ESTIMATED COST OF THE EMERGENCY OBSTETRIC · PDF fileThis Plan of Action is in line with the...

ESTIMATED COST OF THE EMERGENCY OBSTETRIC AND NEWBORN CARE IMPROVEMENT PLAN OF ACTION

TIMOR-LESTE 2016-2019

Ministry of Health

Oecusse

Bobonaro

Cova Lima

Ermera

ManufahiAinaro

ManatutoAileu

DiliLiquiçá

Baucau

Viqueque

Lautém

Atauro

Estimated Cost of the EmONC IPA | III

FOREWORD

While we acknowledge the significant efforts that have led to the decrease of maternal mortality in Timor-Leste between 1990 and 2015 according to the evaluation of the Millennium Development Goal on improving maternal health, we all know that the task is far from being finished, and more efforts are needed in the next fifteen years to further decrease it along with our commitment to the Sustainable Development Goals.

In the Year 2015, Ministry of Health undertook an Emergency Obstetrics and Newborn Care (EmONC) Needs Assessment Covering all Community Health Centres, five Referral Hospitals, National Hospital (HNGV) and two private facilities.

Subsequently, the EmONC Improvement Plan of Action for the period of 2016-2019 was developed in order to address the gaps and deficiencies identified in the EmONC Needs assessment. This Plan of Action is in line with the Health Sector Development plan and once implemented will further accelerate the reduction of maternal and newborn mortality and morbidity in Timor-Leste.

This report present the cost of the implementation of the EmONC Improvement Plan of Action by different components on an annual basis; Cost of new infrastructure additions, Costs involved in upgrading of existing health facilities, Cost of remunerating newly assigned health staff, Cost of purchasing and distribution (logistics) of drugs and supplies required by the additional patients (pregnant mothers and newborns) presenting to BEmONC and CEmONC facilities resulting from improvement plans of actions and the cost of the program management.

We are very thankful to UNFPA and WHO for the excellent technical support provided in development of this document.

I like to urge all relevant health staff and stakeholders including Development partners to study this report and to contribute to the successful implementation of the EmONC Improvement Plan of Action from the first to the fourth year.

Dili, November 06, 2017

Dr. Odete da Silva ViegasDirector General for Health ServiceMinistry of HealthDemocratic Republic of Timor-Leste

IV | Estimated Cost of the EmONC IPA

Estimated Cost of the EmONC IPA | V

TABLE OF CONTENTFORDWARD iii

TABLE OF CONTENT v

LIST OF TABLES AND FIGURES vii

LIST OF ANNEX TABLES AND FIGURE ix

ACRONYMS xiii

EXECUTIVE SUMMARY xv

1. INTRODUCTION 1

1.1 Background 1

1.2 Purpose and Scope of the cost estimation 2

2. METHODOLOGY OF COSTING 3

2.1 Unit Cost Assumptions & Expenditure Schedules 3

2.2 Infrastructure Cost 4

2.3 Human Resource Cost 5

2.4 Cost of drugs and other supplies related to increasing numbers of service provisions 5

2.5 Program management cost 7

3. MUNICIPALITY BASED INCREMENTAL COST OF EMONC IMPROVEMENT ACTIONS 9

3.1 Aileu Municipality 9

3.2 Ainaro Municipality 13

3.3 Baucau Municipality 17

3.4 Bobonaro Municipality 21

3.5 Covalima Municipality 25

3.6 Dili Municipality 29

3.7 Ermera Municipality 33

3.8 Lautem Municipality 37

3.9 Liquica Municipality 41

VI | Estimated Cost of the EmONC IPA

3.10 Manatuto Municipality 45

3.11 Manufahi Municipality 49

3.12 Oecusse Municipality 52

3.13 Viqueque Municipality 55

4. PROGRAM MANAGEMENT COST 59

4.1 Norms & Guidelines Development (Scheduled in Year 1) 59

4.2 Capacity Building (Scheduled in Year 2) 60

4.3 System Reorientations (Scheduled in Year 1) 61

4.4 Public Communication (Annually) 61

4.5 Monitoring & Evaluation 61

4.6 Logistics Cost 62

4.7 Summary of Program Activity Costs 62

5. ANNEXES 63

Annex 1: One Health Tool and Costing Approaches 63

Annex 2: Infrastructure Cost Parameters in BEmONC Facilities 66

Annex 3: Human Resource Requirement by Type of EmONC Facility 69

Annex 4: Detailed cost estimates for program management activities 70

Annex 5: Priority order of upgrading of different institutions (based on EmONC IPA) 75

6. REFERENCES 77

7. ACKNOWLEDGEMENTS 78

8. CONTRIBUTORS 79

Estimated Cost of the EmONC IPA | VII

LIST OF TABLES AND FIGURES

TablesTable 1: Summary of the estimated costs. IPA 2016-2019 XVII

Table 2: Estimated cost of IPA in different Municipalities by cost types XXIII

Table 3: EmONC conditions considered in cost estimates 6

Table 4: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Aileu Municipality 10

Table 5: Staff types to be newly employed in BEmONC facilities in Aileu Municipality 11

Table 6: Infrastructure requirements of newly proposed BEmONC facilities in Aileu Municipality 11

Table 7: Equipment requirements of newly proposed BEmONC facilities in Aileu Municipality 11

Table 8: Cost of implementing IPA in Aileu Municipality from 2016 to 2019 (US$) 12

Table 9: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals & HR Maubisse in Ainaro Municipality 13

Table 10: Staff types to be newly employed in BEmONC facilities in Ainaro Municipality 14

Table 11: Infrastructure requirements of newly proposed BEmONC facilities in Ainaro Municipality 14

Table 12: Equipment requirements of newly proposed BEmONC facilities in Ainaro Municipality 15

Table 13: Cost of implementing IPA in Ainaro Municipality from 2016 to 2019 (US$) 16

Table 14: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals and HR Baucau in Baucau Municipality 17

Table 15: Staff types to be newly employed in BEmONC facilities in Baucau Municipality 18

Table 16: Infrastructure requirements of newly proposed BEmONC facilities in Baucau Municipality 18

Table 17: Equipment requirements of newly proposed BEmONC facilities in Baucau Municipality 19

Table 18: Cost of implementing IPA in Baucau Municipality from 2016 to 2019 (US$) 20

VIII | Estimated Cost of the EmONC IPA

Table 19: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Bobonaro Municipality 21

Table 20: Staff types to be newly employed in BEmONC facilities in Bobonaro Municipality 22

Table 21: Infrastructure requirements of newly proposed BEmONC facilities and HR Maliana in Bobonaro Municipality 22

Table 22: Equipment requirements of newly proposed BEmONC facilities and HR Maliana in Bobonaro Municipality 23

Table 23: Cost of implementing IPA in Bobonaro Municipality from 2016 to 2019 (US$) 24

Table 24: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals in Covalima Municipality 25

Table 25: Staff types to be newly employed in BEmONC facilities in Covalima Municipality 26

Table 26: Infrastructure requirements of newly proposed BEmONC facilities in Covalima Municipality 26

Table 27: Equipment Requirements of newly proposed BEmONC facilities in Coalima Municipality 27

Table 28: Cost of implementing IPA in Covalima Municipality from 2016 to 2019 (US$) 28

Table 29: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals in Dili Municipality 29

Table 30: Staff types to be newly employed in BEmONC facilities in Dili Municipality 30

Table 31: Infrastructure requirements of newly proposed BEmONC facilities in Dili Municipality 30

Table 32: Equipment requirements of newly proposed BEmONC facilities in Dili Municipality 31

Table 33: Cost of implementing IPA in Dili Municipality from 2016 to 2019 (US$) 32

Table 34: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals in Ermera Municipality 33

Table 35: Staff types to be newly employed in BEmONC facilities in Ermera Municipality 34

Table 36: Infrastructure requirements of newly proposed BEmONC facilities in Ermera Municipality 34

Table 37: Equipment requirements of newly proposed BEmONC facilities in Ermera Municipality 35

Estimated Cost of the EmONC IPA | IX

Table 38 Cost of implementing IPA in Ermera Municipality from 2016 to 2019 (US$) 36

Table 39: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals in Lautem Municipality 37

Table 40: Staff types to be newly employed in BEmONC facilities in Lautem Municipality 38

Table 41: Infrastructure requirements of newly proposed BEmONC facilities in Lautem Municipality 38

Table 42: Equipment requirements of newly proposed BEmONC facilities in Lautem Municipality 38

Table 43: Cost of implementing IPA in Lautem Municipality from 2016 to 2019 (US$) 40

Table 44: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Liquica Municipality 41

Table 45: Staff types to be newly employed in BEmONC facilities in Liquica Municipality 42

Table 46: Infrastructure requirements of newly proposed BEmONC facilities in Liquica Municipality 42

Table 47: Equipment requirements of newly proposed BEmONC facilities in Liquica Municipality 43

Table 48: Cost of implementing IPA in Liquica Municipality from 2016 to 2019 (US$) 44

Table 49: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Manatuto Municipality 45

Table 50: Staff types to be newly employed in BEmONC facilities in Manatuto Municipality 46

Table 51: Infrastructure requirements of newly proposed BEmONC facilities in Manatuto Municipality 46

Table 52: Equipment requirements of newly proposed BEmONC facilities in Manatuto Municipality 47

Table 53: Cost of implementing IPA in Manatuto Municipality from 2016 to 2019 (US$) 48

