Download “Strengthening Maternal and Newborn Care in Timor Leste” Health

“Strengthening Maternal and
Newborn Care in Timor Leste”
Health Alliance International
Country Context
• Timor Leste became an independent nation
in April 2002
• In 1999 during Indonesia’s departure, the
health system was devastated and required
rebuilding
– Rehabilitation of health facilities and curative
services
– Development of programs, policies and strategies
• The MOH is young and the health system is
still evolving
Post-independence data*
– Maternal Mortality Rate ~ 800 / 100 000
– Neonatal Mortality Rate 33-42 / 1000 LB
– Home delivery rate 90%
– Skilled Birth Attendance 19%
– Postpartum check 15%
– Rates of use of family
planning methods < 10%
– Total Fertility Rate 8.4
* ( Mainly DHS 2003)
HAI PROGRAM
• HAI’s primary partner for all activities is MoH
• Addresses the continuum of care from pregnancy
through the postpartum/newborn period with
particular emphasis on the latter
• Strategies include:
1. Health services improvement:
Supporting improvement in the quality, access and
utilization of ANC, delivery, PPC / NBC services
2. Community-based health promotion:
To improve appropriate home care and care-seeking
practices involving existing community groups
Objectives of Baseline
Assessments
• HEALTH
FACILITIES
ASSESSMENT:
Conducted in order
to plan for the
health service
delivery arm of the
program
• COMMUNITY
ASSESSMENT:
To obtain “qualitative
information” to
complement the
recent quantitative
data (MICS, DHS)
about maternal and
newborn health
• MIDWIFE Focus Group Discussions: To
explore knowledge, attitudes and practices of
midwives, and their opinions about maternal
and newborn problems in their districts
KEY FINDINGS – POSTPARTUM / NEWBORN CARE
Health Facilities Assessment
• The capacity to
manage sick
newborns is very
limited in all HF visited.
• Services for
postpartum care are
inadequate – systems
for integrated care of
the mother / newborn
after birth are virtually
nonexistent.
KEY FINDINGS – POSTPARTUM / NEWBORN CARE
- Community Assessment
• Families recognize few
signs of newborn
illness. Care seeking
delayed as morbidity
and mortality are
usually ascribed to
supernatural or social
causes (family
problems).
• Traditional naming
ceremony (“Face
Matan”) held between
3-5 days of age
• Postpartum care
delivered by health
staff is uncommon,
but there is a
strong culture of
traditional
postpartum care
practices – most
involve heat
(“sitting fire”)
• Postpartum
seclusion is
common
• Poor breastfeeding
practices are
widespread
- Colostrum discarded,
- early introduction of
sugar - water,
- wet-nursing
Planned Interventions with
potential for impact on PPC / NBC
1. Assist MoH to develop policy and implementing
strategies for PPC/NBC
– Define national “package” of essential
interventions
– Re-establishment of MCH working group to
serve as “advisory council” to MoH
2. Training of MW in integrated PPC/NBC
3. Develop culturally relevant heath promotion
materials designed to increase the community’s
demand for PPC/NBC
4. Pilot means of emergency community referral,
involving community leaders, for unexpected
postnatal emergencies
5. Look at possible ways to increase delivery of
PPC/NBC
- More home visits by midwives (link with traditional
custom: Face Matan)
- Include PPC in mobile clinic services
- Use introduction of Hepatitis B to access mothers
and babies
- Pilot test training and mobilization of CHW / TBA to
identify PP women and possibly deliver PPC
(develop firm links with health staff)
Strengths of MoH-centered approach
• Mixed interventions at national, district and
community levels
• Opportunity to influence MoH policy, with
potentially broader impact than only project
districts
• Opportunity to provide capacity building at a
national level
• Potential for sustainability is enhanced
CHALLENGES
• Less control over the pace of activities
• Dependent on “buy in” of MoH staff
• Requires significant coordination with all agencies
and partner groups
• Demands lower PVO profile than usual
• Requires flexibility in responding to MoH initiatives
Thank You!