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Evaluation of National

Family Health Promoter


Program – the National
Community Health
Volunteers (PSF)
February 2009
Presented by Dr Brett Sutton
from TAIS
on behalf of the Department of
Health Promotion
Directorate of Community Health
Services
Ministry of Health
Democratic Republic of Timor
Leste
Acknowledgements
The MOH and TAIS would like to thank the twelve
partner organizations for their involvement in the
evaluation in the areas of fieldwork and
presentation of preliminary findings to the MOH:
– Health Alliance International (HAI)
– Services for the Health in the Asia Africa Region
(SHARE)
– Oxfam
– CARE
– Cruz Vermelha Timor-Leste (CVTL)
– Alola Foundation
– Alliance of Friends for Medical care in East Timor
(AFMET)
– Medicos del Mundo (MdM)
– Concern
General Objectives
 Understand how well the PSF
program is working, compared to
expectations expressed in the PSF
and SISCa program guidelines and
by the MoH
 Show which aspects are working
well / not working well and why
 Provide recommendations for
making the program more effective
in achieving health goals
Background and History FHP
 2006
program
- Initially a Pilot Program in 4 districts – Viqueque,
Aileu, Manatutu and Liquica – aldeia based.
- Family Health Promoter as a volunteer was to be an
Educator, a Mediator, a Motivator, and a Provider of
Information.
 2008
- SISCa: an initiative to increase access to health care
and health promotion and prevention.
- Monthly service provision in every suco. Necessitated
rapid expansion of training and installation of the
Family Health Promoters (FHP in English PSF in
Portuguese) to all 13 districts.
Methodology - 1
A qualitative assessment of the volunteer
program was expected to examine the following:
 Training modules.
 Supervision and management.
 Strengths and limitations of the PSF program as
perceived by different stakeholders.
 Awareness of roles of PSF in the community
among PSF and among MoH staff at different
levels.
 Competence in technical / health knowledge /
behavior change communication skills.
 Perceptions about what needs to change and
how for the volunteer program.
Methodology - 2
Sampling Focus Key Informant and Competency
category Group In-depth Interviews Tests
Chefe suco none Chefe aldeia of the two No
Chefe aldeia sampled aldeia (close to
SISCa, far from SISCa),
Chefe suco
HP/ none Focal Point for HP, Head of Yes
CHC Staff CHC, Midwife, Nurse
PSF / CHW none With all available PSFs in Yes
suco
Community none 10 mothers with children Yes
under 5 (5 from close aldeia,
5 from far aldeia)
DPHO none One Yes
DTT / MTT 12 DTT Eight National Level All FGD
12 MTT participants
Results - Strengths
Recruitment Training Implementation Management

MOH able to MOH able to PSFs active at SISCa provides


recruit many train PSFs monthly SISCa solid structure
PSFs following the activities to manage
6-day training PSFs
schedule

Training has
been popular
among PSF
Results - Weaknesses
Recruitment Training Implementation Management

Majority of Many PSFs PSFs do limited No supervision


PSFs have work outside of tools
selected by forgotten SISCa Health staff
health staff what topics unclear about
they were their
trained in management
roles
Management
committees
have never
functioned
consistently at
any level
Results –
Competency/
Knowledge testing
Komunidade test scores

2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0

Immunizasaun
Fase liman
Isin Rua

Nutrisaun
SISCa

Susuben
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
SISCa_PSF

Isin Rua

Susuben

Diarea_fase
PSF test scores

liman

Nutrisaun

Immunizasaun
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
SISCa_PSF

Isin Rua

Susuben

Diarea_fase
liman
Pessoal Saude test scores

Nutrisaun

Immunizasaun
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0

SISCa_PSF

Jestaun

Isin Rua

Susuben
DTT & MTT test scores

Diarea_fase
liman

Nutrisaun

Immunizasaun
Recommendations - 1
Recruitment Training
 Need regular  Use supportive supervision
communication between tools to understand and
health staff and community improve areas of PSF
leaders weakness and to help
knowledge and skill retention
 Replacement policy for
PSF needs to be  Classify PSF by whether
articulated; community they have been given the
involvement in PSF “new” training, and ensure
recruitment needs better one round of “new” training
definition to all.
Recommendations - 2
Implementation Management
 Start regular internal  Implement supervision
communication between tools and mentoring / OTJ
program staff and PSFs training
 Conduct monitoring visits
 Provide clarity on job  Clarify roles
description for PSFs –  Create transparent system
particularly on what they are for PSF payments
expected to do beyond  Strengthen PSF database
SISCa. to maintain updated name-
based list of recruited and
trained PSF at sub-district
levels
 Health workers need
training in supervision and
support functions.
Implications for Health Worker
Training
 Communication skills - interpersonal
and group education / advocacy
 Situational analysis and planning skills
 Community involvement and
participation skills
 Adult education skills / adult learning
methodologies
 Follow-up, supervision, monitoring and
on-the-job training / mentoring