Togo’s healthcare inefficiencies limit outcomes despite investment, with medicine shortages, workforce disparities, and equipment gaps. Using the FinHealth Toolkit, Togo linked financial management issues to service challenges, fostering inter-ministerial collaboration and targeted reforms improving efficiency toward universal health coverage.
Togo’s healthcare system, despite progress over the past two decades, continues to face significant inefficiencies that limit the impact of government health spending. Compared to aspirational peers like Ghana, Morocco, and Rwanda, Togo’s health outcomes improve at a slower pace, and disparities persist, notably with expectant women in urban areas being over twice as likely to receive qualified care than those in rural regions. Key challenges undermining healthcare delivery include medicine shortages affecting nearly half of primary healthcare facilities, unequal distribution of healthcare workers concentrated in the capital, and inadequate availability of essential medical equipment such as ultrasound and CT scanners. Addressing these inefficiencies is critical as Togo embarks on health financing reforms aiming for universal health coverage, with the risk that expanding insurance coverage without solving systemic problems could overwhelm the system.
To tackle these issues, the World Bank Group, in partnership with the Togolese government, applied the FinHealth Toolkit, an innovative approach combining public financial management (PFM) and health sector perspectives to analyze how PFM influences healthcare delivery. For instance, medicine shortages result from a complex blend of PFM and operational challenges: insurance reimbursements are delayed by multi-layered approval processes, slowing the flow of funds needed for purchasing medicines; procurement agencies rely on outdated historical sales data rather than actual facility demand forecasts backed by existing hospital software; and prescriptions often lean toward branded drugs instead of cost-effective generics. Additionally, many healthcare staff lack proper inventory management training, further aggravating shortages.
The FinHealth process yielded three main insights from Togo’s experience. First, fostering collaboration between key ministries—including Health, Universal Healthcare Access, and Finance—through joint field visits to over 20 health facilities created shared understanding and accelerated problem-solving. Sustained high-level political commitment is vital to overcome entrenched institutional inertia and incentives benefiting certain stakeholders resistant to reform. Second, the problem-driven methodology tailored analysis to connect specific service delivery issues directly with their PFM causes, producing actionable, focused recommendations instead of broad reviews. Third, raising awareness of spending inefficiencies has spurred concrete reforms, such as the Ministry of Health working with Finance to develop a digital system for medical asset tracking, improving transparency of equipment across hospitals.
Overall, the FinHealth Toolkit offers a practical framework for low-resource countries like Togo striving to enhance healthcare efficiency by systematically integrating financial management insights with frontline service realities. This integrated approach enables the design of targeted, sustainable solutions addressing long-standing health system challenges and promoting universal health coverage objectives.
