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“Don’t
eat too many sweets as they will give you worms,” old people
used to tell children in Timor-Leste. The advice is half- true--sweets
should generally be taken in moderation, but not for this reason.
District Program Health Officer for Nutrition Engracia da Costa
explains patiently to the suco chiefs, aldeia chiefs, and other
community leaders of Manatuto sub-district that contrary to the
popular belief, it is actually poor hygiene and sanitation that
causes intestinal worms in children.
This gathering of community leaders is happening on a clear day
in October, and the exchanges are lively. There are some policemen
in the crowd; one of them asks the health worker what the consequences
of not following the recommended
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In Timor-Leste,
communities have a crucial role
to play in keeping children healthy.
Photo by M. Borges/DAI |
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exclusive breastfeeding
for the baby’s first six months are.
The community problem-solving model was developed by the Ministry
of Health in partnership with USAID’s Timor-Leste Asisténsia
Integradu Saúde (TAIS) project in an effort to address
the most serious health issues the communities are facing. Each
district has a different priority problem to address. For Manatuto,
it is malnutrition; while for Baucau, it is low immunization rates,
and so on. In a few months, the district leaders will then be
sharing lessons learned and their experiences with each other
so they will all have a comprehensive understanding of children’s
health issues and the options they have to solve these problems.
“We are hoping that, once they have the right information
about nutrition issues, the community leaders in Manatuto will
help us convince the parents to bring their children to the health
centers for weighing, de-worming and Vitamin A supplements,”
Emilio Tilman of TAIS explains.
Suco chief Francisco Soares, 56, of Ailili agrees that this is
a reasonable expectation: “I’m very pleased with this
meeting because our children are offered health activities-- particularly
de-worming, weighing and vitamin A. We hope that the health department
and other partners will continue this program in collaboration
with us as local leaders to get the right information to the community
about health, and advise them what they can do to keep their children
healthy.”
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The
Goal Is Child Survival
With most families beyond the reach of the formal health
system in Timor-Leste, ordinary households have a crucial
role to play in preventing childhood death. Recognizing
this, child survival programs in Timor-Leste are putting
greater emphasis on community mobilization and participation.
Minister of Health Dr. Nelson Martins sees many potential
links in the community structure for sharing health information.
“We need to reach families wherever they gather, whether
at church, the market, or civic events,” he advised.
May 2007 marked a milestone for child survival in Timor-Leste,
when the Ministry of Health established an aggressive new
Basic Services Package designed to set the country on a
path toward achieving the Millennium Development Goals,
including a two-thirds reduction in child mortality by 2015.
The package thus defined comprehensive programs for pregnancy
and delivery attendance; newborn care; nutrition services;
immunization; and prevention and treatment of malaria, pneumonia,
and diarrhea.
Two conditions have to be met if the programs in the Basic
Services Package are to succeed: health services must be
accessed by all children, and they must be of high quality.
To complement the community problem-solving model that encourages
families to seek health care, the Ministry and TAIS are
also ensuring that the health services and facilities meet
the standards and targets for national health service provision.
The proof of the effectiveness of the community problem-solving
approach to children’s health will ultimately be the
improved health of Timor-Leste’s 179,000 children
under five years of age. “We’re headed in the
right direction for reducing this country’s critically
high levels of child mortality and infectious diseases,”
said Minister of Health, Dr. Nelson Martins, “but
we still have a long way to go.”
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