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Maternal and Child Health Program

Annual Report 2010

Maternal and Child Health Program - Fundasaun Alola

DECEMBER 2010

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Acknowledgements We would like to acknowledge the ongoing collaboration of the Ministry of Health (MoH) both

at the National and district levels, including staff in 10 MoH district facilities - Dili, Mantuto,

Baucau, Lospalos, Viqueque, Aileu, Ainaro, Ermera, Liquica and Oecusse – who supported the

implementation of Fundasaun Alola’s Maternal and Child Health Program (MCH) throughout

2010.

We appreciatively acknowledge the donors – large and small - that provided funding assistance

to Alola's MCH program in 2010, including UNICEF, ENI, Gulbenkian Foundation, Oxfam

Australia, Merri Community Health Services, ConocoPhillips, Woodside and Fundasaun Alola’s

friends from around the world who have contributed to our Maternity Packs project through

the Australian Foundation for the Peoples of Asia and the Pacific (AFAP), and Alola Australia. In

addition, we would like to express our thanks to the University of New South Wales, our

partners in the implementation of the Harmony in the Family research project.

Thanks goes too to several of our key stakeholders - Bairo Pite Clinic, Clinic Café Timor, Timor-

Leste Assistensia Intergadu Saude (TAIS), Health Alliance International (HAI), Timor Leste

World Vision, and all of our friends from the Nutrition Working Group, who have assisted

Fundasaun Alola in the implementation of the MCH program.

Lastly, our achievements in 2010 would not have been possible without the hard work and

dedication of the MCH program staff, and the support that we received from our colleagues at

Fundasaun Alola.

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A. Executive Summary In 2010, in order to achieve the goals of Fundasaun Alola and to contribute to the

achievement of the United Nations Millennium Development Goals (No. 4: Reduction in Child

Mortality and No. 5: Improve Maternal Health), Fundasaun Alola continued its Maternal and

Child Health Program (MCH) in three main areas: health-facility-based, community-based and

research. In 2010, the MCH program maintained its strong focus on promoting infant and

young child feeding, newborn care, safe motherhood initiatives and family planning or birth

spacing, hospital play rooms, and recently extended to the Community Management of Acute

Malnutrition (CMAM).

Activities resulting from the above focuses included The Baby Friendly Hospital Initiative

(BFHI); Infant and Young Child Feeding (IYCF) refresher training for health workers in Dili and

Baucau Hospitals; IYCF training, safe motherhood, and family planning training for Mother

Support Group (MSG) members; the provision of IYCF counselling in health facilities in ten

districts; IYCF promotion to rural communities; play room set-ups at Dili and Baucau hospitals.

The program's recent expansion has undertaken the Community Management of Acute

Malnutrition program, and an ongoing research project on understanding anger and its

consequences amongst women in conflict-affected Timor Leste: Implications for enhancing

sustainable development.

In 2010, Alola was able to extend the MSG by using the SHIO model in 16 villages across 7

districts: Oecusse(4), Manatuto (2) , Baucau(2) , Viqueque(2) , lautem(3), Aileu(2) and Ainaro

(1) . As a result, a total of 53 maternal and child health community groups (MGS/SHIO) were

stablished in 57 villages across the country with 248 new members. The program was initiated

through consultation with local authorities; identification of a suitable program location;

socialisation to community; participatory problem analysis for the village facilitators;

participatory problem analysis workshop for the community members; a workshop on

regulations and socialisation of the regulations to the community; and finally, the

inauguration of the group.

The MCH facility-based program activities supported skin-to-skin contact for 3526 newborn

babies, and provided breastfeeding counselling to 4245 women at the Dili National Hospital,

1195 women at Baucau Referral Hospital, 261 at Maubisse and 193 in Oecusse. An additional

161 women received treatment for breastfeeding problems. 1673 women received maternity

packs that were distributed by MCH program staff in Baucau, Maubisse and Oecusse referral

hospitals following expansion in 2010.

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The program also trained 374 SHIO members in IYCF, basic safe motherhood and family

planning. As soon as they received training the SHIO members provide information on

Dangers Signs During Pregnancy, Childbirth, postpartum health and the benefits of

Breastfeeding to 7113 Pregnant and 4214 Lactation women at Community Health Centres

and SISCa Posts. During the socialisation of SHIO programs, approximately 500 people

watched movies about breastfeeding and Safe Motherhood.

In 2010, Alola set up two play rooms for young patients, one at each Dili National Hospital and

Baucau Referral Hospital. The play rooms provide a place in which parents and their children

who are staying at the hospital can access games, draw, tell stories, and watch children's

movies. The play rooms also serve to provide a place/distribution centre for information,

particularly relating to breast feeding and complementary feeding.

The training on IYCF, basic safe motherhood, Newborn Care and family planning to MSG and

SHIO members is very helpful for early detection of problems and results in members having

the skills to make quick decision about when to refer cases through MSG/SHIO networks. In

2010, 297 pregnant women were referred to deliver at health facilities for a normal birth or

due to complications, 155 women received Family Planning support, and 34 children were

assisted by MSG/SHIO member to receive treatment on malnutrition.

One important MCH program activity involved conducting community discussion forums in

each MSG/SHIO on various topics, such as IYCF, Family Planning, Women's Nutrition, and

Tuberculosis to 136 participants. 500 participants across 10 villages attended a breastfeeding

week quiz, and all of these villages now have new MSG/SHIO groups. 293 out of 665 babies

were assessed to be in the 'healthy' category because they fulfilled the criteria of The Baby

Contest for World Breastfeeding Week based, on the WHO Child Growth and Development

Chart. 323 babies had received exclusive breastfeeding for the first six months with support

from their local MSG/SHIO members.

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B. Program Background

Fundasaun Alola established its Maternal and Child Health (MCH) Program in February 2003,

through the National Breastfeeding Association (NBFA). Since 2006 to 2010 Fundasaun Alola has

extended its MCH program to include maternity packs, women’s health, newborn care, safe

motherhood initiative and Play room at Dili National Hospital and Baucau referral Hospital.

In 2009, NBFA was handed over to the Ministry of Health’s (MoH) Nutrition Department. To

facilitate the handover process, Fundasaun Alola seconded a senior staff member for two days

to work with MoH. The staff member assisted the coordination and implementation of the

Baby Friendly Hospital Initiative (BFHI), provided breastfeeding training for health workers,

and advocated for a breastfeeding policy and International Code for Breastmilk Substitutes.

