Health Alliance International

Timor-Leste is a small nation of about one million people that occupies the eastern half of the island of Timor in the Indonesian archipelago. It is a new nation and one of the world's poorest. There is widespread poverty, low levels of literacy, and some of the worst maternal and child health indicators in the region.

We have been working in Timor-Leste since they voted for independence in 1999, when we sent a health and human rights delegation to assess the country's human rights and health situation, and to develop a project for the delivery of essential maternal care services. Today our work focuses on strengthening the Ministry of Health's maternal and child health and child survival services and integrating them into primary health care.

Timor-Leste's recent history

Timor-Leste was a Portuguese colony for most of the time between the 18th century and 1975, when it was then occupied by Indonesia for more than 20 years. In 1999, the Timorese people voted for independence, which was followed by retaliation from the Indonesian military and Timorese militias that destroyed most of the country's infrastructure, including health facilities. After three years as a UN protectorate, Timor-Leste became an independent nation in May 2002. The country has been faced with the daunting task of rebuilding an entire infrastructure, including the health system.

At the time of independence:

• Maternal mortality was estimated at 800 per 100,000 live births
• Infant mortality was 80-90 per 1000 live births
• Under 5 mortality was 120 children per 1000 children

Utilization of health services was also very low. Only about half of women receive any antenatal care during pregnancy, use of a skilled birth attendant was less than 20%, and fewer than 10% of births occurred at a health facility. A 2003 Demographic and Health Survey revealed a total fertility rate of 7.8. Not surprisingly, use of a family planning method was very low at 9%, 81% of married women had never used contraception, and a majority of women could not identify family planning methods or where to obtain family planning services.

Early HAI efforts in Timor-Leste included a health promotion project in Venilale, begun in 2001 before there was an operational Ministry of Health. In 2004, HAI received a four-year USAID Child Survival and Health Grant to support the newly established Timor-Leste Ministry of Health in strengthening its national program to improve maternal and newborn health. In December 2005 with funding from USAID Flexible Fund, HAI began a project integrating child spacing promotion with its existing maternal and newborn health program.