I am delighted to join the discussions on HIFA and share some of our experiences in maintaining essential health services in Timor-Leste. [*see note below]
While there have only been 31 confirmed cases and no evidence of community transmission on this half-island nation in the Asia-Pacific region, anxiety and concerns around COVID-19 have adversely impacted on health services.
Preliminary data gathered on mother and child services have shown a reduction in hospital deliveries (with a concomitant increase in home deliveries), a reduction in ante-natal visits and a drop in family planning methods (with a change in preference from short to long acting methods of contraception).
It is hoped that early lessons from a successful campaign to protect childhood vaccination coverage during the past several months will inform ongoing efforts to improve mother-and-child services in Timor-Leste:
Protecting immunization coverage in Timor-Leste - A summary:
Following its first confirmed case in March 2020, childhood immunization coverage dropped by 30% the next month in April. By over-compensating on the supply side (expanded door-to-door campaigns to identify and vaccinate unprotected children), Timor-Leste has been able to achieve similar coverage by July 2020 as compared with July 2019.
Lessons learnt during this effort:
(1) The value of credible and respected leadership
The provision of clear and credible guidance on the need to continue immunization services by professionals respected by the health community (including the NITAG Chair, DGHS, senior Paediatricians) built confidence in vaccinators for providing safe services
(2) The value of supportive supervision
Re-purposing WHO technical staff to work closely with district immunization coordinators has been invaluable in building trust and competence for health workers to deliver vaccination.
(3) The value of user-friendly granular data to target interventions
Districts provided weekly coverage data, disaggregated to the CHC level. This facilitated identification of poor performing health facilities that were provided extra technical support and supervision to improve performance.
(4) The value of door-to-door campaigns to reach the unreached
The intensive infection control training provided health workers with confidence to provide outreach for non-attenders, take immunization to the door-step and significantly improving coverage rates.
Challenges ahead: This early achievement is fragile. Any surge in COVID-19 cases and these early gains are likely to be whittled away. It is therefore critical to 'bank' and increase efforts during this period of no community transmission so that if and when a surge occurs, its adverse effect on coverage rates will be less severe.
I have a special interest in Universal Health Care and look forward to learning and sharing experiences through this forum.
Dr Vinay Bothra
Health Policy Advisor
HIFA profile: Vinay Bothra is a Health Policy Advisor with the World Health Organization in Timor Leste. vbothra19 AT gmail.com
[*Note from HIFA moderator (Neil): Many thanks Vinay and welcome to HIFA. All: Dr Vinay Bothra was one of the lead speakers at the WHO online event on 3 December: Maintaining quality
essential health services during COVID-19. A recording will be available shortly. Please all, keep sharing your experiences on this topic. Email: firstname.lastname@example.org In case you want to contact me off-list, my email is email@example.com ]