Fundasaun Alola is still committed to promoting breastfeeding and timely and appropriate

complementary feeding for children under the age of two in Timor-Leste. Therefore, starting

in 2009, Fundasaun Alola replaced NBFA with the Breastfeeding Promotion Program (BPP). The

program targets health facilities, communities and the general population.

Since the establishment of the NBFA, Fundasaun Alola has set up 53 Mother Support Groups

(MSG) and Suku Hadomi Inan no Oan (SHIO) in 57 out of 441 villages, with more than 1000

members in ten districts of Timor-Leste. The initial guidelines of the MSGs were to promote

colostrums and exclusive breastfeeding for the first six months.

In 2007, Fundasaun Alola piloted the provision of counselling by MSG members at Dili National

Hospital and Baucau Referral Hospital. This counselling was successful in extending the

coverage and promotion of breastfeeding. It also aided and expanded the knowledge and

skills of MSG members, which they had previously gained through training provided by the

MCH team. Due to the success of the program, Fundasaun Alola will continue to support MSG

members to provide counselling at hospitals, Community Health centres (CHC) and Health

Posts, as well as Servisu Integradu Saude Comunitaria (SISCa) posts, which continue to benefit

pregnant and lactating women.

In consultation with MoH, Fundasaun Alola also piloted a community-based safe motherhood

program in Liquica District during 2007/2008, known as Suku Hadomi Inan no Oan (SHIO).

SHIO is modelled on an Indonesian program, known as Desa Siaga (Siap, Antar Jaga), and was

introduced to reduce maternal and child mortality, and address Millennium Development

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Goals numbers 4 and 5. The objectives of SHIO are to raise community awareness about birth

preparedness; recognize danger signs during pregnancy, child birth and postpartum; and to

assist and support women with obstetric complications with transport to a health facility.

SHIO was successful in increasing the number of antenatal care visits, skilled birth attendants

and family planning in piloted villages.

Another exciting new initiative is Fundasaun Alola’s Newborn Care Program. This program

provides additional midwife support in Dili and Baucau hospitals to promote skin-to-skin

contact, and immediate and exclusive breastfeeding education for all new mothers. Essential

to this program is the Maternity Pack project that still exists at Baucau Referral Hospital and

recently expanded to Maubisse and Oecusse Referral Hospital, which provides all new mothers

with clothing, baby goods, and postpartum health promotion materials. MSG members have

been recruited to work in this program to provide ongoing support when mothers return

home.

C. Project Objectives

MCH Vision: To improve the health of women and children in Timor-Leste

MCH Goal: To contribute to the reduction of maternal and children mortality in Timor-Leste

MCH Program Objectives:

1. To promote good practices of infant and young child feeding across the country through

Mother Support Groups and SHIO.

2. To promote and support the safe motherhood initiative and reproductive health through

the establishment of MSG/SHIO networks.

3. To promote and encourage facility-based delivery through the provision of maternity

packs hospitals.

4. Promoting and supporting newborn care at hospitals.

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D.Maternal and Child Health Activities Achieved in 2010

MCH - Facility-based Program activities

Infant and Young Child Feeding Training for Doctors

Infant and Young Child Feeding is an intensive course designed to combine three topics in one

course - breastfeeding, complementary feeding and infant feeding, & HIV Counselling. This

training is developed by IBFAN (Infant Baby Food Action Network) and Breastfeeding Promotion

of India (BPI).

In July, Fundasaun Alola assisted the Ministry of Health and UNICEF to organise IYCF training

for the doctors, midwives and nurses. This training was prioritised for doctors to participate,

however the limited number of Timorese doctors meant that midwives and nurses were

invited to fill the gap. The IYCF training was conducted over 13 days, including 6 days Training

of Trainer to prepare master trainers, and 7 days for counselling specialist training. The

training was conducted from 12 to 26 July 2010 and facilitated by Prof. M.M.A Faridi, an IYCF

Course Director from India. The training resulted in 5 master trainers consisting of 3 Timorese

doctors and two midwives, as well as 24 counselling specialists consisting of 12 doctors

(General Practitioners).

The Infant and Young Child Feeding training for doctors is crucial, as the doctors have a

significant influence on mothers and family decisions on infant feeding, as they are often

trusted by communities. The doctors’ role is very important to improving the infant feeding

practices in Timor-Leste.

Baby Friendly Hospitals Initiative (BFHI) Fundasaun Alola assisted with a re-assessment of baby friendly hospitals in Dili National

Hospital and Baucau Referral Hospital. The assessment was undertaken on the 2nd and 3rd of

August in Baucau Referral Hospital, and the 5th and 6th in Dili National Hospital. The re-

assessment identified that there is no written breastfeeding policy in either of the hospitals

to communicate to all staff; bottle feeding was discovered; and antenatal classes on

breastfeeding only conducted in Baucau Referral Hospital in the Out-Patient Department

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(OPD). Antenatal classes on breastfeeding were not found to be conducted in the Out-Patient

Department (OPD) in Dili National Hospital as this hospital only attends to referral cases from

community health centres and districts. The recommendation from Dr. Faridi is to delay

accreditation of each hospital under the Baby Friendly Hospital Initiative, until they have

improved their practices. Therefore, these two hospitals could not be accredited in 2010 as

planned.

For the effective implementation of BFHI, awareness-raising need occur among all workers at

these hospitals including security guards, cooks and cleaners. Therefore, in September,

Fundasaun Alola in collaboration with the Ministry of Health undertook to socialise the BFHI

for cleaners with objectives to promote, support and protect breastfeeding. The training was

attended by 35 cleaners.

With regards to fulfilling the criteria of BFHI, Fundasaun Alola, together with the Ministry of

Health, also conducted refresher training on Infant and Young Child Feeding over 3 days for

health workers in Baucau hospital. The training was attended by 14 people, 10 female and 4

female.

Assistance and Support at Hospitals To strengthen national programs on IYCF in Timor-Leste, Fundasaun Alola has initiated the

promotion of IYCF at Health Facilities by recruiting 10 people as MSG members and one

midwife working in the Dili National Hospital, Baucau, Maubisse and Oecusse referral

hospitals. The objective is to support the newborn care program that has been implemented

in the maternity ward, including the promotion of skin-to-skin contact and early initiation of

breastfeeding. The program provides information and comprehensive assistance to eliminate

barriers to successful breastfeeding during the mothers' and babies stay at the hospital, and

the distribution of Maternity Packs which provide clothing for mothers and babies, as well as

breastfeeding and other post-partum material information.

