Advancing equitable health systems: Women leading the COVID-19 response

Jessica Cook


Integrate Health Community Health Worker, pre-COVID-19 pandemic, checking in on a mother with a newborn.

Hèzouwè Limazie, an Integrate Health Community Health Worker, during the COVID-19 pandemic.

Togo, a small country in West Africa, is home to over eight million people. Seventy percent of Togolese citizens, nearly six million people, lack access to adequate healthcare, according to the government’s own estimates[1]. This results in maternal mortality rates fourteen times that of developed countries, and one in ten children dying before their fifth birthday

These numbers are expected to be greatly impacted by the COVID-19 pandemic, potentially making the situation much worse for women and children. Ruptures in family planning supply chains, drop-offs in vaccination rates for children, and fear of virus transmission at health facilities all have the potential to make an already challenging situation more difficult for women and children during the pandemic.

The first case of COVID-19 in Togo was recorded on March 11, 2020. Since then, the government of Togo has responded quickly. As a result of the quick response, the spread of COVID-19 has been slow; however, cases continue to rise as they appear outside of the capital, where the health system is weaker. Integrate Health has worked closely with the government to support their response.

Integrate Health works alongside the government and local communities to implement and study an integrated approach to strengthening primary healthcare delivery in order to achieve universal health coverage. By integrating professional Community Health Workers (CHW), lay people who receive training to provide basic medical services to their communities, with improved care in public clinics, this approach creates a patient-centered health system that is accountable to the community and dramatically reduces mortality in severely resource-limited settings. Integrate Health prioritizes hiring women, at every level, to help design and build a health system that works for them.

Women are often left out of health policymaking, resulting in a health system that doesn’t fully address their needs. Integrate Health believes there is enormous untapped human potential in rural Togolese women who are smart, motivated, and capable, though they may not have had the opportunity to obtain a formal education.

One of these women is Justine. Justine has been a CHW for over five years. She lives in the district of Kozah in the Kara region in northern Togo. Her work consists of checking in on pregnant women and children in her community and counselling them if they have questions. She provides care to her patients and refers them to a health center for complicated cases. Justine has counselled pregnant mothers on how to give birth at a health center to the very children she is now checking in on to ensure they receive the vaccinations they need throughout the pandemic.    

Justine, an Integrate Health Community Health Worker, visiting one of her patients, pre-COVID-19 pandemic.

Not only has Justine been part of some of the most exciting times of many parents’ and families’ lives, she also has intimate knowledge of how her community operates. In turn, her community members trust her and the information she provides. Justine is seen as a leader in her community, a position that typically few women hold. Although women in leadership is not the norm in Togo,

90% of Integrate Health’s CHWs are women, helping to break the gender divide. Critically, CHWs have continued to lead their communities through the COVID-19 pandemic, further deepening the trust between CHWs and the patients they serve. Amidst the pandemic, Integrate Health CHWs have time and time again surpassed quality of care targets and continue to deliver essential healthcare.

Women like Justine are leading the way through the COVID-19 pandemic. By instilling trust in their community, they have been able to continue to provide essential, lifesaving care to women and children despite the challenges presented by the pandemic. As health systems look towards building back stronger during and after the pandemic, Integrate Health will continue to champion for the vital voices of women to design a health system that works for everyone.

[1] Ministère de la Santé et de l’Hygiène Publique, 2012. Plan National de Developpement Sanitaire Du Togo 2012-2015.

All views expressed in the foregoing post are the author’s own and do not purport to reflect the opinions or views of the Boston Network for International Development (BNID) or its members or sponsors.