Repositioning Family Planning in Togo. Status of Family Planning Programs in Togo
Health Policy Project, USAID, 2013
Ce document résume les principaux constats et recommandations issus d’une évaluation de 2011 de l’initiative «repositionnement de la planification familiale» du Togo.
Togo is one of the poorest countries in the world, with a per capita income of about US$850. Togo’s economy is largely based on agriculture, which supports nearly two in three Togolese workers.
In the past 50 years, Togo’s population has quadrupled in size. It has a young population, with two in five people under age 15. As these young people become parents, Togo’s population will continue to grow.
Nevertheless, the potential to slow population growth exists because many couples are having more children than they would like. About one in three (32%) married women ages 15–49 want to space or limit future births but are not using any method of family planning.
The overall policy environment for family planning in Togo is favorable. The 1998 National Population Policy seeks to reduce the proportion of high-risk pregnancies.
The 2007 Reproductive Health Law establishes the right of all citizens to access services and information about reproductive health (RH). Since 2009, the Ministry of Health (MOH) has been implementing the Policies and Norms for Family Planning, Reproductive Health, and Sexually Transmitted Infections. These norms include gender equity, male involvement, and men’s reproductive health.
Togo’s Family Planning Program Effort score, which rates 30 indicators reflecting policies, services, evaluation, and access to contraceptives in national FP (family planning) programs, has improved slightly, rising from 53 in 1999 to 55 in 2004 out of a possible score of 100. The 2009 Contraceptive Security Index for Togo was 49.5 on a scale of 100, indicating a relatively low level of contraceptive security.
The Division of Family Health (DSF) within the MOH oversees and manages the FP program, as well as maternal and child health, youth, and nutrition services. With this large portfolio and overburdened staff, the DSF is finding it difficult to provide leadership to FP activities. Key informants recommended that the MOH designate DSF as a directorate; place it higher up in the MOH structure; and give it adequate human resources, equipment, office space, and funding to carry out its mandate.
In addition, districts and communities need more qualified and better trained community health workers, as well as medical professionals such as nurses, midwives, and doctors. Togo has a critical shortage of health workers, with fewer than 0.33 health professionals per 1,000 people, much lower than the WHO’s recommended minimum of 2.28 healthcare professionals per 1,000 people.
Based on its assessment, the assessment team made the following recommendations to the government of Togo and its partners:
• Strengthen, support, and increase the DSF’s capacity for leadership and coordination. The government should place DSF at a higher level within the MOH and provide it with the human, material, and financial resources it needs to address the high unmet need for FP.
• Revise the National Policy on Community-Based Interventions to ensure that CHWs are allowed to provide an initial supply of oral contraceptives and give injectables. The MOH and its partners should continue to scale up provision of pills and injectables in more districts.
• Provide additional training to nurses to enable them to provide quality long-term FP methods.
• Increase the government’s funding for contraceptive commodities.
The assessment team’s recommendations for civil society organizations are to:
• Form a strong network to advocate for improved RH/FP policies and for CSO participation in the design, implementation, and monitoring of RH/FP policies.
• Urge decision-makers to allocate more national resources to support FP services and information throughout the country.
• Intensify efforts to monitor the government’s national and international commitments to FP programs and provide regular updates on progress toward greater support for FP programs.
• Support the formation of the network of Muslim and Christian leaders involved in health.
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