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By Nelson Martins, MD, MHM, PhDBy Nelson Martins, MD, MHM, PhD
Minister of HealthMinister of Health
DiliDili,,JulyJuly 20092009
The Journey of a young nationThe Journey of a young nationfor better healthfor better health
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Historical Background
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NATIONAL HEALTH POLICY
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Government Priority Goals for the Health SectorGovernment Priority Goals for the Health Sector
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5
Dili National HospitalDili National Hospital
Regional Referral HospitalsRegional Referral Hospitals
CHC w/bedsCHC w/beds
(1 each Sub-district)(1 each Sub-district)
CHC without bedsCHC without beds
(1 each Sub-district)(1 each Sub-district)
Health Post villageHealth Post village
level, first point oflevel, first point of
contactcontact
Mobile Clinic Mobile Clinic
outreach fromoutreach from
CHCs (where thereCHCs (where there
is no HP)is no HP)
Radio
CommunicationBetween all levels
CENTRAL SERVICESCENTRAL SERVICES
DISTRICT HEALTH SERVICESDISTRICT HEALTH SERVICES
SUB-DISTRICT HEALTHSUB-DISTRICT HEALTHSERVICESSERVICES
COMMUNITY HEALTHCOMMUNITY HEALTH
SERVICESSERVICES
REFE
RRAL
OF
PATI
ENTS
(AmbulanceServices)
National DiagnosticNational Diagnostic
ServicesServices
(radiology,(radiology,
laboratory)laboratory)
CLINICAL REFERRAL SYSTEMCLINICAL REFERRAL SYSTEM CLINICAL SUPPORT &CLINICAL SUPPORT &TRANSFERTRANSFER
SERVICE SUPPORTSERVICE SUPPORT
Integrated Community Health ServiceIntegrated Community Health Service
(outreach to Suco Posts)(outreach to Suco Posts)
Current National Health Services ConfigurationCurrent National Health Services Configuration
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Health Intervention Progress for Achieving MDGsHealth Intervention Progress for Achieving MDGs
MDG Goal 4 INTERVENTIONS ROUTINE HMIS
Reduce ChildMortality
Accessible, affordable health
careAntenatal CareCare of the newbornImproved nutrition of children:micronutrient supplementationGrowth MonitoringImmunisation of children
Integrated management ofchildhood illnesses
Infant Mortality Rates (target 2015 53/1,000):1998 110/1,0002000 101/1,0002002 98/1,0002008 data not analysed yet but there
is indication of significant improvementto 60/1000 as per national HIS.
U5 Mortality Rates (target 2015 96/1,000):1998 148/1,0002000 194/1,000
2002 129/1,0002008 - data not analysed yet but thereis indication of significant improvementto 83/1000 as per national HIS.
U5 Malnutrition (target 2015 31%)2003 46%2007 32%
2008 21%
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Health Intervention Progress for Achieving MDGHealth Intervention Progress for Achieving MDG
MDG Goal 5 INTERVENTIONS ROUTINE HMIS
Reduce MaternalMortality
(target 2015 252/100,000)
- Skilled attendance duringpregnancy, delivery and postnatal- Basic Emergency ObstetricCare- Comprehensive emergencyobstetric care
- Family Planning
2003 660/100,000
2005 380/100,000 (Reported by 2008MDG)2008 no data analysis on mortalityrates yet, but there is an increase indelivery assisted by skilled birthattendant from 27% of deliveries in2006 to 36% in 2008, which is a positive
indication of improvement. Estimateson MMR around 450/100,000 in 2008.