Table 54: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Manufahi Municipality 49

Table 55: Staff types to be newly employed in BEmONC facilities in Manufahi Municipality 50

Table 56: Infrastructure requirements of newly proposed BEmONC facilities in Manufahi Municipality 50

Table 57: Equipment requirements of newly proposed BEmONC facilities in

X | Estimated Cost of the EmONC IPA

Manufahi Municipality 50

Table 58: Cost of implementing IPA in Manufahi Municipality from 2016 to 2019 (US$) 51

Table 59: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Oecusse Municipality 52

Table 60: Staff types to be newly employed in BEmONC facilities in Oecusse Municipality 53

Table 61: Infrastructure requirements of newly proposed BEmONC facilities in Oecusse Municipality 53

Table 62: Cost of implementing IPA in Oecusse Municipality from 2016 to 2019 (US$) 54

Table 63: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Viqueque Municipality 55

Table 64: Staff types to be newly employed in BEmONC facilities in Viqueque Municipality 56

Table 65: Infrastructure requirements of newly proposed BEmONC facilities in Viqueque Municipality 56

Table 66: Equipment requirements of newly proposed BEmONC facilities in Viqueque Municipality 57

Table 67: Cost of implementing IPA in Viqueque Municipality from 2016 to 2019 (US$) 58

Table 68: Program cost related to IPA 62

FiguresFigure 1: Distribution of IPA costs over time XVI

Figure 2: Radar chart showing relative costs related to different cost elements by Municipality XXII

Estimated Cost of the EmONC IPA | XI

LIST OF ANNEX TABLES AND FIGURE

TablesAnnex 2 Table 1: Infrastructure cost parameters in BEmONC facilities 66

Annex 2 Table 2: List of medical equipment and furniture for BEmONC facility 66

Annex 3 Table 1: Human resource requirements and salary details 69

Annex 4 Table 1: Development of Norms, standards and protocols on EmONC (Year 1) 70

Annex 4 Table 2: In-Service Training On Emonc For Doctors And Midwives - Master Training (Year 2) 70

Annex 4 Table 3: Integrate upgraded standards and treatment protocols into preservice training of doctors and midwives 71

Annex 4 Table 4: EmONC awareness training such as nurses, OT staff, lab technicians, managers, ambulance drivers 71

Annex 4 Table 5: Train Suco and Aldeia chiefs, village committee members, and local NGOs on improving EmONC related health seeking behavior 71

Annex 4 Table 6: Train Suco and Aldeia chiefs, village committee members, and local NGOs on improving EmONC related health seeking behavior 72

Annex 4 Table 7: Administrators (DSM and DPHO-SMI, Municipality level) & EmONC coordinator on EmONC planning, management and monitoring EmONC services 72

Annex 4 Table 8: System reorientation (Year one) 72

Annex 4 Table 9: Public Communication (Annual Activity) 73

Annex 4 Table 10: M & E (Timing under sub activities) 73

Annex 4 Table 11: Partograph review studies (Year two) 73

Annex 4 Table 12: Review meetings (Bi Annual) 74

Annex 4 Table 13: NATIONAL EMONC REVIEW (ANNUAL) 74

Annex 5 Table 1: Priority order of upgrading of different institutions (based on EmONC IPA) 75

FigureAnnex 1 Figure 1: Schematic representation of OneHealth Tool organization 63

XII | Estimated Cost of the EmONC IPA

Estimated Cost of the EmONC IPA | XIII

ACRONYMS

BEmONC Basic Emergency Obstetric and Newborn CareCEmONC Comprehensive Emergency Obstetric and Newborn CareCHC Community Health CentersCSI Centru Saude InternamentuDSM Delegate Saude Municipality (Municipality Public Health Officer)DPHO-SMI Municipality Public Health Officer-Maternal and Child HealthEmONC Emergency Obstetric and Newborn CareHR Human ResourceIEC Information, Education and Communication IPA Improvement Plan of Action IT Information TechnologyMNH Maternal and Neonatal Health NVD Normal Vaginal DeliveryOHT One Health ToolUNFPA United Nations Popultion Fund

XIV | Estimated Cost of the EmONC IPA

Estimated Cost of the EmONC IPA | XV

EXECUTIVE SUMMARY This assessment estimated the incremental cost of implementing proposed Emergency Obstetric and Newborn Care (EmONC) Improvement Plan of Action (IPA) in Timor-Leste for its 4-year period of implementation (2016-2019). The scope of the assessment focused:

1. Cost of new infrastructure additions (Pre Natal Rooms and Training Facilities); 2. Costs involved in upgrading of existing EmONC related infrastructure facilities:

National and Referral Hospitals, Centru Saude Internamentu (CSIs)) and Community Health Centers (CHCs);

3. Cost of remunerating newly recruited health workers;4. Cost of purchasing and distribution (logistics) of drugs and supplies required by the

additional patients (pregnant mothers and newborns) presented to BEmONC and CEmONC facilities resulting from improvement plans of actions;

5. Cost of program management functions.

WHO One Health Tool (OHT) was used for the cost estimates. Unit costs were obtained from relevant Directorates of the Ministry of Health, values presented in the IPA, the cost assumptions used in the RMNCAH strategy 2015-2019 cost assessment report, UNICEF and UNFPA product catalogues, and OHT default data base. For few items, for which the unit cost was not available from any of the above sources, respective costs were obtained by perusing the commercial costs quoted in the internet.

Findings are summarized by 13 Municipalities, with the exception of the program management cost, which is estimated at national level.

The total estimated cost for implementing the Improvement Plan of Action (IPA) over 4 years will be around 7,983,081 US $ (Table 1). The expenditure will be highest during the first 2 years, which will be around 2.6 and 2.2 million US$ respectively (Table 1). This is because the upgrading of priority BEmONC institutions, will be carried during these 2 years. Year 3 and 4 require around 1.98 and 1 million US$ respectively.

At Municipality levels, infrastructure construction, rehabilitation and utility costs together became the largest cost driver, which is around 2.4 million US$ (34%). Equipment supplies also amounted to 2.2 million US$ (31%). Human resource salaries amounted to 2 million US$ (28%) while the incremental cost of drugs and supplies required for IPA will be around 0.5 million US$ (7.4%) (Table2).

Figure 1 shows how different cost elements drive total cost over time.

XVI | Estimated Cost of the EmONC IPA

FIGURE 1 DISTRIBUTION OF IPA COSTS OVER TIME

Sub-Total 2,675,443 2,258,694 1,950,806 1,098,138TOTAL 7,983,081

Year1 Year2 Year3 Year4Drugs&supplies 105,368 126,390 146,583 165,643

Humanresourcecosts 347,856 500,233 615,073 615,073

Equipmentcost 727,889 826,591 612,931 67,197

Infrastructureconstructioncost(Pre-natalrooms) 951,000 390,000 291,000 33,000

Infrastructurerehabilitationcost 313,590 95,421 82,774 12,362

Infrastructureutilitycost(Pre-natalrooms) 47,850 67,650 84,150 80,850

Programmemanagementcost 181,890 252,409 118,295 124,013

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Estimated Cost of the EmONC IPA | XVII

Table 1 summarizes the estimated cost of IPA over 4 years. More disaggregated data is presented in sections devoted for different Municipalities.

Table 1: Summary of the estimated costs. IPA 2016-2019

Municipality Cost Year 1 Year 2 Year 3 Year 4 Total

Aileu

Drugs & Supplies 4,815 5,045 5,257 5,445 20,562

Human resource costs 24,000 24,000 24,000 24,000 96,000

Equipment cost 14,249 22,297 - - 36,546

Infrastructure construction cost (pre-natal rooms)

