How self-care interventions are having an impact in Timor-Leste

As WHO celebrates
Self-Care Month (24 June – 24 July), we shine a spotlight on how self-care
interventions are making a difference to the lives of people in Timor-Leste.

“Timor-Leste is on the verge of a self-care revolution,” said Dr Arvind Mathur, WHO Representative to the island nation. “A lot has changed in terms of the way people approach their health and well-being due to improved access to healthcare in the country.”

An estimated 3.6 billion people – half of the world – lack access to essential health services. WHO recommends self-care interventions for every country as a critical path to reach universal health coverage, promote health, keep the world safe, and serve the vulnerable. This is especially true in a county like Timor-Leste where health infrastructure and access to specialized care can be limited. 

Working with the World
Health Organization (WHO), Timor-Leste’s Ministry of Health is advancing the highest standard of
health for its people with the help of self-care interventions that screen for
diseases, expand options for health service delivery, and prevent illness,
while improving access to health services.   

Detection of diseases through self-testing and self-sampling

In
January 2023, the Government of Timor-Leste launched two pilots for HIV
self-testing, and pre-exposure prophylaxis (PrEP) medication, which helps to protect
against getting HIV. The pilots are in the capital, Dili, and target key
populations such as men who have sex with men and female sex workers.

At
designated drop-in centres 4,000 HIV self-tests have been made available and WHO
has been training outreach workers from those key populations to raise
awareness of HIV and self-testing; demonstrate how to use a self-test kit; and
encourage people to visit the centres to find out their status. Since the pilot
launch, over 700 people have taken a test. For those who test negative,
information is available about how to protect themselves in the future, while
those that test positive are referred for treatment.  To support
these efforts, WHO has also produced targeted information
leaflets, as well as materials aimed specifically at health workers and
counsellors. 

“I
was surprised to find out there was no needle prick involved in this test,”
said a student from the national university in Dili. “I was nervous about
taking the test but the counsellor and health worker at the drop-in centre were
very helpful. They explained the entire process and also there was no pressure
to share the results unless I wanted to.”

Another important
step in expanding self-care health options within the country will be the
introduction of self-sampling for human papillomavirus (HPV) as part of the
national cervical cancer screening programme. In
Timor-Leste, cervical cancer is the second most common cancer among women. Almost
all (99%) cervical cancers are linked to HPV infections, an extremely common
virus transmitted through sexual contact.

Self-sampling
– where women are given a simple kit to take their own sample – is one of the
ways to test for the virus. Women can take the sample alone at home, in a
health clinic or another location typically using a swab (like a cotton bud) or
a soft brush.  The sample is then sent to
be checked at a laboratory and if positive, the woman is invited back for
further care.

“We are committed to promoting self-care interventions in
all areas, including sexual and reproductive health, and our advocacy and
information, education and communication initiatives are strategically and
thoughtfully concentrated in this direction,” Dr Mathur said.  

Self-care and family planning

Timor-Leste has a high unmet need for family planning and increasing access to contraceptive self-care interventions, like condoms and contraceptive pills, is one of the ways to help meet that demand. Timor-Leste also has a very young population: nearly half of Timor-Leste’s population is under 18 and according to a 2018 UNDP report, the country has one of the youngest populations in the Asia and Pacific region with a median age of 17.4 years. An estimated 19% of women 20-24 are married before they are 18, and almost a quarter are pregnant by the time they turn 20.

Through an outreach initiative involving WHO, the Ministry of Health and agencies like Marie Stopes International, condoms and contraceptive pills are now available in every health outpost in the country. Awareness of these self-care options has been raised through focus group discussions and youth and parent corners and this, combined with their wider accessibility, is empowering people to take control of their reproductive health.

“One visible change that I have seen is that women are seeking contraception more openly, and they are now often taking their own decisions in this area,” said Ms Fransisca Rosalina, a midwife for 28 years who works at the national hospital in Dili. “Previously, we had to speak to the husbands or other family members about family planning services. But now, women seek the information on their own. Many of them ask about it [contraception] when they are about to be discharged after childbirth.”  

“Self-care interventions are a crucial aspect of healthcare,” said Dr Odete Maria Freitas Belo, Minister of Health of Timor-Leste. “When self-care interventions are promoted, one promotes prevention of diseases as well as early diagnosis of diseases. In addition, self-care interventions also have the potential to reduce the financial burden on health systems and on individuals and communities, thus paving the way for Universal Health Coverage.” 

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