WHO Country Cooperation Strategy 2009-2013 – Timor-Leste

WHO Country Cooperation Strategy

2009-2013

Timor-Leste

WHO Country Cooperation Strategy 2009-2013ii

© World Health Organization

Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation, in part or in toto, of publications issued by the WHO Regional Office for South-East Asia, application should be made to the Regional Office for South-East Asia, World Health House, Indraprastha Estate, New Delhi 110002, India.

The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

November 2006

Timor-Leste iii

Contents

Preface ..................................................................................................................v

Message from the Minister of Health ......................................................................vi

Acknowledgements ...............................................................................................vii

Executive Summary..............................................................................................viii

1. Introduction .............................................................................................. 1

2. Country health and development challenges ............................................. 3

2.1 Demographic and socio-economic development .......................... 3

2.2 Health challenges ......................................................................... 3

3. Development assistance and partnership ................................................. 11

4. Past and current WHO cooperation ........................................................ 13

4.1 Challenges and opportunities ...................................................... 13

4.2 WHO’s contribution to achieving the national health development agenda across the CCS priorities ............................ 14

5. Strategic agenda for WHO during 2009-2013 ......................................... 20

5.1 Strategic Priority 1: Health policy and systems ............................. 21

5.2 Strategic Priority 2: Disease prevention and control ..................... 23

5.3. Strategic Priority 3: Maternal and child health ............................. 26

5.4 Strategic Priority 4: Overall national capacity building ................. 29

5.5 Strategic Priority 5: Partnership and coordination ........................ 29

5.6. Strategic Priority 6: Emergency preparedness and rapid response (EPR) ................................................................... 31

6. Implementing the strategic agenda .......................................................... 32

6.1 Country level .............................................................................. 32

6.2 Support from the Regional Office and WHO Headquarters ......... 34

7. Conclusion .............................................................................................. 35

WHO Country Cooperation Strategy 2009-2013iv

Annexes

1. Strategic Priorities for CCS Timor-Leste 2009-2013 ................................. 36

2. Abbreviations .......................................................................................... 65

3. References .............................................................................................. 68

Timor-Leste v

The first WHO Country Cooperation Strategy document of Timor-Leste was published in 2004 and during the last three biennia the WHO has developed its Work Plans according to the priorities identified in the first CCS.

Timor-Leste is a post-crisis country, which is now in development stage. The health sector faces new challenges in providing health care services to the people. Some of the health challenges continue to exist over the years. It is the time to revisit and revise the Country Cooperation Strategy of the WHO in Timor-Leste for us to align our programmes in order to assist the Government to address those challenges.

The Ministry of Health of Timor-Leste has developed Health Sector Strategic Plan 2008-2012. The key focus of this plan is on the needs of mothers and children and the poor, and on strengthening of health services, with emphasis on implementing a revised Basic Services Package for Primary Health Care and for Hospitals. In addition, for involving the community in health activities the Government has focused on strengthening SISCa activities.

This second Country Cooperation Strategy has prioritized the approaches of the WHO under six major areas and will closely align with the goals, working principles and strategies of the Ministry of Health. This has been developed following a comprehensive review of the health situation of the country. Wide range of consultations with various key stakeholders and partners in health development were taken place in identifying priority areas of work for WHO in Timor-Leste.

As a WHO Representative, it is my pleasure to present this document to the Ministry of Health and the other ministries and development partners concerned. I am confident that in focusing our work on the priority areas WHO will continue to provide the greatest possible contribution to the health development in Timor-Leste.

Dr. Paramita Sudharto

WHO Representative to Timor-Leste

Preface

WHO Country Cooperation Strategy 2009-2013vi

Betterment of the health of the citizens is the core goal of the health policies of our nation. Considerable progress has been made since we became the first independent country of the 21st century. Still far too many children suffer and die from acute respiratory infections and diarrhoeal diseases, malnutrition, and other vaccine preventable diseases. Pregnant mothers suffer due to lack of assistance during pregnancy and childbirth. The morbidity and mortality due to communicable diseases like TB, malaria and other vector borne diseases, along with the emerging non-communicable diseases are a serious threat to the health of the nation and the productively of its citizens.

Population growth in the country is high at 3.9%; total fertility rate is 6.7 per woman in her child-bearing age and more than 50% of the population is under 15 years of age. More than 40% of the population lives below the national poverty line. These demographic and social factors pose further challenges for the health care delivery system.

The Ministry of Health is determined to provide responsive, equitable and quality assured health care services to all people without discrimination by gender, age, economic or social status. The challenges are daunting and the resources constrained. However, through evidence-based and context-specific policy formulation, meticulous and timely implementation, and intense monitoring and supervision we hope to make a positive change to the quality of life of the people. The key factors to achieving these goals are strengthening of primary health care, integration of health assistance through SISCa, community mobilization, health manpower development and mobilization of resources through sustainable partnerships.

World Health Organization continues to be the leading technical partner for Timor-Leste from the earliest period of our nationhood. We have worked closely with WHO and have gained considerably from our partnership.

The WHO Country Cooperation Strategy (CCS) 2009-2013 is a road map for expanding our partnership in the coming years and elucidates strategic priorities and focus areas for health development. The WHO CCS 2009-2013 has been developed through a consultative process and has the acquiescence of the Ministry of Health and other partners.

Dr Nelson Martins MD,MHM, PhDMinister of Health

Democratic Republic of Timor-Leste

Message from the Minister of Health

Timor-Leste vii

We sincerely acknowledge the significant contribution of all WHO staff at headquarter, regional and country office in developing this document. We are profoundly grateful to the leadership and officials of the Ministry of Health, Democratic Republic of Timor-Leste; UN and UN agencies; multilateral and bilateral agencies; academic institutions and civil society organization for their esteemed views and valuable advice.

Acknowledgements

WHO Country Cooperation Strategy 2009-2013viii

Executive Summary

In consultation with the Ministry of Health and external development partners, the WHO Country Office – Timor-Leste had developed its first Country Cooperation Strategy (CCS) for 2004-2008, which has since served as the basis for WHO’s technical cooperation with Timor-Leste.

The WHO Country Cooperation Review in September 2008 analyzed the WHO’s contribution to and influence on the national health development agenda and have recommended, in the new CCS 2009-2013, to adjust the current priorities, to support the Government in achieving national health objectives including health related Millennium Development Goals (MDGs).

The WHO CCS 2009-2013 has been drafted in context of the Health Sector Strategic Plan 2008-2012, which identifies health priorities, focused on health system strengthening, communicable diseases prevention and control, maternal and child morbidity and mortality, adolescent pregnancy, malnutrition, health promotion and health determinants.

WHO CCS 2009-2013 was developed in a participatory and interactive process of consultations with all major stakeholders in Timor-Leste.

Demographic and socio-economic developments influence present and future health challenges. These challenges are related to health infrastructure, available human and other resources, access to quality health services, burden of communicable diseases, risk factors related to communicable and non-communicable diseases, high maternal and child mortalities, malnutrition, health awareness of citizens specially adolescent and youth, preparedness and response to emergencies, and collaboration and partnership of all partners in health.

WHO applies its core functions to address these challenges within the context of its organizational mandate, WHO’s Eleventh General Programme of Work and the Regional Policy Framework. .

For the period 2009-2013, key principles for WHO Strategic Priorities are based on the national health objectives which include achieving health-related MDGs and universal access to primary health care. WHO’s role has begun to shift from implementing specific health programmes to supporting the MoH to build in-country capacity to formulate evidence based contextually relevant policies and plans, and strengthen health systems for effective service delivery.

Timor-Leste ix

Through a consultative process six strategic priorities have been jointly agreed for WHO’s cooperation with the Government of Timor-Leste for 2009-2013.

In each of the strategic priorities, main focus areas for action have been identified along with strategic approaches to address the challenges while taking into consideration expected impact on country’s capacity, based on WHO’s technical and financial contribution.

In health policy and systems (Strategic Priority 1), strategic approaches will include strengthening district health systems and health management information systems, as well as support senior consultant to work in the MoH in this area.

In disease prevention and control (Strategic Priority 2), there are resources provided by the Global Fund and other partners, and WHO would facilitate the Government’s coordination of multiple actors, and build capacity for effective implementation of these programmes, focusing also on elimination and eradication of some communicable diseases and on diseases of public health concern. Enhancing the integrated disease surveillance would require continuous support.

Efforts to reduce maternal and child mortality (Strategic Priority 3), will focus on support for immunization programme and related activities, and on effective interventions, focusing on the health workforce, facility-based deliveries, quality of care, contraceptive choice, health education and IMCI. High malnutrition rate among children below five years and inadequate nutrition in pregnant mothers leads to low birth weight, stunting and also high maternal and infant mortalities in the country. The approached will be to strengthen nutrition and supplements related intervention delivered through the district and community health centres.

In overall capacity building (Strategic Priority 4), focus of WHO’s work will be on strengthening of national capacity based on the national strategic plan and policy framework and transfer of technical skills to national officials.

In partnership and coordination (Strategic Priority 5), WHO will increase its support to facilitate partnership coordination, leverage with donors by building on existing mechanisms, and facilitating the Government’s involvement in partnership and coordination of external resources for aid effectiveness.

The country is prone to natural and complex emergencies, including emergencies such as floods and epidemics. WHO will enhance its support to ensure adequate emergency preparedness and response (Strategic Priority 6)

Compared to the period of the CCS 2004-2008, there are some major issues that may have implications for the WHO Secretariat, which include (i) shift in priorities from supporting the implementation of specific programmes to supporting the MoH to build its own capacity; (ii) staff profile of WHO Country Office (the WHO Country Office will review the current staffing needs and post descriptions, in order to better

WHO Country Cooperation Strategy 2009-2013x

support its priority areas in the years to come), funding allocation (WHO’s efforts to strengthen national capacity and health systems would require addressing the funding gaps for these priorities, possibly by using the global health initiatives - GFATM, GAVI), logistics/infrastructure and connectivity (WHO must be more responsive, flexible and timely in its response to MOH requests for assistance); and (iii) Regional Office and HQ would play a key role in technical support for priority areas and in mobilizing resources for priority areas where the assessed contribution is limited.

Timor-Leste 1

The World Health Organization (WHO) became involved in health development programmes in Timor-Leste soon after the country’s independence. In 1999, WHO established a field office with a Special Representative of the WHO Director-General. Timor-Leste became a formal member of WHO in May 2003, after which WHO established a Country Office with a WHO Representative as Head of the Country Office and Chief of Mission.

The Country Cooperation Strategy (CCS) is a WHO’s mechanism for alignment with national strategies and priorities as well as for harmonization with other United Nations (UN) agencies working in health and its development partners. It clarifies the roles and functions of WHO in supporting the National Health Plan. The CCS is an Organization-wide reference for country work, which guides planning, budgeting, and resource allocation. It is based on the country’s health situation, government health policy and plans, work of the key partners, and lessons from WHO’s work in the country. The CCS is meant to assist in mobilizing human and financial resources for strengthening WHO support to Timor-Leste in order to contribute optimally to national health development.

In April 2004, WHO developed the first CCS for the period 2004-2008, which served as the basis for technical cooperation with Timor-Leste. The CCS identified four priorities for the period as follows: (i) support for health policy and legislation development; (ii) donor coordination and partnership for health development; (iii) health systems development; and (iv) interventions for priority health problems. These priority areas were used as the basis for planning and implementation of the WHO Country Programme Budget 2004-2005, 2006-2007 and 2008-2009.

In September 2008, a review of WHO’s country cooperation was conducted to analyse WHO’s contribution to the national health development agenda and goals, including the health-related Millennium Development Goals (MDGs), during 2004-2008. The lessons learned from the implementation of the CCS have been used for development of the second WHO CCS, 2009-2013.

The Ministry of Health’s (MoH) Health Sector Strategic Plan (HSSP) 2008-2012, is designed to guide the ministry and its partners in ensuring that all people in Timor-Leste will have equitable access to good quality basic and essential health services at well-equipped facilities, provided by competent health professionals. In addition, there

Introduction 1

WHO Country Cooperation Strategy 2009-20132

will be sufficient information that empowers people to make choices about matters affecting their health and well-being, and that of their families and communities.

The HSSP identifies the following health priorities to be addressed during 2008-2012:

Health system strengthening and building overall national capacity to address • health sector issues and challenges;

High rates of neonatal, infant and child mortality and morbidity from acute • respiratory infections (ARI), diarrhoeal diseases, vaccine-preventable diseases, malaria, dengue and malnutrition;

High maternal mortality due to pregnancy and obstetric complications;•

High rates of malnutrition in women, and young children;•

High burden of mortality from infectious diseases particularly tuberculosis, • malaria and dengue;

Widespread unsafe sexual behaviour, minimal knowledge on HIV/AIDS • and STIs;

High fertility and population growth rates and health-related demographic • factors;

Health issues and challenges related to determinants of health, including • non-communicable diseases.

The WHO CCS 2009-2013 has been developed in the context of this national plan and its priorities, taking into consideration WHO’s strategic directions and the Organization’s core functions.

The WHO CCS in Timor-Leste 2009-2013 coincides with the United Nations Development Assistance Framework (UNDAF) cycle and considers the priorities of UNDAF in order to harmonize WHO’s work with other UN agencies. WHO has been pro-active in the UNDAF process and the areas where WHO would play a significant role have been identified, particularly in the UNDAF Outcome 3: “By 2013, children, young people, women and men have improved quality of life through reduced malnutrition, morbidity and mortality, strengthened learning achievement and enhanced social protection”.

The WHO CCS 2009-2013 was prepared through a participatory and interactive process of consultations and dialogue with major stakeholders from the government, UN agencies, development partners and WHO staff from the Country Office, the Regional Office and WHO Headquarters.

Timor-Leste 3

Country health and development challenges 2

2.1 Demographic and socio-economic developmentMeasured by both income and human development indicators, Timor-Leste is one of the world’s least developed countries. Per capita GDP was estimated at USD 469 (2008). The Human Development Index (HDI) was estimated at 0.512 (Human Development Report 2006), showing an improvement from the HDI value of 0.395 in 1999.

More than 40 % of the population lives below the national poverty line on less than USD 0.55 per day; however there are significant variations between districts, since the vast majority, 85 % of poor people, live in rural areas.

Administratively, the country is divided into 13 districts and 65 sub-districts with a projected total population of 1,047,632 (2007), and a land area of 14,610 square kilometres. The country has a high population growth rate of 3.9 %, with more than 50% of the total population under 15 years of age. The total fertility rate is 6.7 per woman in her child-bearing age (2006-2007) and the percentage of contraceptive users - contraceptive prevalence rate1 - was 19.8 % in 2007 (Timor-Leste Survey of Living Standards). Life expectancy at birth was 59.5 years in 2006, 58.6 years for males and 60.5 years for females. Whereas 75% of women and 45 % of men are illiterate, the net enrolment ratio at primary schools was 77 % in 2005. Awareness about gender equity and gender mainstreaming is limited (MoH, 2007).

2.2 Health challengesThe major health challenges in Timor-Leste include (i) health system strengthening; (ii) prevention, control, elimination and eradication of diseases; (iii) health of mothers, adolescents and children; (iv) health promotion and health determinants; and (v) emergency preparedness and response.

2.2.1 Health system strengthening

The events in 1999 led to a near total destruction of the health system through the exodus of most senior managers and health staff, and the damage to the health infrastructure. The country has gradually re-established its health system through rehabilitation of the infrastructure, re-deployment of staff, and by establishing health management systems at all levels.

1 The number of married women of child-bearing age using any method of contraception per 100 women of child-bearing age


The Ministry of Health (MoH) is the steward as well as the major service provider. It manages health system functions through its five directorates (Administration/Logistics, Finance/Planning, Human Resources Development, Community Health, and Hospital & Referral Services), and also oversees the overall technical implementation of health programmes. In addition, the MoH directly supervises three organizations, namely the Institute of Health Sciences (IHS), providing in-service training; Servico Autonomo de Medicamentos e Equipamentos de Saude (SAMES), responsible for drug procurement, storage and distribution, and the National Laboratory.

The public health care delivery facilities in the 13 districts of Timor-Leste include 65 Community Health Centres (CHC), 183 health posts, 162 mobile clinics, which are all providing primary health care to the community. The CHCs are linked with six referral hospitals providing mainly secondary and tertiary care. These health facilities are currently resourced by about 2500 Timorese health workers with the support of around 300 Cuban doctors.

About 60 % of these health workers are providing health services in primary health care settings. While the MoH is the major provider of health services at all levels of health care, the NGO sector, especially the Catholic Church and Coffee Cooperative structures, also provide substantial care. In the urban setting, the private sector is prevalent. Additionally, efforts are being made to out-source to NGOs on a pilot basis, to ensure access to basic health services in some districts.

The health workforce is one of the key challenges in the health systems, where an acute shortage of different categories of health workforce persists. Comprehensive Human Resources for Health (HRH) plan has been developed and is being updated to reflect health workforce needs for the next decade.

The government has set up the Faculty of Health Sciences (FHS) in the National University of Timor-Leste (UNTL) under the Ministry of Education, for training of medical doctors, nurses and midwives. The training of medical doctors in the country is conducted in collaboration with the Government of Cuba. In addition to those studying medicine in UNTL, more than 600 Timorese have been sent to Cuba for medical training. These trainees in Cuba who will begin returning in 2009 will complete their final year of medical training at the School of Medicine in UNTL and complete their internship in the home country.

In addition to the undergraduate training at UNTL, the Institute of Health Science (IHS) under the Ministry of Health is responsible for the pre-service and in-service training of the health workforce, including nurses and midwives. There is also a private university producing public health graduates.

The entire public health system is financed through the state budget and external resources. While out-of-pocket expenditure does occur, there are no data available on the level or proportion of out-of-pocket costs against total health expenditure. The

Timor-Leste 5

government has given more attention to the health sector. The public expenditure as % of the government spending on health has increased from 12% in 2000 to 19% in 2005 (latest data is not available). Percapita total health expenditure is around US$ 45 (2005).

The East Timor Policy Framework (MoH, 2002) and the subsequent policy and strategy documents had consistently advocated for Sector-Wide Approach (SWAp). Despite the weaknesses of the governance system in Timor-Leste, the MoH had prepared the necessary conditions for moving towards SWAp in the health sector. In this regard, the Health Sector Strategic Plan 2008-2012 and the Medium Term Expenditure Framework (MTEF) are being used as tools for all stakeholders to agree on spending priorities, while closing gaps, avoiding duplication as well as encouraging donors not only to co-finance, but also to harmonize and align funding mechanisms with government systems (Ministry of Health, 2007b).

The government is committed to moving towards political and administrative decentralization, and it is expected that, by 2010, newly established municipal assemblies will vote on the municipal planning and budgets, including those for health. The government is now promoting an Integrated Community Health System (SISCa), which would improve accessibility and acceptance of basic health services with stronger community participation.

The constraints and challenges related to health system strengthening may be summarized as follows:

Substantial resources have been invested, and more are needed to re-• establish the entire health infrastructure, especially in remote areas.

Substantial resources are also needed for development of human resources. • There is a scarcity of human resources for health including health managers, doctors, nurses, midwives and paramedical staff. Apart from capacity building of human resources for health there is a need for strengthening training institutions in the country.

Lack of trained human resources in the public health system is a major • constraint in reducing health problems including maternal and under-five mortalities, in preventing and controlling communicable and non-communicable diseases and risk factors and in increasing awareness of health problems, particularly among women, adolescents and young people.

Shortage of midwives to work in remote locations is a challenge. •

Shortage of essential drugs and adequate equipment is common in health • facilities.

No special health services addressed the adolescent’s special needs, where • there are a significant percentage of young people.


The capacity of laboratories is limited, both at the peripheral and central • levels.

There are gaps in community awareness of services available.•

2.2.2 Prevention, control, elimination and eradication of diseases

Malaria is highly endemic in all districts, with more than 200,000 reported cases in 2007, indicating an incidence rate of about 200 per 1000 population. It is the second major cause of admissions to the national hospital and the second highest in incidence among notifiable diseases. The highest malaria morbidity and mortality rates are reported in children. Plasmodium falciparum was diagnosed in more than 60 % of the cases. However, the Timor- Leste Survey of Living Standards (TLSLS) indicated an improvement in the use of insecticide-treated nets as a measure of effective prevention toward malaria.

Regarding tuberculosis (TB), an in-depth analysis of the national programme data set since 2000 through 2007, indicated that the incidence of new sputum positive cases was 145 per 100,000 in 2008 compared to 250 in 2006 (Global Tuberculosis Control report). Similarly, the prevalence of TB has been estimated at 447 per 100,000 in 2008 compared to 789 per 100,000 in 2006.

Data from the National TB Programme (NTP) show that, since 2000, there have been cumulatively 25,026 cases registered and started on treatment using the WHO recommended drugs combination. Of these, 7,699 cases were new sputum smear positive, 478 were re-treatment cases, and 16,849 cases were included in other categories including children and extra-pulmonary tuberculosis. Treatment results have improved year by year since the beginning of the NTP from a success rate of 65.4% in 2000 to 79% in 2006. In 2001, DOTS centres were established in all 13 districts. In 2002, the programme was expanded to the 65 health centres, and all these centres were covered in 2004. In 2008, the programme launched treatment for multi-drug resistant TB.