The table below shows data on the support provided by MSG at each Dili National Hospital,

and Baucau, Maubise and Oecusse Referral Hospitals in 2010.

No Activities Dili Baucau Maubisse Oecusse Total

1 Total number of mothers that

delivered in Hospital 4711 1195

272 258

6436

2 Total number of mothers that 70 1106 277 260 1713

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received maternity packs

3 Total number of babies born 4791 1135 280 246 6452

4 Babies sex

Female (F) 2286 576 139 117 3118

Male M) 2505 556 141 137 3339

5 Twins 80 53 6 4 143

6 Type of delivery

Normal 3922 987 208 223 5350

Caesarean 578 130 56 25 789

Forceps 28 3 - 3 34

7 Newborn Care and first initiation

Total number of babies that

received skin-to skin contact

Breastfeeding

3294 0

-

232

3526

Total number of mothers

received Breastfeeding

Counselling

4245 1195

261

193

5894

Total number of families that

received Breastfeeding

Counselling

5183 152

514

85

5943

8 Breast and Breastfeeding Problem

Inverted Nipple 73 2 - 5 80

Engorgement 29 0 1 9 39

No breastmilk 27 0 3 1 31

Mastitis 4 4 1 2 11

9 Obstetrics complications

Preeclampsia 17 3 5 3 28

Eclampsi 8 4 2 3 17

Sepsis/ infection 16 4 1 6 27

10 Abortion 732 69 18 12 831

11 Newborn Complication

Asphyxia 139 16 3 4 162

Premature 66 44 7 6 123

Jaundice 2 0 5 3 10

12 Mortality

Maternal Mortality rate 5 2 - 4 11

13 Neonatal mortality 24 0 1 0 25

14 IUFD (Intra Uteri Foetal Death) 117 33 9 14 173

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Breastfeeding Counselling at hospitals by MSG

To strengthen national programs on IYCF in Timor-Leste, Fundasaun Alola has initiated

the promotion of IYCF at Health Facilities by recruiting 10 people as MSG members

and one midwife working in the Dili National Hospital, Baucau, Maubisse and Oecusse

referral hospitals. The objective is to support the newborn care program that has

been implemented in the maternity ward, including the promotion of skin-to-skin

contact and early initiation of breastfeeding. The program provides information and

comprehensive assistance to eliminate barriers to successful breastfeeding during the

mothers' and babies stay at the hospital, and the distribution of Maternity Packs which

provide clothing for mothers and babies, as well as breastfeeding and other post-

partum material information.

The provision of breastfeeding counselling in health facilities is a

core initiative of the MCH program to support mothers with

successful breastfeeding. Support is provided to mother to put a

newborn baby directly on the breast to feed as soon as possible

after birth, as well as to take action when there is a problem for

breastfeeding mothers or their baby.

Family members, especially the women's husband, eldest

daughter, aunt and grandmother tend to be the people closest to the mother, who can then

support exclusive breastfeeding, and are thus also key targets for the distribution of

information and counselling about the benefits of breastfeeding for mothers, babies and

families.

In 2010, there were 5894 women and 5943 relatives’ families’ that received breastfeeding

counselling at Dili National Hospital, and in Baucau, Maubisse and Oecusse referral hospitals.

At Dili National Hospital, MCH staffs provide breastfeeding counselling in the Maternity,

Postnatal, Podiatric and Perinatology wards, and in other wards as requested or required to

provide assistance to mothers and babies who have problems with breastfeeding. The Staff of

the MCH program succefully addressed 44 instances of the bottle feeding that family

brought from home after provide counselling to mother and family to breastfeed.

Some breast problems that were successfully handled by the MCH staff in 2010 included 80

cases of inverted nipples, 19 cases of one breast inverted nipple, 39 cases of engorged

breasts, 31 cases of no breast milk, 11 cases of Mastitis and 6 cases of sore nipples.

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Maternal and Neonatal Mortality Rate and Stillbirth Data In 2010, 11 mothers died at these facilities as the result of childbirth - 5 at Dili National

Hospital, 4 at Oecusse and 2 at Baucaua Referral Hospital. There were no maternal deaths at

Maubisse Referral Hospital. The causes of these deaths are related to obstetric complications:

Preeclampsia and eclampsi, severe anaemia (with HB 2gr %), ruptured uteri with severe

anaemia, and severe anaemia with hypertension and infection.

Besides these deaths, there were 25 neonatal moralities; 24 at Dili National Hospital, and one

at Maubisse, though none at Baucau or Oecusse referral Hospitals. Case of neonatal mortality

related to Hydrocephalus, Premature, and miconium aspirasi with severe asphyxia. An

additional 56 stillbirth occurred, 33 at Baucau, 14 at oecusse and 9 at Maubisse referral

Hospital

Safe motherhood – Maternity Packs Distribution The Maternity Packs Project was initiated to increase the number of health facility deliveries

in Timor-Leste, as based on DHS that in 2003 it was only 9%. We believe that this project has

made a valuable contribution to increasing the number of facility-based deliveries to 22%, as

reflected in DHS 2009/10. The program has been evaluated internally and we trust that this

model will continue to encourage health facility deliveries.

In 2010, Fundasaun Alola expanded its program to two referral hospitals in Timor-Leste -

Maubisse Referral Hospital and Oecusse Referral Hospital. The distributions of the maternity

packs in these 2 hospitals also contributed to the gradual increase of deliveries in these

facilities. In 2010, the Ministry of Health assumed responsibility for distributing maternity

packs in Dili National Hospital.

Distribution Maternity Packs Data

Month Number of Women that Received Maternity Packs Baucau Referral Hospital Oecusse Referral Hospital Maubisse Referral Hospital

January 89 - - February 78 26 11 March 88 29 21 April 92 26 27 May 111 30 26 June 92 16 32 July 102 19 29 August 101 26 31 September 96 29 25 October 95 21 24 November 95 25 28 December 46 11 23 Total 1083 254 277

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Newborn Care – Breastfeeding Promotion Breastfeeding is a crucial component of newborn care. The first initiation of breastfeeding is

crucial to the ongoing successful breastfeeding. DHS data indicates that the prelacteal

feeding is reduced. In terms of newborn care, Fundasaun Alola is assisting midwifes at the Dili

National and Baucau Referral Hospitals to perform skin to skin contact after delivery, and help

with the first initiation of breastfeeding, with objectives to reduce infant mortality. Skin to

Skin contact is important because a mother’s chest can provide the optimal temperature for a

baby, and comfort for both the mother and baby. When a newborn baby licks its mother’s skin

it Swallows “safe” bacteria which colonises the baby’s gut to prevent “harmful” bacteria

growing. This further serves to stimulate uterine contractions to reduce bleeding and

Stimulates milk flow.

