Supporting the Promotor Saude Familiar (Community Health Worker) Program in Timor-Leste

Purpose

Maternal and neonatal mortality rates in Timor-Leste are among the worst in the Southeast Asia region.  While there have been recent increases in the rate of antenatal care (ANC) and skilled birth attendance additional work needs to be done. In 2006, the Timor-Leste Ministry of Health (MOH) began implementation of the Promotor Saude Familiar (PSF). The national rollout of the PSF program offers an opportunity to effect community level behavior change.

HAI proposed to the MOH to a pilot training and supervision model for PSFs using culturally relevant materials to incite behavior change. PSFs were trained to conduct home visits with pregnant women using culturally relvant communication tools.  During the home education visit women chose a behavior to adopt.  PSFs conducted follow-up home visits to support women and families to achieve their behavior change goal.  HAI staff conducted supervision and coaching visits for PSF in both sites.

Methods

An implementation evaluation, both qualitative and quantitative, led by a MPH student from the University of Washington was conducted consisting of 27 interviews and focus group discussions and the review of clinic records of ANC and skilled birth attendance.

Results

PSFs are making home visits and effectively using the health promotion tools.  Women, with support of their families, are selecting behavior change goals and frequently are able to meet them. 

At one site, records showed a 35% increase in antenatal care and if current trends continue there will be a 20% increase in assisted deliveries in 2008 and 59% of facility-based deliveries.  The second site has been less successful with a slight increase in ANC and a decrease in assisted deliveries.

Conclusions

Behavior change can be achieved through a PSF home visit model using culturally appropriate education tools.  PSFs need simple tools for their health promotion work and supportive supervision.