Available data indicate that acute respiratory infections and diarrhoeal diseases are among the most common childhood illnesses with high mortality rates among young children.

Currently, the number of reported HIV/AIDS cases is relatively low; however, available data on incidence of sexually transmitted diseases from some districts and a limited knowledge and awareness about HIV/AIDS and STI among the general population, and among adolescents and young people in particular, suggest risk of HIV/AIDS epidemics in the future.

Avian influenza (AI) is endemic in neighbouring Indonesia. If AI is introduced into Timor Leste, there is a high risk of it becoming endemic due to the marketing chain (live poultry trade), low levels of bio-security in households rearing poultry, and limited

Timor-Leste 7

capacity for early intervention. The government and its partners, including WHO, have undertaken a number of preparatory and contingency steps in the last few years. The Ministry of Health and WHO acknowledge that there are gaps in the preparations and national contingency plans. Capacity building is a major component of AI preparedness planning but lack of national professionals and basic infrastructure are obstacles in implementing the plan. Additionally, the coordination between Ministries and partners needs to be strengthened.

Other communicable diseases such as dengue, lymphatic filiariasis and intestinal parasitic infections remain a challenge. Timor Leste has yet to achieve the goal of eliminating leprosy as a public health problem. Also, Timor Leste remains one of two countries in the Region to eliminate yaws. The main constraints are limited funding, understanding of public health aspect controlling the diseases and commitment at the national level.

Available hospital based data indicate the existence of Japanese encephalitis (JE). Once the recently developed protocol for sentinel surveillance of JE and acute encephalitis syndrome is implemented, the magnitude of the JE burden will be better defined.

International Health Regulations - 2005 (IHR-2005) is a legally binding agreement for international health security. Primary assessment of existing national core capacities for implementation of IHR was conducted in 2007 and gaps identified.

2.2.3 Health of mothers, adolescents, children

The quality of reproductive health care in Timor-Leste, including pre-delivery, delivery and post-delivery care, needs special attention. This is reflected in the high maternal mortality ratio (660 per 100,000 live births) in spite of the relatively high skilled birth attendance rate (41 % of the total births were attended by skilled health personnel in 2007). High maternal mortality is, among others, a consequence of high total fertility rate and low contraceptive prevalence rate. Contraceptive prevalence in 2007 among currently married women 15 to 49 years of age was only 19.8% (Source: 2007 TLSLS). There is limited knowledge about birth-spacing and family planning methods. There is an increasing trend in teenage pregnancy which is also a risk to reproductive health.

In 2006, the estimated infant and under-five mortality rates were high at 88 and 130 per 1000 live births respectively although some declining trends may be observed since 2001. The main causes of under-five deaths are: neonatal causes 30% and approximately 20% each for diarrhoea and acute respiratory infections (ARI). Prevalence of malaria is also high in under-five children. Some smaller studies indicate that the causes for the high neonatal mortality rate are similar to those experienced in many developing countries – newborn babies die or are affected because of birth asphyxia, trauma or infections. The risk of dying is markedly higher in rural than in urban areas and particularly in the highland regions of the country.


The TLSLS 2007 showed that 80% of mothers were reached by antenatal services, but data from the Health Management Information System (HMIS) indicate that only 50% of women giving birth within the past 12 months were protected against neonatal tetanus. Conditions are less deficient in urban areas, and particularly in the major urban centres. Approximately 41% of mothers were assisted by trained birth attendants. In more isolated rural and upland regions only a minority of women are getting access to medical services or receiving adequate protection against neonatal tetanus. The vast majority of women (80%) did not receive a postnatal check up. The interventions to bring services closer to these women and to stimulate demand for their use have been identified as a high priority.

The total fertility rate is 6.7 per woman in her child-bearing age (data for 2006-2007). This level of fertility is consistent with extremely short birth intervals of well under three years. Fertility regulation through the use of family planning is very low. Over 60 % of women and 70 % of men fail to recognize any common method of contraception. Along with a general lack of knowledge of methods of family planning, 75 % of women had no knowledge of where to obtain the information (MoH, 2007).

The immunization programme is well established. The Annual Health Statistics Report: January-December 2007 (Department of HIMS, 2008) gives immunization rates for 2007 as follows: BCG – 74.1%; DPT3 – 69.8%; Measles – 62.5% and Tetanus Toxoid 2+ (TT) for pregnant women 50%. The major constraint to further increasing immunization coverage is inadequate human resources and the difficulty of access to about 30 % of the population even though there are substantial financial resources,

Malnutrition is a serious problem, contributing to high level of under-five deaths (Ministry of Health, 2007). The TLSLS 2007 indicates that for the under-five age group:

50.3% are underweight of which 11.9 % are severely underweight;•

49.9% are stunted, of which 17.7% are severely stunted;•

18.8% are wasting of which 2% are severely wasted.•

Although not quantified, there are reports of high prevalence of anemia, particularly in women.

2.2.4 Health promotion and health determinants

There are health challenges related to known health determinants, which include behavioural, social, economic and environmental determinants. Some determinants of health are outside the health sector, yet impact directly on the health of the people and on the incidence of communicable and non-communicable diseases.

Timor-Leste 9

There is low awareness in the communities about determinants of health and health promotion. Limited expertise in the area of health promotion in the country is a constraint. Training of both health and non-health professionals in health promotion is severely limited across sectors. The health seeking behaviour study for developing a health promotion programme is being conducted. The health promotion strategic plan (2003-2008) needs a revision. No school health policy has been established. Strengthening the capability of the Institute of Health Sciences (IHS) to build the human resource capacity for health promotion remains a major need.

In addition to social and economic determinants mentioned in sub-chapter 2.1, the external tobacco industry has an influence on promotion and sponsoring various events. Smoking is extremely common particularly among the poor and less educated. Fifty percent of the school-boys aged 13-15 years and 20 % of 13-15 year old school-girls regularly smoke. Cigarettes are readily available in small shops or from street vendors to any-one regardless of age. Although the government has ratified the WHO Framework Convention for Tobacco Control (FCTC), the awareness amongst decision makers and state holders are still limited.

Prevention of injuries is an important challenge, taking into consideration the magnitude of the problem. Trauma and traffic accidents are among the ten highest incidences among diseases in the country. In addition, injuries are an important health issue during disasters. The challenges are inadequate expertise in the country on pre-hospital trauma care and non-availability of a focal point in the MoH of health injury prevention.

There is a culture of gender inequity in Timorese communities. The basic services package emphasizes gender sensitivity and there are legislative efforts to address domestic violence. However, addressing gender issues remains a challenge.

As per the WHO/UNICEF Joint Monitoring Programme of Water Supply and Sanitation Report 2008, about 68% of the total population have access to an improved water source; however, only 41% have access to proper sanitation facilities, with significant differences between urban and rural populations. These, in addition to housing and workplace conditions, are among other outstanding public health issues contributing to acute and chronic health conditions.

2.2.5 Emergency preparedness and response

In this important area, building capacity for emergency preparedness and response at all levels is a challenge. This includes national and sub-national capacity to respond to natural and human-generated energies as well as outbreak response to epidemic-prone diseases, which would also address preparedness for an avian influenza outbreak. The challenge is to respond to major natural and complex emergencies.


2.2.6 Partnership and coordination

The contribution of health development partners has been remarkable. These include UN agencies, bilateral partners, international nongovernmental organizations (NGOs), and public-private global health partnerships. The partners’ contribution is critical; however, the challenge is to harmonize the efforts and aligning the partners focus with the government’s priorities.

Timor-Leste 11

In addition to its own resources, the Ministry of Health receives substantial direct financial and technical assistance for various health priority programmes. This assistance is provided through bilateral aid, multilateral agencies, the UN agencies and the global partnerships such as the Global Fund for AIDS, TB and Malaria (GFATM). The contribution of foreign assistance is significant; nearly 50% of the Ministry of Health’s budget is being financed through external resources.

This assistance has generated a huge volume of work load and numerous challenges. In order to effectively manage the volume of assistance, the Ministry of Health recently established the Department of Partnership Management. The department is steadily being strengthened to enable it to play its role. The main responsibilities of this department include maintaining a register of development partners and its technical assistance, organizing regular meetings between the development partners and their counterparts in the government, managing the administrative and financial aspects of specific projects, such as GFATM, the World Bank, EC, and AusAID etc. In addition, the department also functions as a focal point for coordination and information sharing with development partners, managing approval for proposals from NGOs, and serving as a secretariat for the Annual Health Sector Review and for planning meetings.

In addition, the Ministry has established a Health Sector Coordination Group for further strengthening overall donor coordination in the health sector. The group consists of 15 members, chaired by the Director-General, Ministry of Health. International agencies, such as AusAID, the World Bank, USAID, EC, UNICEF, UNFPA, WHO, one representative from the NGO sector, and a representative from the Ministry of Finance are the members of the Group. Specifically, the Health Sector Coordination Group will work to achieve:

Alignment of donor priorities with national priorities, including the alignment • of the planning cycle of the government and the planning cycles of the donors and all agencies.

Consensus on policy of adhering to areas of comparative advantage and • competence.

Mobilization of financial and technical resources in support of agreed national • priorities and in conformity with MoH plans, but with the focus on covering critical gaps.

Development assistance and partnership 3


Consensus on an annual calendar of key national level coordination, planning • and evaluation activities, such as the Joint Annual Health Sector Review, Annual Health Planning Summit, missions of donors and partners on matters of policy/strategy, and the Development Partners’ Meeting organized by the Ministry of Finance.

There have been several strategic documents which are important tools for the coordination of all stakeholders working for health in Timor-Leste. These are (i) Health Sector Strategic Plan 2008-2012; (ii) Medium Term Expenditure Framework; (iii) Workforce Plan; and (iv) Ministry of Health Circular in Donor Coordination.

Several coordination mechanisms are in place, such as the Joint Annual Health Sector Review and Planning Summit, which resulted in the Comprehensive Annual Health Sector Plan. Others are: Quarterly Health Coordination Meetings, Technical Working Groups (such as for Reproductive Health, Nutrition), and district level coordination meeting addressing the implementation issues.

WHO’s role as the main partner in health in Timor-Leste is well recognized. WHO continues to provide technical support and has been considered as a neutral and privileged partner who can facilitate partnership processes among the development community in Timor-Leste.

Timor-Leste 13

4.1 Challenges and opportunitiesWHO began its humanitarian assistance almost a decade ago, in 1999. Over the years, WHO’s cooperation in and with Timor-Leste has been growing in terms of technical and financial capacity. In the recently-developed United Nations Development Assistance Framework (UNDAF) 2009-2013, WHO has indicated a resource mobilization target (for WHO) of USD 16 million.

The Country Office staff increased from two in 1999 to the current number of 24. This includes seven international professionals (three fixed-term including the WHO Representative, and four term-limited staff), 17 nationals (10 technical and 7 support staff). (Annex 2.)

The products and activities in the work-plans of the last two biennia have been quite consistent with the 2004-2008 CCS priorities. The priorities were:

Support for health policy and legislation development•

Donor coordination and partnership for health development•

Health systems development•

Interventions for priority health problems•

A substantial proportion of the budget (72 %) has been allocated to interventions related to priority health problems. Combined, the budget for priority health interventions and the determinants of health account for 75 % of the total allocated budget. Health policy and legislation development, under health priorities, systems and products, has been allocated approximately 8% of the budget. The partnership and coordination component has no explicit budgetary allocation, although it is included under WHO country presence, which also includes the time the WHO Representative devotes to dealing with other partners.

There are a number of reasons why the budgetary allocation to priority health interventions has been so remarkable. The CCS priorities were developed in response to ambitious national health plans and strategies, under the assumption that WHO would be able to mobilize voluntary contributions to implement these priorities. Not all priorities identified in the CCS as mentioned above were fully implemented, although these were the basis for biennial workplans. WHO was able to mobilize voluntary

Past and current WHO cooperation 4


contribution for some CCS priorities, approximately USD 1.5 million, particularly for priority disease interventions2. However, it was not able to mobilize resources to implement other CCS priorities, such as those related to policy, systems and institutional development. Donor preference for a few priority programme areas seems to have resulted in funding gaps for strengthening health system capacity in Timor-Leste.

As the country is still going through a reconstruction and recovery phase, overall national capacity and infrastructure for effective service delivery is relatively limited. Due to the paucity of staff, government officials are, for instance, often designated as focal points for multiple programmes and provided with inadequate resources and support.

4.2 WHO’s contribution to achieving the national health development agenda across the CCS priorities

The application of WHO’s core functions as indicated in Box 1 for the implementation of CCS priorities is described below. WHO’s focus in Timor-Leste continues to shift away from traditional support for direct implementation to supporting the MoH to build its own capacity to develop health policy and strengthen the health system.

Box 1: WHO’s Core Functions

Providing leadership on matters critical to health and engaging in partnerships 1. where joint action is needed.

Shaping the research agenda and stimulating the generation, dissemination, 2. and application of valuable knowledge.

Setting norms and standards, and promoting and monitoring their 3. implementation.

Articulating ethical and evidence-based policy options.4.

Establishing technical cooperation, catalyzing change, and building 5. sustainable capacity.

Monitoring the health situation and assessing health trends.6.

2 Example of donor-preferred priority disease interventions includes HIV, TB, malaria and immunization. The donors are GFATM for AIDS, TB and malaria, and GAVI for immunization.

Timor-Leste 15

4.2.1 Priority 1: Support for health policy and legislation development

WHO has been providing sustained and continuous support to health policy development with the appointment of a full-time senior adviser to the Ministry of Health. This has proved to be a good mechanism in providing policy advice, assisting the government in strengthening health systems, partnership and many other health sector issues.

WHO and EC supported the preparation of the National Health Sector Strategic Plan - HSSP (2008-2012), which is guiding the government in the sector development and informing strategies and plans being developed with other partners, such as AusAID and the World Bank. In addition, WHO contributed to the elaboration of the Medium Term Expenditure Framework (MTEF), which has enabled the MoH to develop a comprehensive national health plan and budget to implement the HSSP.

4.2.2 Priority 2: Donor coordination, partnership for health development and aid effectiveness

WHO has a privileged rapport with the government, and is thus well-positioned to facilitate partnership processes and provide support to donor and external resource coordination among the development community in Timor-Leste.

The Country Office has been able to collaborate successfully with the Ministry of Health, other national institutions, NGOs, and donor agencies to prioritize health on the development agenda. In addition to generating resources for itself (USD 1.5 million), WHO has been assisting the government in generating external resources for the health sector (i.e. USD 2.4 million from GFATM for TB, USD 9.4 million for HIV/AIDS).

WHO has supported the Ministry of Health in establishing donor coordination and partnership mechanisms. These forums resulted in a Combined Annual Plan and Budget, reflecting both government and externally funded activities. Despite limited capacity, the MoH has prepared the necessary conditions for moving towards a SWAp in the health sector. The preparation and approval processes of the HSSP 2008-2012 and the MTEF are being used as tools to achieve stakeholder agreement on spending priorities that close gaps and limit duplication.

WHO’s pro-active participation in the development of UNDAF 2009-2013 was specifically appreciated. There is a constant interaction among the UN agencies which emphasizes the need for the next CCS to consider UNDAF priorities to ensure their work is harmonized with that of other UN agencies.

UNICEF and UNFPA have been working closely with WHO and complementing the work across a number of areas. For example, in the area of immunization, UNICEF and WHO work together. In the area of essential obstetric care and midwifery training, UNFPA and WHO have collaborated effectively.


WHO has been requested to facilitate the coordination of multiple partners involved in specific programmes, such as TB and malaria, to ensure a harmonized response to the challenges in these areas. Further, WHO would provide specific support to build the capacity of the recently established Department of Partnership Management in the Ministry of Health to effectively manage partnership and coordinate resources and programmes of the development partners.

4.2.3 Priority 3: Health System Development

WHO has been working directly with the health authority in developing “initial steps in rebuilding the health sector in Timor-Leste” which have been the basis for the development of the national health system.

Given the enormous need for capacity building particularly to implement the Basic Health Services Package and SISCa (integrated community health services) – both of which are based on primary health care values – there is more scope in this area, as identified below.

WHO’s advocacy role is evident in the extent to which the values and principles of primary health-care have been articulated in the National Development Plan and HSSP. With support from WHO, Timor-Leste recently developed a paper, “Revitalizing Primary Healthcare: Timor-Leste’s Experiences”, to further strengthen the country’s community- based health system. The national health priorities related to the MDGs and Basic Health Services Package has been formulated with support from WHO.

WHO and other partners such as AusAID, the EC and the World Bank have been supporting the government to develop a Human Resources for Health (HRH) plan which is under review, and to develop a number of strategies and guidelines for addressing human workforce development. An example is the Guidelines for Fellowships and Scholarships Programme.

WHO supported the process of curriculum development for the School of Nursing and Midwifery. This included the development of a training plan and health workforce programme for different categories of the health workforce. This has contributed to the revitalization and expansion of primary health care services in Timor-Leste. WHO supported several other training programmes – e.g. two overseas training programmes on pre-hospital care and on public health in complex emergencies, and the development of a Management Training Programme for Community Health Centre Managers.

The HSSP-SP funded by the World Bank and AusAID, and the EC project have planned activities such as the HRH plan, in-service training assessment, and workforce performance analysis. The initiatives require better coordination as well as an agreement on division of labour for harmonized response to government requests. Support for better coordination should focus on health workforce needs assessment that include the planning, production and management of medical doctors, nurses, midwives and other paramedical health workforce such as pharmacists, laboratory assistants and dentists.

Timor-Leste 17

WHO has provided information in health financing tools, practical guidelines, and training on key dimensions of financing and social protection mechanisms. The government is in the process of costing primary and hospital care to assess resources required to finance the health sector. WHO would assist the government to identify health sector needs and develop financing mechanisms to ensure universal coverage as provided for in the HSSP.

Quarterly and annual health reports were produced and disseminated in 2007 and 2008 with WHO support. The Health Management Information System unit needs continuous technical support as there are systemic issues and issues of data quality and reliability. This unit is now integrated with the surveillance unit in the MoH. The MoH conducts integrated disease surveillance with technical and financial support from WHO. In response to a request from the MoH, WHO has also supported the establishment of vital registration in three districts. With funding from HSSP-SP or through any other funding mechanism, WHO will coordinate all initiatives and support the government in setting up a comprehensive HMIS for evidence-based policy development and the monitoring and assessment of the health situation and trends.

There is a need to continue to provide management and leadership training for new managers as well as continuing education for the existing managers, taking into consideration the government’s decentralization policy.

WHO’s contribution to improving the quality and availability of essential medicines has been substantial; technical guidelines on the rational use of drugs have been distributed to health facilities for health workers to follow while dispensing medicines. The resources provided under this programme have been utilized for the emergency purchase of drugs.

Technical support provided by different partners needs more coordination and strategies should be implemented to minimize turnover and ensure sustained national capacity building in health systems development.

4.2.4 Priority 4: Interventions for priority health problems

WHO support was provided in the development of up-to-date standard operating procedures for laboratories and blood banks, as well as disease and programme specific guidelines.

Support in malaria control included technical advice and development of the treatment protocol for prevention and management of malaria, orientation of all doctors, support in vector surveillance, mapping of malaria cases and vector control. The National Malaria Control Programme will receive USD 10.3 million from the GFATM (Round 7). WHO will facilitate implementation by supporting coordination and providing technical assistance.


In the National TB control programme, DOTS expansion has taken place in all community health centres. Technical assistance was provided to MoH in the preparation of a proposal for funding, submitted to the GFATM, during Rounds 4 and 7 both of which were successful. Technical assistance for capacity building of the programme was organized through a horizontal collaboration mechanism facilitated by WHO. The GFATM would provide USD 7 million for TB control. The procurement of first-line and second-line anti-TB drugs is being coordinated through WHO with the Global Drug Facility. Support was also secured from UNITAID for second-line drugs for the programme.

WHO provides support to the MoH in strengthening national capacity in programme management, implementation of HIV and STI prevention, care and treatment interventions, and monitoring and evaluation of the national AIDS programme. Under the HIV grant provided by GFATM to expand the scope of the national programme in controlling the spread of HIV and STI, including blood transfusion services, WHO provides assistance for the procurement of supplies, including pharmaceuticals, and equipment for the proposed new blood banks in four district hospitals.

WHO supported implementation of the National Leprosy Elimination Programme. The programme commenced in 2003 and the incidence has decreased. Support to other programmes, i.e. elimination of lymphatic filariasis, and control of intestinal parasitic diseases continued.

WHO’s role in maternal and child health focused on capacity building and the provision of norms and guidelines. The Human Resources for Maternal and Newborn Health Strategy has been developed, along with a comprehensive intervention plan to ensure skilled care at every birth which has been endorsed by the Ministry of Health. Support was provided to the MoH to improve performance of the maternal and neonatal health programme at district level. The focus on adolescents is through the integrated programme on HIV/STI, family planning and health promotion. The WHO/UNFPA/UNICEF Adolescent Reproductive Health (ARH) Framework “Investing in youth” was translated and widely disseminated in collaboration with UNFPA. Support was provided to the expansion of IMCI in all 13 districts; supervisory capacity is now in place. Six districts have started implementation of community IMCI.

