“ The Journey Of A Young Nation For Better Health”

“The Journey of a young nation for better health” By Nelson Martins, MD, MHM, PhD Minister of Health Dili, July 2009

Historical Background

NATIONAL HEALTH POLICY

Government Priority Goals for the Health Sector

Current National Health Services Configuration

CLINICAL REFERRAL SYSTEM

Dili National Hospital

CLINICAL SUPPORT & TRANSFER

National Diagnostic Services (radiology, laboratory)

Regional Referral Hospitals

R E F E R R A L

SERVICE SUPPORT

CENTRAL SERVICES

DISTRICT HEALTH SERVICES

OF

CHC w/beds (1 each Sub-district)

Health Post – village level, first point of contact

CHC without beds (1 each Sub-district)

Mobile Clinic – outreach from CHCs (where there is no HP)

Integrated Community Health Service (outreach to Suco Posts)

P A T I E N T S

SUB-DISTRICT HEALTH SERVICES

(Ambulance Services)

Radio Communication Between all levels

COMMUNITY HEALTH SERVICES

5

Health Intervention Progress for Achieving MDGs MDG Goal 4

Reduce Child Mortality

INTERVENTIONS

•Accessible, affordable health care •Antenatal Care •Care of the newborn •Improved nutrition of children: micronutrient supplementation •Growth Monitoring •Immunisation of children •Integrated management of childhood illnesses

ROUTINE HMIS Infant Mortality Rates (target 2015 – 53/1,000): 1998 – 110/1,000 2000 – 101/1,000 2002 – 98/1,000 2008 – data not analysed yet but there is indication of significant improvement to 60/1000 as per national HIS. U5 Mortality Rates (target 2015 – 96/1,000): 1998 – 148/1,000 2000 – 194/1,000 2002 – 129/1,000 2008 - data not analysed yet but there is indication of significant improvement to 83/1000 as per national HIS. U5 Malnutrition (target 2015 – 31%) 2003 – 46% 2007 – 32% 2008 – 21%

Health Intervention Progress for Achieving MDG MDG Goal 5

INTERVENTIONS

Reduce Maternal Mortality (target 2015 – 252/100,000)

- Skilled attendance during pregnancy, delivery and post natal - Basic Emergency Obstetric Care - Comprehensive emergency obstetric care - Family Planning

ROUTINE HMIS 2003 – 660/100,000 2005 – 380/100,000 (Reported by 2008 MDG) 2008 – no data analysis on mortality rates yet, but there is an increase in delivery assisted by skilled birth attendant from 27% of deliveries in 2006 to 36% in 2008, which is a positive indication of improvement. Estimates on MMR around 450/100,000 in 2008.

MDG Goal 6

INTERVENTIONS

ROUTINE HMIS

-

Reduce the spread of HIV/AIDS, STIs, Tuberculosis and Malaria (halted by 2015 and begin to reverse trend) -

TB Case detection TB Treatment with DOTS Malaria Treatment Malaria prevention by house spraying Malaria prevention in Pregnancy STI treatment STI Prevention Voluntary counselling and treatment

TB: 1999 – 800/100,000 (prevalence rate) 2006 – 789/100,000 (prevalence rate) 2008 - 447/100,000 (prevalence rate) Malaria Morbidity Rates for Children U5: •2005 – 400/1,000 •2008 – 275/1,000 HIV Reported cases: •2003 – 1 •2006 – 44

Key Health Indicators Indicators

Target by 2015

2004

2008

IMR

53/1000

90/1000

60/1000

<5 MR

71/1000

130/1000

83/1000

Fertility Rate

5

7.8

4,5-6 (quick sample survey ; MoH )

MMR

200/100,000

660/100,000

450/100,000

Malnutrition

-

49%

20%

TB Prevalence Rate

400/100,000

789/100,000

447/100,000

Malaria Morbidity Rate in Children <5

200/1000

400,1000

275,1000

HIV Reported cases

-

44 (2006)

95 (13 deaths due to AIDS)

Population with sustainable access to an improved Water Source (% u/r)

86%/75%

75%/51%

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Population with

Maternal & Child Health Interventions

Progress on Human Resources for Health

Development of Health Infrastructure No.

Capital Works

1. 2.

