How an organic coffee cooperative in Timor-Leste is increasing immunization coverage


Ermera is a mountainous district where villages are difficult to reach, making routine immunization challenging.
Ermera is a mountainous district where villages are difficult to reach, making routine immunization challenging.

Located in the west-central part of Timor-Leste is Ermera, one of the country’s prime coffee-growing districts. In this mountainous district, many farmers are members of Cooperativa Cafe Timor, a cooperative that supports the production and sale of coffee, the country’s principal agricultural export. The cooperative also provides free primary health care services for its member families through its Clinic Café Timor (CCT).

“When babies are born, some are given a LISIO 9a booklet that contains a child’s medical information, including immunizations0, but a lot of times they aren’t, and this can make tracking their immunizations difficult,” explains Filomeno De Deus, Health Facilitator for CCT since 2009. Mothers or other caregivers are responsible for bringing the booklet to appointments so that health workers can enter new information.

In Ermera, as well as other districts in the country, many children receive only some of the vaccinations they need for full protection. Children living in inaccessible mountain villages may receive no vaccinations. Families’ lack of understanding, poor road conditions, and limited health services can prevent children under one year old from receiving recommended vaccines.

The Imunizasaun Proteje Labarik (IPL) project works in Timor-Leste to support the Ministry of Health (MOH) improve its routine immunization services. IPL is funded by the Millennium Challenge Corporation (MCC) and administered by USAID/Timor-Leste through MCHIP.

Community members (right) work with CCT Health Facilitator Filomeno De Deus.
Community members (right) work with CCT Health Facilitator Filomeno De Deus.

To improve CCT’s promotion of children’s vaccinations, IPL and CCT formed a partnership in 2012 by signing a technical terms of reference. The IPL technical team supplied and trained 59 CCT health facilitators and supervisors—like Mr. De Deus—to use the UI tool. After the training, due to the positive response from health facilitators and communities, CCT chose to integrate the UI tool into its Community Extension Program with the support of IPL. Currently, CCT promotes and implements the UI tool in 142 aldeias across three districts.

Uma Imunizasaun (UI), which means Immunization House, is one of the Maternal and Child Health Integrated Program (MCHIP)’s most promising approaches for increasing immunization coverage. The tool is a large chart used by health facilitators in areas where CCT works (and implemented by community health volunteers and local leaders in all other areas) to record the name of every infant in an aldeia (village). In addition to the child’s name, the health facilitator or local volunteer adds the date of birth and date of each vaccination. If a child is missing a vaccine, there will be a gap on the chart, and the health facilitator or volunteer, as well as the community, will become aware. The chart is displayed at the aldeia house where health outreach activities take place and where the chart is visible to everyone in the community. One of the powerful effects of the UI tool is its visibility for the entire community.

While Mr. De Deus expected to grow professionally from the IPL training, he didn’t expect it to impact him personally. While he teaches others how to use the tool in his designated aldeias, his own family lives in an aldeia that currently does not use the immunization tracking tool.

“From my experience using the Uma Imunizasaun tool in the other aldeias, I have advocated to local leaders for the tool to be adopted in my home aldeia as well. I want my own children to be protected, as well as my friends and neighbors,” he says.

Maria Costa, a community member and mother from Ermera, provides evidence that the UI training has reached beyond health facilitators:  “My children are greater than one (year old) and too old to be on the chart, but I try and encourage new mothers to get their baby’s name on the chart and get their vaccinations to keep them healthy.”

Lucia Romillia, another mother from Ermera, adds: “When we are together with family and neighbors, we like to talk about our children, and I try and ask other mothers to please register their children, to keep the entire community healthy.” Informed understanding and recommendation of the UI tool among community members like this is an encouraging ccomplishment of IPL and CCT’s collaboration.

Mr. De Deus and the work being done in Ermera is an important example of how a temporary program can transfer tools and skills to local organizations, working together to meet common goals. This collaboration has more than doubled the number of local areas using the tool and has also demonstrated an approach for a successful intervention that has promise to continue after IPL through a local entity.

IPL is thankful for the opportunity to collaborate with CCT and commends its commitment to increasing immunization coverage in Timor-Leste.

*This article was originally published on December 6, 2013, on the Maternal and Child Integrated Health Program (MCHIP) website.

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