With support from WHO, UNICEF and other partners, immunization is a well established programme in Timor-Leste. Immunization staff at district and sub-district level has been trained, and all districts have one staff that is able to maintain the cold chain properly. Routine immunization coverage for infants has improved (DPT3 coverage increased from 57 % in 2004 to 70 % in 2008) and although it has not reached the regional target, there has been a rapid progress. Introduction of tetravalent (DPT and HepB) vaccine at the end of 2007 is a major achievement. The country has been polio free since 1995. However, during the last 10 years the country has not achieved the required target for AFP surveillance. Measles supplementary immunization activities

Timor-Leste 19

were conducted in 2003 and 2006. However, reported measles incidence varied with high incidence in 2005 and no cases in 2007, indicative of weakness in general surveillance. In spite of several attempts to train laboratory staff in JE surveillance, the process is yet to be completed. SEARO has assigned a Temporary International Professional to assist in priority activities such as surveillance, conducting EPI and AFP surveillance review and preparations of the TT and measles immunization campaigns. The major constraints facing immunization services are inadequate human resources even though there are substantial financial resources, and the difficulty of access to about 30 % of the population.

WHO provided technical support to the MoH and partners in implementing the National Nutrition Strategy to tackle the serious nutrition problem in the country. The support consisted of training workshops on infant and young child feeding across all districts, translation of the 3-in-1 training manuals on feeding for mothers with HIV/AIDS, and training of national staff trainers. Support was also provided to a national workshop to improve the quality of the nutrition programme across all districts. This resulted in an average increase in knowledge on nutrition services by more than 20 %.

WHO support was also provided to address determinants of health and for the development of health promotion training materials for community health volunteers. The school campaign on World No Tobacco Day 2007 was supported and perceived to have improved school students’ knowledge and awareness regarding the ill-effects of tobacco. There has been concerted effort to strengthen the area of school health promotion. A National School Health Working Group has been established and is co-chaired by MoH and the Ministry of Education. Its membership includes nongovernmental organizations, WHO, UNICEF, UNFPA and development partners. Training of teachers on school health promotion was started in six districts with WHO technical support. The remaining districts will receive technical and financial support from WHO in 2009.

In the area of environmental health, WHO assisted the MoH in the development of sanitary norms, establishing an inspection unit, development of water quality standards, capacity building on water quality management and the provision of water testing kits. Support was also provided for a training workshop on clinical waste management for DPHOs in Environmental Health, as well as hospital staff and NGOs working in the environmental health programme. WHO, particularly the Regional Office, has provided continuous support to the MoH in building capacity in preparedness and response with regard to major natural and man-made disasters. WHO has developed guidelines and instructions for the management of emergency situations in IDP camps, and the mapping of the emergencies using Global Image Software (GIS). WHO assisted the MoH in establishing the National Task Force for avian influenza, conducted training for joint outbreak investigation, supervised the UN response to avian influenza at the country level, and assisted in the procurement of diagnostic reagents and personal protection kits.


In providing technical assistance to the Ministry of Health, WHO follows the key principles mentioned below:

WHO priorities are adjusted according to national health objectives which • include achieving the health-related Millennium Development Goals and universal access to primary health care services.

Priority approaches are emphasized in the strategic agendas for which WHO’s • strong input (both technical and financial) are expected to bring substantial outcomes and their impact on country capacity.

Well defined and selected priorities will help to ensure a better match • between the needs of the country and the globally agreed strategic objectives in which WHO has a clear advantage compared to other partners.

Continued support from WHO will help the Ministry of Health to strengthen • health policy and systems as well as public health services and management capacity at all levels; this, in turn, is expected to augment the government’s commitment to decentralization.

WHO’s role has shifted from implementing specific health programmes • to supporting the Ministry of Health to build its own capacity around the core functions and to strengthen the health systems for effective service delivery.

Technical assistance will remain one of the most important core functions • of the Country Office in the foreseeable future.

Enhancing partnership with UN agencies and all partners in health and • harmonization of programmes among development partners is crucial for aid-effectiveness.

Strategic Priorities:

Based on the health issues and challenges in Timor-Leste, the WHO’s Eleventh General Programme of Work, WHO’s core functions (see box 1) and recognizing WHO’s role identified through consultations with national and international partners, six Strategic Priorities have been jointly agreed for WHO’s cooperation with the government of Timor-Leste:

Strategic agenda for WHO during 2009-20135

Timor-Leste 21

Health policy and systems(1)

Disease prevention and control(2)

Maternal and Child Health(3)

Overall national capacity building(4)

Partnership and coordination(5)

Emergency preparedness and rapid response(6)

Under each strategic priority, WHO will identify the main focus with areas for action and apply selected WHO core functions in formulating strategies to address these areas. The main focus indicates high priority in which WHO expects to be able to have an impact through its contributions of dedicated professionals and funds. The CCS main foci will also be linked to WHO’s Medium Term Strategic Plan.

5.1 Strategic Priority 1: Health policy and systemsWHO will continue to provide support and advice in the areas of health policy and systems. Strengthening district health systems, quality of services and the Health Management Information System and support in the areas of health policy and systems are high priorities. The Organization’s support for human resource development needs to be scaled-up, as well in improving national capacity in procurement, logistics and maintenance of a supply system.

Main Focus 1.1: Health systems strengthening

Areas for Action WHO core fun ctions

Strategies

District health systems (DHS)strengthening

3, 4, 5 Strengthen district health systems to deliver and manage the Basic Package of Health Services as defined in the HSSP and the SISCa, especially in view of the government’s commitment to decentralization of the health and other sectors.


Areas for Action WHO core fun ctions

Strategies

Health Management and Information System (HMIS) strengthening

2, 4, 6 Strengthen HMIS all levels, particularly in areas of data collection and reporting, national data management, managerial and epidemiological capacities of HMIS officers at national and district levels, utilization of data and development of user-friendly software for HMIS. Additional financial resources would be necessary.

Main Focus 1.2: Health policy strengthening

Areas for Action WHO core functions

Strategies

Health policy advice 1, 4, 5, 6 Support the Ministry of Health by providing a full-time senior consultant located in the Ministry of Health.

Additional Focus Areas for Strategic Priority 1


Strategies

Human resources for health (HRH) master plan

3, 5 Facilitate harmonizing the multiple efforts of various partners in developing comprehensive human resources for health master plan to address gaps in and improve the quality of the current health workforce.

Institutional capacity strengthening

5 Support for strengthening the Faculty of Health Sciences and the Institute of Health Science.

Timor-Leste 23


Strategies

Improvement of quality of services

3, 5 Support to improving the quality of services, by equipping diagnostic facilities, ensuring an adequate supply of essential medicines, and augmenting integrated disease surveillance for regular monitoring, for taking corrective measures for quality improvement. Operational research in this context will be supported.

Management of essential medicines procurement and supply

3, 5 Improve national capacity in procurement of essential medicines, logistics and maintenance of a supply system and its harmonization.

5.2 Strategic Priority 2: Disease prevention and controlCommunicable diseases continue to be a major public health problem. There are resources provided by the GFATM and other partners. In addition to supporting the government’s coordination of multiple actors, WHO will support capacity building for effective implementation of these programmes, focusing also on elimination and eradication of some communicable diseases and on diseases of public health concern. Enhancing integrated disease surveillance would require continuous support.

Prevention of noncommunicable diseases would be addressed through health promotion. Addressing health determinants (water and sanitation, tobacco, environmental conditions), which are outside the health sector but have a direct impact on health, is also an area for support.


Main Focus 2.1: Disease Prevention and Control

Areas for Action WHO Core Functions

Strategies

Public health workforce and programme intervention

3, 4, 5 Support capacity building of public health workforce and programme interventions for effectively addressing malaria, tuberculosis, STI/HIV/AIDS; for elimination and eradication of diseases (leprosy, lymphatic filariasis, yaws); and for control of communicable diseases of public health concern (dengue, intestinal parasitic infections, Japanese Encephalitis).

Main Focus 2.2: Disease Surveillance and Response


Strategies

Integrated disease surveillance

2, 3, 4, 6 Enhance integrated • disease surveillance, particularly in the area of legislation/ regulation for epidemiological surveillance;

develop national and • sub-national data management;

strengthen technical • capacities of data managers at all levels;

establish a laboratory • network;

enhance surveillance • capacity for risk factors of noncommunicable diseases.

Timor-Leste 25


Strategies

Strengthening implementation of International Health Regulations (IHR) 2005

2, 3, 4, 6 Support national core capacities for implementation of IHR (2005). Surveillance and response, laboratory diagnosis, public health legislation, disease prevention at point of entry (seaport, airport, ground crossings) and risk communication will be key areas for core capacity development in line with IHR (2005).



Strategies

Blood safety 5 Enhance capacities of • the National Laboratory, the National Blood Bank and peripheral level laboratories and blood banks to assist the public health programmes, quality diagnosis and to address blood needs, and to cope with the increasing demand for laboratory testing and blood donations.

Health Promotion 3, 5, 6 Support for revision of the • National Health Promotion Strategic Plan,

capacity building in health • promotion at the national and district levels

support the development • of school health policy.



Strategies

Tobacco control 3, 5, 6 Advocate existing tobacco • control policy and support drafting of national tobacco control legislation.

Water and Sanitation 3, 5, 6 Support for • institutionalization of water safety plans, household water treatment and storage,

promotion of various low-• cost and sustainable latrine options

promotion of water, • sanitation and hygiene in schools.

5.3. Strategic Priority 3: Maternal and child healthEfforts to reduce maternal and child mortality would focus on support for the immunization programme and related activities, and on effective interventions, focusing on the health workforce, facility-based deliveries, quality of care, contraceptive choice, health education, IMCI and nutrition.

Timor-Leste 27

Main Focus 3.1: Child Health

Areas for action WHO Core Functions

Strategies

Immunization programmes 3, 4, 5 Further support to improve • routine immunization coverage,

strengthen polio • eradication documentation,

improve disease burden • knowledge for decision on introduction of new vaccines,

strengthen Ministry of • Health and district level in planning and management capacity

ensure injection safety • including adverse effect following immunization surveillance.

Integrated Management of Childhood Illnesses (IMCI)

5 Support for • implementation of IMCI, particularly the expansion of the community IMCI


Main Focus 3.2: Maternal Health

Areas for action WHO Core Functions

Strategies

Making Pregnancy Safer (MPS)

3, 4, 5, 6 Support for the proper • training of staff in community health centres and district hospitals and the provision of adequate equipment and setting-up safe delivery facilities in the community health centres,

pre- service training and • in-service supervision of midwives,

advocate for expansion • of contraceptive choice, delaying age of first pregnancy and attention for the special care in adolescent pregnancies.



Strategies

Nutrition 3, 5, 6 Strengthen the nutrition-• related interventions and their coverage, with focus on mapping of key stakeholders’ interventions and their impact,

establish quality control • and assurance systems and laboratory for IDD monitoring,

assist in training on the new • WHO growth standards,

assist in adaptation of WHO • guidelines and protocols for the management of children with moderate malnutrition and those recovering from severe malnutrition.

Timor-Leste 29

5.4 Strategic Priority 4: Overall national capacity buildingThe work of WHO together with its development partners will focus to ensure strengthening of national capacity based on the national health policy framework and national health sector strategic plan, as well as transfer of technical skills from international experts to national officials. This would help to ensure sustained national capacity in future. The priority strategic approaches include:

Main Focus 4.1: Strengthening institutional capacity of Ministry of Health


Strategies

Ministry of Health leadership and management capacity

1, 5 Support for further strengthening management, leadership and technical capacity of Ministry of Health

Organizational reform 3, 5 Support legislative, organizational and administrative reforms of management structures, systems and procedures in the Ministry of Health

Technical quality assurance 5, 6 Promote capacity in technical supervision and control throughout the health sector, to promote quality and increase utilization

5.5 Strategic Priority 5: Partnership and coordinationWHO will continue to support the Ministry of Health in the area of donors and partnership coordination, through strengthening the Department of Partnership Management.

As a privileged partner of the MoH and honest broker, WHO needs to increase its support to facilitate donor and partner coordination. WHO will build its support on existing mechanisms and facilitate the government’s involvement in partnership and coordination of external resources for aid effectiveness.


Main Focus: 5.1. Coordination of Partners


Strategies

Department of Partnership Management, Ministry of Health

1, 6 Support for the Department of Partnership Management of the Ministry of Health to effectively manage partnerships and coordinate resources and programmes of the development partners.

Partners coordination 1, 3, 5 Facilitate the coordination of multiple partners involved in specific programmes (e.g. malaria, HRH, HIV), to ensure a harmonized response to the challenges in the specific health programmes.

Support other partners in adhering to the principles of the Paris Declaration and the Accra Accord, especially the harmonization and alignment agenda.

Joint reviews 1, 6 Support for existing mechanisms of effective partnership and coordination, i.e. Joint Annual Review and Annual Planning Summit.

Resource Mobilization 1 Facilitate mobilization of additional financial resources for the health sector from the partners in health and the global partnership mechanisms.

Timor-Leste 31

5.6. Strategic Priority 6: Emergency preparedness and rapid response (EPR)

The country is prone to natural and complex emergencies, including emergencies such as floods and epidemics. Implementation of the International Health Regulations (2005) in the context of Timor-Leste will be emphasized. WHO will enhance its support to ensure adequate emergency preparedness and response.

Main Focus 6.1: Training, advocacy and coordination on EPR


Strategies

Building national capacity 3, 4, 5, 6 Support for the training of the health workforce in rapid response and emergency management including outbreak investigation and disease surveillance, and for providing emergency supplies.

Advocacy 1, 4 Advocate for adequate human resources in the area of health sector emergency preparedness, management and response.

Partnership and coordination 1, 4 Enhance partnerships for effective planning, coordination and response to emergencies.


6.1 Country levelThe proposed agenda for WHO’s Country Cooperation Strategy 2009-2013, Timor-Leste, is based on the situation analysis of the country’s health and development challenges, on achievements and constraints in WHO’s collaborative activities during the past three biennia during the implementation of the WHO CCS 2004-2008, WHO’s core functions and policy framework, and discussions held during the WHO Country Cooperation Review mission, 22 – 26 September 2008. The review mission met Ministry of Health officials and key stakeholders and presented its findings to and received a feedback from the senior MoH officials and the Regional Director, South-East Asia.

Compared to the period of the CCS 2004-2008, there are some major issues that may have implications for the WHO Secretariat, which include (i) shift in priorities; (ii) human resources in WHO Country Office, funding allocation, logistics / infrastructure and connectivity; (iii) role of the WHO Regional Office and HQ.

6.1.1 Shift in priorities

The shift has begun in WHO’s contribution from supporting the implementation of specific health programmes, to supporting the MoH to build its own capacity around the core functions and to strengthen the health system for effective delivery of public health services. WHO will be enhancing its support for strengthening health policy and systems as well as public health services and management capacity at the national, district and community levels. This, in turn, is expected to augment the government’s commitment to decentralization.

While implementation of all health-related programmes has been quite significant, it is somewhat hindered by the limited national capacity. WHO needs to identify where it can boost capacity, prioritize and focus its work.

Maternal and child mortality in Timor-Leste are very high. The country is prone to natural and complex emergencies, including epidemics. WHO will enhance its support to ensure these crucial areas of health are adequately addressed. In addition, effective disease prevention and control interventions will continue to be supported including health promotion and health determinants with special focus on adolescents and young people.

Implementing the strategic agenda6

Timor-Leste 33

6.1.2 Human resources in the WHO Country Office

The current core capacity of essential technical and administrative competency in the WHO Country Office will need to be strengthened for the implementation of the strategic agenda.

Currently, WHO has deployed a full time international senior policy adviser to support the MoH in health systems and policy development. The adviser is based in the MoH and, with adequate backup from the WHO Representative, has consistently proved a very good source of support in policy advice, health system strengthening, effective partnership and other health sector issues.

To address priority health interventions, two international epidemiologists (integrated disease surveillance and IHR), one international TB specialist, one international malaria officer, one national reproductive health programme officer, one national emergency preparedness and response programme officer, one national disease control programme officer, and one national health promotion programme officer are currently based in the Country Office.

Additional staff will be needed for:

Health Management and Information System – a full-time international • professional for two years to strengthen this critical area.

HIV/AIDS/STI – a full-time international professional for two years to support • the national programme in coordinating and harmonizing the assistance and technical support of other stakeholders.

National Planning Officer -- over the years, the size and budget of the Country • Office has grown. A full-time National Professional Officer, Planning, is required to work closely with MoH in planning, implementing and monitoring WHO’s collaborative programme.

Administrative support – a full-time administrative officer is needed to support • the professional and technical staff and to help develop the capacity of the local staff in the administrative unit of the WHO Country Office.

Training is needed in resource mobilization for all technical staff, in programme development and management for national technical staff, and in financial management and secretarial support for local administrative support staff.

6.1.3 Logistics, infrastructure and connectivity

Taking into consideration the country’s transition, WHO must be responsive, flexible and aligned to the country needs while adhering to WHO’s rules and regulations.


In spite of an improvement in connectivity, particularly a GPN and voice/video conference facility, there is a need to address the quality and quantity of the communication facilities for the WHO Country Office.

In support of an integrated UN in Timor-Leste, the WHO Country Office is already a proactive member of the UN Country Team (UNCT) and has actively participated in the development of the UNDAF and relevant coordination and other meetings. As the UNCT operates under the umbrella of the UN Resident Coordinator, UNCT members are expected to contribute to the operations costs of the Resident Coordinator. Therefore, the WHO Country Office has to budget adequately to cover this cost and the office running costs on the shared UN premises.

6.1.4 Financial resources

The cost of the additional human resource needs will add to the biennial budget. While the cost of the National Professional Officer Planning, will be comfortably met by WHO, the funds required for the other planned positions will have to be raised from other sources. Significant costs will also be incurred from WHO funds for shared office space in the common UN premises and for contributions that will be made to the operations of the UN Resident Coordinator.

In addition to its own financial contributions, WHO will also mobilize additional funding for strategic priorities, in particular in the areas of strengthening national capacity and health systems which have a funding gap. WHO’s advocacy role in the partnership and coordination activities could be an important tool to prioritize funding for the systemic activities and mobilize additional resources.

6.2 Support from the Regional Office and WHO Headquarters

Technical support from the Regional Office and HQ (particularly in areas where Country Office expertise is not available) will be required, particularly in the priority areas identified in the CCS 2009-2013.

WHO’s efforts to strengthen national capacity through training and workshops outside the country are quite prominent. However, given the limited number of staff at the MoH and their multiple responsibilities, the number of requests from the Regional Office and HQ for nomination of MoH officials is considerably high. The Regional Office and HQ should be aware of such constraints, and manage their requests accordingly, taking into consideration the country specific context.

The Regional Office and HQ would also play a key role in mobilizing resources for priority areas where the assessed contribution is limited.

Timor-Leste 35

The SEARO/WHO Timor-Leste Country Office team will coordinate Organization-wide actions and collaborate with national counterparts and international development partners to implement, monitor, and evaluate the Country Cooperation Strategy. As with all strategic agendas, the new CCS provides a flexible framework for focused action that will meet the country’s needs. It will be adjusted as needed to respond to changes in the country’s health situation, national health development goals, and the Organizational environment, through periodic, participatory assessment of its implementation.

Conclusion 7


Annex-1St

rate

gic

Prio

rity

1: H

ealth

Pol

icy

and

Syst

ems

Mai

n Fo

cus

1.1:

Hea

lth S

yste

ms

Stre

ngth

enin

g

Area

s of

act

ion

Cha

lleng

esO

ppor

tuni

ties

WH

O p

rior

ityEx

pect

ed R

esul

ts fr

om

WH

O C

olla

bora

tion

Part

ners

Dis

tric

t Hea

lth S

yste

m

(DH

S) s

tren

gthe

ning

Cap

acity

of D

HS

• m

anag

ers

need

s to

be

stre

ngth

ened

.

Cap

acity

of c

omm

unity

-•

base

d he

alth

wor

kers

ne

eds

furth

er

impr

ovem

ent.

Hea

lth s

ervi

ces

• de

cent

raliz

atio

n ha

s be

en id

entif

ied

as a

pr

iorit

y.

Gov

ernm

ent p

olic

y •

on s

treng

then

ing

heal

th s

ervi

ces

thro

ugh

invo

lvem

ent

of c

omm

unity

at g

rass

ro

ot le

vel (

thro

ugh

SISC

a).

Stre

ngth

en d

istric

t •

heal

th s

yste

ms,

bas

ed

on th

e Ba

sic P

acka

ge o

f H

ealth

Ser

vice

s de

fined

in

the

HSS

P an

d th

e SI

SCa,

esp

ecia

lly in

vie

w

of th

e G

over

nmen

t’s

com

mitm

ent t

o de

cent

raliz

atio

n of

the

heal

th a

nd o

ther

sec

tors

.

Trai

ning

DH

S st

aff i

n •

man

agem

ent.

Revi

taliz

ing

PHC

•

thro

ugh

stre

ngth

enin

g co

mm

unity

-bas

ed h

ealth

w

orke

rs a

nd c

omm

unity

vo

lunt

eers

(HM

M/R

C

2006

, Reg

iona

l Stra

tegy

).

