Cablegate: Mission Dili Comments On Unfpa Cpd for Timor-Leste

DE RUEHDT #0216/01 2410924
O 280924Z AUG 08




E.O. 12958: N/A

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

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

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

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