Timor-Leste is committed to the health of its women and Children since Independence. The Government and its Development Partners united under the H4+ initiative have improved the situation since 2008. The good achievements of the Millennium Development Goal 5 (MDG5) on improvement of maternal health, however, should not lead to a decrease of efforts to address maternal and newborn mortality, which remain unacceptably high. The existing strategies have now been enriched with the integration of a Plan of Action to improve Emergency Obstetric and Newborn Care (EmONC) 2016-2019.
A complete assessment of the current EmONC situation was undertaken in 2015 to review progress and identify gaps and needs. In order to address these gaps and needs, an EmONC Improvement Plan of Action (IPA) is being proposed, to be implemented from 2016 to 2019 in the whole country.
The Goal of the EmONC IPA 2016-2019 is to further save lives of mothers and newborns affected by complications of pregnancy, delivery and postpartum, and contribute to the Reduction of Maternal and Newborn Mortality and Morbidity.
The objectives and targets to be achieved by the year 2019 are:
To have increased the availability of EmONC facilities by rationalizing the coverage throughout the country with a network of interconnected facilities beyond the global standards. It is recommended to reach by 2019 a total of 43 functional EmONC facilities, including the 6 Comprehensive facilities already existing that need to be strengthened;
To have ensured accessibility for all, including in the remote parts of the country, through improved distribution of EmONC facilities and a functional referral system 24/7 linking these facilities;
To have ensured effective utilization of EmONC services to over 90% of the needs, through community participation, strong communication, effective referral, delivery of quality services by competent providers (to prevent the 3 delays). The target is 80% of all births in institutions and 60% in EmONC facilities;
To have strengthened the capacity of Municipality health authorities (DSMs and DPHO-SMIs) as well as lower level administrative services to plan, manage, monitor, and support EmONC services;
To have expanded the knowledge and awareness of communities about the need to seek assistance from health services and particularly EmONC services.
Outputs to be achieved:
The objectives, outputs and the key interventions proposed in the Plan of Action must be integrated into the existing health system and build on current major national health programmes such as MCH, Human Resources, Central Medical Stores, Laboratory and Blood Bank. They must be implemented in partnership with the civil society and international development partners. They must also contain their own processes for continues monitoring and periodic evaluation.
Policies, norms and standards revised by adapting international standards and high level commitment and support demonstrated for the optimal delivery of EmONC services;
Distribution of network of BEmONC facilities ensured and CEmONC facilities strengthened for effective coverage of all signal functions in all parts of the country;
Human resources strengthened; Staff redistributed, competencies enhanced at all EmONC facilities prioritizing those serving as clinical training sites and job satisfaction ensured for the benefit of clients;
Enhanced positive supervision, improved data recording and increased focus on newborn that has relatively been neglected so far for further strengthened systems to support increased utilization and continuous quality improvement of EmONC services;
Referral system operationalized in all parts of the country with improved communication and conditions of transport so that no frontline facility should be at more than 2 hours of a referral facility;
Management competencies strengthened at municipality and national level;
EmONC coordinator appointed for improved planning, implementing and monitoring EmONC services; quality of data recording enhanced;
Community involvement further strengthened through Primary Health Care program, village committees, Local NGOs, and community leaders (Suco and Aldeia Chiefs) for improved awareness and increased utilization.
Key interventions to achieve these seven outputs will be implemented synergistically at national and municipality levels, and regularly monitored through national meetings, municipality supervision and field visits.
The three delays model will be kept in mind (delay to make decision to use the health system, delay to access the health system, and delay to provide services while in the health system). The emphasis however is on the third delay once the patient has arrived at a facility
The AMDD “Building Blocks” model will also be kept in mind, to articulate the different components and achieve effective coverage, utilization and quality.
The Improment Plan of Action has been costed, focusing on extra costs that are not already covered by the regular MCH and hospital services programmes. The extra costs to be considered belong to 4 categories:
Cost of infrastructure to upgrade EmONC facilities
Cost of equipment to contribute to the upgrade in EmONC facilities
Cost of drugs and supplies for the same
Cost of human resources, including additional staff to be posted in EmONC facilities, and inservice training to upgrade competencies
These costs were apportioned by year during the four years of the Plan
The total estimated cost for implementing IPA over 4 years will be around 7,983,081 US $.
Budget details can be found in the accompanying costing report.