Impr

oved

hea

lth s

yste

ms

• m

anag

emen

t, in

clud

ing

plan

ning

, sup

ervi

sion,

m

onito

ring,

reco

rdin

g/

repo

rting

at d

istric

t lev

el.

Bette

r man

agem

ent a

t •

SISC

a le

vel

Min

istry

of H

ealth

, Wor

ld

Bank

, USA

ID, U

NIC

EF,

UN

FPA

.

Timor-Leste 37

Area

s of

act

ion

Cha

lleng

esO

ppor

tuni

ties

WH

O p

rior

ityEx

pect

ed R

esul

ts fr

om

WH

O C

olla

bora

tion

Part

ners

Hea

lth M

anag

emen

t In

form

atio

n Sy

stem

(H

MIS

) str

engt

heni

ng

Cha

nge

in th

e na

tiona

l •

polic

y in

clud

ing

repo

rting

sys

tem

of

seve

ral p

rogr

amm

es th

at

requ

ired

new

form

s an

d tra

inin

g fo

r HM

IS s

taff,

an

d ad

just

men

t of t

he

avai

labl

e so

ftwar

e.

Alth

ough

trai

ning

has

•

been

con

duct

ed s

ever

al

times

to im

prov

e th

e ca

paci

ty o

f the

HM

IS

staf

f, m

any

HM

IS s

taff

still

una

ble

to d

eliv

er.

Inad

equa

te c

ompi

latio

n •

and

repo

rting

of t

he

HM

IS d

ata

at th

e C

omm

unity

Hea

lth

Cen

tre (C

HC

) lev

el d

ue

to li

mite

d un

ders

tand

ing

of h

ealth

wor

kers

on

valid

atin

g an

d an

alyz

ing

the

data

.

Cap

acity

for d

ata

• an

alys

is at

all

leve

ls st

ill

inad

equa

te.

Lim

ited

utili

zatio

n of

•

info

rmat

ion

from

HM

IS

for p

olic

y an

d st

rate

gy

form

ulat

ion.

HM

IS is

con

sider

ed a

•

prio

rity

in H

SSP.

Repo

rting

sys

tem

has

•

been

stre

amlin

ed a

nd

avoi

ds d

uplic

atio

n.

Vario

us g

uide

lines

•

for H

MIS

hav

e be

en

deve

lope

d, in

clud

ing

guid

elin

es fo

r val

idat

ing

data

and

dat

a an

alys

is.

Trai

ning

of H

MIS

sta

ff •

at d

istric

t and

nat

iona

l le

vel.

HM

IS U

nit o

f MoH

•

was

abl

e to

pro

duce

its

annu

al H

ealth

Sta

tistic

s Re

port

in 2

007

and

2008

.

Intro

duct

ion

of n

atio

nal

• fa

mily

regi

stra

tion

syst

em

by th

e M

oH, t

hrou

gh

SISC

a.

Pilo

ting

of V

ital

• Re

gist

ratio

n m

odel

in

one

dist

rict,

in

colla

bora

tion

with

the

Min

istry

of I

nter

ior a

nd

the

Nat

iona

l Sta

tistic

s D

irect

orat

e.

Stre

ngth

en H

MIS

at a

ll •

leve

ls, p

artic

ular

ly in

ar

eas

of d

ata

colle

ctio

n an

d re

porti

ng, n

atio

nal

data

man

agem

ent,

man

ager

ial a

nd

epid

emio

logi

cal

capa

citie

s of

HM

IS

offic

ers

at n

atio

nal a

nd

dist

rict l

evel

s, u

tiliz

atio

n of

dat

a an

d de

velo

pmen

t of

use

r-fri

endl

y so

ftwar

e fo

r HM

IS

Esta

blish

men

t of v

ital

• re

gist

ratio

n sy

stem

.

Dev

elop

men

t of

• op

erat

iona

l and

val

idat

ed

tool

s fo

r col

lect

ing

and

upda

ting

info

rmat

ion

and

faci

litat

ing

rout

ine

anal

ysis

for t

he H

MIS

.

Prom

ote

use

of

• ap

prop

riate

hea

lth

info

rmat

ics

incl

udin

g G

IS a

s a

com

mon

to

ol fo

r pla

nnin

g,

impl

emen

tatio

n an

d m

onito

ring

of h

ealth

se

rvic

es a

t all

leve

ls.

HM

IS u

nit i

n M

oH

• st

reng

then

ed a

nd

appl

icat

ion

of th

e sy

stem

at

all

leve

ls.

HM

IS u

nit i

n M

oH

• ab

le to

pro

vide

tim

ely

and

accu

rate

dat

a fo

r pl

anni

ng, m

onito

ring

and

impr

ovin

g th

e pe

rform

ance

and

qua

lity

of h

ealth

ser

vice

s.

Vita

l reg

istra

tion

syst

em

• es

tabl

ished

.

Min

istry

of H

ealth

, •

Wor

ld B

ank,

Aus

AID

, U

SAID

.

Goo

d co

llabo

ratio

n w

ith

• U

NFP

A.

Min

istry

of H

ealth

, •

Wor

ld B

ank,

Aus

AID

, U

SAID

.

Goo

d co

llabo

ratio

n w

ith

• U

NFP

A.


Focu

s on

Hea

lth S

yste

ms

Issu

es

Area

s of

act

ion

Cha

lleng

esO

ppor

tuni

ties

WH

O p

rior

ityEx

pect

ed R

esul

ts fr

om

WH

O C

olla

bora

tion

Part

ners

Hum

an R

esou

rces

for

Hea

lth (H

RH) m

aste

r pl

anD

evel

opm

ent a

nd

• im

plem

enta

tion

of H

R da

taba

se a

nd p

lan.

Gov

ernm

ent p

olic

y in

•

plac

e.

Faci

litat

e ha

rmon

izin

g •

the

effo

rts o

f var

ious

pa

rtner

s in

dev

elop

ing

a co

mpr

ehen

sive

hum

an

reso

urce

s fo

r hea

lth m

aste

r pl

an to

add

ress

gap

s in

and

im

prov

e th

e qu

ality

of t

he

curr

ent h

ealth

wor

kfor

ce.

Assis

t the

mem

ber s

tate

•

in d

evel

opm

ent o

f HR

data

base

and

pla

n (W

HA,

H

MM

/RC

200

6).

HR

data

bas

ed

• de

velo

ped

and

upda

ted

HR

plan

impl

emen

ted.

Min

istry

of H

ealth

, EC

, A

usA

ID, W

orld

Ban

k,

UN

FPA

.

Stre

ngth

enin

g in

stitu

tions

fo

r tr

aini

ng o

f mid

wife

sIn

adeq

uate

qua

lifie

d •

teac

hers

and

in

frast

ruct

ure

in

impl

emen

ting

a ne

w

mid

wife

ry c

urric

ulum

(D

III) b

y th

e In

stitu

te o

f H

ealth

Sci

ence

s (IH

S).

MD

G 4

-5 re

leva

nt.

•

Gov

ernm

ent p

olic

y in

•

plac

e.

On

the

agen

da o

f oth

er

• U

N a

genc

ies.

Scal

e up

ski

lled

birth

•

atte

ndan

ts to

impr

ove

mat

erna

l and

new

born

he

alth

(WH

A , H

MM

/RC

20

05)

Supp

ort f

or s

treng

then

ing

• Fa

culty

of H

ealth

Sci

ence

s an

d th

e In

stitu

te o

f Hea

lth

Scie

nces

and

Nat

iona

l H

ealth

Lib

rary

.

Qua

lity

of m

idw

ifery

•

educ

atio

n im

prov

ed.

Qua

lifie

d te

ache

rs in

•

plac

e.

Min

istry

of H

ealth

, •

UN

FPA

.

EC, A

usA

ID•

Stre

ngth

enin

g in

stitu

tions

fo

r tr

aini

ng o

f nur

ses.

In

adeq

uate

qua

lifie

d •

teac

hers

and

in

frast

ruct

ure

in

impl

emen

ting

a ne

w

Dip

lom

a in

Nur

sing

curr

icul

um b

y IH

S.

Gov

ernm

ent p

olic

y in

•

plac

e.Sc

ale

up p

rodu

ctio

n an

d •

qual

ity o

f hea

lth w

orkf

orce

(W

HA

, HM

M/R

C 2

006)

.

Supp

ort f

or s

treng

then

ing

• Fa

culty

of H

ealth

Sci

ence

s an

d th

e In

stitu

te o

f Hea

lth

Scie

nces

and

Nat

iona

l H

ealth

Lib

rary

.

Qua

lity

of n

ursin

g •

educ

atio

n im

prov

ed.

Qua

lifie

d te

ache

rs in

•

plac

e.

Min

istry

of H

ealth

, •

UN

FPA

.

EC, A

usA

ID•

Timor-Leste 39

Area

s of

act

ion

Cha

lleng

esO

ppor

tuni

ties

WH

O p

rior

ityEx

pect

ed R

esul

ts fr

om

WH

O C

olla

bora

tion

Part

ners

Esse

ntia

l Med

icin

es

and

drug

sup

ply

and

m

anag

emen

t

Inco

rpor

atin

g th

e TL

S •

Nat

iona

l Ess

entia

l M

edic

ines

List

in th

e tra

inin

g of

hea

lthca

re

prof

essio

nals.

Impr

ovin

g D

rug

Supp

ly

• M

anag

emen

t.

Inco

rpor

atin

g th

is in

•

the

train

ing

prov

ides

co

here

nce

from

trai

ning

to

act

ual p

ract

ice

in th

e he

alth

care

sys

tem

.

Impr

oved

sof

twar

e •

prov

idin

g be

tter

feed

back

on

drug

us

e an

d th

ereb

y im

prov

ing

drug

sup

ply

man

agem

ent

Impr

ove

natio

nal c

apac

ity

• in

pro

cure

men

t of e

ssen

tial

med

icin

es, l

ogist

ics

and

mai

nten

ance

of a

su

pply

sys

tem

and

its

harm

oniz

atio

n

Form

ulat

ion

and

• m

onito

ring

of

com

preh

ensiv

e na

tiona

l po

licie

s on

acc

ess,

qua

lity

and

use

of e

ssen

tial

med

ical

pro

duct

s an

d te

chno

logi

es a

dvoc

ated

an

d su

ppor

ted.

Evid

ence

-bas

ed p

olic

y •

guid

ance

on

prom

otin

g sc

ient

ifica

lly s

ound

and

cos

t ef

fect

ive

use

of m

edic

al

prod

ucts

and

tech

nolo

gies

by

hea

lth w

orke

rs a

nd

cons

umer

s de

velo

ped

and

supp

orte

d w

ithin

the

Secr

etar

iat a

nd re

gion

al

and

natio

nal p

rogr

amm

es.

Inte

rnat

iona

l nor

ms,

•

stan

dard

s an

d gu

idel

ines

fo

r the

qua

lity,

saf

ety,

ef

ficac

y an

d co

st-e

ffect

ive

use

of m

edic

al p

rodu

cts

and

tech

nolo

gies

de

velo

ped

and

thei

r na

tiona

l and

or r

egio

nal

impl

emen

tatio

n ad

voca

ted

and

supp

orte

d.

Stre

amlin

ed

• pr

ocur

emen

t and

sup

ply

man

agem

ent s

yste

ms.

Incr

ease

in a

cces

s to

•

and

ratio

nal u

se o

f Es

sent

ial M

edic

ines

.

Min

istry

of H

ealth

, EC

, U

NIC

EF.


Area

s of

act

ion

Cha

lleng

esO

ppor

tuni

ties

WH

O p

rior

ityEx

pect

ed R

esul

ts fr

om

WH

O C

olla

bora

tion

Part

ners

Men

tal H

ealth

Hea

lth s

yste

m

• de

velo

pmen

t to

inco

rpor

ate

men

tal

heal

th.

Men

tal h

ealth

•

prog

ram

me

inte

grat

ed

with

prim

ary

heal

th

care

Build

ing

com

mun

ity

• m

enta

l hea

lth s

yste

m a

nd

prev

entio

n of

har

mfu

l use

of

alc

ohol

.

Hea

lth s

yste

m o

rient

ed

• to

incl

ude

men

tal h

ealth

at

the

prim

ary

heal

th

care

leve

l.

Min

istry

of H

ealth

, A

usA

ID

Timor-Leste 41

Stra

tegi

c Pr

iori

ty 2

: Dis

ease

Pre

vent

ion

and

Con

trol

Mai

n Fo

cus

2.1:

Dis

ease

Sur

veill

ance

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

Inte

grat

ed D

iseas

e Su

rvei

llanc

e Sy

stem

(ID

SS)

Lim

ited

tech

nica

l cap

acity

. •

Reta

inin

g tra

ined

pro

fess

iona

l •

staf

f.

Lack

of u

nder

stan

ding

of

• di

stric

t man

ager

s on

the

use

of e

pide

mio

logi

cal d

ata

for

deci

sion-

mak

ing.

Epid

emio

logy

uni

t •

and

syst

em is

in

plac

e.

All d

istric

ts h

ave

• st

aff d

esig

nate

d fo

r dise

ase

surv

eilla

nce.

FETP

for f

ield

leve

l pub

lic

• he

alth

pro

fess

iona

ls.

Shor

t fie

ld e

pide

mio

logy

•

train

ing

cour

se fo

r pa

rapr

ofes

siona

ls an

d di

stric

t m

anag

ers.

Enha

nce

inte

grat

ed d

iseas

e •

surv

eilla

nce,

par

ticul

arly

le

gisla

tion

for e

pide

mio

logi

cal

surv

eilla

nce.

Publ

ic h

ealth

pro

fess

iona

ls •

train

ed o

n ou

tbre

ak in

vest

igat

ion

and

dise

ase

surv

eilla

nce.

Impr

oved

qua

lity

of d

iseas

e •

repo

rting

and

util

izat

ion

of

epid

emio

logi

cal d

ata.

Min

istry

of H

ealth

, U

SAID

, Aus

AID

.

Nee

d to

Gen

erat

e ev

iden

ce-

• ba

sed

info

rmat

ion

Mul

tidisc

iplin

ary

• ra

pid

resp

onse

te

ams

(RRT

) at

cent

ral l

evel

.

Dise

ase

repo

rting

bas

ed o

n •

labo

rato

ry c

onfir

mat

ion.

Trai

n pr

ofes

siona

ls on

•

appr

opria

te s

ampl

e co

llect

ion,

pr

eser

vatio

n, s

tora

ge a

nd

trans

porta

tion.

Dev

elop

cap

acity

for f

ield

•

diag

nosis

usin

g RD

T an

d ar

rang

e co

nfirm

ator

y di

agno

sis

in N

atio

nal H

ealth

Lab

orat

ory.

Dise

ase

surv

eilla

nce

able

to

• pr

ompt

ly d

etec

t and

resp

ond

to

any

outb

reak

that

mig

ht o

ccur

in

the

coun

try, a

nd p

rovi

de ti

mel

y ep

idem

iolo

gica

l dat

a on

prio

rity

dise

ases

.

A fu

nctio

nal m

ultid

iscip

linar

y •

RRT

at d

istric

t lev

el.

Fiel

d- le

vel p

rofe

ssio

nals

train

ed

• to

col

lect

and

disp

atch

qua

lity

and

appr

opria

te s

ampl

es.

Esta

blish

men

t of l

abor

ator

y •

conf

irmat

ion

for t

he s

urve

illan

ce

syst

em.

Min

istry

of H

ealth

, A

usA

ID, U

SAID

.


Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

Dat

a m

anag

emen

t Im

prov

e da

ta q

ualit

y an

d •

valid

ity.

Com

pute

rized

•

data

base

with

GIS

fa

cilit

y.

Dat

a •

man

agem

ent

syst

em fo

r dise

ase

surv

eilla

nce

data

is

in p

lace

.

Stro

ng d

ata

• m

anag

er a

t th

e na

tiona

l su

rvei

llanc

e un

it.

Dev

elop

men

t of n

atio

nal

• an

d su

b-na

tiona

l dat

a m

anag

emen

t.

Spec

ializ

ed tr

aini

ng o

n •

data

base

man

agem

ent

and

appl

icat

ion

of G

IS fo

r ce

ntra

l lev

el p

ublic

hea

lth

prof

essio

nals.

Supp

ort i

n st

reng

then

ing

• te

chni

cal c

apac

ities

of d

ata

man

ager

s at

all

leve

ls.

GIS

is u

sed

as a

pra

ctic

al to

ol fo

r •

dise

ase

surv

eilla

nce

and

publ

ic

heal

th in

terv

entio

n pl

anni

ng.

Impr

oved

qua

lity

of d

iseas

e •

surv

eilla

nce

data

.

Min

istry

of H

ealth

Sust

ain

IDSS

pro

gram

me.

•

Inte

grat

ion

and

harm

oniz

atio

n of

•

the

IDSS

and

HM

IS is

a s

ensit

ive

issue

and

sho

uld

not b

e a

burd

en fo

r qua

lity,

com

plet

enes

s an

d tim

elin

ess

of re

porti

ng.

IDSS

has

bee

n •

impl

emen

ted

in

all d

istric

ts s

ince

Ju

ly 2

005.

At

natio

nal l

evel

, ID

SS d

ata

have

be

en u

sed

since

th

en to

mon

itor

unus

ual e

vent

s an

d pe

rform

ance

of

dise

ase

cont

rol

prog

ram

mes

.

Dev

elop

gui

delin

es a

nd S

OP

• (g

ener

al a

nd d

iseas

e- s

peci

fic).

Enco

urag

e go

vern

men

t •

to fu

nd ID

SS in

a p

hase

d m

anne

r and

car

ry o

ut e

xter

nal

asse

ssm

ent o

f ID

SS to

iden

tify

gaps

and

dev

elop

act

ion

plan

to

thos

e ga

ps.

IDSS

inst

itutio

naliz

ed a

nd a

ctio

n •

take

n to

sus

tain

the

ongo

ing

activ

ities

.

Impl

emen

tatio

n of

IHR

(200

5)In

com

plet

e la

ws/

decr

ees

for

• pu

blic

hea

lth p

artic

ular

ly

rega

rdin

g co

ntro

l, sa

nita

tion,

and

qu

aran

tine

at p

orts

of e

ntry

.

Lim

ited

tech

nica

l cap

acity

for

• th

e id

entif

icat

ion,

dia

gnos

is an

d co

ntro

l of o

utbr

eaks

.

Lim

ited

reso

urce

s id

entif

ied

• fo

r the

impl

emen

tatio

n of

IHR

2005

.

IDSS

is in

pla

ce.

• C

an s

erve

as

a nu

cleu

s to

st

reng

then

ear

ly

war

ning

and

re

spon

se s

yste

m.

Supp

ort t

o de

velo

p •

natio

nal c

ore

capa

city

for

impl

emen

tatio

n of

IHR

(200

5) b

y 20

12. S

urve

illan

ce

and

resp

onse

, lab

dia

gnos

is,

publ

ic h

ealth

legi

slatio

n,

dise

ase

prev

entio

n at

poi

nt

of e

ntry

(sea

por

t, ai

rpor

t, gr

ound

cro

ssin

g) a

nd ri

sk

com

mun

icat

ion

will

be

key

area

s fo

r cor

e ca

paci

ty

deve

lopm

ent).

Impl

emen

tatio

n pl

an fo

r IH

R •

(200

5) d

esig

ned

and

fund

ed.

Incr

ease

d ca

paci

ty a

t MoH

for

• id

entif

icat

ion

and

cont

rol o

f ou

tbre

aks.

Stre

ngth

ened

labo

rato

ry s

ervi

ces.

•

Min

istry

of H

ealth

, A

usA

ID.

Non

com

mun

icab

le

dise

ase

(NC

D)

surv

eilla

nce

The

NC

D a

rea

need

s to

be

• st

reng

then

ed a

nd ri

sk fa

ctor

s id

entif

ied.

Gov

ernm

ent

• in

tere

st is

evi

dent

.Su

ppor

t est

ablis

hing

risk

•

fact

or a

nd n

on-c

omm

unic

able

di

seas

e su

rvei

llanc

e.

Base

-line

pre

vale

nce

esta

blish

ed

• an

d ris

k fa

ctor

iden

tifie

d.M

inist

ry o

f Hea

lth.

Timor-Leste 43

Mai

n Fo

cus

2.2:

Pri

ority

Com

mun

icab

le D

isea

ses

(HIV

/AID

S, T

uber

culo

sis,

Mal

aria

)

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

HIV

-AID

S/ST

IIn

adeq

uate

•

tech

nica

l cap

acity

of

hea

lth s

taff

in

the

dist

ricts

.

Abse

nce

of a

ny

• au

then

ticat

ed

scie

ntifi

c an

d re

pres

enta

tive

base

line

stud

y in

com

pone

nts

like

prev

alen

ce,

surv

eilla

nce,

se

ntin

el

surv

eilla

nce.

STI r

epor

ting

• sy

stem

doe

s no

t ha

ve s

yste

mat

ic

info

rmat

ion

on v

ario

us

com

pone

nts

of th

e H

IV p

rogr

amm

e.

Low

com

mun

ity

• aw

aren

ess

abou

t H

IV/A

IDS.

