ABOUT SISCa Integrated Health Service
SISCa (standing for "Integrated Community Health Services") is an integrated health service involving the community. It was written and designed by Dr. Nelson Martins, Minister of Health. with strong suport from Vice Minister of Health, General Director and all health staff, it was formally launched in 2008. The program is a key initiative of the Ministry of Health (MOH) to extend the reach of basic primary health care services to community and household level. The program is being implemented in the country╬ô├ç├ûs 13 Districts, 65 Sub-Districts, and 442 villages and hamlets with total of 602 SISCa Posts in all of the territory, including Atauro island.
"With the principle of from, with & to the community, SISCa is an integrated health initiative organized in the community"
Once a month, its objectives are to :
- Bring primary Health Assistance to the Community.
- Collect and improve complete data about the population ,children and pregnant woman in identifying appropriate health interventions.
- Disseminate HP and Education in order to change people's Behaviors .
- Improve Woman & man's participation in Health issues.
- The target Population of SISCa are the General Community, children under Five year old, pregnant woman, adolescent ,elders and disable people.
Activities are organized by table as follows: ta1 Registers basic data, table 2 provide nutrition assistance, table 3 provides health assistance to pregnant mothers & children, table 4 provides information & counseling on personal hygiene & sanitation, table 5 provide curative care, and finally table 6 disseminates HP and education to the community. Services are delivered by the Community Health Centre ( CHC's staff and community Volunteers or PSF's).
SISCa is based on the principle 'From, With and To the community'. No SISCa can take place without the combined commitment, efforts and contributions of the community members, health volunteers and health workers. At the centre of these efforts are community members helping to mobilize everyone to access services. A cadre of health volunteers known as Family Health Promoters or PSFs, who are chosen from their own communities, are committed to assisting the health staff and communities during SISCa. Not only are they providing health promotion and education, they act as motivators, change agents and as an essential liaison between the community and health staff. At SISCa, they are assisting in the provision of preventive care. Rural areas have long been under-served by health services, which SISCa is addressing through bringing services to the people. Many more individuals are now able to receive integrated health care closer to their homes.
The impressive reduction in newborn, infant and child mortality of the last five years could not have occurred without the greater reach of services that SISCa is helping to expand. The recent Demographic and Health Survey indicates a stable decrease on maternal mortality ratio from 660/100,000 live births to 557/100,000 live births in 2009. There has been a steady progress in child health care, with the current indicators showing a reduction of under five mortality rates from 83/1000 in 2003 to 64/1000 in 2009 and improvement in infant mortality rate from 60/1000 to 45/1000 live births.
Immunization coverage has improved greatly in recent years. This in no small part because SISCa takes advantage of children being weighed and medically treated to also give immunization, vitamin A and de-worming tablets. The number of children with pneumonia, malaria and diarrhea being treated has increased significantly as more children get access to medication. Pregnant women are getting more antenatal care and becoming committed to delivering their children with a skilled birth attendant, with an increase in assisted deliveries from 27% to 30% , The total fertility rate has declined rapidly from 7.8 to 5.7.
Yet SISCa cannot stop here. There are now intensified efforts to formalize links between health staff from CHCs and health posts with the suco council, with a focus on improving SISCa mobilization and functioning. Transport, human resources and quality are all being addressed through intensified partnerships at local level and greater monitoring and data analysis. Public spending per SISC
a activities is between 35 & 50 USD, totaling the need for over 1 Million USD per year. However, limited resources are constraining implementation of SISCa and, thus, additional funding to help improve the quality of health care delivered to all communities is mostly needed.
There is much yet to be done, but the commitment is enormous to provide rural communities with the same level of care as urban population. SISCa will continue to be an essential part of the commitment.