In Timor-Leste, skin to skin contact is only encouraged in two hospitals - Dili National Hospital

and Oecusse Referral Hospital, predominantly by Fundasaun Alola’s MCH staff working at these

hospitals. 3294 babies are detailed as having had skin to skin contact with their mother

immediately after delivery, and 1504 as unable to have skin to skin contact with their mother

because of the obstetrics and neonatal complications (at Dili National Hospital). At Oecusse

Referral Hospital, 232 babies received skin to skin contact with their mother immediately on

delivery.

Young Patients Play Room at Hospitals In December 2019, Supported by New Community Church, Fundasaun Alola in collaboration

with MoH have established 2 Play Rooms at Dili National Hospital and Baucau Referral

Hospital. Both play Room were inaugurate by Ms.

Madalena Hajan the Vice Minister of Health and Ms.

Kirsty Sword Gusmao , chairperson of Fundasaun

Alola. Representatives from MoH , Guard National

of Republican -Portugal who was donated the toys

for the Play room.

Play rooms provide a place in which parents and their

children who are under hospital care can access games, draw, tell stories, and watch

children's movies, after the children have a check-up from the doctors. The Play Rooms also

provide a location and forum in which to distribute information relating to breast feeding and

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complementary feeding. The Play Rooms are lead by the MSG members who have been

recruited as Alola employees at both of these hospitals. The play rooms have a very positive

impact in the hospital by helping parents entertain and engage with their children during

recovery time, and providing a place for children to become more relaxed. The Play Rooms

provide an outlet to assist parents to cope with their child's illness and are expected to

provide an example for the government for expansion in other hospitals in the future.

The objectives set out the Play Room at the hospital are:

To provide a well-equipped play room for parents and

children who come to the hospital, especially for those

who need to stay several days in the hospital during

recovery from illness;

Share and provide information on breastfeeding and

complementary feeding to mothers and family

members who bring their children to the play room,

especially for parents that their children in the

treatment of malnutrition;

Provide an opportunity to Mothers Support Group members (MSG) to work directly with

mothers to share knowledge that they have acquired as MSG members.

The total number of children that accessed the Dili and Baucau Hospital Play Rooms was 4953.

An additional 901 parents and family members received breastfeeding counselling at Dili

National Hospital.

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MCH Community-based Program activities

Expansion of the MSG and SHIO to 15 Villages in 7 Districts

Fundasaun Alola, with the support of UNICEF, Moreland Community Health Services, ENI and

Gulbenkian Foundation, extended its MSG and SHIO for promoting infant and young child

feeding, safe motherhood, newborn care, and family planning. MSG and SHIO groups have

been established across 16 villages in 7 districts: Viqueque, Baucau, Manatuto, Oecusse,

Lautem, Aileu and Ainaro.

The details of the establishment process are described below:

1.Consultation and Socialisation

Upon identifying potential villages in which to establish MSGs and SHIOs, the MCH team

conducted consultation meetings with district authorities, especially District Administrator

and the head of District Health Services, heads of district MCH and nutrition. The village

selected needed to fulfil specific criteria, including the availability of a village midwife and

the willingness of the community leader to participate in the establishment processes. The

Consultation meetings were held in January to April 2010.

Following consultation with district authorities, the MCH team contacted the chief of the

selected villages, organized meetings to inform them about the program, and organized

community members to attend the program socialisation meeting in the community.

Socialisation activities were implemented with the assistance from village chiefs, who invited

community and community leaders from each hamlet to the meeting. The meetings held in

each village maintained a key objective to select and identify community members who are

willing to actively participate in MSGs. After the selection of the members, the groups were

invited to discuss and nominate an individual to become the local facilitator. These members

attended training in participatory problem analysis to enable them to facilitate PPA workshop

in their community.

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The details of consultation and socialisation meetings are shown below:

No District Sub-district Villages Activities Total Participants Date of the

socialisation

1 Oecusse Pante

Makasar

Costa –

Kutete

Socialisation 22 people 22-23.4.2010

Cunha Socialisation 19 people 24-25.4.2010

Lifau Socialisation 21 people 16.4.2010

and

19.4.2010

Oe-Silo Bobometo Socialisation 26 people 20-21.4.2010

2 Manatut

o

Manatuto

Vila

Cribas Consultation meeting with

district authorities

13.4.2010

Socialisation to community 34 people include

midwife

16.4.2010

Laclubar Manelima Consultation with sub-

district authorities and

community leaders

14.4.2010

Socialisation to community

groups

31 people include

midwife

22.4.2010

3 Baucau Venilale Uma Ana

Ulo

Coordination with district

authorities and community

leaders

15.4.2010

Socialisation to community 22 people include

midwife

19.4.2010

Vemasse Loilubu Coordination meeting with

community leaders

15.4.2010

Socialisation to community 25 people include

midwife

20.4.2010

4 Viquequ

e

Lacluta Dilor Socialisation to community 23 people 30.4.2010

Ossu Ossu decima Socialisation to community 25 people 01/05/10

5 Laut

em

Lospalos Leuro Socialisation to community 20 people 1/06/2010

Tutuala Tutuala Socialisation to community 25 people 3/06/2010

Lautem Maina II Socialisation to community 40 people 7/06/2010

6Ainaro Ainaro Vill kassa Socialisation to community 20 people 20/4/2010

7 Laulara Madabeno Socialisation to community 30 people include

Chefe Suku

9/10/2010

Remixio Maumeta Socialisation to community 18 people include

Chefe Suku

22/10/2010

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2. Participatory Problem Analysis (PPA) Training of Trainer for Village Facilitators

To empower community members and to enable them to facilitate maternal and child health

participatory problem analysis workshops in their villages, the Alola MCH team conducted 3

days ToT in PPA for the village facilitators. The training was held in Dili, from 3 to 5 May 2010.

Fourteen participants representing 10 villages attended the training. There were seven

female participants and seven male participants. The training covered facilitation skills,

social mapping, history of the obstetric and childhood illness it also covered general cases of

emergency, and identifying gendered domestic activities as means of assessing gender

discrimination occurring in communities that might also contribute to the poor health of

women during the maternal period.

The participants expressed that they were feeling pleased at acquiring new knowledge and

skills which they would not ordinarily have access to in their village. They committed to

contributing to the implementation of the program in their villages.

