Timor-Leste’s intrepid quest to secure health and wellbeing for all

WHO/Timor-Leste/S Singh

Lorentina Amaral’s house sits atop a hill, where the 21-year-old lives with her husband, three children and extended family. The home isn’t easy to reach by car; the best and safest way is to walk.

Two of Amaral’s children are as healthy as any parent could hope for. But the third — Interfenia da Costa, now three-years old— had health issues his mother couldn’t understand. Or at least not until a doctor, nurse and midwife came calling as part of the Saúde na Família programme’s domiciliary visits.

“My third son was born healthy. He weighed a good 3 kg at birth. But the problems started when he was six months old. He developed fever and diarrhea-like symptoms,” Amaral explains at a Community Health Center in Ailieu, a district in Timor-Leste’s northeast.

“We tried some treatment that seemed best to our mind, but his condition didn’t improve. I didn’t know what to make of it till the doctor and a team came. They explained to me that Interfenia is malnourished and that’s why his growth is hampered and stomach bloated. They explained to me the things I need to be careful about,” she says, adding, “I now know I can get fortified food for my son from the nearest health center.”

Amaral’s story is just one of many successes the Ministry of Health’s Saúde na Familia – or ‘health in the family’ – programme is responsible for. Since November 2015 the one-of-a-kind programme has seen health workers fan-out across the country to ensure comprehensive primary health care reaches all people everywhere. That includes each of the 206 483 households in each of the country’s 2225 villages.

Though Timor-Leste has long been committed to achieving primary health care for all, and with it universal health coverage, Saúde na Familia’s launch just one month ahead of the dawn of the Sustainable Development Goal era is indicative of the country’s leadership and drive.

“Timor-Leste is in a unique position. Since Independence in 2002 it has had to totally rebuild its health system. From the start of this process, health equity has been a core concern of the Ministry of Health, as well as the country’s high-level political leadership. For many years they have understood that public health is a determinant of broader development aims – exactly as the SDGs emphasize. Timor-Leste is poised to be a global leader as countries strive to bring health and wellbeing to all and ensure no one is left behind,” says WHO Representative to Timor-Leste Dr Rajesh Pandav.

In addition to mirroring the SDG Agenda, Saúde na Familia is aligned with the WHO South-East Asia Region’s focus on strengthening human resources for health – a Flagship Priority Area. Importantly, the programme helps bridge the challenge of rural staff retention, at the same time as enhancing the skills of health workers in meeting the diverse needs of the country’s citizens.

The experience of Dr Augusta da Costa, a General Practitioner at the Bacau Community Health Center, is instructive. “Ever since I have been associated with this programme,” she explains, “I have learnt so much more about the problems that communities in rural areas face. I have a better understanding of our people, their problems and needs.”

Dr Poonam Khetrapal Singh, Regional Director for WHO South-East Asia, sees this outcome as vitally important amid broader efforts to strengthen the health workforce. This is especially so in a Region where the density of health care providers is currently 12.5 per 10 000 population – less than the WHO-recommended minimum of 44.5 per 10 000 population.

“In 2014 strengthening human resources for health was identified as a Region-wide need and a key tool for achieving universal health coverage. In addition to the ongoing efforts of Timor-Leste’s Ministry of Health to recruit and train health workers, the Saúde na Familia programme will help close gaps and expand health care coverage. That is an outcome sure to drive substantive, inclusive gains in health and wellbeing across the country, contributing to the Region’s progress,” she says.

From her home atop a hill, Lorentina Amaral would surely agree. Due to just one of the programme’s domiciliary visits, her son Interfenia can now develop and thrive as any other child would. Left behind he was not.