IMCI in
Timor-Leste
Young Country
Young bulge
1.1 million population
Young nation - 52%
population under 18 years
Likely to remain young - 3.2%
annual population growth
47,000 live births every year
3.8% of the population is
below one year
GNI US$ 5,303 but 41%
people live below poverty
HEALTH SYSTEMS & SERVICES
Tertiary care
Capital (Dili)
1 DNH
PHC
65 Community Health
Centres (CHC) 15,000
– 16,000 pop
182 Health Posts (5,000–6,000 pop)
BSP
District
Sub-district
Suco
600 SISCa - Outreach post for once in a
month clinic (1,500–2,000 pop)
3
Secondary care
5 Referral
Hospitals
(150,000 200,000 pop)
4
5
IMCI Implementation
IMCI implementation started (If yes, year)
Yes, 2002
Newborn Added (If yes, year)
No (included in
CCM)
Number and Proportion of districts implementing
IMCI
13 / 100%
Number and proportion of MOs trained
5 / 3%
Number and proportion of Nurses/other workers
trained
50%
Proportion of districts (out of IMCI districts) with 60
% or more health providers trained
10 districts
IMCI supervisory checklists introduced
Yes
Proportion of first-level health facilities that had at
least one supervisory visit over a period of 6 month
50%
during previous year
Proportion of districts (out of IMCI districts) covered
with Follow-up IMCI training
Only conducted at
National Level
IMCI Implementation in Timor-Leste
15th group 18
August 2004
TRAINING
5th group 21
October 2002
4rd group 24
October 2002
9th-10th groups 18 & 24
November 2003
8th group 45
June 2003
14th group 22
18th-19th &20th
July 2004
group
16, 8 & 8
13th group 20
August 2005
May 2004
1st group 20
July 2001
3rd group 26
June 2002
2nd group 16
January 2002
2001
7th group 27
April 2003
6th group 23
February 2003
2002
IMCI as national
strategy
Intitial period from
Sep 2001-May 2002
12th group 26
April 2004
11th group 8
January 2004
2003
2004
17th group 21
June 2005
16th group 19
January 2005
2005
Mid implementation
review
Consolidation phase from
May 2002- 2007
21st group 12
January 2006
2006 2007-8 2009-10
IMCI strategy
review
IMCI
refresher
training
Supportive
Supervision;
ENBC &
CCM
introduced
CRISIS
Transition phase from
Jul 2000 – Sep 2001
DHS 2003
DHS 2010
SLIDE 2
Distribution of the health Workers
trained in IMCI
68
33
39
30
37
33
21
21 23
62
12
23
19
% Facilities have at least one IMCI trained staff
89%
90%
80%
70%
60%
42%
50%
25%
40%
30%
20%
10%
0%
All health facilities (
CHC and HP)
CHCs
HPs
Source: HMIS, 2010
Health Facility Case Management for Very Severe Cases 2-11 months,
Hospital Data, HMIS 2010
Very Severe Diseases, 198,
0%
Severe Pneumonia, 314, 1%
Pneumonia, 6790, 11%
Others, 11382, 19%
Malnutrition, 2077, 3%
Ear Problem, 887, 2%
Cough or Cold, 22843, 38%
Fever : DHF Unlikely, 4424,
7%
Dengue, 123, 0%
Measles, 0, 0%
Malaria, 1714, 3%
Very severe febrile disease,
153, 0%
Dysentry, 728, 1%
Diarrhoea, 6085, 10%
10
Fever Malaria Unlikely, 2820,
5%
Health Facility Case Management for Very Severe Cases, 1-5 Years
Old, Hospital Data, HMIS 2010
Severe Pneumonia, 377, 0%
Very Severe Disease, 451,
0%
Pneumonia, 10257, 9%
Others, 27095, 23%
Cough or Cold, 37851, 31%
Malnutrition, 6301, 5%
Ear Problem, 2119, 2%
Fever : Dengue Unlikely,
9814, 8%
Diarrhoea,
11462, 10%
Dengue, 376, 0%
Fever : Malaria
Unlikely, 6979, 6%
Malaria, 4956, 4%
Very severe febrile
disease, 343, 0%
Dysentry, 1827, 2%
11
Measles, 0, 0%
The districts of Ainaro, Baucau, Lautem, Manufahi, Oecusse and
Viqueque districts were able to reach less than half of their health
facilities. The district of Bobonaro had not initiated supervisory visits.
100
63
50
60
39
50
40
30
0
20
0
Quarter 1
83
84
70
10
100
100
100
100
91
100
67
80
78
80
90
77
88
100
100
100
100
100
100
100
% facilities established IMCI corner
Quarter 2
Almost all districts had established IMCI corner.
% facilities with functional ORT corner
% of facilities with Functional ORT corners was variable as low as 25%
in the districts of Covalima and Manufahi
Quality
of IMCI
care: Assessment
93%
of the
children
have beenand
treatment for the danger signs
evaluated
Tremendous progress has been made through IMCI SS in terms of
improving the quality of IMCI case management i.e. correction,
assessment, classification, and treatment.
81% Children needing antibiotic
received the correct prescription for
the antibiotic
85% of children with diarrhea were
treated with Zinc…
Quality of IMCI care: Assessment and
treatment
Tremendous progress has been made through IMCI SS in terms of
improving the quality of IMCI case management i.e. correction,
assessment, classification, and treatment.
Challenges/Constraints
 Limited human resource for health (doctors,
nurses, midwives);
 Not all health facilities are equipped with IMCI
trained staff ;
 Limited number of trainers and supervisors at
sub-national level.
 High work load of MCH care providers.
 Inappropriate human resource management.
 Inadequate public financial management
(costing, budgeting, allocation & delayed
disbursement of funds).
Challenges/Constraints
 Geographical constraints with hilly terrains:
• Distance, sparse / scattered population, condition of
the road, rain, landslides, etc.)
 Lack of communication facilities (Transport,
Telecommunication etc.).
 Irregular supply of the essential drugs and
logistics.
 Dealing with multiple languages:
• Tetun, Portuguese, English, Spanish and
Indonesian
Way forward…..







Increase pool of human resources
(training of 600 doctors returned from
Cuba);
Improve referral services and linkages
with ENBC and CCM;
Improve supply chain management;
Advocacy for increased investment in
MNCH (Investment Case using
MBB/OneHealth);
Finalize MNCH strategy to promote
continuum of care;
Maternal and newborn death audit;
Equity focused programming.
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IMCI program: Updates, challenges and upcoming plan