ProSanté II: Increase of quality and use of reproductive and sexual health services in Togo

Project description

Title: Health System Strengthening – Sexual and Reproductive Health and Rights
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Togo
Lead executing agency: Ministry of Development Planning and Cooperation, Ministère de la Planification du Développement et de la Coopération (MPDC)
Gesamtlaufzeit: 2020 to 2023


Togolese women are at risk when it comes to decisions concerning their health. The health system is underfunded and there is a lack of adequate infrastructure and qualified staff. As a result, mothers have a 57-fold higher risk of dying in childbirth than in Germany. One in seven women gives birth to her first child before the age of 18. It is estimated that 18 babies under one month old die every day. Poverty and a lack of education for mothers are particular risk factors. Since the start of the COVID-19 pandemic, access to health services has deteriorated further.

The weaknesses in health service provision are further exacerbated by external factors, such as climate change. Variations in temperature and rainfall are changing the incidence of infectious diseases such as malaria, which affect women and children first and foremost.


The quality and use of basic health services, especially in regard to sexual and reproductive health, are improved in the Kara region.


To improve the quality of the health services, the project has developed a national quality management programme with its partners which has been piloted in 30 health centres. Eighty health facilities now implement this approach. Staff receive systematic training, in cooperation with the regional and district administrations in Kara. The content includes quality management, reproductive health, sexual rights, and infection prevention and control. In close collaboration with the midwifery school, the project also supports basic midwifery training in Kara. 

To encourage more people to use health services, the project is working with civil society to inform the population about reproductive health and protection against COVID-19. A comprehensive communication strategy makes use of ’change agents’, such as the tantines (young mothers) association, mothers’ and fathers’ clubs and community leaders. The strategy also includes mass communication at cultural events and film screenings, and through the media. 

To foster long-term change, the project is strengthening the ministry’s management capabilities. Organisational development measures and jointly developed conceptual documents are facilitating the work of important organisations. The project also supports the German Embassy’s participation in the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). In addition, it advises the national partners on applying for funding from climate funds and preparing the country for the impacts of climate change.

To contain the spread of the COVID-19 pandemic the project is helping to set up a laboratory. It is also contributing to patient case management and equipping health facilities.


  • The project offers internships for graduates of the national midwifery schools in Kara and has also set up a demonstration room for practical training.
  • A total of 2,318 health workers have been trained in quality management, sexual and reproductive health and rights (SRHR) and COVID-19, which has improved care for Kara's 957,000 inhabitants. 
  • In Kara, the number of births attended by qualified staff has increased from 62.4 percent to 64.8 percent since 2018. Since then, 40.3 percent of mothers have taken advantage of the four prenatal check-ups, against 30.2 percent previously. 
  • The project has trained some 4,000 change agents, who are providing information on SRHR to around 90,000 people.
  • A risk study and adaptation plan have been drawn up to prepare the Togolese health system for the impacts of climate change. 
  • Community radio stations have broadcast a total of 240 interactive programmes informing people about COVID-19 prevention.
  • The project has helped set up a branch of the national laboratory in Kara to meet the need for COVID-19 PCR testing in the northern regions.

Last updated: May 2021

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Additional information