33,000 33,000 - - 66,000

Infrastructure rehabilitation cost 6,784 20,086.00 - - 26,870

Infrastructure utility cost (Pre -natal rooms) 1,650 3,300 3,300 3,300 11,550

Total for the Municipality 84,498 107,728 32,557 32,745 257,528

Ainaro

Drugs & Supplies 5,546 7,005 8,571 10,242 31,364

Human resource costs 51120 69480 69480 69480 259560

Equipment cost 91,112 90,943 - - 182,055


66,000 33,000 - - 99,000

Infrastructure rehabilitation cost 34,659 3,500 - - 38,159



Baucau

Drugs & Supplies 10,072 10,852 11,594 12,287 44,805


Equipment cost 13,135 109,320 - - 122,455


148,500 33,000 - - 181,500




XVIII | Estimated Cost of the EmONC IPA


Bobonaro

Drugs & Supplies 8,067 10,100 12,073 13,961 44,201


Equipment cost 8,453 63,806 105,456 - 177,715


148,500 33,000 66,000 - 247,500

Infrastructure rehabilitation cost 0 24,137 34,748 - 58,885



Covalima

Drugs & Supplies 6,841 7,332 7,792 8,214 30,179


Equipment cost 87,228 95,717 93,899 - 276,844


148500 33000 33000 - 214,500

Infrastructure rehabilitation cost 1650 6355 13475 - 21,480



Dilli

Drugs & Supplies 35,099 39,603 43,929 47,999 166,630


Equipment cost 111,172 73,363 86,200 67,197 337,932


33000 33000 33000 33000 132,000

Infrastructure rehabilitation cost 3,860 5,775 3,980 12362 25,977



Estimated Cost of the EmONC IPA | XIX


Ermera

Drugs & Supplies 7,565 11,223 14,484 17,271 50,543


Equipment cost 47,583 97,413 22,903 - 167,899


33,000 33,000 33,000 - 99,000

Infrastructure rehabilitation cost 6,835 7,026 4,294 - 18,155



Lautem

Drugs & Supplies 5,479 6,483 7,454 8,378 27,794


Equipment cost 65,559 62,373 88,706 - 216,638


30,000 30,000 30,000 - 90,000




Liquica

Drugs & Supplies 5,427 7,184 8,894 10,537 32,042


Equipment cost 30,946 36,377 99,082 - 166,405


33,000 33,000 33,000 - 99,000


Infrastructure utility cost (Pre -natal rooms) 1,650 3,300 4,950 - 9,900


XX | Estimated Cost of the EmONC IPA


Manatuto

Drugs & Supplies 2,975 3,962 4,924 5,847 17,708

Human resource costs - 6,120 18,360 18,360 42,840

Equipment cost 12,386 42,937 42,334 - 97,657


30,000 30,000 30,000 - 90,000




Manufahi

Drugs & Supplies 1,883 2,281 2,667 3,035 9,866


Equipment cost 77,620 73559 - - 151,179


33000 33,000 - - 66,000

Infrastructure rehabilitation cost 32,899 7299 - - 40,198

Infrastructure utility cost (Pre -natal rooms) 1650 3,300 3,300 3,300 11,550


Oecusse

Drugs & Supplies 5,059 7,420 9,727 11,953 34,159


Equipment cost 31,359 - - - 31,359


148500 - - - 148,500

Infrastructure rehabilitation cost* NA NA NA NA NA

Infrastructure utility cost (Pre -natal rooms) 7425 7,425 7,425 7,425 29,700


Estimated Cost of the EmONC IPA | XXI


Viqueque

Drugs & Supplies 6,540 7,900 9,217 10,474 34,131

Human resource costs 24000 36,240 48,480 48480 157,200

Equipment cost 137,087 58,486 74,351 - 269,924


66000 33,000 33,000 - 132,000


Infrastructure utility cost (Pre -natal rooms ) 3300 4,950 6,600 6,600 21,450


All 13 Municipalities

Total cost from all cost elements

2,493,553

2,006,285

1,832,511 974,125

7,306,475

Overall program management cost -As national estimate 181,890 252,409 118,295 124,013 676,607

Grand Total for IPA implementation 2,675,443 2,258,694 1,950,806 1,098,138 7,983,081

*The engineering unit of the ministry of health could not collect this information due to administrative constraints.

XXII | Estimated Cost of the EmONC IPA

The following radar chart (Figure 2) and Table 2 describes the cost of proposed improvement plans of actions according to their relative sizes of expenditures by different cost elements. It shows that infrastructure construction costs in Bacau, Bobonaro, Covalima and OeCusse Municipalities. The reasons for these high estimates are the building of new training sites in these institutions. The equipment costs of Municipalities that have relatively larger number of EmONC institutions seemed to be relatively high. (e.g. in Dili, Viqueque)

FIGURE 2: RADAR CHART SHOWING RELATIVE COSTS RELATED TO DIFFERENT COST ELEMENTS BY MUNICIPALITY

Estimated Cost of the EmONC IPA | XXIII

Table 2: Estimated cost of IPA in different Municipalities by cost types

Municipality Drugs & Supplies

Human resource

costsEquipment

cost

Infrastructure construction

cost (pre-natal rooms)

Infrastructure rehabilitation

cost

Infrastructure utility cost (Pre -natal

rooms)Total

Aileu 20,562 96,000 36,546 66,000 26,870 11,550 257,528

Ainaro 31,364 259560 182,055 99,000 38,159 18,150 628,288

Baucau 44,805 96,000 122,455 181,500 7,468 34,650 486,878

Bobonaro 44,201 178,560 177,715 247,500 58,885 41,250 748,111

Covalima 30,179 290,160 276,844 214,500 21,480 37,950 871,113

Dili 166,630 24,480 337,934 132,000 25,977 19,800 706,821

Ermera 50,543 282,600 167,899 99,000 18,155 14,850 633,047

Lautem 27,794 140,760 216,637 90,000 131,164 14,850 621,205

Liquica 32,042 209,160 166,405 99,000 31,460 9,900 547,967

Manatuto 17,708 42,840 97,657 90,000 11,754 14,850 274,809

Manufahi 9,866 71,955 151,179 66,000 40,198 11,550 350,748

Oecusse* 34,159 228,960 31,359 148,500 NA 29,700 472,678

Viqueque 34,131 157,200 269,924 132,000 92,577 21,450 707,282

Total 543,984 2,078,235

2,234,609 1,665,000 504,147 280,500 7,306,475

Percentage 7.4 28.4 30.6 22.8 6.9 3.8 100.0

*The engineering unit of the ministry of health could not collect this information due to administrative constraints.

XXIV | Estimated Cost of the EmONC IPA

Estimated Cost of the EMONC IPA | 1

1. INTRODUCTION

1.1 BackgroundThe Ministry of Health Timor-Leste is in the process of implementing an EmONC Improvement Plan of Action (IPA) for the 4-year period from 2016 to 2019. This plan will respond to the service gaps identified by the EmONC needs assessment conducted in 2015. Once implemented, the IPA is expected to further facilitate and strengthen the Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy 2015-2019 of the Ministry of Health.

The EmONC IPA focuses on the following objectives:

1. To increase the availability of EmONC facilities by rationalizing the coverage throughout the country with a network of interconnected facilities beyond the global standards in order to reach by 2019 a total of 43 functional EmONC facilities, including the six CEmONC facilities (National Hospital and 5 Referral Hospitals) already existing that need to be strengthened;

2. To ensure accessibility for all, including in the remote parts of the country, through improved distribution of EmONC facilities and a functional referral system 24/7 linking these facilities;

3. To ensure effective utilization of EmONC services to over 90% of the needs, through community participation, strong communication, effective referral, delivery of quality services by competent providers (to prevent the 3 delays). The target is 80% of all births in institutions and 60% in EmONC facilities;

4. To strengthen the capacity of Municipality Health authorities (Delegado Saude Municipality (DSMs) and Saude Materna Infantil (DPHO-SMIs) as well as lower level administrative services to plan, manage, monitor, and support EmONC services;

5. To expand the knowledge and awareness of communities about the need to seek assistance from health services and particularly EmONC services.

Strategic actions related to the realization of above objectives will require financial inputs on the following areas:

1. Development of new infrastructure, rehabilitation and refurbishing of existing facilities, provision of relevant medical equipment, furniture, and other items to newly constructed or upgraded facilities and maintenance and utility functions of the above facilities;

2. Remunerating newly recruited health staff;

3. Purchase and distribution of drugs and other supplies for increasing service demand;

2 | Estimated Cost of the EMONC IPA

4. Meeting service side demands: Capacity building of EmONC, allied services and administrative staff, Development of policies, standards and guidelines and other related job aids. Improve supervision, monitoring and evaluation of actions;

5. Meeting demand side requirements: Raising community awareness and improving health seeking related to EmONC, encourage community participation in EmONC care.

1.2 Purpose and Scope of the cost estimationThis study aimed to estimate the above-mentioned financial requirements at national and subnational levels. Having a prior insight on the potential cost of improvement actions will facilitate the decision making related to operational planning. Knowledge on the cost of the proposed IPA would also provide a rational basis for decisions related to fundraising and financial allocation.

The scope of costing was limited to the incremental costs (extra costs) due to the implementation of new EmONC IPA. The costs that are already covered by the regular MNH and hospital service programmes were not included in cost estimates.

Hence, the scope of cost estimates of this study were limited to the following elements:

1. Cost of new infrastructure additions and upgrading of existing EmONC related infrastructure facilities in CEmONC Hospitals (National, Referral) Centrus Saude Internamentu (CSI)) and Community Health Centers (CHCs);

2. Cost of remuneration of new cadres of health workers. Remuneration of already existing staff is covered by existing budgets and therefore they were not considered to be the focus of the IPA. In-service capacity building was considered as a program management cost (please refer item no 4 below);

3. Cost of procurement and distribution (logistics) of drugs and supplies required by the additional patients (pregnant mothers and newborns) presented to BEmONC and CEmONC facilities resulting from improvement plans of actions;

4. Cost of program management functions: This component included all actions arising out of the IPA that can be categories under themes: Norms, standards and other guidelines development, Capacity building, System Reorientations, Community awareness/advocacy, M & E activities, and Supply logistics.


2. METHODOLOGY OF COSTING This cost estimate was conducted using the One Health Tool (OHT)1. OHT is a software program developed for costing and impact assessment of health programs. OHT also provides interim outputs such as staff time adequacy and utilization patterns, bed day’s capacity assessments, training details, health system element summaries by project periods, financial space analysis and budget mappings etc. a summarized description of OHT based costing approach is given in the annexure 1. A detailed description on OHT can be obtained in the references given.

In this study One Health Tool was customized to estimate the component of EmONC IPA disaggregated as follows:

1. Infrastructure costs: cost of newly establishing/ upgrading EmONC infrastructure and cost of their maintenance and paying for utilities such as electricity, water, laundry etc;

2. Human resource cost: cost of remuneration of new workers who will be joining the EmONC workforce in Municipalities. The basic training cost of new staff was not considered;

3. Cost of drugs and other supplies: required by the EmONC intervention scale up over the project period;

4. Cost of additional program management functions: identified in the IPA on EmONC, including in-service training.

The findings are presented as follows:

• The costs of the first 3 items were estimated for each Municipality separately.