MDG Goal 6 INTERVENTIONS ROUTINE HMIS
Reduce the spreadof HIV/AIDS, STIs,Tuberculosis and
Malaria(halted by 2015 and
begin to reversetrend)
- TB Case detection- TB Treatment with DOTS
- Malaria Treatment- Malaria prevention by
house spraying- Malaria prevention in
Pregnancy- STI treatment- STI Prevention
- Voluntary counsellingand treatment
TB:1999 800/100,000 (prevalence rate)2006 789/100,000 (prevalence rate)2008 - 447/100,000 (prevalence rate)Malaria Morbidity Rates forChildren U5:2005 400/1,0002008 275/1,000HIV Reported cases:
2003 12006 44
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Key Health IndicatorsKey Health IndicatorsIndicators Target by
20152004 2008
IMR 53/1000 90/1000 60/1000
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Maternal & Child Health InterventionsMaternal & Child Health Interventions
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Progress on Human Resources for HealthProgress on Human Resources for Health
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National Health Services FinancingNational Health Services Financing
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SISCa: The Key to achieving healthSISCa: The Key to achieving health
Priority GoalsPriority Goals
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SISCa approach believes inusing real data
to makeplan and propose health needs intervention
SISCa approach believes in local Solution to Localproblem while respecting the international bestpractice and standards
SISCa approach believes in community participationand decision on community health
SISCa approach believes on Trans departmental andinstitutional collaboration in health
SISCa approach believes in the empowerment ofcommunity leaders, village heads, members of SucoCouncil in mobilizing resources available to ensurehealthy life in a healthy environment
The Philosophy Behind SISCaThe Philosophy Behind SISCa
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SISCa
Service DeliveryService Delivery
Utilization of HealthUtilization of HealthFacilityFacility
UP ------------ CHC (Health Staff)UP ------------ CHC (Health Staff)
BottomBottom ----------------(Community)(Community)
Marriege between Access Vs. DemandMarriege between Access Vs. Demand
Quality HealthQuality Health
CareCare
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Table 1 provides basic population data on a monthlyTable 1 provides basic population data on a monthly
basis:basis:
To be able to use the statistic data and to reviseTo be able to use the statistic data and to revise
the denominator and indicator required for HMISthe denominator and indicator required for HMIS
To know the number of household member; To know the number of household member;
number of pregnant women; number of postnumber of pregnant women; number of post
partum; number of TB patients; number ofpartum; number of TB patients; number of
children; number of disable people; number ofchildren; number of disable people; number ofelderly people; etcelderly people; etc
To foresee the number of children to be To foresee the number of children to be
immunized in each village every months; numberimmunized in each village every months; number
of pregnant women need ANC;PNC; number of TBof pregnant women need ANC;PNC; number of TB
patients needs DOT and follow up; number ofpatients needs DOT and follow up; number of
disable and elderly need health assistance.disable and elderly need health assistance. To compare and cross-check data of patients To compare and cross-check data of patients
from CHCs and SISCa ( how many are actually dofrom CHCs and SISCa ( how many are actually do
not go to CHC ?)not go to CHC ?)
To count the drugs, vaccine and other health To count the drugs, vaccine and other health
medication and consumable needed by eachmedication and consumable needed by each
village every monthvillage every month..
What to Expect from SISCa Table 1?:What to Expect from SISCa Table 1?:
Family RegistrationFamily Registration
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Know people with malnourish (child,Know people with malnourish (child,
mothers, elderly), provide immediatemothers, elderly), provide immediate
intervention and referral.intervention and referral.
Know eating habit of the communityKnow eating habit of the community
( how many times and what composition( how many times and what composition
of meal)of meal) Know what are the main source of foodKnow what are the main source of food
available in each sucoavailable in each suco
Predict what the main nutritionalPredict what the main nutritional
deficiencies inside and would be met bydeficiencies inside and would be met by
community in each villagecommunity in each village
Assist community to consume the rightAssist community to consume the right
balance of food.balance of food.
Assist community to access to mainAssist community to access to main
nutrient that are lacking in their suco.nutrient that are lacking in their suco.
