"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 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.”