Making facilities birth-friendly in Timor-Leste

Purpose

Timor-Leste is the newest and the poorest nation in Southeast Asia and has some of the worst health indicators the region:  maternal mortality is estimated at 660/100,000; neonatal mortality at 33/1000 live births; only 18.4% of women had a skilled birth attendant present at their most recent birth with  only 9.8% delivering at health facility. 

After receiving a USAID grant in 2004, Health Alliance International (HAI) worked with an anthropologist at the University of Washington to design a qualitative assessment to solicit community perspectives related to pregnancy and delivery.  One significant finding revealed that health facilities lack support for traditional practices important for a positive Timorese birthing experience. In response, HAI in partnership with the Ministry of Health (MOH) implemented a community-driven plan to establish birth-friendly health facilities (BFHF) in six districts in the country.  BFHF facilities are located near a health clinic and incorporate important cultural accoutrements identified by communities.  This presentation describes this community-driven process to establish BFHF as a fully integrated component of the MOH system.

Methods

A implementation evaluation was led by a MPH student from the University of Washington using a mixed method design. The methods employed were:

·           Semi-structured interviews with clinic staff, community members, women who delivered at BFHF, and those who did not

·           Clinic utilization data

Results

BFHF communities feel a strong sense of ownership of the facilities.  The four-month community development process engendered a sense of facility stewardship and also created stronger ties between community members and health staff.  While total facility-based births have gone up, there has been no consistent increase in overall skilled birth attendance. 

Conclusions

Achieving behavior change in any area is challenging, however, strategies infused with community participation from planning to implementation, and respectful of positive cultural practices can result in successful outcomes.