• The cost of program management functions was computed as non-Municipality specific costs and separately presented.

• All cost projections were arranged to reflect yearly based cost over four year period.

2.1 Unit Cost Assumptions & Expenditure SchedulesCountry specific unit costs various items were obtained from relevant Directorates of the Ministry of Health, Cost estimates presented in IPA, the cost assumptions used in the RMNCAH strategy 2015--2019 cost assessment report, UNICEF and UNFPA catalogues, and OHT default data base. For few items, for which the unit cost was not available from any of the above sources, the costs were obtained by perusing the commercial costs quoted in the internet. In such situations, an average of available quotes was used. Unit costs were included in annexures.

1 Futures Institute,One Health Tool: Technical manual (internet)2012. Available at http://www.avenirhealth.org


EmONC IPA stipulates a priority order, in which upgrading of different institutions in a Municipality to the level of BEmONC facility should take place. Cost related to a particular institution is assigned to the year in which that institution’s upgrading is scheduled in the IPA. This resulted in significant year to year variations of total cost in a Municipality . The investments related to Referral Hospitals and CSIs were considered as priority level one and therefore investments were focused at the year one. Annexure 5 includes priority order of upgrading.

2.2 Infrastructure CostThe IPA has identified health facilities to be upgraded as functional BEmONC in each Municipality and their individual infrastructure requirements (buildings, vehicles, medical and surgical equipment, furniture etc.). A special team from engineering unit of the Ministry of Health has done an assessment of proposed building requirements and estimated cost based on current Timor-Leste rates.

Except for a limited number, equipment supplies to CEmONC facilities were not considered as the need assessment findings indicated that these institutions are already functioning, adequately built, and equipped.

Needs assessment has identified the lack of several infrastructure items in EmONC facilities. They included blood banks, laboratory rooms, delivery rooms and post-natal wards. However, it was observed that additional building spaces are already available in most facilities and they can be used for these purposes. Special assessment carried out by a group of engineers identified these infrastructure requirements and estimated the cost of relevant conversions and rehabilitations. These costs were included in the cost of relevant Municipality cost estimates and separately identified as “Infrastructure rehabilitation cost”.

EmONC IPA mentions that it is recommended that Pre Natal Rooms are installed in the premises of all health facilities (EmONC IPA Page 24). Based on this proposal, the cost of establishing Pre Natal Rooms were factored in to all CEmONCs (except HNGV Dilli), CSIs and CHCs according to the respective upgrading schedules.

The IPA also recommends upgrading four new Clinical Training Sites (EmONC IPA ), in four Referral hospitals (Baucau, Maliana, Suai and Oecusse). Although the cost were estimated to establish these training sites, a decision was taken not to include in this report as implementation of this activity is not envisaged during this period 2016 - 2019.

Construction costs were estimated using the surface area construction cost estimates provided by local sources.

Utility and maintenance cost of newly added infrastructure facilities were also identified based on local experiences in the similar types of institutions in East Timor in the past year. These costs were identified as “Infrastructure utility cost”.


EmONC Needs Assessment indicated that at least a functioning multipurpose vehicle was available for all 42 EmONC institutions targeted. Hence, vehicle costs were not considered in this study.

Once data are compiled, types and numbers of new infrastructure additions required to implement EmONC IPA (i.e. buildings, medical and other equipment, furniture) etc. their unit costs, and the scale up plans were entered in to separate Municipality specific OHT projections. The required infrastructure costs were determined using them.

2.3 Human Resource CostThe aim of human resource (HR) costing was to estimate the cost of remunerating the staff that have to be newly hired/ recruited for EmONC institutions to facilitate implementation of the IPA. A standard number of human resource requirements were stipulated in the IPA (See Annexure 3). The human resource gaps for proposed EmONC facilities were assessed by comparing the standard numbers with the available number of each staff type in the institution.

Though, in the IPA, reshuffling of staff is proposed to fill the staff vacancies, exact planning and feasibility assessment of reshuffling were not carried out. Hence, it was not possible to calculate the number of vacancies that can be filled with reshuffling and the priority order in which they are assigned to different facilities. Therefore, the number of new recruits and cost of recruiting them (except those pertaining to doctors) were calculated as if no filling of vacancies by reshuffling is taking place. It was assumed that reshuffling of doctors could fill the relevant HR gaps in respective EmONC facilities.

The types of HR requirements of each institution is given in respective Municipality sections.

The unit cost of remuneration of each type of the staff were identified from the Ministry of Health sources (Annexure 3).

2.4 Cost of drugs and other supplies related to increasing numbers of service provisions The scale up targets in IPA proposes to increase percentage of deliveries occurring in EmONC facilities from the current level to 60 % by 2019. Realization of this target over the period may result in a considerable increase in the demands of drugs and other medical supplies.

The health services module of OHT was programed to estimate the cost of drugs and other medical supplies required by the expected patient loads presenting to the proposed EmONC facilities (BEmONC and CEmONC) across the project period. Table 3 presents


the EmONC conditions focused for the estimates. These interventions and corresponding incidences were already identified in the IPA.

It should be noted that some of these emergencies require that the mother should be transferred to a CEmONC facility. In some Municipalities, the designated CEmONC facility is situated outside the Municipality and hence the corresponding drugs and supply cost of these mothers should be factored into the CEmONC facility, where the mother is ultimately managed. Therefore, their costs were added to the cost of the EmONC cost of the Municipality at the receiving end. On the other hand, a considerable number of BEmONC conditions are also presented to the CEmONC hospitals. These are BEmONC cases from the draining area of the CEmONC facility.

Measures were taken in programming intervention costs module of OHT to enable the recognition of the relevant interventions and mothers who require CEmONC management and therefore have to be referred and those, who will be managed as BEmONC conditions within the presenting facility. This was done by identifying 2 interventions for each relevant EmONC condition. One of these interventions was made to reflect the cases that need to be referred to CEmONC facility, while the other to reflect the cases that are managed in the BEmONC facility.

Table 3: EmONC conditions considered in cost estimates

EmONC condition Reported Incidence per 100 pregnancies in East Timor

Pre-partum hemorrhage 0.5

Post-partum hemorrhage (not severe) * 1.3

Post-partum hemorrhage (severe) 0.4

Third to fourth degree perineal tears 0.4

Pre-partum Sepsis 0.5

Post-partum Sepsis 2.0

Post abortion care 1.0

Preterm labour and Pre-mature rupture of membranes 0.6

Pre-eclampsia 0.7

Eclampsia 0.2

Prolonged labour 2.0

Obstructed labour 0.6

Placenta accrete 0.3


EmONC condition Reported Incidence per 100 pregnancies in East Timor

Ruptured uterus 0.2

Ectopic pregnancy 0.3

Uterine inversion 0.1

Newborn asphyxia 2.5

Management of premature/LBW 2.0

Pulmonary embolism 0.1Source: EmONC IPA 2016 - 2019

Number of patients, who would be presenting with each of the above conditions at EmONC facilities during 2016-2019 period was estimated using the OHT. DemProj was used to model the changing populations in that Municipalities over 2016-2019 period. Then these population figures were used to estimate target number of pregnancies, who would require respective interventions over the period. Incidence of each condition was obtained based on past experiences of Timor-Leste health system as given in EmONC IPA. In order to obtain the estimated number of pregnancies presenting at BEmONC facilities, coverage of each type of such patients over 2016-2019 period were set as linear increase from the baseline % of birth coverage at each targeted BEmONC institutions to 60% of estimated births coverage as proposed in the IPA as coverage targets at EmONC facilities. An average cost of providing treatment inputs (drugs, supplies, and investigations) specified for each intervention was calculated in the OHT. Treatment protocols were based on OHT defaults, WHO and other international guidelines.

2.5 Program management costProgram management/ cost modules of OHT was used to cost the program management activities such as EmONC coordinator, development of norms and guidelines, capacity building, health system reorientation, public communication, M& E etc. as stipulated in IPA.

Annexure 4 includes detailed list of program management activities proposed in the IPA. This list of items was prepared by perusing the actions proposed in the IPA. Mechanism of implementation of each such activity was assessed by considering system capacity, distribution and types of target recipients and prescribed planning schedules. In addition, a 30 % of all drug purchase cost was identified as logistic cost. The data related to direct calculation of logistic cost was difficult to identify.

Cost of these items were appraised as national estimates.


3. MUNICIPALITY BASED INCREMENTAL COST OF EMONC IMPROVEMENT ACTIONS

This section provides Municipality based cost of implementing the EmONC IPA from 2016 to 2019. When interpreting Municipality based cost it is important to note that some of the Municipality EmONC cases are referred out. The cost (for drugs and supplies) of managing these is added to the cost of the Municipality, where the referral hospital is situated. For example, all ectopic cases, 25% of PIH cases, 25 % of PPH cases, 60% of APH cases and all cases of ruptured uterus, placenta accreta, and obstructed labour have to be referred to relevant CEmONC facilities. Details of these finer adjustments are given in respective sections.

3.1 Aileu MunicipalityAileu Municipality has a population of 48554. One CSI (Aillieu Villa) and 3 CHC (Namoleso, Remexio, and Lauara) are situated in this Municipality . Since there is no referral level hospital situated within the Municipality , patients who need to be refereed to higher centers are directed to HR Maubisse (From CSI Aileu Villa & CHC Nomoleso, 70% referrals) and HNGV Dili (From CSIs Remexio, and Lauara, 30% referrals).

