Create Togo NPHI

Togo has seen dramatic declines in its economy, living standards, and health outcomes since the early 1990s. Despite many challenges—minimal donor presence, fragile infrastructure, human resource deficits, and underfunded public health sector—the country’s leaders, including the president, believe that a comprehensive national public health institute is needed to meet the nation’s many health challenges.

Based on an initial assessment, IANPHI recommended some immediate actions to improve and modernize Institut National d’Hygiene (INH)—the government’s designated agenda for public health leadership— as a foundation for development into an NPHI. These first steps focused on improving the quality of laboratory services for disease surveillance and outbreak response and integrating laboratory and epidemiologic efforts. In addition to strengthening core public health functions at the national and sub-national levels, these strategic investments provided an opportunity to increase Togo’s visibility among international donors and partners and integrate Togo into regional and global public health initiatives.

After 2+ years of IANPHI project support, Togo’s Ministry of Health continues to champion creation of a comprehensive national public health institute. L’Institut National de Santé Publique (INSP) will consolidate and strengthen core public health functions, including disease surveillance, disease prevention and control, outbreak investigations, laboratory science, and applied research, and will be a focal point for the development and use of data to improve health in Togo. Exemplifying IANPHI’s unique peer assistance model, two IANPHI member institutes – Morocco’s Institut Pasteur and France’s Institut de Veille Sanitaire (InVS) -- are generously sharing their expertise to support INSP development. 

Year 1 of the Togo-IANPHI project focused on laying the foundation for INSP creation, which will combine the missions, resources, and staff of INH and the Ministry’s Division of Epidemiology (D-Epi). IANPHI support provided essential equipment and training to position INH as a focal point for development of INSP in close collaboration with D-Epi and potentially other MOH components that perform core public health functions.

Year 2 continued the incremental strengthening of INH with increased emphasis on boosting epidemiologic expertise and beginning efforts to extend the capacity-strengthening initiative to the peripheral levels of the public health system. The focus was on disease surveillance, integration of laboratory and epidemiologic functions, and essential training to support and develop the public health workforce.  A noteworthy organizational achievement including validation of a Strategic Plan for Development of a National Institute of Public HealtH, 2012-2016.  In addition, a formal decree for creation of INSP is imminent.  Both of these milestones signal determined movement toward the goal of strong public health leadership and a fully functional NPHI in Togo.

Notes from the Field

The dream of Togo’s Director General of Health, Dr. Kokou Dogbe, to transform Institut National d’Hygiene (INH) into a comprehensive NPHI that will address the major health problems of the Togolese people continues to move closer to reality.  With IANPHI funding and pro-bono technical assistance from the French Institute for Public Health Surveillance (INvS) and Morocco’s Pasteur Institute, two important initiatives are underway to strengthen information systems and build expertise in scientific research and publication.

Faster, More Accurate Data

Strengthening information systems is an important priority for Director General Dogbe, said Professor Mohammed Hassar, IPM director general emeritus. “Togo’s leaders have a clear view of what they want.” Professor Hassar, a founding member of IANPHI’s Executive Board, and Khalid Gabi, IPM information system engineer, visited INH in March to assess the current information system and make recommendations for improvements. The benefits of a system-wide approach include collecting more accurate and timely data on disease threats, allowing for faster responses to disease outbreaks and more accurate, evidence-based decision making at all levels of government. In addition to short-term solutions, the team developed longer term recommendations on infrastructure, software, data, procedures, and training.

IPM has generously pledged continuing support and mentoring to include on-site technical assistance in Togo, visits to Morocco to study IPM platforms and systems, an internship for a newly hired INH information specialist, and help in identifying other partners and donors to support implementation of the information systems plan.

Strengthening National Capacity for Evidence-based Policy

Augmenting INH’s improved information system was an April 2013 training on scientific research and publication for 19 West African scientists.  Spanning a range of disciplines and affiliations – epidemiologists, biologists, and laboratorians representing academia, public health, and community care in Togo and neighboring Cote d’Ivoire -- their diversity of experience was ideal for network building. All wanted to learn the basic principles of scientific writing and publish findings that could influence policies in their countries.

“They are doing good work and it’s important that they share that work through publications,” says Dr. Jean-Claude Desenclos, deputy director for science of France’s INvS, who facilitated the seminar along with Dr. Didier Ekouevi from the University of Lomé and Adjane Koura, quality manager at the National Blood Transfusion Center of Lomé, who did his Humphrey Fellowship practicum at the IANPHI-U.S. office.  The seminar used case studies relevant to Togo and Cote D’Ivoire to illustrate approaches to scientific research and publication. Over the next 12-18 months, teams of junior and senior researchers will work on five protocols with the goal of publishing their research. IANPHI will help underwrite future data collection, analysis and policy development.