Details of the facilitator Village for participatory program analysis (PPA)

No District Sub-district

Villages/Hamlets Participants Date of training Female Male Total

participants 1 Oe-cusse Pante

Makasar Kutete 1 1 2 people 3 - 5 May

2010 Lifau 1 1 2 people Cunha 1 1 2 people

Oesilo Bobometo 1 1 2 people 2 Manatuto Manatuto Cribas - - -

Laclubar Manelima 1 1 2 people 3 Baucau Venilale Uma Ana Ulo 1 1 2 people

Vemase Loilubu - - -

4 Viqueque Lacluta Dilor - - - Ossu Ossu de Cima 1 1 2 people

5 Lautem Lospalos Leuro 1 1 2 people Tutuala Tutuala 1 1 2 people Lautem Mahina II 1 1 2 people

Total 20 people

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3. Participatory Problem Analysis Workshop with Community

Members PPA workshops were held in villages to identify the main problems faced by the community

regarding maternal and child health. The PPA involved communities to actively identify the

problems faced by their community, and the actions taken by

community in the past. This provides opportunity to identify

other factors which contribute to maternal and child health

morbidity and mortality, including the workload of women,

and gender discrimination between women and men.

The PPA workshop serves to raise community awareness about gender equality and enabled

community to identify stakeholders with whom they can work in the community in regard to

health. Workshop participants were able to develop a morbidity map to represent the referral

mechanism that should be in place, as well as health assistance that they could access both

within and outside their villages.

The details of PPA workshop in every village are shown below:

No District Sub-district Villages Activities Participants Female Male Total

Participants 1 Oecusse Pante Makasar Costa –

Kutete PPA Workshop

11 9 20 people

Cunha PPA workshop

11 10 21 people

Lifau PPA workshop

10 11 21 people

Oe-Silu Bobometo PPA workshop

14 6 20 people

2 Manatuto Manatuto Vila Cribas PPA workshop

25 13 38 people

Laclubar Manelima PPA workshop

14 18 32 people

3 Baucau Venilale Uma Ana Ulo

PPA workshop

11 12 23 people

Vemasse Loilubu PPA workshop

16 7 23 people

4 Viqueque Lacluta Dilor PPA workshop

12 11 23 people

Ossu Ossu decima PPA workshop

22 10 32 people

5 Lautem Lospalos Leuro PPA workshop

12 6 18 people

Tutuala Tutuala PPA workshop

13 9 21 people

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Lautem Maina II PPA workshop

22 11 33 people

6 Ainaro Ainaro Villa Kassa PPA workshop

9 5 14 people

7 Aileu Laulara Madabeno PPA workshop

16 6 22 people

Remixio Maumeta PPA workshop

12 6 18 people

Total participants 218 141 359 people

4. Workshop on Structure, Regulation and Socialisation of the Group Following the PPA community workshop, the Alola-MCH team conducted another workshop to

discuss the structure and regulation for the groups and villages.

The structure related to selection of the head of the group and determining which networks

needed to be established in the community. In the 10 villages, the communities decided to

have networks such as:

1) Notification, Health Promotion Network and Family Planning Network;

2) Fundraising Network; and

3) Transportation Network.

The regulation component was used to regulate the MSG/SHIO group and community that

support the group. This regulation includes behaviour change strategies and goals, such as

encouraging every woman to exclusively breastfeed for

the first six months, attend ANC, PNC and delivery at

health facilities and/or assisted by health workers, and

using the family planning methods for birth spacing.

Regulation also governs fundraising within community,

which is contributed to by every household, and transport

support for women who will need it in the event of an emergency.

Regulations are then socialised to the community and may be revised according to community

input. On completion of this process, inauguration of the program occurred at Mass or another

cultural event.

Details on the structure and regulation of workshops:

No District Sub-district

Villages/Hamlets Participants Date of training Female Male Total

participants 1 Oe-cusse Pante

Makasar Kutete 11 9 20 people 5 – 8 July

2010

19

Lifau 12 8 20 people 12 – 15 July 2010

Cunha 13 11 24 people 22 – 26 July 2010

Oesilo Bobometo 15 6 21 people 16 – 20 July 2010

2 Manatuto Manatuto Cribas 31 7 38 people 24 – 27 July 2010 Laclubar Manelima 21 7 28 people

3 Baucau Venilale Uma Ana Ulo 9 11 20 people 31 Aug – 3 Sept 2010 Vemase Loilubu 13 5 18 people

4 Viqueque Lacluta Dilor 10 12 22 people 19-22 July 2010 Ossu Ossu de Cima 21 16 37 people

5 Lautem Lospalos Leuro 6 12 18 people 5 – 8 July 2010

Tutuala Tutuala 13 9 21 people 19 – 22 July 2010

Lautem Mahina II 22 11 33 people 12 – 15 July 2010

6 Aileu Laulara Madabeno 16 6 22 people 8 – 11 November 2010

Remexio Maumeta 9 5 14 people 9 – 12 November 2010

7 Ainaro Ainaro Villa Kassa 12 6 18 people 26 – 29 April 2010

Total participants 234 141 375

5. Inauguration Inauguration is the final stage of establishing the new MSGs/SHIO program. The inauguration

ceremony were planned to implement through the celebration of Mass or another cultural

ceremony. In these 10 villages, some groups agreed to use a Mass celebration and other used a

cultural ceremony. Inauguration was held to strengthen the commitment of the members who

are joining the group.

In Oecusse district, inauguration activities were officially

opened by the Oecusse District Administrator and attended by

UNICEF, District Health services, Fundasaun Alola, Community

Leaders, NGOs and coordinators of rural area development

from the Ministry of Development and Economy. In his speech

the District Administrator encouraged community leaders such

as heads of sub districts, villages and hamlets to work

together with community volunteers to increase community

awareness of the importance of exclusive breastfeeding for first six months, giving birth with

20

a skilled birth attendant, and promoting use of health facilities.

