Koffivi Madze Barack

Ashoka Fellow
Illustration of a person's face depicting a fellow
Fellow since 2020
This description of Koffivi Madze Barack's work was prepared when Koffivi Madze Barack was elected to the Ashoka Fellowship in 2020 .

Introduction

Koffivi has implemented anti-corruption innovative system, which allows reducing barriers of access, and increase transparency through the use of a team of volunteers’ medical facilitators and a team within the hospital, and connects doctors, pharmacist and people service delivery through a téléhealth app to increase access and better assistance of vulnerable patients.

The New Idea

Koffi addresses the issue of corruption practice in the way hospitals handle patients that come to them using the medical facilitators and teams in hospitals whose work contributes to eliminating the corruption in the healthcare service delivery. In this process, this work allows strengthening the management of the hospitals so that the corrupt practices are addressed and eliminated. Through the work of medical facilitators (COURSIERS D’HOPITAL), Koffivi eases the difficulties of the patient's medical journey undermined by corruption, generates for patients the habit of consultation & medical follow-up and restores trust in using hospitals. Medical facilitators assist in connecting pharmacies, laboratories, and hospital offices to offer the under-accompanied or unaccompanied vulnerable patients facilitation support in the hospital which considerably reducing the pain, discrimination that vulnerable people (people differently capable, term pregnant women,…) go through. The medical facilitator, is a new profile introduced in the healthcare system, made of volunteers empowered to serve with integrity and empathy.
Furthermore, he is introducing téléhealth in the Togolese health system through the use of the DOKITA EYE, app mobile App that he created. The app allows the creation of digital records of patients, connection with doctors, and online consultation. With the support of Google and Facebook, the second version of DOKITA EYE has been installed through which he created a network of +300 doctors, pharmacists, and people of the system delivery who interact through a mobile App to provide health assistance, breaking the barrier of both corruption and access. Moreover, the application revolutionizes health delivery as patients can use it without going to the hospital and at a reduced price, recorded and corruption-free. DOKITA EYES app also allows monitoring patients, consulting doctors without any need of going to the hospital, especially for term pregnant women, other vulnerable who cannot successfully make it to the hospital.
After a successful experience in Lomé, he has called the attention of senior government officials on the need to expand to other hospitals and regions of Togo. The initiative has been recognized in the region and there is an ongoing process for replication in Ghana, Benin, and Senegal, to use the solution to reform the same failures in the medical system. Coursiers d’Hopital International is a unique, creative & replicable initiative that values collective empathy and transparency in the delivery of health services. The model fosters human dignity and value for non-discriminatory practices in the management of patients. Facilitating the patient's medical journey considerably alleviates their suffering and costs. It is a first of its kind initiative in Togo, and well commended by both patients, doctors, government, and other stakeholders supporting its expansion in more places.

