Reaching communities with life-saving vaccines

Reaching Timor-Leste’s most isolated communities with life-saving vaccines

UNICEF Timor-Leste
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UNICEF Timor-Leste/2018/Soares

22 April 2019

Nearly three-quarters of Timor-Leste’s population live rurally, in small villages and hamlets scattered through the mountainous country’s rocky slopes and dense forests. Some villages are only accessible by motorbike, boat or hours of walking—and can be completely cut off with the heavy wet-season rains. But every child has a right to good health, regardless of where they live.  UNICEF and WHO is supporting the Ministry of Health of the Government of Timor-Leste to bringing the life-saving vaccines to Timor-Leste’s most vulnerable children, no matter where they live.

If you ask someone living in Timor-Leste’s capital city, Dili, where they’re from, they’ll tell you the name of their family’s village; their rural home.

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UNICEF Timor-Leste/2018/Helin
A rural landscape in Ermera, Timor-Leste.

More than four hundred villages and countless hamlets dot the tiny half-island nation, whose dramatic rocky mountain slopes, sandy seaside flats and dense, twisting tropical forests provide home and shelter to nearly three-quarters of Timor-Leste’s 1.2 million people; many of them subsistence farmers.

For thousands, the coffee forests, rice plantations, mountainside gardens and wide-open sea provide vital sustenance, income and nourishment—but it comes at a price.

Hundreds of households are accessible by motorbike or foot—by thin, rocky goat-tracks through the bush. People living in rural areas are often walk hours to get to their nearest health clinic. 

Access to health care is critically important for the approximately 500,000 children living in rural areas, who are most vulnerable to missing out.


Caption: The majority of children in Timor-Leste live in rural or remote sub-villages, many of which are up to hours’ walk away from the nearest health care post. (UNICEF Timor-Leste/2016/Helin)


Saving lives in Timor-Leste

Immunisation is recognised as one of the most successful and cost-effective health interventions to save lives and manage childhood illness and death. Its increased coverage is a key priority of the Government of Timor-Leste—it has committed to achieving 90 per cent immunisation coverage, in recognition of the life-saving role vaccinations play in improving child health globally.
 

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UNICEF Timor-Leste/2018/Soares
Mothers are on their way with their children for vaccinations against measles and rubella in Ermera.

UNICEF Timor-Leste stands with a global commitment for immunisation and for measles elimination. 

In 2000, the fourth Millennium Development Goal set out the world’s ambition to reduce child mortality by two-thirds to the end of 2015, with measles vaccination coverage being a key indicator of progress. 

Regionally, the World Health Organization Regional Committee established in 2013 a goal to eliminate measles and to control rubella in Southeast Asia by 2020—and in Timor-Leste, steps have been gradually taken since the restructure of the EPI programme in 2002 to meet complete coverage. 

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UNICEF Timor-Leste/2018/Soares
No single case of measles was reported in 2017 in Timor-Leste, due in part to widespread vaccination coverage.

Significant progress has since been made to reach every child in Timor-Leste with vaccines. A national immunisation campaign in 2015 to protect children against measles, rubella and polio reached 97 per cent of its target population for rubella and measles, and 95 per cent for polio vaccinations—leading to Timor-Leste’s regional certification as a polio-free country. 

On the frontline of healthcare

In 2015, UNICEF followed community health workers, who walked door-to-door to inform parents of available vaccinations and set up temporary medical stations by rivers and in village centres.
 

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UNICEF Timor-Leste/2018/Soares
Health care workers, many of them volunteers, attend every house in all 13 municipalities, in a sub-village, to tell families about vaccination services available.

Ana Paula, a 24-year-old mother of a previously unvaccinated 11-month-old, told UNICEF that she knew immunisation would protect her child from disease, but was reluctant to walk the two hours to the local health post. “Today, when I heard that the health team will come to our neighbourhood, I took this opportunity. I want my child to be healthy.”  

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UNICEF Timor-Leste/2018/Soares

Father-of-three Roque Rangel Amaral, 45, told UNICEF he was visited by the door-to-door team. “I was reluctant,” he said. “We are fortunate the health team came here and provided this service. Otherwise, I would not have immunised my children, as it is too far to travel with three children.”

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UNICEF Timor-Leste/2018/Soares

Health workers reached hard to reach areas with this essential lifesaving services for children- No one left behind, #VaccinesWork for every child.

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UNICEF Timor-Leste/2018/Soares
The vaccination team from from Baucau health center continue to Fataliri aledia which is a part of Soba village, Laga sub district, only accessable by walk.

While significant steps have been taken, gaps still remain. But Timor-Leste is meeting its challenge. 

Between 2 and 14 July 2018, UNICEF Timor-Leste and WHO worked with the Ministry of Health executed a widespread immunisation campaign to address the immunity gaps still prevalent among children aged under five with measles and rubella. 

Its ultimate goal is to eliminate measles and control rubella, and the two-week-long campaign sought to vaccinate more than 95 per cent of children aged between nine months and five years against these deadly but vaccine-preventable diseases.
 

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UNICEF Timor-Leste/2018/Soares
Health care workers administer vaccinations against measles and rubella at an event in Dili, Timor-Leste. Free, universal health care for all citizens is a constitutional right in Timor-Leste.

UNICEF Timor-Leste is assisting the Ministry of Health with the commodities, storage and health worker training required to effectively manage and administer vaccinations, as part of its efforts to promote and protect the rights of all children in Timor-Leste to health and survival. 

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UNICEF Timor-Leste/2019/Helin

The way forward

But closing the immunity gap is just one part of the story. Post-elimination, a plan must be developed to maintain this closure and ensure no children fall victim to vaccine-preventable diseases. This will happen by setting and meeting targets through the enhanced training and support of local experts.
 

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UNICEF Timor-Leste/2018/Soares

UNICEF and WHO is working with Government of Timor-Leste to enhance population immunity for children aged between nine months and five years, with a particular focus on increasing activities in municipalities with less than 95 per cent coverage of measles, Polio and vaccines prevented diseases. 

Increased surveillance will reduce the drop-out rate between rounds of vaccination,and will help local staff working in remote and rural clinics to investigate outbreaks and document new cases and their origins – and strengthened laboratory capacity will track the molecular epidemiology of cases and test samples from suspected cases, helping to prevent the spread of disease.

Globally, vaccines prevent between two and three million child deaths per year—and in Timor-Leste, they’re reaching even the most isolated, vulnerable and youngest children.