The details of the inauguration ceremonies are shown below:

No Distritu Sub-distritu Suku Partisipantes Data Inagurasaun

1 Oecusse Pante Makasar Costa – Kutete 48 people 4 Junho 2010

Cunha 75 people 7 Junho 2010

Lifau 36 people 8 Junho 2010

Oe-Silu Bobometo 88 people 3 Junho 2010

2 Manatuto Manatuto Vila Cribas 67 people 10 Junho 2010

Laclubar Manelima 87 people 10 Junho 2010

3 Baucau Venilale Uma Ana Ulo 75 people 17 Junho 2010

Vemasse Loilubu 49 people 17 Junho 2010

4 Viqueque Lacluta Dilor 96 people 01 Julho 2010

Ossu Ossu decima 56 people 02 Julho 2010

5 Lautem Lospalos Leurio 22 people 10 June 2010

Lautem Mainha II 24 people 14 June 2010

Tutoala Tutuala 35 people 17 June 2010

6 Ainaro Ainaro Villa Kassa 26 people 22 April 2010

7 Aileu Remixio Maumeta 27 people 25 october 2010

Laulara Madabenu 35 people 27 0ctober 2010

Total 846

IYCF, Safe Motherhood, Newborn Care and Family Planning Training

to New MSG Members

To enhance the knowledge and skills of the MSG members

in Viqueque, Baucau, Manatuto and Oe-cusse District

Fundasaun Alola conducted four days training on infant

and young child feeding, safe motherhood and family

planning to the members of the MSG in 10 villages across

four districts. Infant and young child feeding training

consists of 18 sessions include breastfeeding,

complementary feeding, counselling skills and infant feeding in emergency situations, as

well as maternal nutrition.

The Safe Motherhood training covers the importance of

antenatal care, advantages of delivery at facilities and

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postpartum care as well as recognizing danger signs during pregnancy, childbirth and

postpartum. The family planning training is about types of modern contraceptives, natural

contraceptives, and the advantages and disadvantages of each contraceptive method. This

knowledge will help the MSG members to provide counselling to women and their families

and disseminate information to their village communities.

Details of the training are shown below: No District Sub-district Villages/Hamlets Participants Date of training

Female Male Total participants

1 Oe-cusse Pante Makasar

Kutete 11 9 20 people 5 – 8 July 2010 Lifau 12 8 20 people 12 – 15 July 2010 Cunha 13 11 24 people 22 – 26 July 2010

Oesilu Bobometo 15 6 21 people 16 – 20 July 2010 2 Manatuto Manatuto Cribas 31 7 38 people 24 – 27 July 2010

Laclubar Manelima 21 7 28 people 3 Baucau Venilale Uma Ana Ulo 9 11 20 people 31 Aug – 3 Sept

2010 Vemase Loilubu 13 5 18 people 4 Viqueque Lacluta Dilor 10 12 22 people 19-22 July 2010

Ossu Ossu de Cima 21 16 37 people 5 Lautem Lospalos Leuro 12 6 18 people 14-17/06/2010

Tutuala Tutuala 13 9 21 people 21-24/06/2010 Lautem Maina II 22 11 33 people 28- 30/06/2010

6 Ainaro Ainaro Villa Kassa 12 6 18 people 26-29/04/2010 7 Aileu Laulara Madabeno 16 6 22 people 8 -11/11/2010

Remixio Maumeta 9 5 14 people 8 – 11/11/2010 Total participants 240 134 374

MSG Counselling Activities at Health Facilities and Integrated

Community Health Service ( Servisu Integradu Saude Comuitaria = SISCa)

Post A part from doing counselling at to the MSG member’s household, the members also provide

counselling at health facilities and post SISCa nearby their group. The Alola MCH team and MSG

members have a good collaboration and work coordination with CHC and Health workers in each

district regarding the counselling activities. The schedule for health centre prepared by

MSG/SHIO but for the SISCa is timetable from the health worker.

The beneficiaries for the counselling are pregnant and lactation women and fathers who brought

their children for immunization. Counselling occurred twice a week at health facilities and once

a month at SISCa Post.

In 2010, the MSG/SHIO members have able to counsel 4214 Pregnant and 5313 lactating women

on breastfeeding and complementary feeding, across ten districts.

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The details of the counselling are represented in the table below

No Districts Counselling location Health Facility (Hospital,

CHC and HP SISCa Post

Pregnant women

Lactating women

Pregnant women

Lactating women

1 Dili 895 113 35 213 2 Baucau 858 1675 144 448 3 Manatuto 306 330 57 141 4 Oecusse 601 256 84 265 5 Viqueque 225 418 - - 6 Lautem - 25 80 256 7 Liquisa 138 126 75 145 8 Ermera 216 97 - - 9 Aileu 92 143 15 43 10 Ainaro 312 396 81 213

Total 3643 3589 571 1724

Monthly Community Discussion Forum

Monthly Community Discussion Forums are a new strategy developed by Alola's MCH team to

disseminate information on Infant and Young Child Feeding, safe motherhood, family planning

and reproductive health as well as other health

information to communities

The topics discussed in the community forum relate to

various health topics including communicable & non

communicable diseases, reproductive health, hygiene,

nutrition and so on. The community has expressed it is

very interested in this activity, as the meeting provide an

opportunity for them to receive information and discuss

any concerns. Typically, communities have requested health-related topics of interest for

discussion at future meetings. Monthly discussion forums were held in different hamlets

across 10 districts. The Fundasaun Alola and MSG members were able to facilitate

community discussions in the 53 groups of the 57 villages that established MSG/SHIO

groups in across 10 districts with approximate 500 community members.

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Monthly Meeting with Mother Support Group and Suku Hadomi Inan no Oan = Village love its Mother and Children. Every month MSG and SHIO members met up regularly with the Alola staff in ten districts. The

topics been discussed in the meeting is vary as chosen by the different group members and the

schedule of the meeting was decided based on the

request from the members. The opportunity also

been used by the Alola staff to review the

activities conducted by the members, sharing

experiences, collect the community based data

and to visit households. Apart from that during the

meeting the staffs also discuss the obstacles faced

by the members in both facility and community

level such as how encourage and ensure a pregnant

women take iron tablet and having regular Ante

Natal care to the health facility or SISCa Post. Each monthly meeting were lead by either

program officer or Field Officer who responsible for the District. The strategy of Fundasaun Alola

for future monthly meetings is to develop a monthly meeting agenda and encourage the group to

facilitate the meeting with attendance of MCH staff, to enable the group to learn how to

organize and facilitate a meeting, and be independence in the future.

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Celebration of Timor-Leste National Breastfeeding Months Internationally, the first week of August is celebrated as World Breastfeeding Week; however, in

2010 the Ministry of Health's nutrition department decided to promote breastfeeding around

Timor-Leste throughout August.

