MOH collaboration to improve maternal and newborn care in Timor-Leste

This paper describes an approach to strengthening maternal and newborn care services at the national level in Timor-Leste through partnership with the Ministry of Health, careful evaluation of innovative approaches to improving service delivery, and advocacy for policy change. Timor-Leste, formally known as East Timor, is the poorest and newest country in Asia. After the violent departure of Indonesia in 1999, in which 70-80% of the infrastructure was destroyed, Timorese were left with the daunting task of rebuilding an entire health system. HAI was involved in the country before independence, and was in an ideal position to make use of lessons learned from previous work with the MOH in post-independence Mozambique. A critical element of collaboration with the MOH was to co-locate the HAI office with the MCH division of the MOH. In collaboration with a strong minister of health, we identified the need and supported the development of an MOH position for district-based MCH program officers in our program area; soon thereafter the position was established for all districts nationally. With district MOH staff we developed drama to teach communities about safer birthing practices, which had been done successfully in Mozambique. Evaluation of the effects of the drama showed significant and meaningful increases in the understanding of audiences on 10 of 12 topics critical for maternal and newborn health. Subsequently, other groups have supported the deployment of the drama in other settings. In-depth exploration of issues related to the use or non-use of skilled birth attendants led to the development of pilot MOH ‘birth-friendly' facilities that incorporated local cultural norms around childbirth. These and other innovative initiatives to improve rates of skilled attendance at birth and to improve the understanding of rural populations about maternal and newborn health have been developed with MOH staff, critically evaluated, and accepted by the MOH as important elements of their program to improve maternal and newborn health.