Innovative approach pays dividends in Togo

Published: 17 December 2004 0:00 CET

Marko Kokic in Lomé

Homes normally filled with women and children in the town of Kpalimé stand empty. No young children play in the courtyard.

A cooking fire smoulders in a vacant home, a single wisp of smoke rises before the fire finally dies. Outside, the streets are still with only a few adults going about their business.

But a walk through the neighbourhood reveals the sound of people gathered somewhere in the distance.

Following the muffled voices, they soon become recognisable as the shrill cry of young children. A little further, and the source of the cries is identified. Outside a health centre, hundreds of women and children are waiting in long queues.

As if on some life-preserving assembly line, each child is sent from person to person, whose interventions provide the child with protection from a specific disease.

Togo Red Cross volunteers register each boy and girl, and parents are given a number. One by one, each child is vaccinated against polio with an oral vaccine. Next they are given a de-worming tablet called mebendazole, and then are injected with measles vaccine by a Ministry of Health worker.

As the needle is inserted, many begin to cry. Mothers, untroubled their children’s protests, know that their child is being protected from a deadly disease. Finally, each child receives an insecticide treated bed net (ITN).

In this little corner of Togo and at over a thousand vaccination and distribution points across the country, public health history is being made this week.

Never before have so many public health initiatives been integrated on such a scale. The integrated campaign will provide the country’s 900,000 children under the age of five with protection from four serious diseases.

Of particular importance is the unprecedented distribution of 900,000 ITNs - one for every child under five, who by simply sleeping under one will be protected from malaria.

Malaria kills about a million children in Sub Saharan Africa each year and costs African countries US$12 billion to treat. In many of the countries whose health care systems are already struggling, malaria constitutes a major burden sapping limited resources.

In Togo, about 60 per cent of hospital admissions are due to malaria and over 80 percent of the cases are young children.

The success of the campaign will mean that in future the paediatrics hospital wards will be far less burdened by cases of malaria and measles. More beds will be available to address other major health issues facing Togo such as tuberculosis and HIV/AIDS.

For individual families the formidable costs of malaria treatment will also be avoided.

“My son contracted malaria this year. Luckily it was not a serious case and with a doctor’s consultation and some basic medicine costing US$ 4 he was able to recover,” says Augustine Adondgi, standing in line at another vaccination and distribution post outside Saint Kisito Primary School, in Agbetiko community.

“Had he had a serious case requiring hospitalisation, I don’t know how we would have managed to pay for it.”

In a country were the average salary is about a dollar a day, many families simply do not have the disposable income to pay for the treatment necessary for a serious case of malaria.

“We have no national data yet, but from observations made in the field we realize that the message about the campaign got out and people clearly understand what is going on,” says Mark Grabowsky, Senior Health Technical for the American Red Cross on the evident success of the campaign so far.

“The logistics in the vast majority of cases has been done very well especially with the help of the Ministry of Health and our corporate partner DHL. We have seen massive turnout at the vaccination and distribution posts. We observed that the vaccinations are being done safely and anticipate very high coverage for the entire country,” he adds.

The Togo Red Cross Society, through its network of 7,400 volunteers, was a key player in getting the right message to people months before the campaign got under way.

Working in 12 districts, volunteers did door-to-door and community social mobilization campaigns informing people about the importance of protecting their children, as well as the location of the vaccination and distribution centres.

In addition, volunteers spoke with individual community leaders in an effort to get them on board.

Standing in line next to Augustine, is Gentille Afanhteu: “We heard about the campaign on the radio and television and the village chief asked us to take our children to be vaccinated.”

A national cell phone company had also sent their clients SMS messages about the campaign.

Key to the success of this unprecedented public health campaign was a willingness to take a calculated risk, coupled with an innovative and cost-effective delivery mechanism. Using the platform of measles immunisation, an ITN can be delivered to a child for less that US$0.50.

“This campaign required some vision and people daring to take risks,” says Jean Roy, Senior Public Health Advisor with the International Federation. “Big health problems need to be addressed in an innovative way and we need people to inspire us by taking risks.”

“This was demonstrated clearly by the Canadian International Development Agency (CIDA) through the Canadian Red Cross Society. CIDA dared to contribute 3.9 million Swiss francs to this innovative approach. There are other traditional development agencies that would hesitate to do that, preferring to stick with what is safe and sound. But to confront a big health problem we cannot use small solutions and CIDA was the inspiration.”

He says that CIDA has been closely following the results of pilot schemes where, under the auspices of the Measles Initiative, the distribution of ITNs has been integrated into mass vaccination campaigns.

“So when we asked for funds for 50,000 bed nets they said ‘why not 500,000, why not more?’ In the end we got funds for 730,000 bed nets. CIDA was willing to provide what it took to address the problem, but they were also looking for ways to do more for less. It’s not only a question of how much money you sink into addressing public health problems. To make a dent in huge public health problems such as malaria we need to find new innovative ways that are effective by doing far more for less. Through this integrated approach we have done just that,” Roy explains.

Over the next few months an extensive follow-up measuring coverage, its impact on disease, cost effectiveness and the impact of the social mobilization campaign will be done.

Togo Red Cross volunteers will be visiting every home on a monthly basis to make the evaluation and advise families on the proper use of the bed net. In those places where there is new person at risk, such as a pregnant woman, newborn child or a new immigrant with children, Red Cross volunteers will work to help them get vaccinations and a free bed net.

Next year a similar campaign is envisioned in Equatorial Guinea, Niger and areas of Southern Chad at risk of malaria risk.

As a final comment on the campaign, says Jean Roy, “Years from now we hope that the campaign in Togo will be seen as the beginning of the end of malaria.”