West Timor is one half of the island of Timor and forms part of the province of Nusa Tenggara Timur (NTT) within the Indonesian archipelago. The other half of the island is East Timor which became independent in 2002. West Timor has a population of approximately 2 million, 30% of whom live below the poverty line.
Among lowest maternal mortality rates in country
As one of the poorest regions in the country, In the district where we work, Timur Tengah Selatan (TTS), maternal mortality rates (MMR) in 2014 remained high at 290 per 100,000 live births. The under 5 mortality rate in NTT was 14.8 per 1,000 live births and in the TTS district in 2014, from 8,000 pregnancies, there were 130 stillborn babies and 85 neonatal deaths. The 4 main contributing factors to the high mortality rates here are: long distances and bad roads to access healthcare facilities, lack of transport, high transport costs and high living costs for care-givers at health clinics and at home and traditional beliefs and practices, for example neonatal respiratory problems caused by the traditional practice of keeping newborn babies in smoke-filled traditional houses as a means to keep them warm.
Challenges for healthcare providers
In rural communities in the TTS district, most sub-districts offer a primary healthcare centre (Puskesmas) in larger, more accessible villages, with up to 2 basic healthcare units (Puskesmas Pembantu/Pustu) serving remote villages. In TTS, there are 63 Puskesmas Pembantu of which only 42% have assigned trained healthcare workers, many of whom are based at the Puskesmas due to lack of resources and long distances.
Our proposal is to pilot a programme across 3 sub-districts in TTS (Amanatun Selatan, Amanuban Selatan and Amanuban Barat) to address the lack of accessible trained healthcare workers in Puskesmas Pembantu in areas with high levels of maternal and child mortality. Our approach is to match local, young, trained midwives with each Puskesmas Pembantu.
Challenges for pregnant mothers
Many pregnant women do not attend ante-natal checks and/or do not deliver at the Puskesmas because of long distances and, in some cases, dangerous roads. Transport options are limited to 1-2 hour motorbike ride over bad roads or walking for at least 1 hour to wait for a bus that then takes a further hour to reach the primary healthcare centre. In the rainy season, both options are more challenging and lengthy. As a consequence, many pregnant women do not have regular ante-natal checks and are often forced to deliver at home without skilled birth attendants.
FMCH Indonesia is working to support pregnant mothers and their families
To continue our work to improve the health of mothers and children in NTT, we offer
- Pregnancy Support programme to pregnant women in target areas. This programme includes ante-natal checks, health & nutrition education relating to pregnancy, cooking classes and pregnancy exercise
- Health Education programme to mothers of children under 5 with health & nutrition education for mothers to improve their knowledge and change behaviour to prevent the main causes of child mortality in the area, diarrhea, life-threatening fevers and respiratory problems
- Development of a partnership model for Community Health Workers-Traditional Birth Attendants-Midwives to ensure sustainability and development of improved healthcare service for pregnant women and newborn babies in hard-to-reach areas in NTT
Challenge to access pre-school education
Since 2008, as part of our aim to improve primary school enrolment rates and improve the education foundation of children in isolated, rural communities, we have supported 7 Early Learning Centres (ELCs) helping at least 150 children per year to prepare for primary school. Our support helps fund teachers’ salaries (just $9 per month per person), educational materials, basic equipment, and teacher training.
In November 2014 a refresher training course was held for the teachers. 13 teachers from 6 ELCs participated in the training which covered revised curriculum and indicators.
We are working to provide more health services to the children. In 2013 and 2014, we held several health education sessions in each ELC, focusing on personal hygiene (nail cutting). In 2015, we are planning to carry out medical checkups for the children, as well as deworming treatment twice a year.
East Nusa Tenggara: Training for Community Health Workers
To help combat lack of access to health and nutrition services, in 2013 and 2014, we trained nearly 100 Community Health Workers (CHWs) from 5 villages in the region: Anin, Oinlasi, Nifuleo, Toi and Sunu with the indirect benefit of providing health and nutrition support for over 1500 families.
Topics covered included: the role of CHWs in delivering health education, anthropometry – the theory and practice of weighing and measuring children, completing accurate measurement charts, and nutrition. In 2014, we have been requested by the local health office to continue to provide training for the community health workers.