Activities conducted by Alola during National Breastfeeding Week and the rest of the month

were:

Seminar on Breastfeeding

In 2010, for the first time, Fundasaun Alola and the Association of Timorese Doctors initiated a

seminar on breastfeeding for doctors and women’s organisations. The seminar was held on 6th

August 2010 and attended by approximately 40 participants. Prof. M. M. A. Faridi, course

director of Infant and Young Child Feeding, spoke at the seminar, on topic relating to infant

feeding, breastfeeding policy, the international code of breastmilk substitutes marketing, and

the Baby Friendly Hospital Initiative. The seminar concluded with a Question and Answer session

and received good feedback from participants. It provided a good forum for advocating

breastfeeding policy and promotion in Timor-Leste, and will therefore look to become an annual

event for raising awareness about the importance of breastfeeding for reducing under five age

malnutrition and child mortality, as well as improving the health status of infants and young

children in Timor-Leste.

Healthy Baby Contest

The second activity conducted by Fundasaun Alola during

National Breastfeeding Month was a Healthy Baby Contest,

which provided a forum for the dissemination of breastfeeding

information and hygiene promotion to communities in 10

districts. The objective of the healthy baby contest is to

encourage all mothers to exclusively breastfeed their babies

for the first six months, to take the baby to health facilities or

SISCa post for monthly weighing, and to improve the infant and young child feeding

practices.

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665 were babies entered and 293 babies were selected as winners of the contest, based on five

criteria:

1. Exclusively breastfed for their first six months;

2. Had undergone regular weighing and growth well as

evidenced in their growth chart;

3. Had receive all vaccinations at the correct age (DPT3

for > 9 months and measles < 9 months);

4. Was born at a health facility; and

5. Could demonstrate good hygiene.

The winning babies received a prize from Fundasaun

Alola. The event was attended by 1338 people including community leaders, district

authorities and communities.

Details are shown below:

No

MSG/SHIO Locations

District No of Baby participants in contest

Number of Babies that fulfilled the criteria

Number of community participants

Total Attendees

Details

Female

Male

1 MSG Nipane Oecusse 21 10 22 12 34 2 MSG Bausiu 14 8 29 4 33 3 MSG

Naimeco 19 9 38 10 48

4 MSG Tenae 12 7 37 5 42 5 MSG Oe-sono 15 9 33 8 41 6 MSG Oelulan 20 8 45 10 55 7 Ponilala Ermera 25 10 35 12 47 8 Gleno 30 10 45 5 50 9 Railaco 10 9 15 1 16 10

Dato Liquisa 20 10 29 7 36

11

Tibar 40 10 66 6 72

12

Mota-ulun 50 9 90 7 97

13

Guico 20 10 15 9 24

14

Baucau I & II Baucau 13 7 31 9 40

15

Baguia 19 9 23 6 29

16

Lavateri 9 4 23 8 31

17

Quelecai 9 5 18 8 26

1 Laga 11 6 18 5 23

26

8 19

Venilale 19 9 25 6 31

20

Vemase 9 5 23 6 29

21

Triloka 23 12 24 10 34

22

Viqueqeu Viqueqeu

37 20 47 4 51

23

Lacomesak Manatuto

15 10 20 9 29

24

Manatuto Vila

24 14 23 6 29

25

Batara 84 13 50 9 59 29 babies were identified as malnourished based on their growth chart

26

Aiturilaran Dili 25 20 70 10 80

27

Becora 30 10 66 3 69

28

Beto 15 10 54 7 61

29

Bebonuk 12 10 60 1 61

30

Aimutin 15 10 59 2 61

Total Number 665 293 1133 205 1338

Breastfeeding Quiz In 2010, Fundasaun Alola celebrated National Breastfeeding Month by conducting a

breastfeeding quiz in 10 villages in which new

Mother Support Groups and SHIO groups had been

established. The quiz was conducted as part of

information dissemination at the community level.

The breastfeeding quiz involved members of the

MSG and SHIO groups and was attended by

approximate 500 people. The quiz was used as a

mechanism to disseminate information on

breastfeeding to community members that attended. The team than won the quiz

received a prize from Fundasaun Alola.

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Hygiene Kits Distribution Concurrent with World Breastfeeding Week, Fundasaun Alola took the opportunity to undertake

hygiene promotion with the objective to educate communities on how to prevent some

communicable diseases. The hygiene promotion emphasised the importance of washing hands

and brushing teeth. Along with community education, Alola distributed hygiene kits, donated by

volunteers from Australia, to 2000 adults.

The CMAM Training

The Community Management of Acute Malnutrition (CMAM) is one of the key national priorities

identified by the Department of Nutrition to be achieved in 2010. The Alola Foundation is

assisting the Ministry of Health and Department of Nutrition to extend the nutrition program to

other districts. For the first three months, the Alola Foundation is assisting MoH to conduct

CMAM socialisation for community leaders, CMAM training for PSF and health workers in 3

districts - Viqueque, Aileu and Ainaro.

During the first three months, Alola was only able to provide training for the Oecusse MSG, which

was attended by 45 members. The training was conducted in 3 different locations - Sakato, Oe-

Sono and Baqui. Fifteen MSG members attended the CMAM training in each location.

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Exclusive Breastfeeding supported by MSG/SHIO member

The Global Strategy on Infant and Young Child Feeding (WHO, 2002) details that, 'Exclusively

breastfeeding' means giving the infant nothing but breast milk (no water, no other liquids or

foods) from 0 to 6 months.

To support this, the initial actions of MSG/SHIO members were to provide counselling to women

on exclusive breastfeeding for the first six months. As a result, their involvement contributes

significantly to the development of the health

sector in Timor-Leste. Based on the 2003

Demographic Health Survey, 30% of babies

were exclusively breastfed for the first six

months, whereas the 2009-10 survey revealed

this to be 52%. A large number of exclusive

breastfeeding mothers became members of

the MSG/SHIO and in turn provided

breastfeeding counselling to their friends.

Mothers reported that exclusive

breastfeeding requires ongoing support from family, husbands and neighbours so mothers

could not be influenced to give other food and drinks to their babies before 6 months of

age.

Details are shown below:

No District Total area of the MSG/ SHIO group

Total of exclusive Breastfeeding babies

1 Baucau 17 60 2 Lospalos / Lautem 3 106 3 Viqueque 3 18

4 Manatuto 5 12 5 Dili 5 60 6 Aileu 3 15 7 Ainaro 4 30 8 Liquica 4 24 9 Ermera 3 51 10 Oecusse /Ambeno 10 67 Total 57 villages 443

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Referrals Cases by MSG/SHIO Member to Health Facilities Training on IYCF, Safe Motherhood, new born care, family planning and the Management of Acute

Malnutrition to MSG/ SHIO members was undertaken in order to improve their knowledge and

experience identifying danger signs in pregnancy, childbirth, post-partum, and improve their

capacity to refer women to health facilities as required. MSG/SHIO members also provide advice

to breastfeeding mothers who have recommenced menstruation to go to CHC to obtain

contraception from the midwife and understand the importance of birth spacing.

