Health services in Togo: Growing dissatisfaction with government performance

The health system in Togo, although having made significant progress with regard to basic indicators, remains fragile (Africa Renewal, 2010). It has been going through periodic disruptions for several years, which in 2018 were particularly trying for users of health services with even a dry strike without minimum service (Tounou-Akué, 2018; L-frii, 2018; alome.com, 2018; VOA , 2018; Kamako, 2018). These strike movements relate not only to the improvement of working conditions and the technical platform, but also to wage conditions (Republicoftogo.com, 2018; lomeinfos.com, 2018).

The governance of the Togolese health system also seems to pose problems, but the solutions recommended by the government do not convince their social partners (Togotribune.com, 2018). Indeed, if the leaders of the Union of Hospital Practitioners of Togo (SYNPHOT), the main social partner of the government, recognizes that the option of contractualization of the management of the University Hospital Center Sylvanus Olympio taken by the government can improve the management of the centre, he also reminds us that health problems are not limited to questions of good governance (Lomeinfos.com, 2018).

Health, a top priority

When Togolese are asked what they consider to be the most important issues that their government should address, health ranks 2nd, mentioned by 42% of respondents among their top three priorities.

Experience with health services

Citizens place such a high priority on government action over health services perhaps because many believe it is difficult or impossible for them to get the care they need. . As one might expect, poor or less educated citizens are more likely than their better off and more educated compatriots to go without health services. In addition, disparities emerge from one region of Togo to another. Even when they do not have to go without medicine and treatment, almost half (48%) of Togolese say it is “difficult” or “very difficult” for them to obtain the health services they need .

While rural and less educated residents are more likely to report going without health services, urban (55%) and better educated (51%) citizens are more likely to say it is difficult for them to get the care they need. The difficulties felt in obtaining care also increase with the respondents' poverty line, ranging from 32% among those with a low or no level of lived poverty to 57% among those with a high level of lived poverty.

Regarding another quality of service indicator – the waiting time before obtaining the necessary care – almost two-thirds of Togolese say they received the services “immediately” (24%) or “after a short delay” (40%). One in three (34%) claim to have had to wait "a long time", and 1% claim to have "never" received care.

As for the evaluation of access to health services, more Togolese think that the possibility for them to obtain medical care has deteriorated compared to "A few years" earlier: A relative majority (44%) affirms that it is "worse" or "much worse", while 33% think it is better. One in four (23%) say things are the same.

Government performance in improving basic health services

Overall, six out of 10 Togolese (62%) say the government is doing "fairly badly" or "very badly" when it comes to improving basic health services, marking an 11-point increase in percentage compared to negative ratings in 2014. The proportion of respondents who praise the government for its performance has fallen from almost half (48%) to one third (36%).

Authors of the article: Thomas Isbell and Hervé Akinocho, see more: http://afrobarometer.org/fr/publications/ad310-services-de-sante-au-togo-mecontentement-croissant-face-la-performance