15 Nov 2011 Regional CH Meeting, Kathmandu 1 Meeting of South-East Asia Regional Programme Managers on Child Health, Kathmandu, 15 – 18 Nov 2011 Progress in Implementation of Child Health Programme Country: Timor-Leste

TIMOR-LESTE Population: 1,066, 409 Land area: 14,610 sq.km Country organization : Districts - 13 Sub districts - 65 Villages (Sucos) -442 Hamlets (Aldeia) Language: Tetum, Portuguese Economy : Gross National Income per capita – US$ 5,303 (2010) Literacy: 79.1% (15-24 years) Poverty: 41 per cent of the population (about 400,000) below the national poverty line of US$ 0.88 per person per day (World Bank, 2010).

INFANT MORTALITY RATE & UNDER-5 MORTALITY RATE (PER 1,000 LIVE BIRTHS)

Child Mortality (Source: DHS ) Relatively slower decline in Neonatal Mortality

5 Nutrition - Trend analysis Estimates from MICS 2002, DHS 2003, LSMS 2007 and DHS 2010, according to the old NCHS reference. National underweight prevalence increased from 43% in 2002 to 52% in National stunting prevalence increased from 47% to 53%. Prevalence of LBW is 10% of all births (DHS )

15 Nov 2011Regional CH Meeting, Kathmandu 6 Epidemiology / burden of childhood diseases: (WHO, 2006) Table 3.1: Distribution of Causes of Death among Children under 5 years of age and neonates (Timor-Leste ) Distribution of Causes of Death among Children under 5 years of age (Timor-Leste ) Distribution of Causes of Death among neonates (Timor-Leste ) Neonatal Causes 1 32%Neonatal Tetanus5% Diarrheal Diseases22%Severe Infection 2 29% Measles3%Birth Asphyxia27% Malaria0%Diarrheal Diseases3% Pneumonia20%Congenital Anomalies6% Injuries2%Preterm Birth 3 23% Others20%Others8% [1] [1] Includes diarrhea during the neonatal period [2] [2] Includes deaths from pneumonia, meningitis, sepsis and other infections during the neonatal period. [3] [3] Includes only deaths directly attributed to prematurity and to specific complications of preterm birth such as surfactant deficiency, but not all deaths in preterm infants

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IMCI Implementation IMCI implementation started (If yes, year)Yes, 2002 Newborn Added (If yes, year)No (included in CCM and it has addressed separately, ENBC) Number and Proportion of districts implementing IMCI13/100% Number and proportion of MOs trained5/3% Number and proportion of Nurses/other workers trained51% Proportion of districts (out of IMCI districts) with 60 % or more health providers trained 10 districts IMCI supervisory checklists introducedYes Proportion of first-level health facilities that had at least one supervisory visit over a period of 6 month during previous year 47% Proportion of districts (out of IMCI districts) covered with Follow-up IMCI training 100%

IMCI implementation IMCI implementation review conducted (If yes, year; National or sub-national) Yes, National & sub national, 2010 IMCI Health Facility Survey conducted (If yes, year; National or sub-national) No, Planned for 2012 Proportion of first-level health facilities with at least one health worker who cares for children trained in IMCI 82% Pre-Service IMCI teaching/training: Number and proportion of Medical Schools teaching IMCI NA Number and proportion of Nursing Schools teaching IMCI 1/1 ICATT introduced (If yes, year and scale)NO

STAFF TRAINING & SUPERVISION In-service training: ◦ In-service training for child health program conducted separately by respective program ◦ In-service training conducted regularly at least once in a year Pre-service training: ◦ At the moment only University of Timor Leste provides medical, nursing and midwifery training. ◦ IMCI is incorporated to their nursing and midwifery training curriculum Supervision: ◦ All programs adopted the Supportive Supervision approach, however further improvement is necessary to improve the quality, effectiveness and regularity of supervision ◦ Supervision is not conducted in integrated manner ◦ Each program use different supervision tools ◦ Review or discussion following supervision is not a practice 11

15 Nov 2011Regional CH Meeting, Kathmandu12 IMCI Implementation Key factors that helped scaling up 1.Government’s commitment and priorities 2.Program management leadership at all levels 3.Interest and motivation of health workers to learn case management skills 4.Support from partners (WHO, UNICEF & USAID) Key challenges to scaling up: 1.Shortage of qualified human resources 2.Availability of trainers for IMCI CMT 3.Frequent transfer / movement of trained staff 4.Availability of MCH funding

15 Nov 2011Regional CH Meeting, Kathmandu13 Newborn Health ENC Course adapted: 2010 Other training courses: CCM includes some elements of home based newborn care Healthcare providers trained: Healthcare providersTotal no.No. Trained % MO none Nurses/ % CHW N/A Volunteers %

15 Nov 2011Regional CH Meeting, Kathmandu14 In-Patient (Hospital) care of sick newborns and children WHO Pocket Book introduced: Not introduced Training courses for Hospital care done: NO Number and proportion of Healthcare providers trained: –MOs: –Nurses: Proportion of hospitals providing pediatric care having oxygen: 100% ( Referral, National, district- based) Hospital assessment using WHO tools carried out: –Year/s: –How many hospitals covered:

15 Nov 2011Regional CH Meeting, Kathmandu15 CHW approach for care of sick newborns and children District implementing CHW approach Total No. of Distt Implementing Districts % Home based newborn care13215% Sick child package13215% Healthy child package (ECD) % Any review of the experience Not yet

15 Nov 2011Regional CH Meeting, Kathmandu16 Programme Review and Management CH Short Programme Review introduced, if yes : NO (Planned for 2012) –Year: –National or sub-national: Programme Management Course introduced, if yes: NO (Planned for 2012) –Year: –National or sub-national:

HEALTH MANAGEMENT INFORMATION SYSTEMS (HMIS) 17 Key Indicators: The decision to include indicators in the HMIS is made by program HMIS covers key indicators for all programs, except Newborn and IYCF Data Collection: Primary Health Care and Community Data analysis: As per guidelines, analysis and utilization should be done at all level In practice analysis is carried out only at the National level by HMIS- Surveillance Unit. Analysis and data utilization at subnational level is rarely done Immunization, nutrition and malaria is more advance compare to other program in term of data analysis and utilization.

15 Nov 2011Regional CH Meeting, Kathmandu18 Future Plans Strengthening and scale-up plans for Next 2 years IMCI: Health facility survey in 2012, train Timorese doctors ICATT use: Not yet decided. CHW Packages: –Home Based NB Care package: (integrated in CCM) –Sick child package: (Currently Health workers (PSF) have only been allowed referral in CCM package, antibiotics for pneumonia management will be considered in the future) –Healthy Child (ECD) package: Referral (Hospital) Care: Facility based IMCI in 2012 Program Review and Management: –CH Short Program Review: in 2012 –Program Managers Course: in 2012

PROPOSED FUTURE ACTIONS Strategic Refinement: Equity-based interventions to maximize coverage Decentralized capacity, micro-planning & management Community education, mobilization & empowerment. Better donor coordination for integrated budget “ one plan one budget” Programmatic Refinement: Proper packaging of interventions (BSP Review) Continuum of care across life cycle & place of delivery Costing, budgeting and bottleneck analysis (MBB) to remove the barriers. Increase capacity of Timorese doctors

Obrigado wain 20