Volunteers help bridge the gap between rural communities and their health centres

AILEU, Timor-Leste, 27 February 2008 – Some Timorese communities face many challenges in ensuring the survival of their children. On average, each person in Timor-Leste visits health facilities less than twice a year. This low number is due largely to the country’s extremely rugged terrain, as impassable as it is beautiful.

Much of the country's basic infrastructure collapsed after conflict in 1999. Now, low levels of adult literacy, sporadic outreach services and short hours at existing health facilities all hamper the regular provision of health care – especially to rural, outlying communities.

"In one village of Aileu district, I met a family where six of nine children died before reaching the age of five," recounts UNICEF Child Survival and Maternal Health Care Specialist Jennifer Barak. "These children first became ill at home, and the couple never sought care at a health facility. It was only during the woman's ninth pregnancy that a midwife, as part of a mobile team, made contact with the family and intervened with counselling and health services."

Expanding care through volunteers

These challenges have prompted the country's Ministry of Health to expand health care provision through an innovative network of community-based volunteers. The volunteers are part of the Family Health Promoter Programme, which trains local residents to be health educators and behaviour-change agents, encouraging their communities to adopt simple disease-prevention practices.

The formal launch of the programme took place in the hill community of Liquidoe, where the blustery winds and frigid temperatures did not dampen the new team's optimism.

Volunteers like Augusto Ramos, a farmer from Daulala village, are working to bridge the gap between rural communities like Liquidoe and their distant, barely accessible health centres. Pointing to the struggle Liquidoe faces in addressing undernutrition and poor growth in children, Mr. Ramos said, "The food here is ample and available. We have corn, rice and plenty of fruits. But the parents don’t know how to prepare appropriate food for their children."

The difference between life and death

One student-volunteer from Kotolau village, Augustinha Barreto, explained that women find giving birth at a health facility intimidating because they have to incur costs and be away from their families for many days.

"Our village is far from the health centre," Ms. Barreto said. "A lot of the women believe that it is better to deliver their babies at home. So we will give them information about skilled birth attendants who can help them."

Such advice from a fellow community member could mean the difference between life and death in a country with relatively high rates of maternal and infant mortality.

'Your health is in your own hands'

The Family Health Promoter Programme was developed in late 2005 with support from UNICEF and the Government of Thailand, and input from other experts. However, civil unrest in May 2006 disrupted its implementation at that time.

Now the programme is back on its feet, having launched a pilot roll-out in four districts in July 2007, after training more than 430 volunteers.

So far, the response has been encouraging, with volunteer numbers exceeding the original targets. Because the motivation to change behaviour often starts with the community itself, the health authorities hope this experiment in volunteer mobilization will be a success.

The challenge of scaling up the programme to the country's 13 districts still lies ahead, but the country's Health Promotion Chief at the Ministry of Health, Pedro Amaral, is optimistic. "Our health slogan has always been: 'Your health is in your own hands,'" said Mr. Amaral.