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“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 CLINICAL SUPPORT & SERVICE SUPPORT


TRANSFER

National Diagnostic
Dili National Hospital Services R CENTRAL SERVICES
(radiology, E
F
laboratory)
E
R
R
A
Regional Referral Hospitals L
DISTRICT HEALTH SERVICES

OF

P
CHC w/beds CHC without beds A
(1 each Sub-district) (1 each Sub-district) T
I
SUB-DISTRICT HEALTH
E
N SERVICES
T
S
Health Post – village Mobile Clinic –
level, first point of outreach from (Ambulance
contact CHCs (where there Services)
is no HP) COMMUNITY HEALTH
Radio SERVICES
Integrated Community Health Service
Communication
(outreach to Suco Posts)
Between all levels
5
Health Intervention Progress for Achieving MDGs

MDG Goal 4 INTERVENTIONS ROUTINE HMIS

Infant Mortality Rates (target 2015


– 53/1,000):
1998 – 110/1,000
2000 – 101/1,000
2002 – 98/1,000
•Accessible, affordable health 2008 – data not analysed yet but there
care is indication of significant improvement
•Antenatal Care to 60/1000 as per national HIS.
Reduce Child •Care of the newborn
Mortality •Improved nutrition of children: U5 Mortality Rates (target 2015 –
micronutrient supplementation 96/1,000):
•Growth Monitoring 1998 – 148/1,000
•Immunisation of children 2000 – 194/1,000
•Integrated management of 2002 – 129/1,000
childhood illnesses 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 ROUTINE HMIS


2003 – 660/100,000
2005 – 380/100,000 (Reported by 2008
Reduce Maternal - Skilled attendance during MDG)
Mortality pregnancy, delivery and post 2008 – no data analysis on mortality
(target 2015 – natal rates yet, but there is an increase in
252/100,000) - Basic Emergency Obstetric delivery assisted by skilled birth
Care attendant from 27% of deliveries in
- Comprehensive emergency 2006 to 36% in 2008, which is a positive
obstetric care indication of improvement. Estimates
- Family Planning on MMR around 450/100,000 in 2008.

MDG Goal 6 INTERVENTIONS ROUTINE HMIS

- TB Case detection TB:


Reduce the spread - TB Treatment with DOTS 1999 – 800/100,000 (prevalence rate)
of HIV/AIDS, STIs, - Malaria Treatment 2006 – 789/100,000 (prevalence rate)
Tuberculosis and - Malaria prevention by 2008 - 447/100,000 (prevalence rate)
Malaria house spraying Malaria Morbidity Rates for
(halted by 2015 and - Malaria prevention in Children U5:
begin to reverse Pregnancy •2005 – 400/1,000
trend) - STI treatment •2008 – 275/1,000
- STI Prevention HIV Reported cases:
- Voluntary counselling •2003 – 1
and treatment •2006 – 44
Key Health Indicators
Indicators Target by 2004 2008
2015
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 200/1000 400,1000 275,1000
in Children <5
HIV Reported cases - 44 (2006) 95 (13 deaths
due to AIDS)
Population with
sustainable access to 86%/75% 75%/51% -
an improved Water
Source (% u/r)
Population with
Maternal & Child Health Interventions
Progress on Human Resources for Health
Development of Health Infrastructure

No. Capital Works 2002 2003 2004- 2005 2006- 2008 Tota
- - 2005 - 2007 l
2003 2004 2006
1. Health Post 29 31 17 17 13 15 122
2. Sub-district CHC 4 2 7 3 3 2 21
12 (Birth
3. District CHC - 1 1 - 1 rooms & mini 15
Labs)
4. Referral Hospitals - - - - 1 3 4
5. National Hospital - - - - - 1 1
6. Doctor House - 7 2 - 50 3 62
7 MOH/Nurse - - 1 - - 1 2
Residency
8. Oxygen - 1 1 - - - 2
9. Plant/Storage
Incinerators House - 12 18 - - - 30
10. DHS Office 3 2 - - - 3 8
11. Maternity - - 1 - - 3 4
House/clinic 1
12. National - - (storage - - 1 2
Laboratory & fence) (Testing Unit)
National Health Services Financing
SISCa: The Key to achieving health
Priority Goals
The Philosophy Behind SISCa

 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

 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

 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

 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

 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

• 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.

• 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.

• 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 Timor-
Leste

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