Safe Motherhood Project - East Timor (2010)

The Rotary Club of Morialta (RCM) founded the Infancy, Midwifery, Obstetrics and Gynaecology Aid Program (IMOG) through Rotary Australia World Community Service (RAWCS) with the vision to improve access to sustainable and effective reproductive health for the people of developing countries.

 

The initial project was based on a Memorandum of Understanding between the Ministry of Health of the Government of Timor Leste (MOH) and RAWCS to address the high burden of maternal deaths and morbidity associated with child bearing in East Timor. The project focussed on contributing to the government's efforts in improving access to comprehensive and integrated primary health care services with a particular focus on safe motherhood in the District of Bobonaro.

 

RCM ran IMOG as a club program with the support of RAWCS as an accredited program for volunteers. This provides the necessary structure for medical and other volunteers to be able to assist RCM in implementing Safe Motherhood Project in Bobonaro with government approval and the cover of Rotary insurance and support.

 

• High maternal mortality in East Timor, and inadequate access to skilled attendants for births, and lack of effective care during pregnancy

• Poor nutritional health, high fertility, and high burden of infectious diseases contributing to poor maternal health

• Reproductive health and safe motherhood is a national priority as defined by the government, with a focus on strengthening health care services for improved services for pregnancy and delivery by skilled attendants.

• Project planned after two visits to the community, in consultation with the District Health Services, District Hospital management and staff, and with the Ministry of Health East Timor.

• The Project is implemented in collaboration with the East Timor MoH, with technical support from the University of Adelaide, Discipline of Public Health, and some support from RANZCOG.

• The Project is supported, funding and in kind support and time input, by a large number of individual volunteers, many Rotary Clubs, Rotary Districts and many other government, non government and corporate entities.

• In Dili, the Rotary Liaison Office provides support in terms of assistance to the field teams, links with other development organisations and with the Ministry of Health.

 

• About 100,000 people, 40% below the poverty line; majority living in villages across 1300 square kilometres.

• Poor transport infrastructure making it difficult for people to access district hospital and health centres

 

• To improve availability, accessibility and affordability of reproductive health services • To improve community knowledge of RH,

• To contribute to reduction in maternal, neonatal and perinatal mortality

 

• Human Resource Development through on -the-job training and coaching of health workers

• Infrastructure Development through upgrade and renovating and provision of equipment

• Strengthened ANC, PNC, Intrapartum care through provision of technical support, strengthening primary care infrastructure, community involvement, education and counselling, and preventive and curative care provision.

• A strengthened Emergency Obstetric Care Service through technical support, on-the-job training, equipment and medical supplies support, and improved health care infrastructure at primary care level

• Improved Referrals through community participation, health education, provision of ambulance services, community awareness about the need to access trained health care providers, transport

• Strengthen Planning and Management through needs assessment, feedback and information for planning

INFRASTRUCTURE DEVELOPMENT

The Project has contributed to the professional development in terms of knowledge and skills learning of nurses, midwives and other staff at Maliana Hospital, Community Health Centres, HPs and outreach clinics (SISCa). This was achieved through on-thejob training & coaching. Additionally, special sessions on various concepts such as neonatal resuscitation, infection control, laboratory, and quality reviews were conducted. Inputs included:

 

• The Project midwife/field coordinator worked at the hospital to provide on the job support to the other staff involved in maternal and child health

• Weekly visits by the Project staff to the communities with the governmental SISCa clinic teams for service & for interaction with health staff, health volunteers, village chiefs and community members, particularly women to improve quality and access to ANC Major Sponsor Needs Assessment – Balwyn Rotary Club

• CHCs visits by the Project staff, and work with the clinic staff

• Hospital: on-call support for maternal health emergencies

• Hospital: training for nurses and midwifes on infection control assessment and education and use of partograms

• Training of laboratory staff at hospital & CHC by a visiting specialist

• Neonatal resuscitation training for CHS & hospital staff

• English language sessions for the local medical students in Maliana

• Provision of library, books, computer and other learning material

• Involvement of 4 women and 2 men as project staff contributed to local professional development in terms of project coordination, health education, community involvement

• Involvement and training of six local community workers in the needs assessment project for the purpose of health and health services data collection Number of hospital midwives/nurses receiving ongoing support from the Project midwife/field activities coordinator - 7

As part of the development initiatives (human resource development, infrastructure development and community involvement), the Project staff provides services to the community on an ongoing basis. These services include:

 

• Provision of medical/nursing/midwifery care at SISCa clinics – 9 visits a month • Midwifery services at the hospital – one day a week (Feb-Sept 2009)

• Contribution to radio program health education – one session per week

• Provision of clinical care at the CHCs - as needed during the month visits

• Assistant (human resource and transport) to the government ongoing vaccination program – as part of SISCa and as part of the special vaccination days

• Funding, food and in kind support to the internally displaced people, and women whose husband died (A$40,000 cash and in kind support to 419 people in Bobonaro, and support to an NGO working with widows)

• Distribution of Malaria prevention bed nets to community members Number of SISCa visits by the Project staff: 70 visits in 2009, 50 visits JanJune 2010)

This objective is achieved through renovation of two CHCs, equipping those two CHCs with the needed equipment, working with the primary care staff, promoting with community the need to use CHC for deliveries.

 

Additionally, the provision of ambulance which provides supports to more than 600 patients annually in the rugged terrain for remote and rural people is an important link in this regard. Most ANC given at SISCa clinics or at CHC’s. In 2009, more than 80% of women in Bobonaro district received ANC from a midwife or doctor (Demographic Health Survey 2009-2010) & about 25% of birth were assisted by a health professional.

Community development is achieved through various means including involvement of locals community members ias Project staff and supporting them for professional development, interaction with villagers and village chiefs as part of health education and service planning initiatives, sessions with the communities about awareness about newly renovated facilities, involvement in planning renovations at the CHCs. Number of communities visited as part of SISCa: 28 different communities in 2009 & 9 communities on a regular basis in 2010 Number of local East Timorese Project staff: 6 (and around 12 local men worked on the building projects at different times, 1 as an interpreter and 3 as security guards),

 

Needs Assessment Survey: an extensive health needs assessment was conducted and sharing of the results on cultural, social, health knowledge and behaviours and health service use related factors affecting health of mothers and babies.

 

The needs assessment results such as the evidence about how the health service and health workers were perceived by the community provided an understanding about the discrepancy between the midwives perception of the antenatal education they are giving and women’s perception of the antenatal education they are receiving can contribute to the local planning and development.

 

Needs Assessment Major Sponsor – Balwyn Rotary Club Funding for Placement of Survey field coordinator - AusAID.

 

Collaborative Planning with the DHS: The Project staff participates in the monthly district health staff meetings which are used to review and plan the services. In addition to technical inputs, the Project staff contributes to the initiative to improve the committee working.