Leve

l of a

war

enes

s •

on H

IV/A

IDS

and

STI i

s m

uch

low

er

amon

g ad

oles

cent

s an

d yo

ung

peop

le.

Lack

of p

rope

r •

data

man

agem

ent

syst

em.

All

HIV

Gui

delin

es (P

EP, P

MTC

T,

• A

RT,S

TI) d

rafte

d.

STI:

synd

rom

ic c

ase

• m

anag

emen

t app

roac

h ad

apte

d in

the

gove

rnm

ent

heal

th s

yste

m a

nd tr

aine

d st

aff

avai

labl

e.

Con

dom

dist

ribut

ion

syst

em is

•

oper

atio

nal.

Fund

ing

supp

ort f

rom

the

• G

loba

l Fun

d (G

FATM

) rec

eive

d.

Sent

inel

sur

veill

ance

trai

ning

•

and

PMTC

T tra

inin

g fo

r m

idw

ives

est

ablis

hed.

Min

istry

of H

ealth

has

trai

ned

• m

idw

ives

and

nur

ses

in th

e sy

ndro

mic

man

agem

ent o

f STI

.

Beha

vior

al a

nd p

reva

lenc

e •

stud

ies

have

bee

n co

nduc

ted

and

thes

e da

ta w

ill h

elp

in

the

furth

er im

plem

enta

tion

of

prev

entiv

e pr

ogra

mm

es fo

r STI

s an

d H

IV/A

IDS.

Act

iviti

es o

n co

mm

unity

•

awar

enes

s on

HIV

/AID

S an

d ST

Is h

ave

star

ted.

Impl

emen

t STI

syn

drom

ic m

anag

emen

t in

all

• he

alth

faci

litie

s.

“Mai

ntai

n” lo

w e

ndem

icity

of H

IV in

Tim

or-

• Le

ste.

Supp

ort a

nd a

ssist

dev

elop

men

t and

•

impl

emen

tatio

n of

nat

iona

l pol

icie

s,

stra

tegi

es a

nd a

ctio

n pl

ans

on p

reve

ntio

n an

d co

ntro

l of S

TI/H

IV.

Supp

ort e

xpan

sion

of V

CT

in th

e co

untry

•

incl

udin

g de

velo

pmen

t of s

yste

ms

for q

ualit

y co

ntro

l of c

ouns

elin

g an

d te

stin

g, a

nd

regu

lar s

uper

visio

n.

Supp

ort p

artn

ersh

ips

for c

oord

inat

ed m

ulti-

• se

ctor

al re

spon

se to

STI

/HIV

/AID

S w

ithin

the

natio

nal s

trate

gic

fram

ewor

k.

Supp

ort e

stab

lishm

ent o

f bas

elin

e st

rate

gic

• in

form

atio

n on

HIV

pre

vale

nce

incl

udin

g in

th

e ge

nera

l com

mun

ity a

nd in

mos

t affe

cted

ris

k gr

oup

(MAR

Gs)

, thr

ough

inte

grat

ion

of

STI/H

IV/A

IDS

epid

emio

logi

cal s

urve

illan

ce

with

in th

e na

tiona

l int

egra

ted

dise

ase

surv

eilla

nce.

Supp

ort e

vide

nce

base

d BC

C in

itiat

ives

with

•

focu

s in

HIV

pre

vent

ion

incl

udin

g co

ndom

pr

omot

ion

and

infe

ctio

n co

ntro

l mea

sure

s in

he

alth

car

e se

t up;

stig

ma

redu

ctio

n an

d ris

k m

itiga

tion

to p

reve

nt H

IV in

fect

ions

.

Supp

ort t

he n

atio

nal p

rogr

amm

e to

impr

ove

• im

plem

enta

tion

of G

F fu

nded

pro

ject

and

in

mob

ilizi

ng a

dditi

onal

fund

ing

in fu

ture

ro

unds

of c

all f

or p

ropo

sal.

Prov

ide

tech

nica

l sup

port

to th

e N

AC

• th

roug

h th

e U

N T

hem

e G

roup

.

A q

ualit

y as

sure

d •

netw

ork

of V

olun

teer

C

ouns

elin

g an

d Te

stin

g fa

cilit

ies

expa

nded

and

op

erat

iona

lized

.

The

natio

nal H

IV/

• A

IDS

prog

ram

me

unit

stre

ngth

ened

thro

ugh

appr

opria

te tr

aini

ng

and

othe

r cap

acity

bu

ildin

g m

easu

res.

Hea

lth s

taff

train

ed

• in

the

synd

rom

ic

appr

oach

in th

e m

anag

emen

t of S

TIs.

STI a

nd H

IV/A

IDS

• su

rvei

llanc

e in

tegr

ated

in

to th

e di

seas

e su

rvei

llanc

e sy

stem

and

m

onito

red.

Enha

nced

cap

acity

•

of th

e N

atio

nal

Labo

rato

ry in

pro

vidi

ng

spec

ializ

ed la

bora

tory

su

ppor

t to

the

natio

nal

Prog

ram

me

and

in

supp

ortin

g th

e EQ

AS

for H

IV te

stin

g.

Coo

rdin

atio

n am

ong

• th

e pa

rtner

s in

clud

ing

the

Nat

iona

l TB

Con

trol P

rogr

amm

e es

tabl

ished

.

Min

istry

of H

ealth

, de

velo

pmen

t pa

rtner

s, G

loba

l Fu

nd a

nd N

GO

s.


Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Tube

rcul

osis

cont

rol

Low

cov

erag

e of

•

DO

TS s

trate

gy in

su

b-di

stric

ts a

nd

lack

of m

onito

ring

syst

em.

Low

cas

e de

tect

ion

• an

d cu

re ra

tes

in

TB c

ontro

l.

Inad

equa

te

• te

chni

cal c

apac

ity

for T

B co

ntro

l at

the

natio

nal a

nd

sub-

natio

nal l

evel

s.

Del

ay in

•

impl

emen

ting

a st

ruct

ured

nat

iona

l H

IV p

rogr

amm

e is

an o

bsta

cle

for

esta

blish

ing

TB/

HIV

sur

veill

ance

sy

stem

.

Expa

nsio

n of

cov

erag

e of

DO

TS

• st

rate

gy b

ased

NTP

into

all

CH

Cs

in a

ll 13

dist

ricts

.

NTP

nat

iona

l uni

t est

ablis

hed.

•

MO

H to

ok o

ver t

he

• re

spon

sibili

ty o

f NTP

from

the

NG

Os

in 2

006

whi

le th

e N

GO

s co

ntin

ued

to s

uppo

rt N

TP.

TB d

iagn

ostic

faci

litie

s •

esta

blish

ed in

all

dist

rict-

leve

l C

HC

s an

d se

lect

ed s

ub-d

istric

t C

HC

s an

d N

GO

/priv

ate

clin

ics.

Anti-

TB d

rugs

wer

e ob

tain

ed

• fro

m th

e G

loba

l Dru

g Fa

cilit

y as

gr

ant u

p to

200

9.

Stor

age

and

dist

ribut

ion

of

• dr

ugs

inte

grat

ed w

ith th

e SA

MES

, the

pro

cure

men

t sup

ply

man

agem

ent a

genc

y.

Anti-

TB d

rugs

sto

cks

esta

blish

ed

• in

all

dist

ricts

.

TB p

rogr

amm

e re

cord

ing

and

• re

porti

ng s

yste

m e

stab

lishe

d at

di

stric

t and

nat

iona

l lev

els.

DO

TS P

lus

for t

he m

anag

emen

t •

of M

DR-

TB c

ases

laun

ched

.

Disc

ussio

ns fo

r TB/

HIV

•

colla

bora

tion

initi

ated

at

natio

nal l

evel

. NTP

stra

tegy

dr

afte

d an

d di

ssem

inat

ed.

Supp

ort c

apac

ity b

uild

ing

of p

ublic

hea

lth

• w

orkf

orce

and

pro

gram

me

inte

rven

tions

.

Stre

ngth

en D

OTS

del

iver

y un

der p

rope

r cas

e •

man

agem

ent c

ondi

tions

and

as

the

prim

ary

TB c

ontro

l stra

tegy

.

Esta

blish

sys

tem

to im

prov

e qu

ality

of

• sp

utum

sm

ear m

icro

scop

y in

clud

ing

exte

rnal

qu

ality

ass

essm

ent p

roto

col.

Esta

blish

an

effe

ctiv

e an

d su

stai

nabl

e m

odel

•

for f

undi

ng, p

rocu

rem

ent a

nd lo

gist

ics

man

agem

ent o

f ant

i-TB

drug

s, la

bora

tory

eq

uipm

ent a

nd c

onsu

mab

les.

Faci

litat

e th

e es

tabl

ishm

ent o

f a ro

bust

•

mon

itorin

g an

d ev

alua

tion

syst

em fo

r the

TB

pro

gram

me

with

in th

e ov

eral

l hea

lth

info

rmat

ion

syst

em.

Stre

ngth

en c

apac

ity fo

r pro

gram

me

• pl

anni

ng, i

mpl

emen

tatio

n, e

valu

atio

n an

d re

porti

ng th

roug

h in

tegr

ated

trai

ning

and

re

fresh

er tr

aini

ng.

Build

cap

acity

for i

mpr

oved

sup

ervi

sion

at a

ll •

leve

ls of

hea

lth d

eliv

ery

netw

ork.

Impr

ove

gene

ral a

war

enes

s ab

out t

he

• tre

atab

le n

atur

e of

the

dise

ase

and

the

avai

labi

lity

of q

ualit

y an

d fre

e di

agno

stic

an

d tre

atm

ent s

ervi

ces

at th

e pu

blic

hea

lth

faci

litie

s.

Supp

ort e

stab

lishm

ent o

f PAL

mod

els

for

• su

bseq

uent

cou

ntry

wid

e im

plem

enta

tion

in

a ph

ased

man

ner.

Coo

rdin

ate

and

build

cap

acity

to a

ddre

ss

• ch

alle

nges

incl

udin

g TB

/HIV

co-

infe

ctio

n,

MD

R-TB

and

oth

er e

mer

ging

pub

lic h

ealth

iss

ues.

Acce

ssib

le D

OTS

•

serv

ices

for a

ll ci

tizen

s of

the

coun

try.

Impr

oved

TB

case

•

dete

ctio

n ra

te to

ac

hiev

e gl

obal

and

na

tiona

l tar

gets

.

Qua

lity

assu

red

sput

um

• m

icro

scop

y se

rvic

es

avai

labl

e to

all

citiz

ens.

Impr

ovem

ent i

n •

the

outc

ome

of T

B tre

atm

ent.

A ro

bust

pro

gram

me

• fo

r mon

itorin

g an

d su

rvei

llanc

e sy

stem

for

TB e

stab

lishe

d.

Hea

lth w

orkf

orce

•

train

ed to

pro

vide

hi

ghes

t qua

lity

of T

B ca

re in

faci

lity

and

dom

icili

ary

setti

ng.

Impr

oved

MD

R-•

TB m

anag

emen

t es

tabl

ished

incl

udin

g in

fect

ion

cont

rol

mea

sure

s in

ser

vice

de

liver

y po

ints

.

TB a

war

enes

s •

impr

oved

am

ong

the

gene

ral c

omm

unity

an

d he

alth

car

e pr

ovid

ers.

Coo

rdin

atio

n •

esta

blish

ed b

etw

een

natio

nal T

B an

d H

IV

cont

rol p

rogr

amm

es.

Min

istry

of H

ealth

, G

loba

l Fun

d,

deve

lopm

ent

partn

ers

and

NG

Os

Timor-Leste 45

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Mal

aria

con

tol

Nee

d fu

rther

•

enha

ncem

ent

of t

echn

ical

ca

paci

ty in

con

trol

of m

alar

ia a

nd

othe

r vec

tor-

born

e di

seas

es.

Mal

aria

Tre

atm

ent P

roto

col

• la

unch

ed in

June

200

7.

Mor

e th

an 1

50,0

00 b

ed n

ets

• di

strib

uted

for c

hild

ren

unde

r 5

year

s an

d pr

egna

nt w

omen

.

Full

time

coun

try p

rogr

amm

e •

man

ager

for m

alar

ia in

pos

ition

.

Fund

ing

supp

ort f

rom

Rou

nd

• 2

GFA

TM g

rant

s re

ceiv

ed a

nd

prop

osal

for R

ound

7 a

ppro

ved.

477

heal

th s

taff

have

bee

n •

train

ed in

the

use

of th

e N

atio

nal S

tand

ard

for M

alar

ia

Trea

tmen

t Pro

toco

l.

Mal

aria

Cas

e M

anag

emen

t •

train

ing

prov

ided

to 1

3 Ti

mor

ese

doct

ors

and

140

Cub

an d

octo

rs.

Thre

e-da

y en

tom

olog

y fie

ld

• tra

inin

g w

as c

ondu

cted

for 1

5 st

aff

com

pose

d of

all

DPH

O

CD

C a

nd n

atio

nal s

taff.

Thre

e-da

y ve

ctor

con

trol

• tra

inin

g in

13

DPH

O d

istric

ts.

Basic

mal

ario

logy

and

•

prog

ram

me

man

agem

ent

train

ing

cond

ucte

d fo

r 13

DPH

O.

The

biol

ogic

al m

etho

d of

vec

tor

• co

ntro

l was

not

intro

duce

d.

The

ento

mol

ogic

al s

urve

y ha

s •

been

sta

rted

in th

ree

dist

ricts

: M

anat

uto,

Cov

alim

a an

d Lo

s Pa

los.

Supp

ort c

apac

ity b

uild

ing

of p

ublic

hea

lth

• w

orkf

orce

and

pro

gram

me

inte

rven

tions

.

Trai

ning

of m

edic

al s

taff

on th

e na

tiona

l •

diag

nost

ic a

nd tr

eatm

ent p

roto

col.

Trai

ning

labo

rato

ry s

taff

in m

icro

scop

ic

• di

agno

sis a

nd R

DT

use.

Stre

ngth

enin

g of

qua

lity

cont

rol o

f mal

aria

•

mic

rosc

opy

and

RDT.

Prov

ision

of L

ong

Last

ing

Inse

ctic

ide

Trea

ted

• Be

d- n

ets

(LLI

N),

thro

ugh

publ

ic a

nd p

rivat

e ch

anne

ls fo

r at l

east

80%

of p

opul

atio

n re

sidin

g in

hig

h ris

k re

gion

s.

Stre

ngth

enin

g of

ent

omol

ogic

al s

urve

illan

ce

• fo

r im

plem

enta

tion

of e

vide

nce

base

d in

tegr

ated

vec

tor c

ontro

l pro

gram

me.

Intro

duct

ion

and

impl

emen

tatio

n of

•

biol

ogic

al m

etho

ds o

f vec

tor c

ontro

l (i.e

., in

trodu

ctio

n of

larv

ivor

ous

fish

and

use

of

bio-

larv

icid

es).

Stre

ngth

enin

g ca

paci

ty o

f hea

lth v

olun

teer

s •

for e

arly

dia

gnos

is/ tr

eatm

ent a

nd v

ecto

r co

ntro

l act

iviti

es in

the

high

risk

rem

ote

villa

ges.

Build

ing

and

supp

ortin

g na

tiona

l cap

acity

for

• ep

idem

ic re

spon

se.

Prov

idin

g co

nsist

ent a

nd s

usta

ined

tech

nica

l •

assis

tanc

e to

sup

port

mal

aria

con

trol

inte

rven

tions

pla

nned

und

er th

e G

loba

l Fun

d su

ppor

ted

proj

ect/s

.

Hea

lth s

taff

train

ed

• in

use

of n

atio

nal

mal

aria

dia

gnos

is an

d tre

atm

ent p

roto

cols

for

all m

alar

ia c

ases

.

Labo

rato

ry s

taff

train

ed

• in

labo

rato

ry d

iagn

osis

of m

alar

ia.

Impr

oved

qua

lity

• co

ntro

l of m

alar

ia

diag

nosis

.

Mos

quito

net

s,

• di

strib

uted

to a

t lea

st

80%

of p

eopl

e in

the

high

risk

regi

ons.

Redu

ced

mal

aria

•

vect

or d

ensit

y by

im

plem

enta

tion

of e

vide

nce

base

d m

alar

ia v

ecto

r con

trol

met

hods

.

Biol

ogic

al m

etho

ds

• of

vec

tor c

ontro

l in

trodu

ced

in h

igh

mal

aria

-end

emic

di

stric

ts.

Qua

lity

cont

rol o

f •

Indo

or re

sidua

l sp

rayi

ng a

nd L

LIN

.

Stre

ngth

ened

•

coop

erat

ion

with

co

mm

unity

hea

lth

volu

ntee

rs in

the

rem

ote

high

risk

m

alar

ious

are

as fo

r m

alar

ia c

ontro

l and

pr

even

tion.

Min

istry

of H

ealth

, G

loba

l Fun

d,

Aus

AID

, UN

ag

enci

es a

nd N

GO

s


Mai

n Fo

cus

2.3:

Elim

inat

ion

and

Erad

icat

ion

of D

isea

ses

(Lep

rosy

, Lym

phat

ic F

ilari

asis

, Yaw

s)

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

Lepr

osy

The

secu

rity

situa

tion

in

• th

e di

stric

ts d

urin

g 20

07

has

cons

train

ed th

e ab

ility

to

inte

nsify

elim

inat

ion

activ

ities

.

The

encl

ave

of O

ecus

se

• ha

s th

e hi

ghes

t num

bers

an

d ra

tes

of le

pros

y an

d al

thou

gh it

has

dec

reas

ed

from

54.

2 pe

r 10,

000

popu

latio

n in

200

4 to

13.

8 pe

r 10,

000

in 2

006,

it s

till

rem

ains

una

ccep

tabl

y hi

gh.

Inad

equa

te n

umbe

r of F

ocal

•

staf

f for

lepr

osy

prog

ram

me

at th

e M

oH.

Sinc

e th

is •

prog

ram

me’

s in

cept

ion

all d

istric

ts

and

sub-

dist

ricts

th

roug

hout

Tim

or-

Lest

e ha

ve a

dopt

ed

the

sam

e ap

proa

ch

and

cond

uct t

he

sam

e ac

tiviti

es fo

r th

e el

imin

atio

n of

le

pros

y.

The

Lepr

osy

• El

imin

atio

n Pr

ogra

mm

e ha

s de

tect

ed a

nd

regi

ster

ed 1

303

lepr

osy

case

s of

w

hich

100

1 ha

ve

been

cur

ed.

All d

istric

ts h

ave

• re

duce

d th

e in

cide

nce

and

rate

of

lepr

osy

since

20

04.

Supp

ort c

apac

ity

• bu

ildin

g of

pub

lic h

ealth

w

orkf

orce

and

pro

gram

me

inte

rven

tions

.

Incr

ease

act

ive

case

find

ing

• ac

tiviti

es.

Ensu

re c

ontin

uous

, •

unin

terr

upte

d su

pply

of

MD

T.

Elim

inat

ion

targ

et (<

1 ca

se p

er

• 10

,000

pop

ulat

ion)

ach

ieve

d by

20

12.

Min

istry

of H

ealth

, LR

M, S

asak

awa

Mem

oria

l Hea

lth

Foun

datio

n.

Timor-Leste 47

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

Fila

rias

isFi

nanc

ial c

onst

rain

ts h

ave

• ha

mpe

red

the

prog

ram

me’

s ab

ility

to c

ontin

ue in

the

rem

aini

ng fo

ur d

istric

ts

whe

re it

is y

et to

be

star

ted.

Se

curin

g co

mm

itmen

t for

pr

ogra

mm

e (fi

nanc

ial a

nd

polic

y) is

nee

ded.

The

prog

ram

me’

s co

ntin

ued

• im

plem

enta

tion

will

be

affe

cted

by

pote

ntia

l ch

ange

s to

the

MoH

st

rate

gy.

Appr

oxim

atel

y 1

mill

ion

• D

EC ta

blet

s de

stro

yed

in

early

200

8 as

they

had

ex

pire

d.

Don

or s

uppo

rt ha

s be

en

• ob

tain

ed fo

r pro

visio

n of

Iv

erm

ectin

. A d

ecisi

on

need

s to

be

take

n by

MoH

ab

out f

utur

e di

rect

ion

of

the

prog

ram

me

vis-

à-vi

s th

e us

e of

Iver

mec

tin in

stea

d of

DEC

.

Follo

win

g su

cces

sful

•

pilo

t pro

gram

me

in th

e di

stric

t of

Oec

usse

, the

pr

ogra

mm

e w

as

rolle

d ou

t in

othe

r di

stric

ts a

nd h

as

been

ong

oing

in

nine

of t

he c

ount

ry’s

13

dist

ricts

.

The

prog

ram

me

• ha

s be

en g

radu

ally

an

d su

cces

sful

ly

impl

emen

ted

with

mor

e th

an

650,

000

peop

le w

ith

hous

ehol

d co

vera

ge

and

med

icin

e ad

min

istra

tion

exce

edin

g 90

%.

Mon

itorin

g an

d •

eval

uatio

n of

sent

inel

sit

es, d

esig

ned

to

mon

itor m

icro

filar

ia

dens

ity h

ave

been

es

tabl

ished

.

Supp

ort M

oH fo

r the

•

cont

inua

tion

of th

e pr

ogra

mm

e.