The Problem

Like the West African countries, Togo experiences a cruel deficit of human resources for health, with a coefficient of health staff of only 0.6 staff, 15 per 1,000 inhabitants while the minimum threshold of acceptable nursing staff density according to WHO is 2.3 . Despite these staffing challenges, the distribution and deployment of staff is extremely inequitable, with less than 25% alone in rural areas. According to the results of the QUIBB survey (Unified Basic Well-being Questionnaire), of the patients dissatisfied with the health services, 32% considered the service too expensive; 28%, the waiting time was too long; About 41% found the treatment to be ineffective and 15% mentioned the unavailability of drugs. The situation becomes worse for patients presenting alone to the hospital, or unaccompanied,
The lack of reliance, the fear of being badly treated, badly taken care of because of the system of corruption in the hospitals pushed to the lack of confidence in the health system in TOGO. As people no longer trust the hospital because of corruption, they barely go there again to have to live this ordeal, except in cases of extreme emergency, and rather have turned to self-medication, traditional medicine and other practices that have had very harmful effects on populations. Even despite the deleterious state of health, patients suffer from the same issue. Several cases are reported of patients dying within hospitals because they have not been taken care of on time, especially if not ready to bribe or pay extra cost they shouldn’t. This challenge is even worse for the unaccompanied vulnerable & without influence. It has been noted that the group of vulnerable patients arrives at the hospital almost unaccompanied. Only 2 out of 10 patients come accompanied or under-accompanied to the hospital in the event of illness or follow-up of treatment. There are people within the hospital that try to overcharge them, having to pay to go the next step, or taking advantage of their position and patients’ vulnerability to make money in the process or through the purchase of drugs. People with means, paying for a lot of facilitation they shouldn’t, and people who can’t pay are just pushed aside just because they can’t participate in the process of all the payoff to go through the very different stages. Besides this, another serious threat affecting most vulnerable people, unaccompanied is the sale of fake drugs, overbidding, for the benefit of drug sellers who exploit their vulnerability and/or they are under information. According to the WHO, between 40 and 60% of medicines on the African market are fake, causing on average more than 100,000 deaths / year. In Togo, there has never been a medical facilitation service in hospitals and health centers to resolve these access difficulties.
The Togolese state has created a number of initiatives in the area of social protection, social safety nets and programs, and even a new social health protection scheme, which has been implemented in recent years, but this has proven to not resolve the problem. The government has shown willingness to ensure this issue stops and has seen in the initiative an opportunity to tackle the issue. Not for profit organizations have tried the community approach, as has been the case since 2005 of the International Association of Doctors for the Promotion of Education and Health in Africa (AIMES-Africa), which takes the hospital to poor communities in rural and semi-urban areas through care campaigns especially because they cannot go to the hospitals. This approach is certainly good, but insufficient since campaigns are made periodically only yet the diseases are sporadic while the campaigns are periodic, and thus it is not sustainable.

