In the rugged highlands and remote rural areas of Timor-Leste, residents rely on community health centers and mobile clinics for primary health care. It is often the nurses at these facilities who make the day-to-day decisions about patient care because Timor-Leste is a country with few doctors.

To help improve the delivery of health services to Timor-Leste's residents, the Ministry of Health has begun a new training course for nurses, and especially for those who work in rural areas. The Advance Practice Nurse Training Program is funded by the Trust Fund for Timor-Leste.. Over the next four years, the aim is to train more than 200 nurses in improved patient care and community health education.

The course lasts six months and covers a wide range of topics, including ethics, best use of medicines, and health promotion. It also focuses on the prevention and management of priority diseases, such as malaria and tuberculosis, and on making pregnancy and birth safer. This will help reduce maternal and infant mortality rates that are among the highest in the region. The first 32 nurses have completed the course, and another 16 are about half way through it.

Classroom work involves video instruction, case studies, simulations, and role play. Nurses also attend supervised practice at hospitals with coaching from experienced clinical facilitators. During the course, nurses serve a three-month residency to practice their new skills with guidance and support from field workbooks and district medical officers. They gain experience in taking histories, doing physical exams, making diagnoses, and treating and counseling patients. The nurses also educate their patients and communities on disease prevention. Instruction is provided by a team of Ministry of Health and World Health Organization facilitators and trainers, including doctors, nurses and health educators.

USAID supports the nurse training program through an in-kind grant of $33,500 for printing, making instructional videos, and supervising district visits. The program is a cost-effective strategy to provide better health care to Timor-Leste's residents and improve maternal and child health.

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