CSI Aileu Villa and CHC Remexio have been identified to be improved as BEmONC facilities. In 2015 approximately 50 % of estimated births were presented at these 2 proposed BEmONC facilities.

Estimates of pregnancy related patient loads indicate that during the 2016 to 2019 period, Aillieu villa CSI will remain to be a facility with 300- 600 EmONC cases, while Remexio will remain to be a CHC with less than 300 EmONC cases.

3.1.1 IPA RELATED RESOURCE INPUTS AILEU MUNICIPALITY

The following table presents the expected number of various EmONC conditions and normal vaginal deliveries to be presenting at proposed BEmONC facilities of Aileu Municipality over four years from 2016 to 2019.


Table 4: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Aileu Municipality

Presenting conditions Year 1 Year 2 Year 3 Year 4 Total

Post-abortion case management 8 8 8 9 33

Postpartum hemorrhage 10 10 11 11 42

Maternal Sepsis case management 15 16 17 17 65

Ante-Partum Haemorrhage 2 2 2 2 8

PIH & Eclampsia 5 5 6 6 22

Newborn Asphyxia 14 15 16 17 62

Perineal tears 3 3 3 3 12

Pre partum sepsis 4 4 4 4 16

Prolonged labour 15 16 17 17 65

Placenta Accreta 2 2 2 3 9

Ruptured uterus 2 2 2 2 8

Uterine inversion 1 1 1 1 4

Obstructed labour 5 5 5 5 20

Preterm labour & PROM 5 5 5 5 20

Pulmonary Embolism 1 1 1 1 4

Premature labour and LBW 11 12 13 13 49

Ectopic case management (Referred to CEmONC) 2 2 2 3 9

Postpartum hemorrhage (Referred to CEmONC) 3 3 3 3 12

Ante-Partum Haemorrhage (Referred to CEmONC) 2 2 2 3 9

Eclampsia (Referred to CEmONC) 2 2 2 2 8

Normal Vaginal Deliveries in EmONC facilities 672 704 733 759 2868

Total 784 820 855 886 3345

The need assessment identified that the following additional numbers of staff types should be newly employed to ensure smooth functioning BEmONC services in Aileu Municipality (Table 5).


Table 5: Staff types to be newly employed in BEmONC facilities in Aileu Municipality

Staff type to be newly employed CSI Aileu Vila* (300-600 deliveries)

CHC Remexio (Less than 300 deliveries)

Midwife 3 0

Laboratory technician 1 0

Need assessment reported that existing infrastructure facilities are adequate for the smooth functioning of BEMONC facilities in the Municipality , provided that the following equipment are provided to these 2 institutions (Table 6 & 7). The maintenance cost of the new ambulances was also factored in to the Municipality cost. Several infrastructure rehabilitations were identified in these two facilities.

Table 6: Infrastructure requirements of newly proposed BEmONC facilities in Aileu Municipality.

Infrastructure items (Buildings, Vehicles Equipment)

Number required for CSI Aileu Vila* (300-600

deliveries)

Number required for CHC Remexio (Less than

300 deliveries)

Provide Tower Tank + Sanyo + Accessories 1 -

Provide New Door accessories 3 -

Install new Accessories Hand Basin 1 1

Provide + install new water tap for toilet 1 -

Painting wall for Internal & External 841.02 m2 788.7 m2

Provide + install new curtain for pre delivery & delivery room 2 -

Extension Delivery Room (5 m x 6 m) + bathroom - 30 m2

Provide New ventilation frame + Accessories - 1.00

Painting Existing ceiling - 131.04 m2

Pre-natal room (60M2) 1 1

Table 7: Equipment requirements of newly proposed BEmONC facilities in Aileu Municipality

Infrastructure items (Buildings, Vehicles Equipment) CSI Aileu Vila* CHC Remexio

Beds/ Bedside cupboards 2 1

Backup generator 1 1

Functional fan/air conditioning 1 1

functioning solar refrigerator 0 1

Hot air sterilizer (dry oven) 0 1


Infrastructure items (Buildings, Vehicles Equipment) CSI Aileu Vila* CHC Remexio

Steam sterilizer 1 1

Sterilization drum 0 2

Sterilization drum stand 1 1

Vacuum extractor with cups 0 2

Volsullum forceps 6 0

3.1.2 COST OF IMPLEMENTING IPA IN AILEU MUNICIPALITYThe total cost of Aileu Municipality over 4-year period amounts to 255,511 US $. The breakdown of costs by cost elements are given in the table 8. It should be noted that the total cost for the Municipality does not include the cost of managing patients who are referred outside the Municipality (managed in HR Maubisse and NH HNGV). They will be added to the Municipality s where these patients are usually managed.

Table 8: Cost of implementing IPA in Aileu Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all the EmONC cases and normal deliveries from Aileu Municipality . (cases managed in BEmONC facilities & Referred to CEmONC facility)

5,195 5,443 5,672 5,875 22,185

2. Cost of drugs and supplies for the cases managed outside Municipality (CEmONC cases* managed in HR Maubisse & NH HNGV)

380 398 415 430 1,623

3. Cost of drugs and supplies for the BEmONC cases** and normal deliveries managed within the Municipality (BEmONC facilities in Aileu)

4,815 5,045 5,257 5,445 20,562

4. Human resource costs 24,000 24,000 24,000 24,000 96,000

5. Equipment cost 14,249 22297 - - 36,546

6. Infrastructure construction cost (Pre-natal room) 33000 33,000 - - 66,000

7. Infrastructure rehabilitation cost 6,784 20,086.00 - - 26,870

8. Infrastructure utility cost (Pre -natal room ) 1,650 3,300 3,300 3,300 11,550

Total cost for the Municipality (sum of the item 3 to 8) 84,498 107,728 32,557 32,745 257,528

(* CEmONC case: Emergencies that requires blood transfusion and/ or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone; )


3.2 Ainaro Municipality Ainaro Municipality is home to 66397 people. One referral hospital (Maubisse), one CSI (Ainaro Villa) and a CHC (Hautio) is situated in the Municipality . Ainaro Villa CSI and Hautio CHC are targeted to be improved as BEmONC facilities in the IPA. At present, these 2 facilities and HR Maubisse cater for about 28 % estimated births in Ainaro Municipality.

Estimates of number of pregnancy coverage by BEmONC facilities indicate the Ainaro Villa CSI will receive more than 300 deliveries form 2017 onwards, provided proposed BEmONC coverage will be materialized as planned. Hence, HR and infrastructure requirements for these facilities were based on its impending rises inpatient intakes with the intervention scale up.

3.2.1 IPA RELATED RESOURCE INPUTS AINARO MUNICIPALITYTable 9 presents the estimated number of pregnancy related cases to be presenting in two BEmONC facilities and HR Maubisse in Ainaro Municipality over next 4 years.

Table 9: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals & HR Maubisse in Ainaro Municipality

























Total 751 962 1183 1427 4323

After considering the present HR status and Proposed HR norms the following personnel will have to be newly appointed for Ainaro Villa and Hautio facilities.

Table 10: Staff types to be newly employed in BEmONC facilities in Ainaro Municipality

Staff type to be newly employed

Number required for CSI Ainaro Villa (300-600 deliveries

from 2017)

Number required for CHC Hautio (Less

than 300 deliveries)

Number required for HR Maubisse (more than 600 from 2017)

Midwife 1 3 5

Anesthetist 0 0 1

According the field assessments and IPA the following types of equipment are to be provided in these hospitals.

Table 11: Infrastructure requirements of newly proposed BEmONC facilities in Ainaro Municipality


Number required for CSI

Ainaro Villa

Number required for CHC Hautio*

Number required for HR Maubisse

Extension Pre-natal room & post Natal Room + bathroom (15 m x 4 m) 60 m2 - -

Provide New Frame door + Panel + Accessories 1 - -

Provide new ceiling + ceiling list at existing delivery room & post-natal room 68.4 m2 - -

Painting new ceiling at existing room 68.4 m2 - -

Repair Existing Bathroom 1 - -

Provide New light TL Neon 6 - -

Solar panel - 1 -

Pre-natal room (60 M2) 1 1 1*Construction cost is not included as KOICA had undertaken new constructions in CHC Hautio


Table 12: Equipment requirements of newly proposed BEmONC facilities in Ainaro Municipality

Equipment CSI Ainaro Villa CHC Hautio HR Maubisse

Autoclave 1 0 1

Air conditioning 1 1 0

Backup generator 1 1 0

Beds 4 3 0

Blood pressure apparatus 1 0 0

Baby weighing scale 0 1 0

Curtains 5 0 0

Cellphone 1 0 0

Hot air sterilizer (dry oven) 0 1 1

Incinerator 1 1 0

Instrument trolley 0 2 0

Instrument tray 0 2 1

Infant laryngoscope with spare bulb and batteries 1 1 1

Newborn resuscitation table 1 1 1

Oxygen cylinder 0 1 0

Radiant warmer 1 1 0

Steam sterilizer 0 1 1

Sterilization drum 1 0 0

Sterilization drum stand 1 0 1

Sterilizer /Kerosene 1 0 1

Small cups for breast milk expression 0 5 5

Sharpe bin 0 1 0

Thrash bin 5 5 0

Vacuum extractor with cups 0 1 0

Vacuum aspirator/syringes 0 1 0

Volsullum forceps 0 6 0

Ultrasound machine 0 1 0


3.2.2 COST OF IMPLEMENTING IPA IN AINARO MUNICIPALITY Around 628,288 US$ will be required for the managing EmONC conditions and normal deliveries managed in in Ainaro Municipality between year 1 and year 4.