What to Expect from SISCa Table 2?:What to Expect from SISCa Table 2?:
NutritionNutrition
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Number of Pregnant Mother receiveNumber of Pregnant Mother receiveroutine ANCroutine ANC Number of Post Partum MotherNumber of Post Partum Mother
receive PNCreceive PNC Number of Child have LISIO andNumber of Child have LISIO and
receive routine immunizationreceive routine immunization Number of Child receive VitaminNumber of Child receive Vitamin
and other nutrient supplementationand other nutrient supplementation Early referral of high risk PregnantEarly referral of high risk Pregnant
MotherMother
Routine access to information andRoutine access to information andintervention on Family planningintervention on Family planning
Place for plan a delivery togetherPlace for plan a delivery together
with pregnant motherwith pregnant mother Other Gynecology consultationOther Gynecology consultation
What to Expect from SISCa Table 3?: MCHWhat to Expect from SISCa Table 3?: MCH
h f T bl
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Will treat and demonstrate personnel hygieneWill treat and demonstrate personnel hygiene Know how people manage their personnelKnow how people manage their personnel
hygienehygiene
Know number and type of toilet in each SucoKnow number and type of toilet in each Suco
Know number of water source in each SucoKnow number of water source in each Suco
How community breed their cattle , and othersHow community breed their cattle , and others
How community organize their plan that riskierHow community organize their plan that riskierfor Malaria and Denguefor Malaria and Dengue
Know number of healthy housesKnow number of healthy houses
Know the water and sewage drainage in eachKnow the water and sewage drainage in each
SucoSuco
Know number of place and how people manageKnow number of place and how people manage
their household wastetheir household waste
Work with member and leader of Suco to planWork with member and leader of Suco to plan
and propose interventionand propose intervention
What to Expect from SISCa Table 4?:What to Expect from SISCa Table 4?:
Hygiene & SanitationHygiene & Sanitation
h f blWh E f SISC T bl 5?
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At SISCa Posts, the community will have access to someAt SISCa Posts, the community will have access to somemedical treatment if required and the medical team maymedical treatment if required and the medical team mayidentify the need for referrals to a health facilityidentify the need for referrals to a health facility
What to Expect from SISCa Table 5?:What to Expect from SISCa Table 5?:
Curative ServicesCurative Services
h f S SC T bl 6?Wh t t E t f SISC T bl 6?
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Develop local health promotion materialDevelop local health promotion material
identified in each Suco from table 1-5.identified in each Suco from table 1-5.
Then, conduct Health promotion andThen, conduct Health promotion and
education every month through differenteducation every month through differentcommunication tools such as films, groupcommunication tools such as films, group
discussion; sport activities; distributediscussion; sport activities; distribute
brochure or banners; Band music andbrochure or banners; Band music and
theatre; etc.theatre; etc.
Promote participation of LocalPromote participation of Local
Community RadioCommunity Radio
What to Expect from SISCa Table 6?:What to Expect from SISCa Table 6?:
Health Promotion & EducationHealth Promotion & Education
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It expressed the need forIt expressed the need for urgent actionurgent action by all governments, allby all governments, allhealth and development workers, and the world community to protect andhealth and development workers, and the world community to protect andpromote the health of all the people of the world.promote the health of all the people of the world.
It was the first international declaration underlining the importance ofIt was the first international declaration underlining the importance ofprimary health careprimary health care.. The primary health care approach has since then The primary health care approach has since then
been accepted by member countries ofbeen accepted by member countries of WHOWHO asas the key tothe key toachieving the goal of "Health for All".achieving the goal of "Health for All".
The Conference called for urgent and effective national and internationalThe Conference called for urgent and effective national and internationalaction to develop and implement primary health care throughout theaction to develop and implement primary health care throughout theworld and particularly in developing countries in a spirit of technicalworld and particularly in developing countries in a spirit of technicalcooperation and in keeping with a New International Economic Order.cooperation and in keeping with a New International Economic Order.
It urged governments, WHO andIt urged governments, WHO and UNICEFUNICEF, and other international, and other international
organizations, aorganizations, ato channel increased technical andto channel increased technical and
financial support to it, particularly in developingfinancial support to it, particularly in developingcountries.countries.
ili-kekereLautem
http://en.wikipedia.org/wiki/Primary_health_carehttp://en.wikipedia.org/wiki/Primary_health_carehttp://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/UNICEFhttp://en.wikipedia.org/wiki/UNICEFhttp://en.wikipedia.org/wiki/UNICEFhttp://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/Primary_health_care8/14/2019 2009 Plenary Speech by Health Minister Dr Nelson Martins
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Health Timorese in a Healthy Timor-Health Timorese in a Healthy Timor-
LesteLeste
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