Elim

inat

ion

of L

F in

the

coun

try

• af

ter f

ive

year

s of

con

tinuo

us

mas

s dr

ug a

dmin

istra

tion.

Min

istry

of H

ealth

.

Yaw

sD

ata

on th

e pr

eval

ence

of

• ya

ws

rem

ains

lim

ited.

Nat

iona

l pro

gram

me

for t

he

• el

imin

atio

n of

yaw

s no

t yet

co

mm

ence

d.

No

fund

s to

impl

emen

t the

•

elim

inat

ion

plan

.

Nat

iona

l pla

n to

•

elim

inat

e ya

ws

by

2011

dev

elop

ed

Supp

ort M

inist

ry o

f Hea

lth

• fo

r the

est

ablis

hmen

t and

on

goin

g im

plem

enta

tion

of

a na

tiona

l pro

gram

me

to

elim

inat

e ya

ws.

Elim

inat

ion

of y

aws.

• M

inist

ry o

f Hea

lth.


Mai

n Fo

cus

2.4:

Con

trol

of C

omm

unic

able

Dis

ease

s of

Pub

lic H

ealth

Con

cern

(Den

gue

and

Japa

nese

enc

epha

litis

)

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

Den

gue

Inad

equa

te im

plem

enta

tion

• of

che

mic

al v

ecto

r con

trol.

Nat

iona

l sta

ff an

d di

stric

t •

staf

f res

pons

ible

for d

engu

e ne

ed fu

rther

trai

nini

ng o

n in

tegr

ated

vec

tor c

ontro

l.

Nee

d en

hanc

ed

• co

ordi

natio

n be

twee

n C

DC

an

d th

e de

partm

ent o

f En

viro

nmen

tal H

ealth

.

Den

gue

is m

onito

red

• un

der I

DSS

, and

ab

le to

pro

vide

ep

idem

iolo

gica

l da

ta.

The

Nat

iona

l Tas

k •

Forc

e fo

r den

gue

esta

blish

ed s

ince

20

05.

Inte

grat

ed

• ve

ctor

con

trol

impl

emen

ted.

Year

ly e

pide

mic

•

prep

ared

ness

pla

n in

pl

ace.

Supp

ort c

apac

ity

• bu

ildin

g of

pub

lic h

ealth

w

orkf

orce

and

pro

gram

me

inte

rven

tions

.

Trai

ning

of d

engu

e ca

se

• m

anag

emen

t for

doc

tors

an

d nu

rses

, par

ticul

arly

th

ose

who

are

wor

king

in

hosp

itals.

Med

ical

doc

tors

and

nur

ses

in

• al

l hos

pita

ls ab

le to

pro

perly

di

agno

se a

nd im

plem

ent d

engu

e ca

se m

anag

emen

t.

Redu

ce th

e m

orta

lity

due

to

• de

ngue

infe

ctio

n.

Min

istry

of H

ealth

, A

usA

ID.

Japa

nese

enc

epha

litis

(JE)

Lim

ited

hum

an re

sour

ces

to

• fo

cus

on JE

sur

veill

ance

.

Inad

equa

te c

old

chai

n •

syst

em (-

20C

) has

also

be

com

e on

e of

the

cons

train

ts to

con

duct

JE

surv

eilla

nce.

Esta

blish

a

• su

rvei

llanc

e sy

stem

fo

r JE.

Stre

ngth

en

• di

agno

stic

ski

lls o

f la

bora

tory

sta

ff.

Obt

ain

burd

en

• of

dise

ase

data

fo

r the

pot

entia

l in

trodu

ctio

n of

va

ccin

e pr

ogra

mm

e.

Supp

ort t

he M

oH to

•

esta

blish

a s

urve

illan

ce

syst

em.

Enha

nce

capa

citie

s of

•

the

natio

nal a

nd h

ospi

tal

labo

rato

ries

to a

ssist

the

publ

ic h

ealth

pro

gram

mes

.

Incr

ease

d bu

rden

of d

iseas

e •

data

.M

inist

ry o

f Hea

lth

Timor-Leste 49

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Bloo

d sa

fety

Abse

nce

of n

atio

nally

•

coor

dina

ted

serv

ices

.

Non

avai

labi

lity

of

• ad

equa

te u

nits

of b

lood

.

Wea

k te

stin

g fa

cilit

ies.

•

Inad

equa

te c

linic

al u

se

• of

blo

od.

The

draf

ting

of n

atio

nal

• bl

ood

polic

y sh

all f

acili

tate

de

velo

pmen

t of n

atio

nally

co

ordi

nate

d bl

ood

trans

fusio

n se

rvic

es to

ass

ure

acce

ss to

sa

fe b

lood

and

its

ratio

nal u

se

in th

e co

untry

.

The

SOPs

for b

lood

ban

k ar

e •

in p

lace

.

A se

ries

of tr

aini

ng s

essio

ns

• ha

ve b

een

cond

ucte

d on

bl

ood

safe

ty fo

r lab

orat

ory

tech

nici

ans

spec

ifica

lly th

ose

wor

king

for b

lood

tran

sfus

ion

back

in D

ecem

ber 2

004.

MO

H h

as ta

ken

the

initi

ativ

e •

to e

stab

lish

a N

atio

nal B

lood

Ba

nk.

Enha

nce

capa

citie

s of

•

the

Nat

iona

l Lab

orat

ory,

th

e N

atio

nal B

lood

Ban

k an

d pe

riphe

ral l

evel

la

bora

torie

s an

d bl

ood

bank

s to

ass

ist th

e pu

blic

he

alth

pro

gram

mes

, qu

ality

dia

gnos

is an

d to

ad

dres

s bl

ood

need

s,

and

to c

ope

with

the

incr

easin

g de

man

d fo

r la

bora

tory

test

ing

and

bloo

d do

natio

ns.

Impl

emen

tatio

n of

•

WH

O’s

Stra

tegy

for S

afe

Bloo

d w

ith th

e fo

llow

ing

com

pone

nts:

Nat

iona

lly c

oord

inat

ed

• bl

ood

trans

fusio

n se

rvic

es;

Col

lect

ion

of b

lood

•

from

vol

unta

ry, n

on-

rem

uner

ated

don

ors;

Proc

essin

g of

don

ated

•

bloo

d us

ing

SOP;

Ratio

nal u

se o

f blo

od a

nd

• co

mpo

nent

s; a

nd

Assu

ring

qual

ity a

t all

• st

eps.

Avai

labi

lity

of s

afe

bloo

d •

and

bloo

d co

mpo

nent

s to

all

thos

e w

ho n

eed

it th

roug

h na

tiona

lly-

coor

dina

ted

bloo

d tra

nsfu

sion

serv

ices

Min

istry

of H

ealth

Focu

s on

oth

er D

isea

se P

reve

ntio

n an

d C

ontr

ol


Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Hea

lth

labo

rato

ries

Lim

ited

labo

rato

ry

• su

ppor

t for

the

publ

ic

and

heal

th c

are

deliv

ery

serv

ices

.

Inad

equa

te te

achi

ng

• la

bora

torie

s in

the

med

ical

sch

ool.

Gro

win

g aw

aren

ess

amon

gst

• po

licy

mak

ers

abou

t the

ne

ed fo

r lab

orat

orie

s fo

r pu

blic

hea

lth, c

urat

ive

as

wel

l as

teac

hing

of s

tude

nts

in m

edic

al a

nd a

llied

hea

lth

scie

nces

.

Impr

ovin

g ac

cess

to

• la

bora

tory

ser

vice

s fo

r bo

th p

ublic

hea

lth a

nd

clin

ical

ser

vice

s th

roug

h a

natio

nal n

etw

ork

of

labo

rato

ries.

Assu

ring

qual

ity o

f •

labo

rato

ry s

ervi

ces

thro

ugh

impr

oved

qua

lity

syst

ems.

Prom

otin

g ra

tiona

l use

of

• la

bora

tory

ser

vice

s.

Impr

ovin

g sa

fety

in th

e •

labo

rato

ries.

Usin

g la

bora

torie

s •

to te

ach

and

impa

rt ev

iden

ce-b

ased

trai

ning

to

stu

dent

s an

d he

alth

pr

ofes

siona

ls.

Avai

labi

lity

of s

afe

and

• re

liabl

e la

bora

tory

se

rvic

es a

t all

leve

ls of

hea

lth c

are

in th

e co

untry

to s

uppo

rt bo

th p

ublic

hea

lth a

nd

clin

ical

ser

vice

s.

Esta

blish

men

t of

• na

tiona

l ref

erra

l la

bora

torie

s in

the

scho

ol o

f med

icin

e.

Min

istry

of H

ealth

Timor-Leste 51

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Hea

lth P

rom

otio

nH

uman

reso

urce

•

capa

city

to p

rom

ote

heal

th is

lim

ited.

Incr

easin

g de

man

d fo

r •

both

com

mun

icab

le

and

non-

com

mun

icab

le

dise

ase

inte

rven

tions

.

Addr

essin

g he

alth

and

•

soci

al n

eeds

of y

oung

pe

ople

in a

nd o

ut o

f sc

hool

.

Inte

grat

ion

of h

ealth

•

prom

otio

n ac

tiviti

es in

to th

e ex

istin

g di

stric

t hea

lth s

yste

m

by p

rovi

ding

trai

ning

to h

ealth

w

orke

rs a

t the

se c

entre

s on

bas

ic h

ealth

pro

mot

ion

appr

oach

es.

Polit

ical

will

exi

sts

to a

ddre

ss

• ris

k fa

ctor

s as

wel

l as

the

maj

or d

eter

min

ants

of h

ealth

su

ch a

s po

verty

.

The

Min

istry

of E

duca

tion

• an

d M

inist

ry o

f Hea

lth j

oint

ly

colla

bora

te in

sch

ool h

ealth

pr

omot

ion.

Supp

ort f

or re

visio

n of

•

the

Nat

iona

l Hea

lth

Prom

otio

n St

rate

gic

Plan

.

Cap

acity

bui

ldin

g in

•

heal

th p

rom

otio

n at

th

e na

tiona

l and

dist

rict

leve

ls.

Tech

nica

l sup

port

to IH

S •

to tr

ain

heal

th w

orke

rs

to im

plem

ent a

nd

mon

itor h

ealth

pro

mot

ion

activ

ities

.

To a

ddre

ss ri

sk fa

ctor

s •

iden

tifia

ble

with

bot

h co

mm

unic

able

and

non

-co

mm

unic

able

dise

ases

in

clud

ing

the

soci

al

dete

rmin

ants

of h

ealth

.

Dev

elop

men

t of s

choo

l •

heal

th p

olic

y.To

add

ress

kno

wle

dge

and

skill

s re

quire

d to

ad

dres

s th

e nu

mer

ous

conc

erns

of y

oung

pe

ople

.

To a

vail

appr

opria

te a

nd

• ad

equa

te h

ealth

ser

vice

s fo

r you

ng p

eopl

e.

Cap

abili

ty o

f IH

S •

stre

ngth

ened

.

Dist

rict h

ealth

cen

tre

• st

aff e

xpos

ed to

hea

lth

prom

otio

n co

ncep

ts,

cont

ent a

nd s

kills

.

Spec

ific

heal

th

• pr

omot

ion

actio

n ta

ken

on H

IV/A

IDS,

toba

cco,

al

coho

l, ro

ad s

afet

y an

d do

mes

tic v

iole

nce

amon

g ot

her f

acto

rs.

Prev

entiv

e m

easu

res

for

• di

abet

es, h

eart

dise

ases

an

d hy

perte

nsio

n im

plem

ente

d.

Dev

elop

men

t of s

choo

l •

heal

th p

rom

otio

n po

licy

and

stra

tegi

es.

Trai

ning

of t

each

ers

to

• de

liver

and

mon

itor

stru

ctur

ed s

choo

l hea

lth

prom

otio

n.

Min

istry

of H

ealth

, UN

ICEF

, U

NFP

A


Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Toba

cco

cont

rol

The

coun

try h

as a

hug

e •

prev

alen

ce o

f tob

acco

us

e.

The

prev

alen

ce o

f •

curr

ent c

igar

ette

sm

okin

g am

ong

stud

ents

age

d 13

-15

yea

rs is

50.

6% a

mon

g bo

ys a

nd 1

7.3%

am

ong

girls

in T

imor

- Les

te.

The

prev

alen

ce o

f •

curr

ent u

se o

f tob

acco

pr

oduc

ts o

ther

than

ci

gare

ttes

in s

tude

nts

aged

13-

15 y

ears

is

29.0

% a

mon

g th

e bo

ys

and

20.2

% a

mon

g gi

rls.

Ther

e is

lack

of

• co

mpr

ehen

sive

toba

cco

cont

rol l

egisl

atio

n.

The

peop

le’s

aw

aren

ess

• an

d kn

owle

dge

on th

e da

nger

s of

toba

cco

is lo

w.

Tim

or-L

este

is a

new

•

coun

try a

nd h

as n

o le

gisla

tion

on to

bacc

o co

ntro

l. Th

e co

untry

is

ther

efor

e be

ing

targ

eted

by

the

toba

cco

indu

stry

.

Ther

e ar

e no

toba

cco

• ce

ssat

ion

activ

ities

at t

he

com

mun

ity le

vel.

Tim

or-L

este

is a

Par

ty to

the

• W

HO

FC

TC.

Supp

ort f

or to

bacc

o co

ntro

l •

is av

aila

ble

from

WH

O

and

othe

r int

erna

tiona

l or

gani

zatio

ns a

nd th

is sh

ould

be

mad

e us

e of

.

Des

pite

the

cons

train

ts, t

he

• co

untry

has

the

will

ingn

ess

for t

obac

co c

ontro

l and

th

e M

OH

has

con

duct

ed a

fe

w h

ealth

cam

paig

ns a

nd

sem

inar

s fo

r pub

lic h

ealth

st

uden

ts a

nd h

ealth

effe

cts

of

toba

cco

use

is in

clud

ed in

the

prim

ary

scho

ol c

urric

ulum

.

Tim

or-L

este

is a

new

cou

ntry

; •

the

toba

cco

indu

stry

is y

et

to in

flict

the

coun

try w

ith it

s ta

ctic

s. H

ence

, if a

dequ

ate

and

effe

ctiv

e to

bacc

o co

ntro

l m

easu

res

are

take

n rig

ht

now

, the

nef

ario

us e

fforts

of

the

toba

cco

indu

stry

can

be

thw

arte

d.

Toba

cco

grow

ing

and

• em

ploy

men

t in

the

toba

cco

sect

or is

neg

ligib

le.

This

prov

ides

an

oppo

rtuni

ty fo

r m

ore

effe

ctiv

e an

d m

ore

rapi

d im

plem

enta

tion

of th

e to

bacc

o co

ntro

l mea

sure

s.

The

toba

cco

cont

rol

• pr

ogra

mm

e in

Tim

or-L

este

ca

n be

wel

l ext

ende

d up

to

the

com

mun

ity le

vel i

n th

e co

untry

at l

arge

.

Advo

cate

exi

stin

g •

toba

cco

cont

rol p

olic

y an

d su

ppor

t dra

fting

of

natio

nal t

obac

co c

ontro

l le

gisla

tion.

Tech

nica

l ass

istan

ce in

the

deve

lopm

ent,

adop

tion

and

impl

emen

tatio

n of

the

toba

cco

cont

rol

legi

slatio

n.

Tech

nica

l ass

istan

ce to

•

deve

lop

natio

nal p

olic

y,

stra

tegy

and

pla

n of

ac

tion

for t

obac

co c

ontro

l an

d its

impl

emen

tatio

n.Su

ppor

t the

im

plem

enta

tion

of

rele

vant

toba

cco

cont

rol

activ

ities

for s

choo

l st

uden

ts.

Tech

nica

l sup

port

in

the

deve

lopm

ent o

f IEC

m

ater

ials

for t

he ta

rget

ed

popu

latio

n.

Tech

nica

l sup

port

in

• to

bacc

o su

rvei

llanc

e.

Supp

ort i

n Be

havi

our

• C

hang

e C

omm

unic

atio

n (B

CC

).

A co

mpr

ehen

sive

• to

bacc

o co

ntro

l le

gisla

tion

in p

lace

.

Nat

iona

l tob

acco

•

cont

rol p

olic

y, s

trate

gy

and

plan

of a

ctio

n de

velo

ped

and

impl

emen

ted.

Dev

elop

men

t, tra

nsla

tion,

pro

duct

ion

and

dist

ribut

ion

of

a gu

ide

on s

mok

ing

cess

atio

n as

wel

l as

rele

vant

adv

ocac

y m

ater

ials.

Advo

cacy

and

aw

aren

ess

agai

nst

toba

cco

use

thro

ugh

WN

TD (W

orld

No

Toba

cco

Day

) act

iviti

es.

Taxa

tion

of to

bacc

o •

prod

ucts

.

Min

istry

of H

ealth

Timor-Leste 53

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Wat

er a

nd

Sani

tatio

nAc

hiev

ing

the

wat

er a

nd

• sa

nita

tion

MD

G.

Ensu

ring

safe

ty a

nd

• su

stai

nabi

lity

of d

rinki

ng

wat

er s

uppl

ies.

Fina

ncia

l sup

port

from

don

ors

• lik

e Au

sAid

ava

ilabl

e.Su

ppor

t for

•

inst

itutio

naliz

atio

n of

w

ater

saf

ety

plan

s,

hous

ehol

d w

ater

tre

atm

ent a

nd s

tora

ge.

Prom

otio

n of

var

ious

•

low

-cos

t and

sus

tain

able

la

trine

opt

ions

.

Prom

otio

n of

wat

er,

• sa

nita

tion

and

hygi

ene

in

scho

ols.

Prov

ide

tech

nica

l sup

port

• fo

r dev

elop

ing

stra

tegi

es

to a

chie

ve th

e M

DG

s.

Prov

ide

tech

nica

l and

•

finan

cial

sup

port

in

impl

emen

ting

wat

er

safe

ty p

lans

and

its

inst

itutio

naliz

atio

n.

Prom

ote

hous

ehol

d •

wat

er tr

eatm

ent a

nd s

afe

stor

age.

Prov

ide

tech

nica

l in

• pr

omot

ing

vario

us lo

w

cost

and

sus

tain

able

la

trine

opt

ions

.

Prom

ote

wat

er, s

anita

tion

• an

d hy

gien

e in

sch

ools

Rese

arch

on

wat

er a

nd

• sa

nita

tion.

Impr

oved

wat

er a

nd

• sa

nita

tion

targ

ets.

Impr

oved

qua

lity

of

• dr

inki

ng w

ater

.

Vario

us la

trine

s op

tions

•

avai

labl

e fo

r the

co

mm

uniti

es.

Impr

oved

qua

lity

of

• he

alth

of s

tude

nts.

Min

istry

of H

ealth

, UN

ICEF

, A

usA

id


Stra

tegi

c Pr

iori

ty 3

: Mat

erna

l and

Chi

ld H

ealth

Mai

n Fo

cus

3.1

: Im

mun

izat

ion

Prog

ram

me

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Impr

ovin

g •

rout

ine

imm

uniz

atio

n

Intro

duct

ion

of

• ne

w v

acci

nes

Con

duct

ing

• in

tegr

ated

su

pple

men

tary

im

mun

izat

ion

activ

ities

Achi

evin

g VP

D

• su

rvei

llanc

e st

anda

rds

Inje

ctio

n •

safe

ty a

nd

man

agem

ent

of a

dver

se

even

ts fo

llow

ing

imm

uniz

atio

n

Nec

essit

y of

WH

O

• fo

cal p

oint

to p

rovi

de

tech

nica

l sup

port

for E

PI.

Lim

ited

num

ber o

f •

train

ed h

ealth

sta

ff in

bot

h m

anag

emen

t an

d te

chni

cal a

reas

; th

is lim

its s

peed

at

whi

ch p

rogr

amm

e im

prov

emen

ts c

an

occu

r.

Hig

h pr

opor

tion

• of

pop

ulat

ion

lives

in

rura

l, di

sper

sed

com

mun

ities

; di

fficu

lt to

acc

ess

for v

acci

natio

ns a

nd

othe

r ser

vice

s.

Smal

l pro

porti

on o

f •

birth

s is

atte

nded

by

train

ed h

ealth

sta

ff.

Dise

ase

surv

eilla

nce

• sy

stem

requ

ires

stre

ngth

enin

g.

Inte

grat

ed in

-ser

vice

•

train

ing.

MO

H c

omm

itmen

t •

for i

mpr

ovin

g ro

utin

e im

mun

izat

ion

serv

ices

as

part

of

prim

ary

heal

th c

are

pack

age.

Avai

labi

lity

of

• fin

anci

al re

sour

ces

from

GAV

I

Cou

ntry

pol

io fr

ee

• an

d fe

w c

ases

of

mea

sles,

thus

free

ing

time

and

reso

urce

s fo

r oth

er a

ctiv

ities

.

MO

H in

tere

st

• to

incl

ude

TT

imm

uniz

atio

n,

mea

sles

supp

lem

enta

l im

mun

izat

ion

activ

ities

(SIA

) and

ot

her c

hild

hea

lth

inte

rven

tions

as

part

of th

e in

tegr

ated

co

mm

unity

hea

lth

pack

age

(SIS

Ca)

.

