Community Health Services in Timor-Leste
In Timor-Leste, about three-quarters of the population live in rural areas with little access to a health facility. In order to bring services and health promotion information to people who otherwise have little contact with the formal health system, the Timorese Ministry of Health has prioritized a new program called Servisu Integrado Saude Communitaire (SISCa), which means "Integrated Health Services at the Community Level" in the local Tetum language.
The SISCa program is an effort to connect the government health system with rural communities, and to give communities responsibility for assuring that care is available and accessible. SISCa events revolve around a "Six Table Assistance System" consisting of 1) population registration, 2) nutrition assistance, 3) maternal and child health, 4) personal hygiene and sanitation, 5) health care services, and 6) health education.
Families lined up to begin rotation through the six stations.
A health worker speaking at a SISCa event.
Families come to the event and have the chance to visit these six stations. They get their families taken care of, their babies weighed, ask health staff questions and receive information on available services all in a familiar setting. Community members visit with neighbors and local leaders get involved as well. The local Chefe de Suco (village chief), works alongside health staff in planning the event. HAI produced films featuring health promotion messages are also often shown on TVs powered by generators specially brought for the event. With very few televisions outside of the capital of Dili, the films offer an attractive medium for the community to receive health information. Many community members walk far to attend SISCa events, so the films provide something to engage people while the team is setting up. A "family health promoter" (community health worker) then gives a short reminder of the key messages and conducts a question and answer session.
The Ministry of Health asked partner NGOs and agencies working in health to support SISCa in the 13 districts of the country.
We are currently supporting SISCa in six rural districts of the central region. In order to provide integrated support to SISCa posts and build a collaborative relationship between health staff and volunteers, we focus on one sub-district at a time. Our staff provide support for SISCa through monitoring and supervision of the community health workers, who are tasked with staffing the registration table and conducting health promotion activities at the events. Our team also builds the capacity of district health leadership staff by working with team members specifically charged with overseeing the events.
In order to assist the health teams in providing the highest quality services to rural communities, we worked with the Ministry of Health to develop a SISCa checklist to ensure the completeness of equipment and medicines provided at a SISCa post. On the SISCa day, the HAI team arrives early at the community health center to assist in any last-minute preparations and then helps transport the SISCa team to the location where they meet the community health workers who live locally.
As the six services are delivered throughout the day, our staff fill in a monitoring tool which captures statistical information about the day. How many services were delivered compared to the SISCa guidelines? How many community health workers and health staff were in attendance? At the end of the SISCa, our staff compare observations with those made by the health staff and together they identify strengths and gaps in the services.
In doing this, HAI and Ministry staff are working together to actively improve the quality of services provided for future events. Over time, this focused capacity building aims to both improve the quality of services and the ability of health staff and volunteers to conduct a high quality SISCa event by themselves.
Kids enjoying the day at a SISCa event.