital application Dokita Eyes.
To achieve this objective, the action plan is as follows:

The CHWs are in charge of taking vitals and performing analyses (temperature, blood pressure, haemoglobin levels, blood sugar levels, etc.). They enter these data, as well as the symptoms observed, into the application, which becomes a patient’s health record. The PHU staff is then alerted of the recording.
The nursing staff (nurses, midwives and medical assistants) of the PHU analyse these parameters and decide on the action to be taken: issue a prescription; ask the patient to come to the PHU; make a visit to the patient’s home; request the expertise of the doctors of the Medical Council of ISME – Togo; or take no specific action. The doctors of the medical council are recruited on the project to give medical advice and ensure remote treatment with the PHUs and CHWs of the community. These gynaecologists and paediatricians are 4, eventually there will be 11 or 13. They are permanently connected to the application for any request.

A synergy is created between the community health worker (CHW) in the community, the peripheral health care unit (PHU) located more than 5Km away and the specialist located hundreds of km away for an integrated management of the patient directly in his community without the need to travel. In the event that the patient needs to be placed, the PHU is informed in advance by the CHW who has been trained and knows when to refer. These CHWs receive training on Integrated Management of Childhood Illness at Community Level (IMCI-C) and danger signs in pregnant women.

In Togo, first-contact care is structured around three levels:

Community Health Workers (CHWs) provide health care (including maternal, neonatal and child health) at the family and community levels. CHWs are volunteers and have not received formal professional or para-professional training. In ISME-Togo, they act as an interface between the community and health services. In addition, they are on the front line to detect and report dangerous situations and have a key role in the early warning of health centers;
Peripheral health care units (PHUs) as the base of the health care system and from which outreach activities are carried out as a fixed strategy and towards the population;
District and regional hospitals, which constitute the first and second referral level respectively.