Timor-Leste. Health Sector Resilience and Performance in a Time of ...

second half of the year attendancelevels were well below the attendancelevels seen prior to the April-Mayconflict. Lower attendance levels forthe rest of 2006 may have resultedfrom people using a wider range ofservices, or may reflect the reductionin total population residing in Dili dueto displacement and migration toother districts.Number500450400350300250200150100Daily attendances at Centro CHCFrom April 1 - June 30 200650Daily attendances at Centro, the0largest CHC in Dili, show gradualdeclines over the 90-day period fromAprilMayDay and MonthJunethe beginning of April to the end ofJune, as well as considerable dailyFigure 4: Daily attendances at Centro CHC from April 1 - June 30 2006. Source Timor-LesteMinistry of Healthvariation (Figure 4). The days in which no data are available were days at the end of May when the Cuban MedicalBrigade were assisting to keep Centro CHC open as usual staff were not at work; data were not submitted as perusual on these days.Examination of quarterly outpatient attendances from the five districts studied reveals similar patterns: most notableare the large declines in Dili, with more marginal impacts in the other districts (Figure 5).Data from other service providers, such as Bairo Pite Clinic in Dili, and the private Cooperative Cafe Timor, revealsimilar patterns of disrupted services in May and June. For the first four months of 2006, an average of 18583patients were seen by all Café Timor Clinics combined, per month; this declined by nearly 50% to 9866 patients permonth in May and June [11,12]. Mobile services as a group were especially affected: the average number of patientsseen per month in the three mobile services (Ermera, Liquica and Ainaro) combined was 6552 in January to Aprilwhich decreased to 1943 per month, less than 30% of usual levels, for May and June [11,12]. Seasonal factors arealso likely to have played a part in these patterns.Health workers were themselves displaced, and many were anxious and fearful, in some cases failing to present towork for several months. The TB program illustrates well the range of disruptions resulting from the Crisis duringMay-July 2006. The TB CentralManagement Unit ceased to functioneffectively because most of its staffwere absent from work forapproximately two months. A highlevel of knowledge and commitmentby TB patients and their families, aswell as by health workers, is requiredfor treatment to be successful. Manyprogram activities were, however, cutback, and program staff were notavailable.Figure 5: Quarterly outpatient attendances in Dili and four study districts, 2006.Source Timor-Leste Ministry of Health16 TIMOR-LESTE HEALTH SECTOR RESILIENCE AND PERFORMANCE IN A TIME OF INSTABILITY