What is the problem?
East Timor is the most undernourished country in Asia[1] and was recently listed as the second ‘hungriest’ nation in the world on the Global Hunger Index[2].
The Demographic Health Survey (2016) reported rates of stunting (failure to reach expected height) at 46% among children under five, and wasting (dangerously underweight) at 24%. That means almost half of Timor-Leste’s children will suffer the life-long consequences of undernutrition, and a quarter of children under five are at immediate risk of dying from complications of undernutrition.
Of those with severe acute malnutrition, one in four children will die without medical care, and many of the survivors suffer lifelong consequences to their physical health and brain function.
Acute childhood malnutrition triggers a wicked cycle, affecting the whole life course of a child where children struggle to develop properly (physically and mentally), they then miss school because of their chronic health problems, which then results in difficulties securing employment. This can lead to generational under nutrition, and a continuation of the cycle.
This is why screening, treatment and support at the childhood stage are such a vital window of opportunity.
The key problems are:
- One in four: One quarter of children are still afflicted by undernutrition
- Missed opportunities: Detection of undernutrition at health facilities remains patchy
- Slipping through the cracks: Many children are lost to follow up from feeding programs
- Unsupported: Nutrition workers lack ongoing training and support
- Supply chain: Essential supplies such as therapeutic foods are frequently unavailable
- Lack of engagement: Families often dissatisfied with their encounter with local health system
What is the solution?
Millions of dollars are already spent on nutrition interventions and there are many stakeholders involved, but Maluk Timor team has identified a targeted strategy needing only a limited investment. We believe our approach will make a large impact.
We have identified the nutrition services being offered at community health centres (CHCs) as the key leverage point. These services already exist across almost 70 health centres nationally but they are currently functioning well below expectation. We believe that by strengthening these nutrition services and demonstrating an optimal model of care we can support the Ministry of Health to meet these critical challenges.
First, Maluk Timor has selected Comoro CHC as it has the largest catchment of children, serving approximately 10% of the national population. We already have a strong working relationship with Comoro CHC, which is just metres from our front gate. We intend to partner with the Ministry of Health and the National Hospital to develop this site as a Centre of Excellence for the treatment of malnutrition.
Objectives:
- Establish one selected CHC as a “Nutrition Centre of Excellence”
Working directly with government health staff, we will develop an existing CHC nutrition services into a model, or a “Centre of Excellence” which can serve as a template for others to follow. This will include a Nutrition Resource Centre where families can access nutrition counselling and education. Government staff who will be offered additional training, supervision and support to optimise the level of care provided, and staff from other centres will be offered short-term placements on rotation to experience how the service works, taking those lessons back to their own health centres.
- Nutrition Health Workers’ Networking Forum
We’ve already been running monthly meetings with the Nutrition Health Workers in Dili,
facilitating improved communication between different centres, sharing of ideas, resolving of mutual problems and peer-to-peer teaching (facilitated by Maluk Timor’s Nutrition Team). Guest speakers and clinical tutors are also invited to contribute to upskilling activities.
- National Hospital (HNGV) referral pathway partnership project
Collaborative project working with paediatric department at HNGV to improve discharge planning processes for children admitted to HNGV with severe acute malnutrition (SAM), including targeted education of families and staff. This aims to ensure successful follow up at CHC level, as children with SAM are extremely vulnerable after discharge from hospital.
How can donors support?
Developing sustainable partnerships takes time. We need to work closely with the Ministry of Health programs to ensure they share in the ownership of this project. We need to ensure that any changes we make are adopted and embedded into routine practice.
We need donors who can partner with us toward this goal. We will need funding to improve the existing facility, to provide some of the basic resources, to fund our Nutrition Team and to support operational research that demonstrates the effectiveness of our work.
All figures are in USD, inclusive of local taxes, based on annual expenses:
Improvements to existing facility : $30,000
Salaries (five full-time staff) : $25,000
Fieldwork & training costs : $8,000
Resourcing and supplies: $5,000
Monitoring & Evaluation: $4,000
Implementation costs: $8,000
Total : $80,000
This project is highly cost-effective, leveraging existing staff and infrastructure for a large impact. Some
refurbishment will be required to develop the Nutrition Resource Centre, but this facility will then endure as a sustainable resource in the hands of the government health centre, available to staff and patients alike beyond the conclusion of the project.
[1] Asian Development Bank, compiled by DataLEADS/ANN
[2] Global Hunger Index 2020