Table 2 Implementation of effective PHC components in remote communities - SISCa, Posyandu and Cuban systems

Values

Component 1

Strong leadership and government in human rights for health

Health as a human right in Timor-Leste’s constitution since 2002. Free basic healthcare for all citizens

Government support for health as a basic human need to live a productive life. Primary care free via social insurance scheme (if eligible)

Post-revolutionary socialist government responsible for healthcare as a human right and free for all citizens

Component 2

Establishing an interactive and integrated culture of community engagement

Community empowerment through community health workers (PSF), women’s self-help groups and village councils

Use of community volunteers (cadres) to provide support to communities

Active community participation encouraged in health system through family doctor outreach as a joint social responsibility

Structural

Component 3

Prioritisation of cost effective interventions

Six tables targeting MDGs 1,4,5,6,7 but also providing some comprehensive ambulatory care via monthly outreach clinics in villages (sucos)

Five tables targeting maternal and child health (MDGs 1,4 & 5) via monthly clinics at community healthcare post

Comprehensive primary healthcare (family & preventive medicine, inter-sectoral action) mainly via family doctors based at community clinics but who also live in the communities.

Component 4

Provide an integrated continuum of care

Comprehensive coverage of maternal & child health, active case finding and home visits including TB, leprosy, malaria control to whole community. General ambulatory care for all ages including chronic disease management. Occasional outreach specialist care (eg dental, eyes)

Outreach clinic focus on maternal and child health

Doctor-led health team in local polyclinic. Active case-finding and home visitation from these facilities. High coverage of health facilities in remote areas.

Functional

Component 5

Supporting skilled and equipped health workers at all levels of system

Healthcare delivery and referral at outreach clinics by doctors, midwives, nurses and health promotion staff with support of NGOs

Village midwife and immunisation nurse deliver MCH program with supervision of doctor from sub-district clinic

High ratio of doctors per community, with responsibility for local health outcomes

Component 6

Create a systems cycle of feedback using data to inform healthcare

A ‘library’ of register books for each community

Data collection and feedback not systematic

Local register books of community health data systematically collected and maintained by family doctors