Table 13: Cost of implementing IPA in Ainaro Municipality from 2016 to 2019 (US$)

Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Ainaro Municipality (cases managed in both BEmONC & CEmONC Facilities)

4,988 6,372 7,866 9,471 28,697

2. Cost of drugs and supplies for CEmONC cases* from Ainaro Municipality s managed in HR Maubisse

365 466 576 693 2,100

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Ainaro Municipality

4,623 5,906 7,291 8,777 26,597

4. Cost of drugs and supplies for managing CEmONC cases referred to HR Maubisse from Aileu and Manufahi Municipality

558 633 704 772 2,667


6. Equipment cost 91,112 90,943 - - 182,055

7. Infrastructure construction cost (PRE NATAL ROOM) 66,000 33,000 - - 99,000

8. Infrastructure rehabilitation cost 34,659 3,500 - - 38,159

9. Infrastructure utility cost (PRE NATAL ROOM) 3,300 4,950 4,950 4,950 18,150


(* CEmONC case: Emergencies that requires blood transfusion and/ or surgery in addition to basic signal functions); **BEmONC case: Emergencies that can be managed with 7 signal functions alone; )


3.3 Baucau MunicipalityThe population of Baucau Municipality reaches 124061. This population is served by 7 CHCs and the referral hospital HA Baucau. Out of these CHCs, CHC Quelicai is being upgraded as A CSI through another project. Quelicai CSI and CHC Baguia are ear marked as BEmONC facilities for the Municipality . Baguia and Quelicai Hospital and HR Baucau together cater for around 42 % of births occurring in the Municipality.

3.3.1 IPA RELATED RESOURCE INPUTS BAUCAU MUNICIPALITYTable 14 presents the estimated number of patients to be presenting in 2 BEmONC facilities and HR Baucau in Baucau Municipality over next 4 years.

Table 14: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals and HR Baucau in Baucau Municipality






















Normal Vaginal Deliveries in EmONC fcailities 1644 1789 1927 2054 7414

Total 1915 2085 2245 2395 8640


Estimates of the numbers of pregnancy related conditions indicate that CHCs; Qualicai and Bauguia will be remain as small scale (Less than 300 deliveries) facilities even after scale up of coverage to 60%. The HR and infrastructure requirements of these 2 institutions were carried out accordingly.

Table 15: Staff types to be newly employed in BEmONC facilities in Baucau Municipality


Number required for CHC Qualicai (Less than 300 deliveries)

Number required for CHC Baguia (Less than

300 deliveries)

Number required for HR Baucau (More than 600 deliveries)

Midwife 0 3 0

Lab Technician 0 1 0

CHC Qualicai has been identified as priority one stage while CHC Bauguia has been identified at priority 2 stage. Hence infrastructure investments were scheduled accordingly.

Table 16: Infrastructure requirements of newly proposed BEmONC facilities in Baucau Municipality


Number required for CHC Quelicai

Number required for CHC Baguia

Number required for HR Baucau

Repair Tower Tank 1100 L + Sanyo + Accessories 1 1 -

Repair & provide accessories Hand Basin 2 2 -

Repair Switch / outlet 3 3 -

Repair water installation for maternity room 1 - -

Wall Paint (Internal and External) Maternity 481 m2 481 m2 -

Provide new Curtain Roll at Delivery Room 2 2 -

Repair water installation for maternity room - 1 -

Pre-natal room 60 M2 1 1 1

Training Facility 0 0 1


Table 17: Equipment requirements of newly proposed BEmONC facilities in Baucau Municipality

Equipment CHC Quelicai CHC Baguia HR Baucau

Ambu (ventilator) bag for newborn 250-400 ml 2 0 0

Autoclave 1 0 0



Blood pressure apparatus (mercury) 2 0 0

Covered contaminated waste trash bin 5 5 0

Fetal stethoscope 0 5 0

Filled oxygen cylinder with cylinder carrier and key to open valve 1 1 0

Fluorescent tubes for phototherapy to treat jaundice - - 4

Functional fan/air conditioning 1 1 1

functioning electric/gas refrigerator 1 0 0

functioning solar refrigerator 1 0 1


Incinerator 1 0 1

Incubator - - 1




Regular trash bin 5 0 0

Small cup for breast milk expression 5 5 5

Steam instrument sterilizer/pressure cooker, electric 1 1 1



Sterilizer/pressure cooker, kerosene heated 1 1 1

Total bed for obstetric patient 3 5 0

Total delivery table 1 3 0

Towels or cloth for newborn 20 20 0

Ultrasound 1 1 0




3.3.2 COST OF IMPLEMENTING IPA IN BAUCAU MUNICIPALITYTotal incremental cost of IPA implementation in Baucau Municipality from year 1 to year 4 is estimated to be around 486,878 US$. Construction of a new clinical training facility is planned for the Baucau Municipality which resulted in relatively high infrastructure construction cost in the first year.

Table 18: Cost of implementing IPA in Baucau Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Baucau Municipality (managed in BEmONC & CEmONC facilities)

7,066 7,691 8,285 8,835 31,877

2. Cost of drugs and supplies for the CEmONC cases* managed in HR Baucau 621 675 727 776 2,799

3. Cost of drugs and supplies for the BEmONC cases ** and normal deliveries managed within the Baucau Municipality

6,445 7,016 7,557 8,059 29,077

4. Cost of drugs and supplies for managing CEmONC cases referred to the Baucau Municipality (Baucau hospital) from Lautem and Viqueque Municipalities

3,006 3,161 3,310 3,452 12,929


6. Equipment cost 13,135 109,320 - - 122,455

7. Infrastructure construction cost (Training facility & Pre Natal Room) 148,500 33,000 - - 181,500

8. Infrastructure rehabilitation cost 3,734 3,734 - - 7,468

9. Infrastructure utility cost (Training facility & Pre Natal Room) 7,425 9,075 9,075 9,075 34,650


(* CEmONC case: Emergencies that requires blood transfusion and/or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone)


3.4 Bobonaro MunicipalityPopulation of Bobonaro Municipality is around 98932. Six CHCs and HR Maliana provide health services for this population. CHCs; Cailaco, Atabae, Lolotoe and Bobonaro are identified as prospective BEmONC facilities. At present about 25% of estimated births from Bobonaro Municipality are delivering in these 3 CHCs and in HR Maliana.

3.4.1 IPA RELATED RESOURCE INPUTS BOBONARO MUNICIPALITYTable 19 presents the estimated number of patients to be presenting in 2 BEmONC facilities and Referral Hospital Maliana in Bobonaro Municipality in over next 4 years.

Table 19: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Bobonaro Municipality























Total 1216 1519 1820 2103 6658


The HR inputs, infrastructure facilities and equipment proposed to be supplied for Bobonaro Municipality by IPA is as follows. All CHCs in Bobonaro Municipality remain facilities with less than 300 deliveries annually for next 4 years, even after scale up plans are implemented.

Table 20: Staff types to be newly employed in BEmONC facilities in Bobonaro Municipality


Number required for CSI Cailaco

(Less than 300 Deliveries)

Number required for CHC Atabae


Number required for CHC Lolotoe


Number required for

CHC Bobonaro (Less than 300

Deliveries)

Number required for HR Maliana

(More than 600

Deliveries)

Midwife 1 2 2 2 0

Laboratory technician 0 0 0 1 3

Anesthetist 0 0 0 0 1

Infrastructure requirement of Bobonaro Municipality is as follows.

Table 21: Infrastructure requirements of newly proposed BEmONC facilities and HR Maliana in Bobonaro Municipality


Number required for CSI Cailaco

Number required for CHC Atabae

Number required for CHC Lolotoe

Number required for CHC

Bobonaro

Number required for HR Maliana

Extension Post Natal Room (5 m x 7,5 m) 37.5 m2 - - - -

Repair Bathroom 2 2 - 2 -

Painting wall for Interior & Exterior 1 - - 841 m2 -

Install new Accessories door 7 5 - 6 -

Extension Post Natal Room (3 m x 7,5 m) - 22.5 m2 - - -

Extension waiting Room - 18.8 m2 - - -

provide new water tank 2200 L - 1 - - -

Provide new Installation water + accessories - - - 500 m2 -

Training facility - - - - 1

Pre Natal Rooms 1 1 1 1 1


Table 22: Equipment requirements of newly proposed BEmONC facilities and HR Maliana in Bobonaro Municipality