Furth

er s

uppo

rt to

impr

ove

rout

ine

• im

mun

izat

ion

cove

rage

.

Impr

ove

rout

ine

imm

uniz

atio

n co

vera

ge to

•

reac

h G

loba

l Im

mun

izat

ion

Visio

n an

d St

rate

gy

(GIV

S) g

oals.

Impr

ove

dise

ase

burd

en k

now

ledg

e fo

r •

deci

ding

on

new

vac

cine

s

Intro

duct

ion

of n

ew v

acci

nes:

Hep

atiti

s B,

JE.

•

Stre

ngth

en d

ocum

enta

tion

of p

olio

era

dica

tion

• ef

forts

.

Reac

hing

cer

tific

atio

n st

anda

rd A

FP

• su

rvei

llanc

e to

pro

ve a

bsen

ce o

f tra

nsm

issio

n/

impo

rtatio

n of

wild

pol

iovi

rus;

car

ry o

ut la

b co

ntai

nmen

t act

iviti

es in

line

with

WH

O

Glo

bal A

ctio

n Pl

an o

n po

liovi

rus

cont

ainm

ent;

and

subs

eque

ntly

to b

e ce

rtifie

d as

a p

olio

-free

co

untry

.

Elim

inat

e m

ater

nal a

nd n

eona

tal t

etan

us a

nd

• su

stai

nabl

e m

easle

s m

orta

lity

redu

ctio

n.

Ensu

re in

ject

ion

safe

ty a

nd A

EFI s

urve

illan

ce

• sy

stem

.

Stre

ngth

en M

inist

ry o

f Hea

lth /

DH

S pl

anni

ng

• an

d m

anag

emen

t cap

acity

.

Ensu

re in

ject

ion

safe

ty in

clud

ing

adve

rse

effe

ct

• fo

llow

ing

imm

uniz

atio

n su

rvei

llanc

e.

Esta

blish

ing

natio

nal r

egul

ator

y au

thor

ity fo

r •

mon

itorin

g va

ccin

e sa

fety

and

AEF

I.

Redu

ctio

n of

•

mor

bidi

ty a

nd

mor

talit

y du

e to

va

ccin

e pr

even

tabl

e di

seas

es.

Safe

inje

ctio

n •

prac

tices

are

ad

here

d to

.

Min

istry

of H

ealth

, U

NIC

EF, G

AVI

Timor-Leste 55

Mai

n Fo

cus

3.2

: Mat

erna

l and

New

born

Hea

lth: I

mpr

ovin

g Q

ualit

y an

d A

cces

s

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

MPS

/RH

Low

leve

l of C

PR,

• w

hile

TFR

is v

ery

high

.

Low

cov

erag

e •

of p

ropo

rtion

of

deliv

erie

s as

siste

d by

ski

lled

birth

at

tend

ant.

Incr

easin

g pr

eval

ence

•

of a

dole

scen

t pr

egna

ncy.

Com

mitm

ent o

f Min

istry

•

of H

ealth

to a

dvoc

ate

and

impr

ove

FP

serv

ices

.

Com

mitm

ent o

f MoH

•

and

UN

age

ncie

s in

incr

easin

g th

e pr

opor

tion

of d

eliv

erie

s as

siste

d by

ski

lled

birth

at

tend

ants

.

Role

of r

elig

ious

•

lead

ers

to d

elay

age

of

mar

riage

.

Impr

ove

qual

ity o

f car

e an

d ex

pand

•

cont

race

ptiv

e ch

oice

.

Plan

ning

and

mon

itorin

g M

NH

•

prog

ram

me.

Stre

ngth

en p

re-s

ervi

ce tr

aini

ng a

nd

• in

-ser

vice

sup

ervi

sion/

mon

itorin

g pe

rform

ance

of m

idw

ives

.

Supp

ort f

or th

e pr

oper

trai

ning

of

• st

aff i

n co

mm

unity

hea

lth c

entre

s an

d di

stric

t hos

pita

ls.

Prov

ision

of a

dequ

ate

equi

pmen

t •

and

setti

ng-u

p sa

fe d

eliv

ery

faci

litie

s in

the

com

mun

ity h

ealth

cen

tres.

Del

ay a

ge o

f firs

t pre

gnan

cy.

•

Advo

cate

for e

xpan

sion

of

• co

ntra

cept

ive

choi

ce.

Spec

ial a

ttent

ion

in c

arin

g •

adol

esce

nt p

regn

ancy

.

Focu

s on

Ado

lesc

ent S

exua

l and

•

Repr

oduc

tive

Hea

lth (A

SRH

) stra

tegy

de

velo

pmen

t.

Impr

oved

cap

acity

of

• re

leva

nt h

ealth

pro

vide

rs

for p

rovi

sion

of F

P se

rvic

es.

Faci

litat

ion

and

capa

city

•

build

ing

of d

istric

t MN

H

prog

ram

me

man

ager

s.

HIS

supp

orte

d in

impr

ovin

g •

inst

itutio

nal c

apac

ity.

Cap

acity

bui

ldin

g of

•

mid

wiv

es in

impr

ovin

g M

NH

car

e an

d m

onito

ring

MN

H p

rogr

amm

e co

vera

ge.

Impr

oved

acc

ess

to F

P •

serv

ice

for a

dole

scen

t.

Addr

essin

g iss

ues

rela

ted

to

• ad

oles

cent

pre

gnan

cy.

Min

istry

of H

ealth

, U

NFP

A, U

NIC

EF


Mai

n Fo

cus

3.2

: Mat

erna

l and

New

born

Hea

lth: I

mpr

ovin

g Q

ualit

y an

d A

cces

s

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

MPS

/RH

Low

leve

l of C

PR,

• w

hile

TFR

is v

ery

high

.

Low

cov

erag

e •

of p

ropo

rtion

of

deliv

erie

s as

siste

d by

ski

lled

birth

at

tend

ant.

Incr

easin

g pr

eval

ence

•

of a

dole

scen

t pr

egna

ncy.

Com

mitm

ent o

f Min

istry

•

of H

ealth

to a

dvoc

ate

and

impr

ove

FP

serv

ices

.

Com

mitm

ent o

f MoH

•

and

UN

age

ncie

s in

incr

easin

g th

e pr

opor

tion

of d

eliv

erie

s as

siste

d by

ski

lled

birth

at

tend

ants

.

Role

of r

elig

ious

•

lead

ers

to d

elay

age

of

mar

riage

.

Impr

ove

qual

ity o

f car

e an

d ex

pand

•

cont

race

ptiv

e ch

oice

.

Plan

ning

and

mon

itorin

g M

NH

•

prog

ram

me.

Stre

ngth

en p

re-s

ervi

ce tr

aini

ng a

nd

• in

-ser

vice

sup

ervi

sion/

mon

itorin

g pe

rform

ance

of m

idw

ives

.

Supp

ort f

or th

e pr

oper

trai

ning

of

• st

aff i

n co

mm

unity

hea

lth c

entre

s an

d di

stric

t hos

pita

ls.

Prov

ision

of a

dequ

ate

equi

pmen

t •

and

setti

ng-u

p sa

fe d

eliv

ery

faci

litie

s in

the

com

mun

ity h

ealth

cen

tres.

Del

ay a

ge o

f firs

t pre

gnan

cy.

•

Advo

cate

for e

xpan

sion

of

• co

ntra

cept

ive

choi

ce.

Spec

ial a

ttent

ion

in c

arin

g •

adol

esce

nt p

regn

ancy

.

Focu

s on

Ado

lesc

ent S

exua

l and

•

Repr

oduc

tive

Hea

lth (A

SRH

) stra

tegy

de

velo

pmen

t.

Impr

oved

cap

acity

of

• re

leva

nt h

ealth

pro

vide

rs

for p

rovi

sion

of F

P se

rvic

es.

Faci

litat

ion

and

capa

city

•

build

ing

of d

istric

t MN

H

prog

ram

me

man

ager

s.

HIS

supp

orte

d in

impr

ovin

g •

inst

itutio

nal c

apac

ity.

Cap

acity

bui

ldin

g of

•

mid

wiv

es in

impr

ovin

g M

NH

car

e an

d m

onito

ring

MN

H p

rogr

amm

e co

vera

ge.

Impr

oved

acc

ess

to F

P •

serv

ice

for a

dole

scen

t.

Addr

essin

g iss

ues

rela

ted

to

• ad

oles

cent

pre

gnan

cy.

Min

istry

of H

ealth

, U

NFP

A, U

NIC

EF

Timor-Leste 57

Focu

s on

oth

er M

ater

nal a

nd C

hild

Hea

lth a

ctiv

ities

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

Inte

grat

ed

Man

agem

ent o

f C

hild

hood

Illn

ess

(IM

CI)

Ther

e ar

e di

ffere

nt

• so

urce

s fo

r ind

icat

ors

avai

labl

e in

the

coun

try,

so th

ere

is on

ly a

n es

timat

e ch

ild m

orta

lity

rate

.

Lack

of h

uman

reso

urce

s •

train

ed in

IMC

I.

A ne

ed to

enh

ance

•

the

regu

lar p

lan

on

supe

rvisi

on, m

onito

ring,

an

d ev

alua

tion.

MO

H w

ith

• su

ppor

t of W

HO

ha

d ad

apte

d an

d pr

oduc

ed IM

CI

train

ing

mod

ules

, tra

ined

365

nur

ses

in IM

CI.

Supp

orte

d ex

pans

ion

• of

IMC

I at a

ll di

stric

ts.

Adap

ted,

prin

ted,

•

and

impl

emen

ted

IMC

I gui

delin

es

2001

.

Upd

atin

g of

new

•

IMC

I gui

delin

es

and

orie

ntat

ion

for t

he fa

cilit

ator

s,

Cub

an d

octo

rs, a

nd

Tim

ores

e do

ctor

s st

artin

g in

200

7 - a

nd

ongo

ing.

Supp

ort f

or im

plem

enta

tion

of IM

CI,

• pa

rticu

larly

the

expa

nsio

n of

the

com

mun

ity IM

CI.

IMC

I pro

gram

me

• im

plem

ente

d in

all

dist

ricts

an

d co

mm

unity

IMC

I.

Min

istry

of H

ealth

, U

NIC

EF, N

GO

s


Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

WH

O

colla

bora

tion

Part

ners

Nut

ritio

nN

atio

nally

-app

licab

le

• in

form

atio

n ba

selin

e on

th

e nu

tritio

n pr

ofile

of

the

popu

latio

n.

Iodi

ne d

efic

ienc

y •

diso

rder

s (ID

D) a

re

prev

alen

t.

Abse

nce

of n

atio

nal I

DD

•

cont

rol a

nd p

reve

ntio

n pr

ogra

mm

e.

Man

agem

ent o

f •

mal

nutri

tion

in th

e co

mm

unity

is n

eede

d.

Abse

nce

of a

ppro

pria

te

guid

elin

es a

nd p

roto

col

for t

he c

omm

unity

-bas

ed

man

agem

ent o

f chi

ldre

n su

fferin

g fro

m m

oder

ate

mal

nutri

tion

and

thos

e re

cove

ring

from

sev

ere

mal

nutri

tion.

The

‘Lan

dsca

pe

• An

alys

is’: o

bjec

tive

of a

sses

sing

the

exist

ing

gaps

/ c

onst

rain

ts

and

iden

tifyi

ng

oppo

rtuni

ties

to

stre

ngth

en th

e na

tiona

l nut

ritio

n pr

ogra

mm

e.

Prom

otin

g gr

owth

•

mon

itorin

g of

infa

nts,

yo

ung

child

ren

and

adol

esce

nts

as th

e be

st to

ol to

m

easu

re th

e st

atus

of

mal

nutri

tion

in th

e co

mm

unity

.

Assis

t the

nat

iona

l aut

horit

ies

in c

arry

ing

• ou

t the

‘Lan

dsca

pe A

naly

sis’ -

map

ping

of

key

sta

keho

lder

s / n

utrit

ion-

rela

ted

inte

rven

tions

/ fie

ld a

sses

smen

ts /

cove

rage

/ im

pact

of s

uch

inte

rven

tions

.

WH

O c

ould

ass

ist in

pro

vidi

ng

• te

chni

cal s

uppo

rt in

est

ablis

hing

qu

ality

con

trol /

ass

uran

ce s

yste

ms

and

labo

rato

ry fo

r ID

D m

onito

ring.

Assis

t in

orga

nizi

ng tr

aini

ng in

the

use

• an

d in

terp

reta

tion

of th

e ne

w W

HO

gr

owth

sta

ndar

ds fo

r inf

ants

, you

ng

child

ren

and

adol

esce

nts.

Prov

ide

tech

nica

l ass

istan

ce in

the

• ad

apta

tion

of e

xist

ing

WH

O g

uide

lines

an

d pr

otoc

ols

for t

he m

anag

emen

t of

child

ren

with

mod

erat

e m

alnu

tritio

n an

d th

ose

reco

verin

g fro

m s

ever

e m

alnu

tritio

n.

Assis

ting

in a

dapt

atio

n of

WH

O

• gu

idel

ines

and

pro

toco

ls fo

r the

m

anag

emen

t of c

hild

ren

with

mod

erat

e m

alnu

tritio

n an

d th

ose

reco

verin

g fro

m

seve

re m

alnu

tritio

n.

Scal

ed-u

p nu

tritio

n-re

late

d •

actio

ns th

roug

h co

nsol

idat

ed

/ har

mon

ized

act

ion

at

the

coun

try le

vel b

y al

l na

tiona

l and

inte

rnat

iona

l st

akeh

olde

rs.

Iodi

ne s

tatu

s of

vul

nera

ble

• se

gmen

t of p

opul

atio

n –

preg

nant

wom

en a

nd

child

ren

- im

prov

ed.

Nut

ritio

n su

rvei

llanc

e /

• m

onito

ring

syst

em in

the

com

mun

ity s

treng

then

ed.

This

will

also

ass

ist in

de

tect

ing

food

inse

curit

y in

th

e fa

ce o

f risi

ng fo

od p

rices

.

Prev

alen

ce o

f mal

nutri

tion

• in

chi

ldre

n re

duce

d th

ereb

y le

adin

g to

pro

gres

s to

war

ds

the

MD

Gs.

Min

istry

of H

ealth

, U

NIC

EF, W

FP, F

AO

Gen

der

Mul

ti-se

ctor

app

roac

h •

in c

onsid

erat

ion

of s

ocio

ec

onom

ic a

nd c

ultu

ral

dete

rmin

ants

.

CAR

EID

pro

gram

me

• 20

07-2

010

for

gend

er s

ensit

ive

heal

th c

are.

Prom

ote

wom

en’s

em

pow

erm

ent

• re

late

d to

gen

der e

quity

and

soc

ial

dete

rmin

ants

of h

ealth

acc

ompa

nied

by

adv

ocac

y to

gen

der s

ensit

ive

heal

th c

are

serv

ices

and

mul

ti-se

ctor

ap

proa

ch.

Incr

easin

g se

lf/fa

mily

and

•

com

mun

ity c

are

and

awar

enes

s in

wom

en’s

/ m

ater

nal h

ealth

.

Min

istry

of H

ealth

Timor-Leste 59

Stra

tegi

c Pr

iori

ty 4

: Ove

rall

Nat

iona

l Cap

acity

Bui

ldin

gM

ain

Focu

s 4.

1: M

anag

emen

t and

Tec

hnic

al C

apac

ity S

tren

gthe

ning

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Min

istr

y of

Hea

lth c

apac

ity

on m

anag

emen

t and

he

alth

pol

icy

deve

lopm

ent

Lim

ited

expe

rienc

e in

•

polic

y de

velo

pmen

t.

Lim

ited

qual

ified

•

natio

nal s

taff.

Nee

d to

focu

s at

tent

ion

• on

dev

elop

men

t of

regu

lato

ry p

olic

ies

for f

ood

and

drug

ad

min

istra

tion,

hea

lth

and

med

ical

edu

catio

n,

heal

th/ m

edic

al re

sear

ch.

Dev

elop

a c

apac

ity

• pr

oces

s w

ithin

the

MO

H a

ppro

pria

te to

the

cultu

re, l

angu

age

and

polit

ical

issu

es o

f the

co

untry

.

Addr

ess

emer

ging

issu

es

• in

the

heal

th s

ecto

r in

clud

ing

ince

ntiv

es

for h

ealth

sta

ff, p

rivat

e pr

ovid

ers.

One

full-

time

polic

y •

advi

ser i

n pl

ace

with

W

HO

.

Hea

lth S

ecto

r Stra

tegi

c •

Plan

(HSS

P) p

repa

red.

Hum

an R

esou

rces

for

Hea

lth P

lan

prep

ared

.

Med

ium

Ter

m

• Ex

pend

iture

Fra

mew

ork

prep

ared

.W

HO

has

an

easil

y ac

cess

ible

wea

lth

of e

xper

tise

and

info

rmat

ion

in h

ealth

po

licy

deve

lopm

ent a

nd

impl

emen

tatio

n.

At th

is po

int i

n Ti

mor

-•

Lest

e’s

heal

th s

yste

m

deve

lopm

ent,

soun

d po

licy

is es

sent

ial.

Con

tinue

d pr

ovisi

on

• of

a fu

ll-tim

e W

HO

in

tern

atio

nal p

rofe

ssio

nal

staf

f, to

wor

k in

Min

istry

of

Hea

lth u

nder

the

supe

rvisi

on o

f the

WR.

Dev

elop

trai

ning

•

sche

mes

that

are

sp

ecia

lly d

esig

ned

for

Min

istry

of H

ealth

sta

ff an

d de

velo

ped

with

in

the

cont

ext o

f the

cu

lture

, pol

itics

and

he

alth

situ

atio

n in

Tim

or-

Lest

e us

ing

a va

riety

of

lear

ning

and

men

torin

g m

etho

ds.

Stre

ngth

ened

cap

acity

in

• po

licy

deve

lopm

ent a

nd

plan

ning

in th

e M

inist

ry

of H

ealth

.

Min

istry

of H

ealth

, D

evel

opm

ent P

artn

ers

in

the

heal

th s

ecto

r.


Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

MoH

ogn

aniz

atio

nal

refo

rms

Appr

opria

te d

eplo

ymen

t •

of a

dequ

atel

y qu

alifi

ed

and

expe

rienc

ed o

ffici

als

at n

atio

nal a

nd d

istric

t le

vels.

Ther

e is

a ne

ed to

•

furth

er d

evel

op a

nd

enfo

rce

heal

th s

ecto

r la

ws

and

legi

slatio

ns.

Min

ister

ial D

iplo

ma

of

• th

e O

rgan

ic S

tatu

te fo

r th

e C

entra

l Ser

vice

s:

role

s an

d re

spon

sibili

ties

of th

e M

inist

ry o

f Hea

lth

and

its o

rgan

s le

gally

de

fined

.

WH

O c

an p

rovi

de

• ex

perti

se in

the

furth

er

deve

lopm

ent o

f le

gisla

tion

for t

he h

ealth

se

ctor

.

Supp

ort l

egisl

ativ

e,

• or

gani

zatio

nal a

nd

adm

inist

rativ

e re

form

s of

m

anag

emen

t stru

ctur

es,

syst

ems

and

proc

edur

es

in th

e M

inist

ry o

f Hea

lth.

Supp

ort d

evel

opm

ent

• of

ade

quat

e an

d ap

prop

riate

hea

lth

legi

slatio

n fo

r Tim

or-

Lest

e.

Appr

opria

te h

ealth

•

legi

slatio

n de

velo

ped,

re

view

ed, a

nd fu

rther

m

odifi

ed.

Syst

emat

ic H

R pl

anni

ng

• an

d de

ploy

men

t of

qual

ified

man

ager

s in

pl

ace.

Min

istry

of H

ealth

, Min

istry

of

Just

ice,

Cou

ncil

of

Min

ister

s, P

arlia

men

t.

Tech

nica

l qua

lity

assu

ranc

eTe

chni

cal a

udit

syst

ems

• ne

ed to

be

deve

lope

d.

Lim

ited

orga

niza

tiona

l •

and

man

ager

ial c

apac

ity

and

perfo

rman

ce b

y he

alth

pro

vide

rs.

Def

icie

ncie

s in

hum

an

• re

sour

ces,

faci

litie

s,

man

agem

ent a

nd

supp

ort s

ervi

ces.

HSS

P ha

s w

ell d

efin

ed

• ar

eas

of fo

cus

and

indi

cato

rs. P

rope

r m

onito

ring

and

tech

nica

l au

dit s

yste

m w

ill re

sult

in g

ood

qual

ity te

chni

cal

prog

ram

mes

.

Impr

ovem

ent o

f •

qual

ity o

f the

wor

k an

d m

anag

emen

t of

the

heal

th s

ecto

r has

be

en id

entif

ied

as a

m

ajor

prio

rity

by th

e go

vern

men

t of T

imor

Le

ste.

Prom

ote

MoH

cap

acity

•

in e

nhan

cing

a s

yste

m

of te

chni

cal s

uper

visio

n an

d m

onito

ring

thro

ugho

ut th

e he

alth

se

ctor

.

