Supporting the Promotor Saude Familiar Family Health Promoters Program in TimorLeste

1
Supporting the Promotor Saude Familiar (Family
Health Promoters) Program in Timor-Leste

• Paul Vasconcelos, BS (candidate)
• Health Alliance International, Dili, East Timor

2
Background

• 2006MOH piloted community volunteer program
• Political instability in country impeded pilot
  phase
• 2008Country-wide implementation
• HAI adapted workplan to support efforts of the
  MOH

3
Promotores Saude Familiar (PSF) Program

• Minimum of 3 volunteers per village
• Rapid expansion from pilot of 450 PSF to 1500
  nationwide within a year
• PSF work approximately 4 hours/week
• PSF do home visits and assist with outreach
  services provided by health staff

4
PSF Volunteers
5

• Limitations
• The initial training curriculum in maternal
  health was inadequate
• Lack of appropriate health education tools for
  use by the volunteers
• Material development
• Photocards for PSF use
• Posters for distribution to pregnant women to
  hang in their homes
• Training on the use of the tools

6
Mai Ita Koko Come, Lets try

• Focused on 6 key behaviors that addressed
  identified gaps
• Early antenatal care
• Developing a birth plan
• Delivery with a SBA
• Giving colostrum soon after birth
• Early postpartum check for mom and baby
• Child spacing

• Messages and images are
• Simple
• Clear
• Culturally relevant
• Choice- and action-oriented

7
Photo Card 3 Clinic Birth with Skilled Birth
Attendant
8
Photo Card 4 Home Birth with Skilled Birth
Attendant
9
Photo Card 5 Giving Colostrum
10
Poster I would like to try.
11
Implementation Process

• 35 PSFs trained in 2 pilot sites
• Links between PSF and health staff encouraged
• HAI staff provided supportive supervision and
  capacity building for PSFs

12
Data Collection

• Evaluation designed and assisted by UW MPH
  student
• Data collected July 2008, approx 7 months after
  implementation
• Interviews (27) and focus group discussions held
  with mothers, PSF, and health staff
• Health clinic records
• ? Antenatal visits ? Facility-based
  births
• ? Home birth with SBA ? Post-partum checks

13
Qualitative Results

• PSFs effectively use health promotion tools and
  carry out home visits
• Women are selecting and often achieving behavior
  change goals
• Supervision visits from HAI staff lent
  credibility to PSFs in the eyes of mothers
• PSFs value the supervision and coaching and would
  like it to continue

14
Quantitative Results Fahisoi
15
Quantitative Results Guico
16
Contributing Factors to Program Success

• Strong local political support
• PSF used in a variety of village activities
• Strong relationship between health staff, PSFs
  and community
• Consistent availability of staff at the health
  facility

17
Lessons Learned 1

• Having simple, culturally relevant health
  promotion tools encouraged the PSF to carry out
  home visits in their community
• PSF appreciated the interactive style that was
  used for training on the use of the tools
• Community-level behavior change can be achieved
  through a PSF home visit model

18
Lessons Learned 2

• Active links between the PSF and local health
  staff are essential
• Supportive supervision visits for PSFs enhances
  their work and the likelihood of successful
  outcomes
• Quality services and 24 hour access must be
  assured

19
Value of early evaluation

• Lessons learned were used to adapt and improve
  the training module on the use of the tools
• Lessons learned from the pilot experience have
  also contributed to development of support
  systems for the PSF program
• MOH has a health education tool as well as a
  training module that will be used nationwide

20
Obrigadu!