Equipment CSI Cailaco CHC Atabae

CHC Lolotoe

CHC Bobonaro

HR Maliana

Adult ventilator bag and mask 0 0 0 0 0

Autoclave with temperature and pressure gauges 0 1 1 0 0

Baby weighing scale 0 0 0 0 0

Back up generator 1 0 0 0 0

Blood pressure apparatus (mercury) 0 1 0 1 0

Covered contaminated waste trash bin 5 0 5 5 0

Cuscos speculum 0 0 1 0 0

Decontamination container 0 0 0 0 0

Disposable uncuffed/cuffed tracheal tubes, for newborn 1 1 1 1 0

Fetal stethoscope 5 0 0 5 0

Filled oxygen cylinder with cylinder carrier and key to open valve 1 0 0 1 0

Functional fan/air conditioning 2 0 0 0 0

functioning solar refrigerator 1 1 0 1 0

Heavy duty gloves 10 10 10 10 0

Hot air sterilizer (dry oven) 0 1 1 0 0

Incinerator 1 1 0 0 0

Infant laryngoscope with spare bulb and batteries 1 1 1 1 0

Instrument trolley 0 0 0 0 0

Mucus extractor 0 0 0 0 0

Newborn resuscitation table 0 0 0 1 0

Puncture-proof sharps container 0 0 5 0 0

Radiant warmer 1 0 0 0 0

Small cup for breast milk expression 1 1 1 1 1

Steam instrument sterilizer/pressure cooker, electric 1 1 1 0 0

Steam sterilizer 1 1 0 1 0

Sterile Gloves 0 0 0 1 0

Sterilization drum 0 1 1 1 0


Equipment CSI Cailaco CHC Atabae

CHC Lolotoe

CHC Bobonaro

HR Maliana

Sterilization drum stand 0 1 1 1 0

Sterilizer/pressure cooker, kerosene heated 1 0 1 0 0

Suction catheter for newborn 0 0 1 0 0

Towels or cloth for newborn 1 1 1 1 0

Ultrasound 1 1 1 1 0

Urinary catheters 1 0 0 0 0

Vacuum aspirators/syringes 0 0 1 0 0

Vacuum extractor with cups 1 0 1 0 0

Volsullum forceps 0 1 1 0 0

3.4.2 COST OF IMPLEMENTING IPA IN BOBONARO MUNICIPALITYTotal cost of IPA implementation in Bobonaro Municipality is around 748,111 US$.

Table 23: Cost of implementing IPA in Bobonaro Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Bobonaro Municipality (cases managed in both BEmONC & CEmONC Facilities)

8,067 10,100 12,073 13,961 44,201

2. Cost of drugs and supplies for CEmONC cases* from Bobonaro Municipality s managed in HR Maliana

590 739 883 1,021 3,233

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Bobonaro Municipality

7,477 9,361 11,190 12,940 40,968


5. Equipment cost 8,453 63,806 105,456 - 177,715

6. Infrastructure construction cost (Training facility & Pre Natal Room) 148,500 33,000 66,000 - 247,500

7. Infrastructure rehabilitation cost - 24,137 34,748 - 58,885

8. Infrastructure utility cost (Training facility & Pre Natal Room) 7,425 9,075 12,375 12,375 41,250

Total cost for the Municipality (sum of the items 2 to 8) 199,085 178,998 287,172 82,856 748,111

(*CEmONC case: Emergencies that requires blood transfusion and/ or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone)


3.5 Covalima MunicipalityCovalima Municipality has a population of 64550. The Municipality has 7 CHCs and HR Suai for providing health services to this population. CHCs Fohorem, Tilomar and Sumolai are identified as proposed BEmONC facilities. At present around 49 % of Births from Covalima Municipality is occurring in these 3 CHCs and HR Suai.

Less than 300 deliveries are expected at all CHC is Covalima Municipality during 2016 2019 period.

3.5.1 IPA RELATED RESOURCE INPUTS COVALIMA MUNICIPALITYTable 24 presents the estimated number of patients to be presenting in 2 BEmONC facilities and HR Suai in Covalima Municipality in over next 4 years.

Table 24: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals in Covalima Municipality

























Total 1006 1053 1096 1136 4291

The HR inputs, infrastructure facilities and equipment proposed to be supplied for Covalima Municipality by IPA is as follows.

Table 25: Staff types to be newly employed in BEmONC facilities in Covalima Municipality


Number required for CSI Fohorem (Less than 300

Deliveries)

Number required for CHC Tilomar (Less than 300

Deliveries)

Number required for CHC Zumalai (Less than 300

Deliveries)

Number required for HR Suai(More than 600 deliveries)

Midwife 3 3 1 1

Laboratory technician 1 1 1 2

Anesthesiologist 0 0 0 1

Table 26: Infrastructure requirements of newly proposed BEmONC facilities in Covalima Municipality


Number required for CHC Fohorem

Number required for CHC Tilomar

Number required for CHC Zumalai

Number required for

HR Suai

Repair Bathroom - - 2 -

Provide new Installation water + accessories - - 1 -

Install new accessories door 6 - 10 -

Extension new Room for Post Natal (3,5 m x 7 m) - 24.5 m2 - -

Provide New wall Ceramic at delivery room 72 m2 - - -

Provide new Installation water + accessories 1 m2 - - -

Painting wall for Interior & Exterior 841.02 m2 - - -

Pre Natal room (60 M2) 1 1 1 1


Table 27: Equipment Requirements of newly proposed BEmONC facilities in Coalima Municipality

Equipment CHC Fohorem

CHC Tilomar

CHC Zumalai HR Suai

Autoclave with temperature and pressure gauges 1 0 0 0

Backup generator 0 1 1 0

Cell phone (own by facility) 1 1 1 1

Clinical thermometer 2 0 0 0

Covered contaminated waste trash bin 2 2 0 0

Curtains/means of providing patient privacy 5 0 0 0

Disposable uncuffed/cuffed tracheal tubes, for newborn 2 2 0 0

Filled oxygen cylinder with cylinder carrier and key to open valve 1 0 1 0

Functional fan/air conditioning 2 2 2 0

functioning electric/gas refrigerator 0 0 0 1

functioning solar refrigerator 0 1 1 1

Heavy duty gloves 10 10 10 0

Hot air sterilizer (dry oven) 1 1 1 1

Incinerator 1 1 0 1

Infant face masks, sizes 0, 1 0 0 0 0

Infant laryngoscope with spare bulb and batteries 1 0 0 0

Instrument tray 1 0 0 0

Instrument trolley 0 0 0 0

Mucus extractor 1 1 0 0

Newborn resuscitation table 0 1 0 0

Puncture-proof sharps container 0 0 0 0

Radiant warmer 0 1 0 0

Small cup for breast milk expression 5 5 5 5

Steam instrument sterilizer/pressure cooker, electric 1 1 1 1

Steam sterilizer 1 0 1 0

Sterile Gloves 0 0 0 1

Sterilization drum 1 0 1 1

Sterilization drum stand 1 0 1 1


Equipment CHC Fohorem

CHC Tilomar

CHC Zumalai HR Suai

Sterilizer/pressure cooker, kerosene heated 1 1 0 1

Stethoscope 0 0 0 2

Suction catheter for newborn 2 2 0 0

Towels or cloth for newborn 20 20 20 20

Ultrasound 1 1 1 0

Urinary catheters 0 0 0 0

Vacuum aspirators/syringes 2 0 0 0

Vacuum extractor with cups 2 0 0 0

Volsullum forceps 6 6 0 0

3.5.2 COST OF IMPLEMENTING IPA IN COVALIMA MUNICIPALITY

Around 871,113 US$ are estimated to be required for IPA implementation over the 4 year period of IPA focus in Covalima Municipality . Constrictions planned in HR Suai (A training facility and a Pre Natal Room) raise the first year cost to a relatively higher level.

Table 28: Cost of implementing IPA in Covalima Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Covalima Municipality (cases managed in both BEmONC & CEmONC Facilities)

6,841 7,332 7,792 8,214 30,179

2. Cost of drugs and supplies for CEmONC cases* from Covalima Municipality s managed in HR Suai

502 540 575 607 2,224

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Covalima Municipality

6,339 6,792 7,217 7,607 27,955


5. Equipment cost 87,228 95,717 93,899 - 276,844

6. Infrastructure construction cost (Training facility & PRE NATAL ROOM) 148500 33000 33000 - 214,500

7. Infrastructure rehabilitation cost 1650 6355 13475 - 21,480

8. Infrastructure utility cost (Training facility & PRE NATAL ROOM) 7,425 9,075 10,725 10,725 37,950


(**CEmONC case: Emergencies that requires blood transfusion and/ or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone)


3.6 Dili MunicipalityThe largest population in East Timor is found in Dili Municipality . This population of 252884 has access to NH HNGV and 6 CHCs. Of these CHCs, CHC Centro, CHC Atauro, CHC Becora, and CHC Vera Cruz are planned to be upgraded as BEmONC facilities. At present around 63 % of estimated births from Dili Municipality are occurring in these earmarked CHCs and NH HNGV. Referral hospital for Dili Municipality is the HNGV Dili.

Estimates of expected number of pregnancy related cases indicate that the CHCs, Atauro and Centro will still be considered as small scale CHC (deliveries less than 300) and CHCs Becora and Vera Cruz also will also have 500 to 700 cases. HR and infrastructure requirements of these hospitals were calculated without changing their present status.

3.6.1 IPA RELATED RESOURCE INPUTS DILI MUNICIPALITY

Table 29: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals in Dili Municipality






PIH & Eclampsia 23 31 38 46 138



















Total 5923 6321 6697 7037 25978

The HR inputs, infrastructure facilities and equipment proposed to be supplied for Dili Municipality by IPA is as follows.