Supp

ort t

o im

prov

ing

• th

e qu

ality

of s

ervi

ces,

by

equ

ippi

ng d

iagn

ostic

fa

cilit

ies,

ens

urin

g an

ad

equa

te s

uppl

y of

es

sent

ial m

edic

ines

, and

au

gmen

ting

inte

grat

ed

dise

ase

surv

eilla

nce

for r

egul

ar m

onito

ring,

fo

r tak

ing

corr

ectiv

e m

easu

res

for q

ualit

y im

prov

emen

t.

Ope

ratio

nal r

esea

rch

• in

this

cont

ext w

ill b

e su

ppor

ted.

Tech

nica

l aud

it sy

stem

•

deve

lope

d an

d pe

riodi

c an

d jo

int s

uppo

rtive

su

perv

ision

pro

vide

d to

dist

rict a

nd C

HC

m

anag

ers.

Qua

lity

assu

ranc

e •

stan

dard

s an

d cr

iteria

im

plem

ente

d an

d fu

rther

enh

ance

d.

Min

istry

of H

ealth

, Aus

AID

, U

NIC

EF, U

NFP

A.

Timor-Leste 61

Stra

tegi

c Pr

iori

ty 5

: par

tner

ship

and

coo

rdin

atio

nM

ain

Focu

s 5.

1: S

tren

gthe

ning

par

tner

ship

and

coo

rdin

atio

n

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Stre

ngth

enin

g D

epar

tmen

t of

Par

tner

ship

and

M

anag

emen

t, M

oH

Gov

ernm

ent

• ca

paci

ty to

co

ordi

nate

ne

eds

furth

er

enha

ncem

ent i

n st

ream

linin

g an

d ha

rmon

izat

ion

of

EDPs

sup

port.

Vario

us s

yste

ms

• to

man

age

EDPs

’ re

sour

ces

pres

ent

a ch

alle

nge

to a

ne

wly

dev

elop

ed

MO

H.

WH

O c

an p

rovi

de a

ssist

ance

•

in d

onor

coo

rdin

atio

n in

two

man

date

s: 1

) its

resp

onsib

ility

to

ass

ist th

e M

OH

in it

s ac

tiviti

es a

nd n

eeds

; and

2)

its re

spon

sibili

ty to

lead

in

heal

th is

sues

in th

e do

nor

com

mun

ity.

With

a fu

ll tim

e po

licy

advi

ser

• in

the

MO

H, W

HO

can

pr

ovid

e ad

equa

te s

uppo

rt in

th

is ar

ea.

Cle

arly

def

ined

role

s •

and

resp

onsib

ilitie

s fo

r co

ordi

natio

n io

n th

e M

OH

. Pr

oced

ures

for d

onor

co

ordi

natio

n de

fined

.

Supp

ort f

or th

e D

epar

tmen

t •

of P

artn

ersh

ip M

anag

emen

t of

the

MoH

to e

ffect

ivel

y m

anag

e do

nors

/ pa

rtner

ship

s an

d co

ordi

nate

re

sour

ces

and

prog

ram

mes

of

the

deve

lopm

ent p

artn

ers.

Serv

e as

the

info

rmat

ion

• an

d te

chni

cal r

esou

rce

to a

foru

m to

disc

uss

and

coor

dina

te a

ssist

ance

to th

e he

alth

sec

tor.

Don

or c

oord

inat

ion

• an

d al

loca

tion

of

reso

urce

s fa

cilit

ated

.

Min

istry

of H

ealth

, EC

, G

loba

l Fun

d


Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Partn

ers

coor

dina

tion,

in

clud

ing

NG

Os

and

priv

ate

sect

or

Lack

of i

nfor

mat

ion

• on

act

ual

and

pote

ntia

l co

ntrib

utio

n of

the

priv

ate

sect

or, N

GO

s an

d vo

lunt

eers

to th

e he

alth

sys

tem

.

Lim

ited

• go

vern

men

t in

itiat

ive

to

invo

lve

the

priv

ate

sect

or, N

GO

s an

d vo

lunt

eers

in

deliv

ery/

finan

cing

of

hea

lth s

ecto

r.

Impr

ovin

g pr

ivat

e se

ctor

, •

NG

O/v

olun

teer

col

labo

ratio

n an

d pa

rtner

ship

has

bee

n id

entif

ied

as a

prio

rity

by th

e U

N d

evel

opm

ent p

artn

ers

and

dono

r age

ncie

s in

volv

ed in

the

heal

th s

ecto

r reh

abili

tatio

n.

Min

istry

of H

ealth

stra

tegi

es

• an

d po

licie

s to

invo

lve

the

priv

ate

sect

or, N

GO

and

vo

lunt

eers

in h

ealth

sec

tor

refo

rms

taki

ng p

lace

in th

e co

untry

.

Coo

rdin

atin

g m

echa

nism

s •

exist

for a

ctiv

ities

suc

h as

an

nual

join

t rev

iew

and

an

annu

al p

lann

ing

sum

mit.

Faci

litat

e th

e co

ordi

natio

n of

•

mul

tiple

par

tner

s in

volv

ed

in s

peci

fic p

rogr

amm

es

(e.g

. mal

aria

, HRH

, HIV

), to

ens

ure

a ha

rmon

ized

re

spon

se to

the

chal

leng

es

in th

e sp

ecifi

c he

alth

pr

ogra

mm

es.

Supp

ort o

ther

par

tner

s in

•

adhe

ring

to th

e pr

inci

ples

of

Paris

Dec

lara

tion,

esp

ecia

lly

the

harm

oniz

atio

n an

d al

ignm

ent a

gend

a.

Dev

elop

men

t of t

rans

pare

nt

• an

d ef

fect

ive

fram

ewor

k fo

r pr

ivat

e, N

GO

and

vol

unte

er

parti

cipa

tion

in th

e he

alth

se

ctor

.

Supp

ort e

xist

ing

mec

hani

sms

• of

effe

ctiv

e pa

rtner

ship

an

d co

ordi

natio

n, i.

e. Jo

int

Annu

al R

evie

w (J

AR) a

nd

Sect

or W

ide

Appr

oach

(S

WAp

).

Coh

eren

t wor

k of

•

all p

artn

ers

invo

lved

in

hea

lth s

ecto

r es

tabl

ished

.

Mut

ual c

onfid

ence

•

and

unde

rsta

ndin

g be

twee

n th

e go

vern

men

t and

the

priv

ate

sect

or, N

GO

s an

d vo

lunt

eers

w

orki

ng in

hea

lth

sect

or p

rom

oted

.

Min

istry

of H

ealth

, UN

ICEF

, U

NFP

A, W

orld

Ban

k,

Aus

AID

.

Reso

urce

mob

iliza

tion

Reso

urce

gap

exi

sts

• in

the

curr

ent

bien

nial

wor

kpla

ns

Mul

tiple

par

tner

s in

tere

sted

to

• su

ppor

t the

hea

lth s

ecto

r.

WH

O is

con

sider

ed a

s a

• cl

ose

partn

er o

f the

Min

istry

of

Hea

lth a

nd a

key

pla

yer i

n ED

P co

ordi

natio

n.

Faci

litat

e ge

nera

tion

of

• vo

lunt

ary

reso

urce

s fo

r the

bi

enni

al w

orkp

lans

from

th

e pa

rtner

s in

hea

lth a

nd

the

glob

al p

artn

ersh

ip

mec

hani

sms.

Reso

urce

•

mob

iliza

tion

plan

de

velo

ped

and

impl

emen

ted.

Min

istry

of H

ealth

, de

velo

pmen

t par

tner

s.

Timor-Leste 63

Stra

tegi

c Pr

iori

ty 6

: Em

erge

ncy

Prep

ared

ness

and

Rap

id R

espo

nse

Mai

n Fo

cus

6.1:

Str

engt

hen

EPR

prog

ram

me

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Trai

ning

, adv

ocac

y an

d le

gisl

atio

n on

EP

R

Due

to re

sour

ce li

mita

tions

, •

the

MoH

has

no

unit

nor f

ull

time

staf

f ass

igne

d fo

r Disa

ster

M

anag

emen

t. C

urre

ntly,

it is

und

er

the

Spec

ializ

ed U

nit o

f the

NC

D

Dep

artm

ent i

n ad

ditio

n to

its

othe

r re

spon

sibili

ties,

incl

udin

g to

bacc

o C

ontro

l.

The

foca

l poi

nt fo

r Disa

ster

•

Man

agem

ent a

nd h

ealth

sta

ff at

the

dist

rict a

nd s

ub-d

istric

t lev

els

have

lit

tle u

nder

stan

ding

of t

he N

atio

nal

Disa

ster

Risk

Man

agem

ent P

lan.

Non

-exi

sten

ce o

f Sta

ndar

d •

Ope

ratio

nal P

roce

dure

s (S

OP)

fo

r the

hea

lth s

ecto

r at d

iffer

ent

leve

l of h

ealth

ser

vice

s, in

clud

ing

hosp

itals.

Tech

nica

l gui

delin

es fo

r the

hea

lth

• st

aff t

o pr

epar

e an

d re

spon

d to

di

sast

er n

ot e

xist

.

Emer

genc

y pr

epar

edne

ss a

nd

• re

spon

se p

lans

for h

ospi

tals

are

alm

ost n

on-e

xist

ent.

The

maj

ority

of

hos

pita

ls ar

e no

t tra

ined

in

emer

genc

y pr

epar

edne

ss a

nd

resp

onse

.

Lack

of r

egul

ar s

imul

atio

n an

d •

tabl

e-to

p ex

erci

ses

on d

isast

er

man

agem

ent a

nd re

spon

se in

he

alth

sec

tor.

Nat

iona

l Disa

ster

•

Risk

Man

agem

ent

was

fina

lized

, di

strib

uted

and

us

ed.

Che

ck li

st

• fo

r hos

pita

l pr

epar

edne

ss

and

resp

onse

is

avai

labl

e.

The

Emer

genc

y •

Prep

ared

ness

and

Re

spon

se m

anua

l fo

r Tim

or-L

este

has

be

en d

evel

oped

.

Supp

ort f

or th

e tra

inin

g of

the

• he

alth

wor

kfor

ce (d

istric

t and

sub

-di

stric

t, ho

spita

ls) in

em

erge

ncy

prep

ared

ness

and

resp

onse

in

clud

ing

outb

reak

inve

stig

atio

n an

d di

seas

e su

rvei

llanc

e, a

nd fo

r pr

ovid

ing

emer

genc

y su

pplie

s.

Advo

cate

for a

dequ

ate

hum

an

• re

sour

ces

in th

e ar

ea o

f hea

lth

sect

or e

mer

genc

y pr

epar

edne

ss,

man

agem

ent a

nd re

spon

se.

Enha

nce

partn

ersh

ips

for e

ffect

ive

• pl

anni

ng, c

oord

inat

ion

and

resp

onse

to e

mer

genc

ies.

Stre

ngth

en le

gisla

tion,

pol

icie

s •

and

cont

inge

ncy

plan

s th

at w

ill

supp

ort e

ffici

ent w

ork

in E

PR

with

in h

ealth

sec

tor a

nd a

cros

s ot

hers

.

Dev

elop

Sta

ndar

d O

pera

ting

• Pr

oced

ures

(SO

P) fo

r the

hea

lth

sect

or.

Supp

ort /

stre

ngth

en M

oH in

•

setti

ng-u

p a

unit

/ mec

hani

sm /

prog

ram

me

that

will

add

ress

the

need

of E

PR.

Supp

ort t

o th

e M

oH in

•

cond

uctin

g re

gula

r sim

ulat

ion

exer

cise

s on

disa

ster

man

agem

ent

and

resp

onse

.

Hea

lth s

taff

train

ed

• in

em

erge

ncy

prep

ared

ness

and

re

spon

se in

clud

ing

outb

reak

inve

stig

atio

n an

d re

spon

se.

Emer

genc

y co

ordi

natio

n •

and

partn

ersh

ip

in h

ealth

sec

tor

stre

ngth

ened

.

Emer

genc

y •

prep

ared

ness

pla

ns a

nd

cont

inge

ncy

plan

s fo

r di

sast

ers

prep

ared

and

up

date

d.

Nat

iona

l stra

tegy

, •

legi

slatio

n a

nd

tech

nica

l gui

delin

es fo

r di

sast

er m

anag

emen

t in

hea

lth s

ecto

r de

velo

ped.

Stan

dard

ope

ratin

g •

proc

edur

es (S

OP)

fo

r hea

lth s

ecto

r de

velo

ped.

Disa

ster

Man

agem

ent

• un

it at

the

Min

istry

of

Hea

lth is

sup

porte

d.

Regu

lar s

imul

atio

n •

exer

cise

s ar

e su

ppor

ted.

Min

istry

of H

ealth

, N

atio

nal D

irect

orat

e of

Disa

ster

M

anag

emen

t (M

inist

ry

of S

ocia

l Sol

idar

ity),

UN

age

ncie

s, N

GO

s.


Focu

s on

oth

er E

mer

genc

y Re

late

d Is

sues

Area

of a

ctio

nC

halle

nges

Opp

ortu

nitie

sW

HO

Pri

ority

Expe

cted

Res

ults

from

W

HO

col

labo

ratio

nPa

rtne

rs

Inju

ry p

reve

ntio

nLa

ck o

f hum

an

• re

sour

ces

in th

e fie

ld o

f chr

onic

di

seas

e an

d in

jury

.

Min

istry

of H

ealth

has

•

esta

blish

ed a

n N

CD

Uni

t and

re

cogn

ized

road

traf

fic in

jurie

s an

d an

imal

bite

s as

a m

ajor

he

alth

pro

blem

.

Trai

n he

alth

sta

ff.•

Hum

an re

sour

ce

• de

velo

ped

on

epid

emio

logy

of

NC

D a

nd in

jury

pr

even

tion

and

safe

ty p

rom

otio

n.

Min

istry

of H

ealth

No

natio

n w

ide

• in

jury

pre

vent

ion

prog

ram

.

Min

istry

of H

ealth

has

•

reco

gniz

ed ro

ad tr

affic

inju

ries

and

anim

al b

ites

as a

maj

or

heal

th p

robl

em.

Dev

elop

and

impl

emen

t •

inte

grat

ed in

jury

pre

vent

ion

prog

ram

me

on a

pilo

t bas

is.

Feas

ible

and

•

cost

-effe

ctiv

e in

jury

pre

vent

ion

prog

ram

me

for t

he

coun

try d

evel

oped

.

Timor-Leste 65

Annex 2

Abbreviations

AI Avian influenza

AEFI Adverse events following immunization

AFP Acute Flaccid Paralysis

ARI Acute Respiratory Infections

ART Anti Retroviral Treatment

ASRH Adolescent Sexual and Reproductive Health

AusAID Australian Agency for International Development

BCC Behavior Change Communication

BCG Bacille Calmette Guerin, an effective immunization against tuberculosis

CAREID Canada-Asia Regional Emerging Infectious Diseases

CCS Country Cooperation Strategy

CDC Communicable Diseases Control

CHC Community Health Centres

CPR Contraceptive Prevalence Rate, is the percentage of women between 15-49 years who are practising, or whose sexual partners are practising, any form of contraception.

DHS District Health Systems

DOTS Directly Observed Treatment, Short-course

DPHO District Public Health Officer

DPT Diphtheria, Pertussis (whooping cough), Tetanus.

EC European Commission

EDP External Development Partners

EPI Expanded Programme on Immunization

EPR Emergency Preparedness and Response

EQAS External quality assessment team

FAO Food and Agriculture Organization

FCTC Framework Convention on Tobacco Control

FETP Field Epidemiology Training Programme

FHS Faculty of Health Sciences


FP Family Planning

GAVI Global Alliance for Vaccines and Immunization

GDP Gross Domestic Product1

GF Global Fund

GFATM Global Fund for AIDS, TB and Malaria

GIS Global Image Software

GIVS Global Immunization Vision and Strategy

HDI Human Development Index

HIV/AIDS Human Immunodeficiency Virus/ Acquired Immuno-Deficiency Syndrome

HMIS Health Management Information System

HMM Health Ministers Meeting

HR Human Resources

HRH Human Resources for Health

HSSP Health Sector Strategic Plan

IDD Iodine Deficiency Disorders

IDSS Integrated Diseases Surveillance Systems

IEC Information Education Communication

IHR-2005 International Health Regulations – 2005

IHS Institute of Health Science

IMCI Integrated Management of Childhood Illness

JE Japanese Encephalitis

LF Lymphatic Filariasis

LLIN Long Lasting Insecticide Treated Bednets

MARG Most-at-risk group

MDG Millennium Development Goals

MDR Multi Drugs Resistance

MDT Multi Drug Treatment

MNH Maternal and Neonatal Health

MoE Ministry of Education

MoH Ministry of Health

MPS Making Pregnancy Safer

MTEF Medium Term Expenditure Framework

NAC National AIDS Commission

1 GDP is the total market value of all final goods and services produced in a country in a given year, equal to total consumer, investment and government spending, plus value of exports and minus value of imports

Timor-Leste 67

NCD Non-Communicable Diseases

NGO Non-Government Organizations

NMH Non-communicable Diseases and Mental Health

NTP National Tuberculosis Program

PAL Practical approach to Lung Health

PEP Post Exposure Prevention

PMTCT Preventing Mother-to-Child Transmission of HIV

RC Regional Committee

RDT Rapid Diagnostic Test

RH Reproductive Health

RRT Rapid Response Team

SAMES Servico Autonomo de Medicamentos e Equipamentos de Saude

SIA Measles supplemental immunization activities

SISCa Servisu Integrado Saude Communitario (Integrated Community Health System)

SOP Standard Operating Procedures

STIs Sexually Transmitted Infection

SWAp Sector-Wide Approach

TB Tuberculosis

TFR Total Fertility Rate: total number of children a woman would have by the end of her reproductive period.

TLSLS Timor Leste Survey of Living Standards

TT Tetanus Toxoid

UN United Nations

UNDAF United Nations Development Assistance Framework

UNFPA United Nation Population Fund

UNICEF United Nation Children’s Fund

UNTL National University of Timor-Leste

USAID United States Agency for International Development

USD US Dollar

VCT Voluntary Counseling and Testing

VPD Vaccines and Preventable Diseases

WFP World Food Programme

WHA World Health Assembly

WHO World Health Organization

WNTD World No Tobacco Day

WR WHO Representative


Annex 3

References

WHO Country Office Timor-Leste. (2008). WHO Country Cooperation Review – Timor-Leste, Internal Report WCO Timor-Leste

WHO Regional Office for South-East Asia. (2004). WHO Country Cooperation Strategy 2004-2008, WHO SEARO, New Delhi

The Government of Timor-Leste. (2006). Functional Analysis of the Ministry of Health – Report, Project Report of Support to the Implementation of Health Sector Investment Programme (SIHSIP), Ministry of Health, Dili.

Ministry of Health Timor-Leste. (2007). Health Sector Strategic Plan 2008-2012, unpublished document, Ministry of Health, Dili.

Ministry of Health Timor-Leste. (2007). Medium Term Expenditure Framework, unpublished document, Ministry of Health, Dili.

Ministry of Health Timor-Leste. (2007). Basic Services Package for Primary Health Care and Hospitals, unpublished document, Ministry of Health, Dili.

Ministry of Health Timor-Leste. (2007). Strengthen Communities in the area of Health through SISCa, Implementation Guide, unpublished document, Ministry of Health, Dili.

Ministry of Health Timor-Leste. (2005). National Health Workforce Plan 2005-2015, unpublished document, Ministry of Health, Dili.

Ministry of Health Timor-Leste. (2006) Annual Health Statistics Report: January-December 2006, Department of HMIS, Dili.

Ministry of Health Timor-Leste. (2007) Annual Health Statistics Report: January-December 2007, Department of HMIS, Dili.

Ministry of Health Timor-Leste. (2008) Annual Health Report 2008, Office of HMIS and Epidemiological Surveillance, Dili.

Ministry of Finance Timor-Leste. (2008). Timor-Leste Survey of Living Standards 2007, Ministry of Finance, Dili.

UNFPA. (2007). Country Population Assessment Timor-Leste 2007, UNFPA Timor-Leste, Dili.

National Statistics Directorate and UNFPA. (2008). Mortality Monograph according to the 2004 Census, UNFPA Timor-Leste, Dili.

National Statistics Directorate and UNFPA. (2008). Population Projections for Districts, UNFPA Timor-Leste, Dili.

United Nations in Timor-Leste. (2008). United Nations Development Assistance Framework, UNDAF 2009-2013, UN Timor-Leste, Dili.

Timor-Leste 69

Government of Timor-Leste and United Nations Timor-Leste. (2009). The Millenium Development Goals, Timor-Leste, UN Timor-Leste, Dili.

The World Bank. (2008). Policy note on Population Growth and Its Implications in Timor-Leste, The World Bank, Washington, D.C.

Zwi AB., Martins J., Grove N.J., Martins N., Kelly P., (2007). Timor-Leste Health Sector Resilience and performance in a Time of Instability, University of New South Wales, Sidney.

Counahan, M. (2008). Situational Analysis of Avian Influenza in Timor-Leste, internal document.

De Araujo, R.M. (2008). Revitalising Primary Health Care: Timor-Leste’s Experiences, internal document.

Documents

WHO Country Cooperation Strategy 2009-2013 – Timor-Leste