Strategic partnership improves health infrastructure and quality of care in Oecusse, Timor-Leste

When a pregnant woman visits a community health clinic or hospital, she has a right to expect the clinic or hospital to have electricity, running water, any medicine she might need, and well-trained medical staff on hand. In Timor-Leste, one of the world’s newest countries, such a clear-cut scenario is unfortunately not always the case. It is not uncommon for Timorese women in labor to arrive at health clinics that do not have running water, electricity, or essential medicines.

But thanks to serious commitment on behalf of the Ministry of Health and a successful partnership among a group of international and local organizations, things are beginning to change.

In 2007, the Timor-Leste Ministry of Health developed the Basic Services Package for Primary Health Care and Hospitals, which provides a detailed description of the minimum level of services that must be delivered at each health service delivery point. The basic services package is the guide for every manager and health worker in the national health system. It defines the continuum of care, which starts in the community with the primary health care system and is
supported and complemented by the hospital and referral system.

In Timor-Leste, there are 67 health centers, five referral hospitals, and one national hospital. To ensure that each of these meets the basic services package standards, the Ministry of Health developed policies, strategies, and guidelines, standard operating procedures, training curricula, and health promotion materials. However, achieving the standards set out in the basic services package is not an easy task. Whether community health clinics or hospitals, all facilities
must have the following components in place to meet the standards:

  • functioning infrastructure with running water, electricity, and waste management;
  • availablity of services and skilled health workers;
  • availability of drugs, equipment, and materials;
  • functioning referral system; and finally,
  • full participation from the community

To achieve each one of these components in all Timorese health facilities, the Ministry of Health coordinates support from its development partners. A recent collaboration in Oecusse District showcases the impact that development partners can have when working closely with the government.

A group of organizations worked together to improve both the infrastructure and quality of services in four health facilities in Oecusse, which together represent the three levels of the health system: the Oecusse referral hospital, the outpatient and maternity wards in the Boacnana community health center (CHC), and the Usitaco and Bebo health posts.

Before the collaboration began, the Oecusse referral hospital, Boacnana CHC, and Usitaco and Bebo health posts did not have reliable running water systems. This made it nearly impossible for health workers to maintain hygiene standards and prevent the spread of infections. In addition, the referral hospital was operating with only two hours of electricity per day. This meant that critical equipment such as operating lights, the x-ray machine, laboratory equipment, incubators, IV infusion pumps, and electrocardiograph machines were unusable.

In June 2013, a team of professionals from the USAID-funded HADIAK project (“to improve” in the local language) accompanied staff from the four health facilities to conduct initial assessments of the conditions at each facility. Using the basic services package checklist, the teams were easily able to identify what steps needed to be taken to improve the standards of care at each facility.

As a result, key functions at the four Oecusse health facilities have been added or repaired and each facility is well on its way to approaching the basic services package standards. Infrastructure repairs were provided by the U.S. Navy Seabees and the Timor-Leste Defense Forces and technical assistance was provided by the USAID HADIAK project, Imunizasaun Proteje Labarik (Millennium Challenge Corporation Threshold Project on Immunization), St. John of God Health Care, and biomedical engineers from the National Hospital Guido Valadares.]
JSI/WEI Photo Library Photo
Damages tiles at the Boancana CHC
JSI/WEI Photo Library Photo
Community members repaired all of the tiles at the center.
Infrastructure work included fixing leaks and damaged wires in the Usitaco and Bebo health posts and in the Boacnana CHC. The referral hospital’s electricity system was improved by connecting it to the town’s electricity network and installing solar panels on the emergency department roof as back-up. Fixing the hospital’s electricity problems solved the running water problem as well, since the water supply runs on an electrical pump.

HADIAK provided refresher trainings in basic lifesaving skills and infection control for all health staff at the hospital, health center, and health posts. The project also conducted technical orientations for hospital staff on how to operate critical equipment that had previously gone unused, such as incubators and x-ray machines. HADIAK also helped the citizens of Oecusse develop a community action plan to improve their use of health services. The collaboration has showcased, among other things, that infrastructure renovations, technical assistance, and community involvement are all necessary for improving the quality of services.

JSI/WEI Photo Library Photo
Increasing maternal and child health coverage in remote areas is discussed at a planning meeting.
JSI/WEI Photo Library Photo
Community mapping was integral to the development of a community action plan.
More than 70,000 people living in Oecusse will directly benefit from the improved quality of services at the four health facilities, including 3,255 pregnant women, 13,023 children under five-years old, and 2,742 children under one-year old.

The work in Oecusse builds on the successful renovation of a health center in Ermera District earlier in 2013. Due to the promising results of the collaborations in Ermera and Oecusse, HADIAK, the Ministry of Health, U.S. Navy Seabees and other involved partners will continue to work together to replicate the approach at other health facilities in HADIAK-supported districts with the aim of a roll out as part of a national program.