Making facilities birth-friendly in Timor-Leste

Purpose: In 2002 Timor-Leste (formerly East Timor) became the newest and the poorest nation in Southeast Asia and has some of the worst indicators of maternal and child health in this region: maternal mortality is estimated at 800/100,000; neonatal mortality at 33/1000 live births; only18.4% of women had a skilled birth attendant present at their most recent birth; and only 9.8% delivered in a health facility.

In 2004, HAI conducted a community-based qualitative assessment. One significant finding revealed that health facilities lack the hallmarks of traditional methods important for a positive Timorese birthing experience. In response to this finding, HAI implemented a community-driven plan to establish birth-friendly health facilities (BFHF) in four districts in the country. BFHF facilities are located near a health clinic, but have incorporated important traditional and cultural accoutrements identified by communities. This presentation describes a community-driven process to plan and establish BFHF which has resulted in an increase in families electing a facility-based birth with a skilled attendant.

Methods: Data were collected in four program districts. Methods employed: • BFHF register review • Comparable district-level register review at other facilities (non-BFHF) • Semi-structured interviews with clinic staff, community members, women who delivered at the BFHF and women who chose to deliver at home.

Results: Communities located around a BFHF and who participated in the planning process feel a strong sense of ownership of the facilities. The three to four month BFHF community development process not only engendered a sense of facility stewardship, but also stronger ties between health staff and community and served as a vehicle for safe motherhood health promotion. Skilled birth attendance and facility-based births increased in areas with a BFHF as compared to areas without BFHF.

Policy Implications: Achieving behavior change in any area is challenging. However, strategies infused with community participation along the continuum, from planning to implementation, and respectful of positive cultural practices can result in successful outcomes.