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Togo has one of the highest levels of unmet need for contraception in the world: According to the 2006 Multiple Indicator Cluster Survey (MICS), two in five (41%) married women in Togo have an unmet need. Unmet need for birth spacing (26%) and limiting (15%) are both very high. Preliminary results from the 2010 MICS show that 20% of married women use family planning (FP). While the use of modern methods grew from 11% in 2006 to 18% in 2010, use of long-acting and permanent methods of contraception (LA/PMs) remained under 2%. 

RESPOND's strategy in Togo is to provide the Division for Family Health (DSF) and nongovernmental organizations with technical assistance addressing the three pillars of effective FP programs: supply, enabling environment, and demand. The project addresses supply and demand in three health districts and addresses the enabling environment for FP at the national level. 

On the supply side, RESPOND will assist the DSF to train or update FP providers in FP counseling, infection prevention, and clinical FP, including long-acting methods. Since health center cleaning staff share a large part of the responsibility for preventing infection, RESPOND and the DSF will also train cleaning staff on infection prevention. RESPOND will train district-level doctor-nurse teams in permanent methods. In addition, RESPOND will build the capacity of DSF supervisors through training in facilitative supervision and the COPE process for quality improvement. Furthermore, RESPOND will provide technical assistance to the DSF as it organizes special FP days in which the DSF provides FP services free or at a reduced price. Some of these special days are considered "mobile services" because providers with training in LA/PMs travel to lower-level facilities to expand the range of contraceptive options available on the special day. 

On the demand side, JHU•CCP leads RESPOND's efforts to increase and improve communication about FP, including LA/PMs. Having completed formative research in the previous project year, RESPOND will hold a workshop to develop information, education, and communication (IEC)/behavior change communication (BCC) messages. Based on the results of the workshop, RESPOND will develop, pretest, and produce a number of IEC/BCC materials for different audiences. Some of these materials, such as flipcharts to improve counseling, will be designed for use at health centers. RESPOND will also reach a wider audience through spots on community radio that communicate the benefits of FP. In addition, RESPOND will recruit volunteers who are providers, satisfied clients, and community members to serve as FP champions. Champions will discuss FP and answer audience questions on local radio programs. 

To improve the enabling environment, RESPOND and the DSF will organize meetings of the National Working Group for Repositioning FP. During the prior project year, RESPOND trained DSF personnel and partners in Reality √ to build their capacity for FP planning and advocacy. The action plans of Reality √ trainees included using Reality √ at the regional and district levels. During the current project year, RESPOND will provide trainees with technical assistance to complete their action plans. During the prior project year, RESPOND assisted the DSF with the finalization of updated Policies, Norms, and Protocols for RH/FP. This project year, RESPOND will print the Policies, Norms, and Protocols document and will disseminate it in RESPOND's intervention districts and regions.

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Photo credits: M. Tuschman/EngenderHealth; A. Fiorente/EngenderHealth; C. Svingen/EngenderHealth.

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