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“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!