Family Planning in Asia and the Pacific - International Council on ...

<strong>in</strong>clud<strong>in</strong>g <strong>the</strong> Catholic Church leaders of Timor Leste,have expressed <strong>the</strong>ir support for implementation of [a]family plann<strong>in</strong>g programme” (MOH, 2004a: 4). Thepolicy document makes explicit reference to <strong>the</strong> ICPDProgramme of Action, not<strong>in</strong>g that <strong>the</strong> latter “shifted <strong>the</strong>population debate away from a demographic framework,with its focus on population control, to a reproductivehealth framework, with a focus on meet<strong>in</strong>g <strong>the</strong> needs of<strong>in</strong>dividuals <strong>and</strong> couples” (MOH, 2004a: 6). The “guid<strong>in</strong>gpr<strong>in</strong>ciple” of <strong>the</strong> policy is “‘plann<strong>in</strong>g a family’ with<strong>in</strong> <strong>the</strong>context of responsible parenthood” (MOH, 2004a: 7) 3 .Among its clauses <strong>the</strong> policy states: “In order to ensurethat all couples <strong>and</strong> <strong>in</strong>dividuals <strong>in</strong> Timor-Leste have <strong>the</strong>means <strong>and</strong> <strong>in</strong>formation needed to make <strong>in</strong>formed <strong>and</strong> freechoices about <strong>the</strong> number <strong>and</strong> spac<strong>in</strong>g of <strong>the</strong>ir children,<strong>the</strong> Government undertakes to make accessible at all levelsof <strong>the</strong> public health system, with technical <strong>and</strong> f<strong>in</strong>ancialassistance from <strong>the</strong> <strong>in</strong>ternational community if necessary,family plann<strong>in</strong>g, <strong>in</strong>clud<strong>in</strong>g natural family plann<strong>in</strong>g,<strong>in</strong>formation, counsel<strong>in</strong>g <strong>and</strong> services” (MOH, 2004a:9-10). The policy covers service delivery (both healthcentre-basedservices <strong>and</strong> outreach activities), humanresources <strong>and</strong> <strong>in</strong>formation, education <strong>and</strong> communication(IEC).The M<strong>in</strong>istry of Health has overall responsibility forimplement<strong>in</strong>g <strong>the</strong> national family plann<strong>in</strong>g policy. Thisresponsibility rests with <strong>the</strong> Department of Maternal <strong>and</strong>Child Health, ensur<strong>in</strong>g that FP is <strong>in</strong>tegrated with o<strong>the</strong>rreproductive health services (as advocated by ICPD).Implementation is also guided by <strong>the</strong> M<strong>in</strong>istry’s NationalReproductive Health Strategy 2004-2015 (MOH, 2004b).The strategy has four ma<strong>in</strong> components:Young people’s sexual <strong>and</strong> reproductive healthReproductive choice (family plann<strong>in</strong>g)Safe mo<strong>the</strong>rhoodGeneral reproductive health.FP <strong>and</strong> RH programmes are implemented <strong>in</strong> partnershipwith o<strong>the</strong>r stakeholders, <strong>in</strong>clud<strong>in</strong>g communities <strong>and</strong>o<strong>the</strong>r relevant government departments, <strong>and</strong> threenational work<strong>in</strong>g groups have been established (one eachon FP, RH, <strong>and</strong> adolescent reproductive health) withbroad stakeholder representation to provide a forum fordiscussion <strong>and</strong> debate <strong>and</strong> facilitate wide ownership of<strong>the</strong> programme. Timor-Leste’s system of governance isadm<strong>in</strong>istratively decentralized so much of <strong>the</strong> responsibilityfor implementation of programme activities lies with <strong>the</strong>districts <strong>and</strong> <strong>the</strong>ir local communities. Accord<strong>in</strong>g to <strong>the</strong>strategy document:As with education, community actionfor health is critical <strong>in</strong> all <strong>the</strong> priorityareas of <strong>in</strong>terventions outl<strong>in</strong>ed below.The community has a particularly strongrole to play <strong>in</strong> streng<strong>the</strong>n<strong>in</strong>g l<strong>in</strong>kagewith health services, <strong>in</strong> <strong>in</strong>creas<strong>in</strong>gawareness of reproductive health needs<strong>and</strong> <strong>in</strong> improv<strong>in</strong>g <strong>the</strong> quality of care. In<strong>the</strong>se areas, <strong>in</strong>creased knowledge of <strong>the</strong>community results <strong>in</strong> <strong>in</strong>creased actionfor health <strong>and</strong> <strong>in</strong>creased participation <strong>in</strong>problem-solv<strong>in</strong>g to meet maternal <strong>and</strong>newborn health needs.As decentralization streng<strong>the</strong>ns, efforts<strong>and</strong> plann<strong>in</strong>g will <strong>in</strong>clude streng<strong>the</strong>n<strong>in</strong>gof district <strong>and</strong> community forums sothat community representatives canactively assume ownership of reproductivestrategies <strong>and</strong> pass this ownership on [to]<strong>the</strong> community <strong>in</strong> general. For community<strong>in</strong>terventions, skills for communitymobilization, community dialogue,communication, research, educationalapproaches <strong>and</strong> for <strong>in</strong>teract<strong>in</strong>g with <strong>the</strong>community, need to be assessed.Community efforts should work closelywith advocacy efforts of reproductivehealth programs. Several community<strong>in</strong>terventions are advocacy-oriented,<strong>in</strong>creas<strong>in</strong>g <strong>the</strong> “dem<strong>and</strong>” fromcommunities, rais<strong>in</strong>g communityawareness about reproductive health issues<strong>and</strong> participation <strong>in</strong> <strong>the</strong> decisions taken at<strong>the</strong> district level for f<strong>in</strong>d<strong>in</strong>g solutions <strong>and</strong>allocat<strong>in</strong>g resources.The various levels of <strong>the</strong> district healthservices (DHS) are directly responsible for338