VZCZCXRO0419
OO RUEHDT
DE RUEHDT #0216/01 2410924
ZNR UUUUU ZZH
O 280924Z AUG 08
FM AMEMBASSY DILI
TO RUEHC/SECSTATE WASHDC IMMEDIATE 4073
INFO RUCNDT/USMISSION USUN NEW YORK IMMEDIATE 1083
RUEHDT/AMEMBASSY DILI 3537

UNCLAS SECTION 01 OF 02 DILI 000216 
 
SIPDIS 
 
STATE FOR PRM AND IO 
 
E.O. 12958: N/A 
TAGS: PREF SOCI TT
SUBJECT: MISSION DILI COMMENTS ON UNFPA CPD FOR TIMOR-LESTE 
 
REF: STATE 88698 
 
¶1.  In response to reftel, US Mission Dili offers the following 
comments on UNFPA's Country Program Document for Timor-Leste for 
2009-13. 
 
¶2.  General:  In general, the proposed Country Program Document 
(CPD) is analytical, well written and reality/evidence based. 
The document aptly incorporates lessons learned from past 
technical approaches, as well as programmatic experiences.  The 
overall program goal appears to be achievable and certainly 
contributes to the Government's plan to reduce poverty and 
accomplish the benchmarks set forth in the MDG/Millennium 
Development Goals. 
 
In the area of Population and Reproductive Health, the CPD 
correlates well with the GoTL Basic (Health) Service Package 
recently being implemented throughout the country. 
Additionally, the proposed Reproductive Health component is 
congruent with the USG Strategic Objective of addressing the 
health needs of the Timorese people, especially children and 
woman at greater risk. 
 
In light of the Kemp-Kasten Amendment, nowhere in this Country 
Program Document does UNFPA suggest their participation in the 
management of a program of coercive abortion and/or involuntary 
sterilization.   Abortion as a method of family planning is 
illegal in Timor-Leste. 
 
¶3.  Some general comments about the CPD follow: 
 
--  UNFPA In Its Timor-Leste Context:  UNFPA has a long-standing 
and strong reputation in Timor -Leste.  From 1999- 2002 UNFPA 
and other UN Agencies functioned as a surrogate "Ministry of 
Health" and helped to re-establish the totally destroyed basic 
health infrastructure.  UNFPA has also assisted the GoTL in 
establishing sound health policies, specifically in the area(s) 
of Reproductive Health, Population and Gender Equity.  Because 
of their assistance, Reproductive Health and Family Planning 
commodities can be found in practically all health facilities 
across the country. 
 
Timor-Leste's National Family Planning Policy reflects the 
consensus reached at the International Conference on Population 
and Development (ICPD) held in Cairo in 1994 and; the Key 
Actions for the Further Implementation of the ICPD Program of 
Action adopted by the twenty-first special session of the United 
Nations General Assembly in New York from June 30-July 2, 1999. 
 
--  Lessons Learned: 
Human resources:  The lack of qualified human resources was a 
key constraint identified in previously implemented UNFPA 
programs.  The development of human and institutional capacities 
at all levels will be critical for managing the next program and 
ensuring the attainment of national development goals 
 
Youth:  Youth needs in the areas of reproductive health, 
education, employment and empowerment were identified as crucial 
for the country's stability and development.  USAID concurs with 
UNFPA's assessment in the area of youth 
 
 
¶4.  Program Component: 
 
Reproductive Health:  The proposed program component,  as 
stated, supports the country's Basic (health) Services Package. 
 Additionally, the proposed Reproductive Health component is 
congruent with the USG Strategic Objective of addressing the 
health needs of the Timorese people, especially children and 
woman at greater risk. 
 
 
Challenge 1:   Midwifery School - The program proposes to 
establish a Midwifery school for the purpose of increasing the 
number of skilled birth attendants; a formidable approach which 
can help reduce infant and maternal mortality rates -especially 
in rural areas.  However, there is no mention of the more than 
1,000 Timorese doctors on Cuban-sponsored scholarships who will 
soon graduate from  Cuban and Timorese universities.  According 
to the Cuban curriculum (a system which does not utilize 
midwives), the function of these doctors is to assist in 
deliveries. Thus, UNFPA may want to consider (and explain more) 
how output 1.d  (establishment of midwifery school) would add 
value and not contribute to the duplication of services. The 
country currently has around 350 midwives and 250 Cuban doctors 
working in the Primary Health Care. 
 
Challenge 2:   Community mobilization and participation - 
Involving the local community and residents in health care 
services is paramount to the success of this component. 
Currently, birth by skilled birth attendant is only 24%-- 
although the country has approximately 500 skilled birth 
 
DILI 00000216  002 OF 002 
 
 
attendants working at the Primary Health Care. Without 
activities to increase community mobilization and participation, 
demand for quality services will continue to be low. 
 
Challenge 3:   Health workers performance: Staffing analysis 
suggests that motivation of health workers in general, and 
midwives in particular, is extremely low. According to project 
assessments, this is due to a lack of a performance-base work 
objectives and a lack of monitoring and evaluation by the 
District Health Management Team. UNFPA will need to ensure that 
health care providers have clearly defined job descriptions that 
health workers are adequately compensation for extra-work. 
Addressing these urgent issues is crucial to increase demand 
for, and access to, high-quality maternal health services. 
 
Challenge 4: Concerted public education for FP - UNFPA will need 
to encourage support and advocacy from key institutions for the 
delivery of Family Planning messages. One approach could be for 
UNFPA to work with the Government of Timor-Leste, the private 
sector and Catholic Church, in developing and conducting public 
education campaigns highlighting the benefits of family 
planning. 
 
 
¶5.  Population and Development: 
 
Many of the outputs, listed in the program component will 
contribute to the development of the Timor Leste. Some thoughts: 
 
The next Demographic and Health Survey and Population and 
Housing Census can be used as a measure of progress/success, as 
well as identify areas for improvement. 
 
The ability of key institutions to analyze and effectively use 
data for decision making is extremely low. At the sub-national 
level this capacity is virtually non-existent. In 2009, the 
government intends to implement decentralization strategies for 
planning, budgeting, and monitoring. In order for this approach 
to be successfully, building capacity on the sub-national level 
and strengthening institutions is a must.  UNFPA may want to 
address in greater detail how the country strategy plans to 
build capacity at the sub-national level. 
 
Challenge:   Data utilization/demand is extremely low.  As 
current trends shows (e.g. the recent state budget design), 
planners tends to design programmes based only on supply of 
resources, and not based on policy and the use of data to make 
decisions. 
KLEMM