In Oecusse district, Oelulan SHIO members also identified children

aged under 5 years who are malnourished for referral to the CHC.

The CHC is able to provide malnutrition treatment with

supplementary food such as plumpynut.

The SHIO members then assisted and monitored the child for a

three month period to help parents understand how to administer

plumpynut to their child until they return to a healthy weight. The families of identified

children have expressed that they are very happy to have their children healthy again, and they

value the presence of the SHIO members that assist them in addressing their children's

malnutrition.

Details are shown below:

No District Cases Safe Motherhood family Planning Malnutrition

1 Baucau 69 25 5 2 Lospalos / Lautem 20 15 - 3 Viqueque 52 23 5 4 Manatuto 19 18 8 5 Dili 25 - 3 6 Aileu 78 36 - 7 Ainaro 12 17 - 8 Liquica 7 10 5 9 Ermera 5 11 3 10 Oecusse /Ambeno 10 Not reported 5

Total 297 155 34 people

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Harmonia Iha Famailia This project reflects a partnership between the Psychiatry Research and Teaching Unit,

University of New South Wales and the Alola Foundation Timor Leste. The project is supported by

a grant from the Australian Research Council (ARC). We designed the research project with the

Alola Director and staff from the Maternal and Child Health Unit. We have consulted with a

network of women's agencies and this network was involved in information sharing sessions and

cross checking of findings.

The naturalistic research approach was suitable to follow-up the findings of a previous

epidemiological mental health study (known as ETMHENS study), particularly the common

experience of anger amongst women that was considered problematic to the woman or her

family (Silove et al 2009).

A mixed methods approach was employed to recruit women from the existing ETMTHENS

epidemiological data base, in essence, following up women five to six years later. From the

database of 664 women participants, 177 were identified at baseline with anger (Silove et al

2009). We interviewed a sample of these women, half from rural Hera and the other half from

urban Becora. We also interviewed a smaller sample of women who did not have anger in the

ETMHENS study to allow for the examination of changes in anger status across time.

Phase 1 of the research involved the application of semi-structured exploratory in-depth

interviews.

Phase 2 used a more structured approach, based on knowledge gathered in an iterative

fashion from Phase 1.

The final phase involved a focus group with staff members in NGOs and other agencies

specifically working with women. These expert informants reflected on the causes

and manifestations of anger observed from our interviews with women, and from

their direct experiences with women they assist and support. The focus group

considered the possible causes, perpetuating and protective factors, and the

familial and social consequences.

We are currently analysing the data. Overall, there appears

to be a degree of improvement in women’s level of anger

over time although this trend needs to be confirmed by the

ongoing analysis. Nevertheless, anger and its manifestations

continue to present a major problem for women and their

families. Early insights suggest that a complex pattern of

disadvantage and distress lead at times to severe

31

manifestations of anger and frustration. Relevant factors include past trauma and loss, current

socio-economic hardship, and changes in expectations in relation to traditional roles. These

factors are impacting on women and their relationships, their capacities to parent and support

the family, and their ability to engage more effectively in existing (or future) opportunities

related to the development of Timor Leste.

We will be publishing reports on our research findings which will be widely circulated and

discussed with the view to developing a strategy to translate findings into policy, interventions

and existing programs during 2011 and 2012.

E.Professional Development for Alola’s Staff The following professional development was undertaken by Alola MCH staff through 2010:

Infant and Young Child Feeding Training

Newborn care training

Two week intensive English Course

Attending International Event

Complementary Feeding Promotion to reduce stunting

Advocacy enhancement

UN Conference

A call to an End to baby Infant food Promotions in Jakarta (supported by IBFAN)

F.Lessons Learned Two key lessons were learned during the implementation of projects in 2010:

1. The consultation and socialisation processes at the district level.

This process is very helpful because of the involvement of district leaders to determine

which remote villages cannot access health facilities (because of bad roads or rain that

prevents health workers from reaching a community) and would benefit most from having

MSG/SHIO groups established to enable communities to help each other to seek health

care if there are mothers and infants who need emergency assistance at a health facility.

32

2. Midwife expectation of Alola staff presence at health facilities.

Midwives at the Dili National Hospital, Baucau, Maubise and Oecusse have come to expect

the presence of Fundasaun Alola’s staff at all times, but due to closure of the Fundasaun

Alola office in Dili over Christmas and on other holidays, Alola staff are not always

available to support. Without their presence at the hospital, some midwives have

expressed they feel overwhelmed because of the breadth of their responsibilities.

Midwives have said they are contacted by husbands and families about such problems as

babies crying due to a lack of Breast milk; jaundice; breast engorgement or pain, and so

on. Midwives do not have enough time to be able to help mothers and babies immediately

after birth because the number of midwives is limited. When midwives are supported and

have time to provide thorough counselling to the mother and can observe her and the

baby during breastfeeding, problems can be identified and addressed early on. In order to

minimise breastfeeding problems occurring with mothers and babies, Alolo’s MCH staff

reschedule their holidays to ensure midwives are consistently supported to meet

community needs.

G. Closing Remarks On behalf of Fundasaun Alola’s Maternal and Child Health Program team, I would like to

offer our sincere gratitude to the donors who have kindly provided financial, technical and

moral support to us in 2010. The support of our donors and partners has assisted us to

conduct Facility-Based Activities and Community-Based Activities in 10 districts,

particularly in remotes areas across in Timor-Leste.

We particularly appreciate the understanding and flexibility of our donors that has allowed

for changes during program implementation to ensure best possible results.

We look forward to continuing to work with the MoH and all stakeholders to further extend

and expand MCH’s program activities in Timor-Leste’s districts, to improve the practice of

Infant and Young Child Feeding in Timor-Leste, and therefore to assist in the reduction of

malnutrition and child mortality in Timor-Leste.

In 2010 Fundasaun Alola’s MCH Program required a significant amount of support from our

donors to sustain and expand existing activities to an increased number of hospitals and

33

villages. With their support, we have had a successful year promoting Safe Motherhood

through distribution of maternity packs at health facilities and Infant and Young Child

Feeding at community-based group, and can see improvements in maternal and child

health status in Timor-Leste. We look forward to continuing this work in 2011.

Kind Regards,

Angelina Fernandes

Maternal and Child Health Program Manager

Fundasaun Alola