Togo, located in West Africa and surrounded by Burkina Faso, Benin and Ghana, has 26 official points of entry and exit (PoEs) that are relatively well controlled and allow for the tracking of travelers as part of the fight against COVID-19. However, unofficial points of entry exist along the land borders, which are missed by the country’s PoE surveillance system. Thus, travellers who cross fraudulently are not recorded or captured by control and tracking system. This constitutes a major risk of case explosion, as was the case in the district of Mô at the western border of the country, where the number of COVID-19 cases increased from 0 to 14 between week 17 and week 20 of 2020.[1]

In response to this situation, and in an effort to reduce risk of case explosions, community surveillance cells have been set up in the border areas. These cells are composed of Community Health Workers / Community Relays (CHWs/CRs) as well as other community actors (village and neighbourhood chiefs, religious leaders). These CHWs/CRs are under the authority of the village chiefs and are supervised by the managers of the health facilities. The watch committees identify any traveller who arrives in the village or neighbourhood and notify the health facility manager for follow-up.

WHO, with funding of approximately US$ 5000, supported this initiative by training 6160 CHWs/CRs as well as health facility managers and village leaders in all health districts. This initiative improved the surveillance system at unofficial PoEs by putting into place a tool for tracking travellers: census form (to notify the health facility manager) of travellers upon arrival in the village and of any traveller who is quarantined and followed-up for 14 days. This tool has allowed the detection and follow-up of all travellers entering Togo outside official PoEs. Community awareness activities focused on the respect of barrier measures have also been conducted.

This initiative, a collaboration between WHO, the Ministry of Health, Public Hygiene and Universal Access to Health Care, the Minister of Territorial Administration, the National Civil Protection Agency, UNICEF and UNFPA, is a successful multisectoral partnership built around community participation. It has strengthened the multisectoral response capacity to the pandemic, and had thus contributed to the achievement of Outcome 2.3. for the “rapid detection and management of health emergencies” of the second pillar of the WHO’s Thirteenth General Programme of Work to have “one billion more people better protected in health emergencies.”

This community-based surveillance work carried out by CHWs/CRs allowed for the notification and follow-up of 7766 travellers placed in dedicated hotels, of whom 334 tested positive between April and mid-September 2020. This strong involvement of communities through CHWs/RCs has helped the system in the effective follow-up of all travellers (both official and unofficial) and contacts in villages and neighbourhoods, thus avoiding the explosion of clusters. Involving community stakeholders throughout the process allows for greater community buy-in at the grassroots level and early detection of cases in the community, leading to effective community participation in addressing health issues.

The involvement of CHWs/CRs has facilitated the monitoring of travellers, who trust them more. For their part, CHWs/CRs have benefited from the trust of their communities and the support of local authorities (village chiefs, prefects). Thus, they felt valued for their effective involvement in the management of the response in their communities. This has led to their motivation and commitment to continue to invest in the management of the pandemic and strengthen community participation. In addition to their main role, they have contributed to the identify of rumours about the disease and raising these to authorities, thus facilitating preventive management and development of an appropriate response.

The continuity of this initiative, including the motivations of CHWs/CRs and the financing of field visits, represents one of the main challenges, which is why WHO has advocated with other partners for the mobilization of resources for CHWs/CRs. WHO has also responded to the insufficient availability of communication tools for raising awareness among the population by producing and making available to CHWs/CRs communication tools. Through periodic supervision of CHWs/CRs, WHO also supports managers of the health facilities with planning the initiative.

To ensure the maintenance of the initiative, WHO will continue to advocate for the funding of community activities in the frame of the joint planning of the Ministry of Health, Public Hygiene and Universal Access to Health Care through the inclusion of a budget line for the strengthening of community-based surveillance through financial incentives for CHWs/CRs. This initiative demonstrates not only the benefits of community involvement in the response to COVID-19, but also the potential of multisectoral work with communities to protect and promote the health of the people of Togo.

[1] Mô had a population of 46 497 inhabitants and a density of 47 inhabitants/km² in 2020.

Photo caption: Briefing of CHWs at the Koumondè PACU (Peripheral Care Unit) in Assoli District (Kara).

Photo credit: WHO