The Strategy

From his passion for serving the vulnerable in the health sector to the urge to combat corruption in hospitals, Koffivi has forged alliances with the government through the health ministry, senior hospital leaders to allow the implementation of his solution which has helped him as an entry point in the hospital structures. After the go-ahead of the hospital senior leaders, with the backup support of the ministry of health, he approaches hospitals to implement the initiative, by creating a team within the hospital to support his work. There follow awareness-raising to build allies within the system, in the hospital, recruitment of medical facilitators and training on values and principles of COURSIERS D’HOPITAL. His model consist of bringing about change by convincing a team within the system to work with the volunteers, medical facilitators to achieve change in the way patients are handled. He works with a series of hospitals to address the issue of corruption they are facing in, and strengthen the management of the hospital.
Through this work, Koffivi has been building a volunteering-based team that work with the team of people from within the hospital, staff committed to eliminate corruption. The volunteers are medical facilitators, whom he selects carefully based on their value, experience, and commitment to serve. This is because finding volunteers for this type of work profile in the health system becomes very complicated, given that it is a humanitarian mission for which young people are less and less interested, so you have to find passionate people by serving the vulnerable. He has successfully created a collaboration with the Ministry of public hygiene and Health, which has been since providing volunteers to serve as medical facilitators. Selected volunteers have a track record of volunteering repeatedly for public health events such as vaccination campaigns. They are deemed reliable by the organizations for whom they volunteered, and they did that prior volunteer work with little or no expectation of financial support, apart possibly with help for travel expenses and a small allowance for food and have high standards of integrity. Volunteers stay focus on monitor to patients whether they are being treated and what the case is about, and intervene when needed to facilitate. With this he uses both pressures from inside and outside to solve the corruption problem, coming more from his personal experience of the suffering they face as a result of their ignorance of the hospital system, Koffivi has set up a model that allows the accompaniment of patients to the hospital and their facilitation of on-site care and support for those who cannot move to the hospital due to their vulnerability. Koffivi has placed volunteer, after their trainings in areas where corruption is more obvious. Medical facilitators serve therefore. A substantive part of the corruption and the payoff for services that people shouldn’t pay for happen the most while buying drugs at the pharmacy, the results at the laboratory, and others depending on the hospital. CH International has 3 different but related services within the hospital that are the Express Hospital (HE), The Express Pharmacy (PE), The Express Laboratory (LE). These services allows interaction between different actors, Hospital, pharmacy and laboratory, which are the main links through which a patient passes for treatment. This configurations mitigate the proliferation of false drugs and the traceability of medicines. Assisted patients (vulnerable) are kept informed on the processes and costs of steps they are on and their medical appointments required paperwork and being taken care of.
Koffivi has created a mobile medical monitoring application available, Dokita Eye that serves as digital health record and connects doctors, pharmacists, patients … the app revolutionize the way healthcare is delivered and increase access for those in remote rural areas. The application allows creating medical record for patients, and traceability of expenses of treatments, facilitating the consultation and medical follow-up with doctors, which allows reducing the gap of access. Koffivi has established a partnership French Embassy in Togo and the Togolese government to provide medical follow-up to ensure preventive and curative monitoring, through the Dokita Eye remotely, within a radius of 5Km. This project implemented by CH international is part of the Innovation for the Health of Mothers and Children of Togo (ISME-Togo) and aiming by June 2021, to monitor 100,000 five (5) years old children and 25,000 pregnant women. In rural areas, 455 smartphones have been availed to community mobilizers who assist in follow up and filling the info into the app, and 150 smartphones to health centers in rural areas. The Dokita Eye is therefore used to expand telehealth in Togo where access is a challenge. The app creates digital records of what has been paid and therefore play a key anticorruption role. The costs become affordable because free of corruption and then affordable for people.
Three (3) major international media groups have shed light on the initiative: France 24, TV5Monde, Canal+. The volunteer work done since the start of this initiative has enabled the funding of nearly 700,000 euros to be obtained from the French Ministry of Foreign Affairs and International Development on a project to monitor pregnant women and children under the age of 5 in Togo. In November 2018, the initiative won the Youth SDGs Awards in the “Leave no one behind” category Co-organized by the Ghanaian government and the UNDP in Accra. Version 2 of the mobile application for medical monitoring of patients was installed in 2018 by more than 300 doctors, pharmacists and laboratory workers.
The community have started to understand the need for transparency and approach medical facilitators as corrective agents, or recommend patients to connect with them; the number of patients reached by the initiatives at the end of 2019 was about 73,648. KOFFIVI's ambition is to extend this initiative to the main hospitals and health centers in Togo, having a critical mass of hospitals adopting this new service proposal, which is key to making it a national standard for definitively stem the corruption that handicaps the health system. He would also like to extend the idea to other countries, where the need is felt, including Ghana, Benin, and Senegal, which have all visited the initiative, and where studies are underway with teams from these countries to replicate the model and solve systemic problems in the national health system.

The Person

His passion comes more from his childhood and his family education which transmitted to him a sense of generosity and active solidarity. Koffivi was raised by parents with a big heart and selflessness. His father, a man for whom service to the community was second to none, he was an ombudsman. His mother had the same character, despite the social conditions, she was always ready to serve. She was the main wife but could treat other co-wives and their children with respect and value. Having grown up in such an environment, where "finding a solution to get others out of their problems" is a daily occurrence, Koffivi sees himself through CH International realizing a personal passion and perpetuating a family tradition, that of refusing the status quo and active innovation.
It all changed for him, when he had experienced first-hand the devastating impact of the lack of care and corruption in the hospital system on the ordinary citizens. His experience seeing people die or not being taken care of because of their vulnerability, seriously affected him. This feeling became even stronger when he lost his father and mother due to this challenge. He realized that the importance of having a companion with you on the medical journey when you are sick especially when his physical condition requires this. He was personally confronted with the hospital environment during these periods and was shocked to see the suffering of vulnerable people without accompanying due to corruption, he decided to take action. This is where the struggle began to reduce as much as possible the sufferings of the sick, already vulnerable by their living conditions, and their illnesses, and thus contribute to a more liveable world for all and respectful of human dignity.
His dream is to provide humanity with a solution that will have an impact and promote justice in access to care without taking into account differences of all kinds. He wishes to see the work of medical facilitators globally replicated and adopted in the future, like that of the Red Cross around the world, the SCOUT movement, etc.