Health Post Sub-district CHC

3.

District CHC

4. 5. 6. 7

Referral Hospitals National Hospital Doctor House MOH/Nurse Residency 8. Oxygen 9. Plant/Storage Incinerators House 10. DHS Office 11. Maternity House/clinic 12. National Laboratory

2002 2003 2003 2004 29 31 4 2

20042005 17 7

2005 20062007 2006 17 13 3 3

2008

Tota l 122 21

-

1

1

-

1

-

7 -

2 1

-

1 50 -

15 2 12 (Birth rooms & mini Labs) 3 1 3 1

3 -

1 12 2 -

-

-

3 3

2 30 8 4

-

-

1 18 1 1 (storage & fence)

-

-

1 (Testing Unit)

2

15 4 1 62 2

National Health Services Financing

SISCa: The Key to achieving health Priority Goals

The Philosophy Behind SISCa 

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SISCa approach believes in using real data to make plan and propose health needs intervention SISCa approach believes in local Solution to Local problem while respecting the international best practice and standards SISCa approach believes in community participation and decision on community health SISCa approach believes on Trans departmental and institutional collaboration in health SISCa approach believes in the empowerment of community leaders, village heads, members of Suco Council in mobilizing resources available to ensure healthy life in a healthy environment

Marriege between Access Vs. Demand

UP ------------ CHC (Health Staff)

Service Delivery

SISCa

Quality Health Care

Utilization of Health Facility Bottom (Community)

--------

What to Expect from SISCa Table 1?: Family Registration Table 1 provides basic population data on a monthly basis:  To be able to use the statistic data and to revise the denominator and indicator required for HMIS  To know the number of household member; number of pregnant women; number of post partum; number of TB patients; number of children; number of disable people; number of elderly people; etc  To foresee the number of children to be immunized in each village every months; number of pregnant women need ANC;PNC; number of TB patients needs DOT and follow up; number of disable and elderly need health assistance.  To compare and cross-check data of patients from CHCs and SISCa ( how many are actually do not go to CHC ?)  To count the drugs, vaccine and other health medication and consumable needed by each village every month.

What to Expect from SISCa Table 2?: Nutrition

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Know people with malnourish (child, mothers, elderly), provide immediate intervention and referral. Know eating habit of the community ( how many times and what composition of meal) Know what are the main source of food available in each suco Predict what the main nutritional deficiencies inside and would be met by community in each village Assist community to consume the right balance of food. Assist community to access to main nutrient that are lacking in their suco.

What to Expect from SISCa Table 3?: MCH

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Number of Pregnant Mother receive routine ANC Number of Post Partum Mother receive PNC Number of Child have LISIO and receive routine immunization Number of Child receive Vitamin and other nutrient supplementation Early referral of high risk Pregnant Mother Routine access to information and intervention on Family planning Place for plan a delivery together with pregnant mother Other Gynecology consultation

What to Expect from SISCa Table 4?: Hygiene & Sanitation  

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Will treat and demonstrate personnel hygiene Know how people manage their personnel hygiene Know number and type of toilet in each Suco Know number of water source in each Suco How community breed their cattle , and others How community organize their plan that riskier for Malaria and Dengue

• Know number of healthy houses • Know the water and sewage drainage in each Suco •Know number of place and how people manage their household waste •Work with member and leader of Suco to plan and propose intervention

What to Expect from SISCa Table 5?: Curative Services

At SISCa Posts, the community will have access to some medical treatment if required and the medical team may identify the need for referrals to a health facility

What to Expect from SISCa Table 6?: Health Promotion & Education

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Develop local health promotion material identified in each Suco from table 1-5. Then, conduct Health promotion and education every month through different communication tools such as films, group discussion; sport activities; distribute brochure or banners; Band music and theatre; etc. Promote participation of Local Community Radio

ili-kekere Lautem

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It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world.

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It was the first international declaration underlining the importance of primary health care. care. The primary health care approach has since then been accepted by member countries of WHO as the key to

achieving the goal of "Health for All". •

The Conference called for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order.

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It urged governments, WHO and UNICEF, UNICEF, and other international organizations, ato channel increased technical and

financial support to it, particularly in developing countries.

Health Timorese in a Healthy TimorLeste