Togo HEALTH SITUATION The health situation in Togo is characterized by persistently high morbidity and mortality rates, despite progress in recent years regarding a number of interventions, such as use of treated mosquito nets and immunization coverage. In general, it would appear the majority of disorders and health problems are caused by infections that are for the most part avoidable. Scant progress has been made on most health indicators, particularly those related to the Millennium Development Goals. Malaria remains among the leading causes of morbidity, accounting for an average 40% of outpatient consultations and 28% of hospital admissions. It is also responsible for 8-25% of deaths among children under 5. Progress on HIV/AIDS has been remarkable. The prevalence rate among the general population has been 3.2% since 2006, as against 5.9% in 2001. The number of new tuberculosis cases increased from 1452 to 2097 in the period 20012010. Approximately 25% of tuberculosis patients are coinfected with HIV 1+2. Certain noncommunicable diseases have emerged in connection with high levels of exposure to risk factors such as tobacco use, alcohol abuse, use of drugs and psychoactive substances, obesity, etc. In the population aged 15 to 64, high blood pressure prevalence is 19% and that of diabetes 2.6%. Cardiovascular diseases are responsible for 6% of all deaths recorded at health-care facilities nationwide. Policies and strategies in the water sector have improved access to drinking water; 34% of the population were using improved sources in 2007 and 57.3% in 2010. Only 34.9% of the Togolese population were using improved sanitation facilities in 2010.
http:// www.who.int/countries/en/ WHO region World Bank income group CURRENT HEALTH INDICATORS Total population in thousands (2012) % Population under 15 (2012) % Population over 60 (2012) Life expectancy at birth (2012) Total, Male, Female Neonatal mortality rate per 1000 live births (2012) Under-5 mortality rate per 1000 live births (2012) Maternal mortality ratio per 100 000 live births (2010) % DTP3 Immunization coverage among 1-year-olds (2012) % Births attended by skilled health workers (2010) Density of physicians per 1000 population (2008) Density of nurses and midwives per 1000 population (2008) Total expenditure on health as % of GDP (2011) General government expenditure on health as % of total government expenditure (2011) Private expenditure on health as % of total expenditure on health (2011) Adult (15+) literacy rate total (2006) 6643 41.89 4.44 57 (Male) 58 (Both sexes) 59 (Female) 33 [21-54] (Both sexes) 96 [73-125] (Both sexes) 300 [180-530] 84 43.9 0.053 0.274 8 15.4 47.8 56.9 59 (Total) 40 (Rural) 90 (Urban) 11 (Total) 26 (Urban) 3 (Rural) 28.2 122 159 Africa Low-income
HEALTH POLICIES AND SYSTEMS Since 2010, Togo has availed itself of regional and international health partnership initiatives such as Harmonization for Health in Africa and the International Health Partnership and related initiatives (IHP+), and proceeded to reform the political and strategic framework of its health system using an approach based on dialogue between all stakeholders in the sector. In addition, Togo drafted a new national health policy in 2011 and a national health development plan for 2012-2015. In order to facilitate a political dialogue around the outcomes of the health development plan, a joint monitoring and evaluation framework has also been developed. These reforms led to the signing, in May 2012, of a national compact between the Government and its partners to support implementation of the health development plan through operational plans at all levels of the health sector. Togo’s health system is relatively well-equipped in terms of infrastructure, with 66.8% of the population enjoying access. Geographical, economic and social disparities with respect to the delivery of and access to essential care nonetheless remain. Analysis of the distribution of human resources for health indicates that most of the health workforce is concentrated in the capital, to the detriment of rural areas. Various initiatives are under way to ensure that qualified health workers are present in rural and remote areas. Access to high-quality, affordable essential and generic medicines is problematic. Health financing is hobbled by the small proportion of Government expenditure on health (approximately 5%) and under-mobilization of internal resources. 51% of all health spending is out-of-pocket expenditure by households through the direct payment system. In 2012, however, Togo introduced mandatory social health insurance for public-sector workers, who account for 10% of the population. The main challenge will be to extend health insurance as quickly as possible to the most vulnerable groups.
Population using improved drinking-water sources (%) (2011) Population using improved sanitation facilities (%) (2011) Poverty headcount ratio at $1.25 a day (PPP) (% of population) (2011) Gender-related Development Index rank out of 148 countries (2012) Human Development Index rank out of 186 countries (2012) Sources of data: Global Health Observatory, April 2014 http://apps.who.int/gho/data/node.cco
COOPERATION FOR HEALTH By subscribing to IHP+, Togo has strengthened and galvanized cooperation and mobilization of partnerships and resources. The national health compact signed in 2012 is the concrete outcome of this cooperation. The current challenge is to improve coordination, monitor partnerships, and mobilize and manage resources at all levels of the health sector in the spirit of the national compact.
WHO COUNTRY COOPERATION STRATEGIC AGENDA (2009-2013) Strategic Priorities STRATEGIC PRIORITY 1: Improve maternal, child and adolescent health •
Main Focus Areas for WHO Cooperation Support strengthening of maternal and neonatal health-care services (monitoring during pregnancy, delivery and the postpartum period), repositioning of family planning and elimination of mother-to-child transmission of HIV (EMTCT), and strengthening the Expanded Programme on Immunization including introduction of new vaccines. Support community-based integrated management of childhood illness (IMCI) and promote essential family practices at the household and community level. Improve the reproductive health of adolescents and young people. Support the promotion of nutrition interventions, including micronutrient supplements, food fortification, nutritional advice and routine deworming of children under age 5. Support control of HIV/AIDS, tuberculosis and malaria. Support control of communicable diseases, including for epidemic-prone diseases. Support control of neglected tropical disease. Prevention of health risk factors related to noncommunicable diseases. Capacity-building for management noncommunicable diseases. (secondary and tertiary prevention) for
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STRATEGIC PRIORITY 2: Communicable and noncommunicable disease control
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STRATEGIC PRIORITY 3: Health and community system strengthening
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Support improved governance and health system steering. Support the development of human resources for health. Improved availability of services and quality of care. Support for the pharmaceutical sector and the availability of medicines, vaccines, blood products and medical technologies. Support necessary research into health financing and draft a national strategy to finance and develop universal health coverage. Strengthen the national health information system. Development of community-based interventions. Strengthen the mobilization of partnerships and resources. Strengthen national leadership in coordinating stakeholder interventions in the health sector.
STRATEGIC PRIORITY 4: Strengthening of partnerships, coordination and resource mobilization
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e note that the 3 generation CCS 2014-2018 is being finalized
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WHO/CCU/14.03/Togo
Updated May 2014