With continuous quality improvement, community healthcare builds trust among mothers

A UNICEF-supported programme aimed at bettering the care provided in rural Timor-Leste is seeing more families accessing essential health services in their communities 

Ermera, Timor-Leste: Bendita and Lize are sisters-in-law and are both six months pregnant. For Bendita, this will be her second child. For Lize, it will be her sixth. Each of her previous five children were born at home, Lize says, but this time she is aiming to deliver at the Railaco Community Health Center (CHC) in Railaco, Ermera Municipality. That is, if she can make it in time.

“It takes me three to four hours to walk here,” says Lize. “During my fifth pregnancy I started bleeding unexpectedly. But I was so far from the health center that we just decided to handle it at home. My mother-in-law has helped me with all of my deliveries.”

But since the UNICEF-supported Continuous Quality Improvement (CQI) programme has been implemented at the Railaco CHC, Lize says she feels that the long journey is worth it, due to the level of care her and her family can expect at the center. While previously it would not be uncommon for patients to arrive at the clinic and find it closed or be met by rude staff who would not allow children inside, now mothers such as Lize are confident they will be taken care of. 

“I can come at 8.30am in the morning, or at 5 or 6pm in the evening, and there is always someone here now,” says Lize. “They’re kind and gentle and never rude. They always explain the medicines and dosages clearly.” 
 

The framework for CQI that is focused on maternal, newborn and child health (MNCH) was developed by the Ministry of Health with technical and financial support from UNICEF. At its core, the CQI approach ensures that healthcare is safe, effective, patient-centered, timely, efficient and equitable, and these qualities are driving more mothers than ever to visit the CHC.

Bendita, a mother of two, has brought her 18-month-old son to the CHC to be vaccinated. She says she gave birth to him in Dili after developing high blood pressure and being referred to the national hospital. An ambulance drove her to the capital, but when it came time to be discharged, Bendita was on her own. “I spent one night in hospital then had to pay $25 for a car to bring my two-day-old son and I back home,” she says. 

“Depending on a family’s economic status, this can be extremely expensive,” says Sancha Lopes de Carvalho, a midwife at the CHC. “Some mothers simply can’t afford to do it. I’ve seen a lot of mothers having to walk for miles to get home after giving birth.”
 

While this situation is not ideal, UNICEF and its partners are working to improve it. This is being done via making improvements to infrastructure at the CHC, as well as purchasing supplies, and providing additional training, clinical support, and behavior-change activities among the health staff and community members. 

While both Lize and Bendita agree that the care provided at the Railaco CHC has certainly improved, they say one key challenge remains - the maternity ward can only accommodate a mother for up to two hours after giving birth before she must be discharged, provided she is found to be in good health. If a patient needs further care, they must be referred either to Gleno, the capital of Ermera Municipality (which can also only accommodate three to four patients at a time) or to Dili. 

According to Gaspar Silva Gomes, the director of the Railaco CHC, plans are underway to soon rectify this situation for the roughly 10 mothers who give birth at the center each month. The need has been clearly highlighted thanks to the structure of the CQI programme, allowing Gaspar and his colleagues to formulate a clear workplan that maps out the path to better care for mothers and their children.

“Once our proposed workplan is approved by the government and state, we will accelerate work on extending an additional building to have a maternity ward, laboratory, storage room for nutritious food and others,” he says. “This is to respond to the needs of our community, especially mothers.”

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