Table 30: Staff types to be newly employed in BEmONC facilities in Dili Municipality


Number required for CSI Atauro (< 300 deliveries)

Number required for CHC Becora

(300-600 deliveries)

Number required for CHC Vera Cruz (300-600

deliveries)

Number required for CHC Centro

(< 300 deliveries)

Midwife 1 0 0 0

Table 31: Infrastructure requirements of newly proposed BEmONC facilities in Dili Municipality


Number required for CSI Atauro

Number required for CHC Becora


Vera Cruz

Number required for CHC Comoro*

Number required for CHC Centro

Provide new Tower Tank + Sanyo + Accessories 1 - - - -

Provide New glass for ventilation 1 - - - -

Provide + install new curtain roil for pre delivery & delivery room 2 - - - -

Provide + install new wall Fan for delivery room & pre delivery room 2 - - - -

Extension new Laundry (3,5 m x 3 m) - 10.5 m2 - - -

Extension to Delivery Room - - - 7.5 m2 -

Repair Water Tank - - - 2.5 m2 -

Generator Room - - - 6 m2 -

Provide new Generator - - - 1 -

Provide + install New Door Asesories - - - 1 -

Provide + install new wall Fan for delivery room & pre delivery room - - - 2 -

Provide new washing mechine - - - 1 -

Pre-natal rooms (60 m2) 1 1 1 1 1

*Comoro CHC was found to be a fully functional BEmONC facility during the EmONC Needs Assessment


Table 32: Equipment requirements of newly proposed BEmONC facilities in Dili Municipality

Equipment CSI Atauro CHC Becora CHC Vera Cruz CHC Centro

Adult ventilator bag and mask 0 2 2 2


Baby weighing scale 0 1 0 0


Blood pressure apparatus (mercury) 0 0 1 0


Clinical thermometer 0 0 0 2

Covered contaminated waste trash bin 0 2 0 0

Curtains/means of providing patient privacy 5 0 0 0

Disposable un cuffed /cuffed tracheal tubes, for newborn 2 2 2 2

Fetal stethoscope 5 5 0 0

Fluorescent tubes for phototherapy to treat jaundice - - - -

functioning electric/gas refrigerator 0 0 0 1


Heavy duty gloves 0 1 1 1


Incinerator 1 1 1 1

Infant face masks, sizes 0, 1 0 5 0 5


Infusion set for newborn 0 2 0 2


Mucus extractor 0 0 0 0

Newborn resuscitation table 1 0 1 1

Prepared disinfection solution 1 1 0 0

Radiant warmer 0 0 1 0

Small cup for breast milk expression 5 5 5 5





Equipment CSI Atauro CHC Becora CHC Vera Cruz CHC Centro



Suction catheter for newborn 0 0 2 2


Ultrasound 1 1 0 1


Vacuum extractor with cups 0 0 2 2


3.6.2 COST OF IMPLEMENTING IPA IN DILI MUNICIPALITY Total cost for implementing IPA in Dilli Municipality as planned will be around 706,821 US $ over 4 years. It should be noted that institutional rehabilitation estimates done by special engineer team has estimated a cost of 12,362 US$ cost for the CHC Comoro, which is not a CHC earmarked for upgrading to a BEmONC facility according to IPA. However, this cost has been added to year four infrastructure rehabilitation cost.

Table 33: Cost of implementing IPA in Dili Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Dili Municipality (cases managed in both BEmONC & CEmONC Facilities)

34,436 38,725 42,839 46,708 162,708

2. Cost of drugs and supplies for CEmONC cases* from Dili Municipality managed in NH HNGV 2,525 2,836 3,135 3,415 11,911

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Dili Municipality

31,911 35,888 39,704 43,293 150,796

4. Cost of drugs and supplies for managing CEmONC cases referred to NH HNGV from Liquica and Manatuto Municipality

663 879 1,090 1,291 3,923


6. Equipment cost 111,172 73,363 86,200 67,197 337,932

7. Infrastructure construction Cost (pre natal room ) 33000 33000 33000 33000 132,000

8. Infrastructure rehabilitation cost 3,860 5,775 3,980 12362 25,977

9. Infrastructure utility cost (Pre Natal Room) 1,650 3,300 6,600 8,250 19,800

Total cost for the Municipality (Sum items 2 to 9) 190,901 161,161 179,829 174,928 706,819(* CEmONC case: Emergencies that requires blood transfusion and/ or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone; *)


3.7 Ermera MunicipalityPopulation of Ermera Municipality is around 127,283. This Municipality has 1 CSI and 5 CHCs. Of them CSI Gleno and CHCs Atsbe and Hatolia are identified as BEmONC institutions to be established. At present these institutions cater for the 10% of deliveries in the Municipality . The CEmONC cases from the Municipality s are also managed at the CSI Gleno.

Patient load estimates shows that CSI Gleno and CHC Atsabe will have more than 600 deliveries annually with in the 2016 to 2919 period while CSI Hatalia will receive less than 300 cases.

3.7.1 IPA RELATED RESOURCE INPUTS ERMERA MUNICIPALITY

Table 34: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals in Ermera Municipality























Total 1137 1692 2179 2605 7613


The HR inputs, infrastructure facilities and equipment proposed to be supplied for Ermera Municipality by IPA is as follows.

Table 35: Staff types to be newly employed in BEmONC facilities in Ermera Municipality


Number required for CSI Gleno (> 600

deliveries)

Number required for CHC Atsabe(300-600

deliveries)

Number required for CHC Hatolia (< 300

deliveries)

Midwife 6 4 2

Laboratory technician 1 1 0

Table 36: Infrastructure requirements of newly proposed BEmONC facilities in Ermera Municipality

Infrastructure items (Buildings, Vehicles Equipment)Number

required for CSI Gleno

Number required for CHC Atsabe

Number required for CHC Hatolia

Install new dump / pemasangan tempat sampah. 4 - -

Provide + install New Ceiling Fan 5 - 5

Provide + install New Wastafel 2 2 -

Painting Wall for Interior & Exterior 841 m2 841 m2 841 m2

Install new Accessories door 6 - 6

Extension & Install New block for maternity consultation ( 32,2 m2) - 46 -

Repair Bathroom - 2 -

Install new door (Aluminum ) - 4 -

Pre Natal Rooms 1 1 1


Table 37: Equipment requirements of newly proposed BEmONC facilities in Ermera Municipality

Equipment CSI Gleno CHC Atsabe CHC Hatolia



Cell phone (own by facility) 1 0 1

Autoclave with temperature and pressure gauges 0 1 0





Incinerator 0 1 0

Heavy duty gloves 10 10 10




Ultrasound 1 1 1


Clinical thermometer 0 0 2

Adult ventilator bag and mask 0 1 0





Mucus extractor 2 0 0

Infant face masks, sizes 0, 1 0 5 0

Suction catheter for newborn 2 2 0






3.7.2 COST OF IMPLEMENTING IPA IN ERMERA MUNICIPALITYIPA implementation cost for Ermera Municipality reaches 633,047 US $.

Table 38 Cost of implementing IPA in Ermera Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Ermera Municipality (cases managed in both BEmONC & CEmONC Facilities)

7,565 11,223 14,484 17,271 50,543

2. Cost of drugs and supplies for CEmONC cases* from Ermera Municipality s managed in CSI Gleno

553 821 1,059 1,263 3,696

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Ermera Municipality

7,012 10,402 13,425 16,008 46,847


5. Equipment cost 47,583 97,413 22,903 - 167,899

6. Infrastructure construction costs (PRE NATAL ROOM) 33,000 33,000 33,000 - 99,000

7. Infrastructure rehabilitation cost 6,835 7,026 4,294 - 18,155


Total cost for the Municipality (Sum items 2 to 8) 138,753 223,962 163,871 106,461 633,047(*CEmONC case: Emergencies that requires transfusion and/ or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone; )


3.8 Lautem MunicipalityLautem Municipality has a population of 64135. CSI Lospalos and CHCs, Lautem, Iliomar, Luro, Tutuala are situated in the Municipality . CSI Lospolos and CHCs, Iliomar and Luro are selected for upgrading to be BEmONC facilities. These 3 institutions together receive around 28 % of births in the Municipality.

CEmONC case from Lautem Municipality are referred to HR Baucau. Estimates of patient loads indicated that CSI Lospolos will have more than 600 deliveries during the project period while the other 2 CSIs, Iliomar and Luro will have less than 300 deliveries.

3.8.1 IPA RELATED RESOURCE INPUTS LAUTEM MUNICIPALITYThe following table presents the expected number of various EmONC conditions and normal vaginal deliveries to be presenting at proposed BEmONC facilities of Lautem Municipality from 2016 to 2019.

Table 39: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC hospitals in Lautem Municipality

























Total 848 1026 1199 1363 4436

Table 40: Staff types to be newly employed in BEmONC facilities in Lautem Municipality


Number required for CSI Lospalos (600 Deliveries)

Number required for CHC Iliomar (< 300

deliveries)

Number required for CHC Luro (< 300

deliveries)

Midwife 2 3 3

Table 41: Infrastructure requirements of newly proposed BEmONC facilities in Lautem Municipality


required for CSI Lospolos

Number required for CHC Iliomor

Number required for CHC Luro

Renovation ( 17 m x 10 m) 170 m2 - -

Provide new closet + accessories - 1 -

Repair accessories hand basin - 2 -

Lighting TL 1x14w - 1 -

Repair Accessories zinc at kitchen - 1 -

Provide New Door panel + accessories - 1 -

Provide new Curtain Roil at Delivery Room - 2 -

Provide New Door handle and door lock - 2 -

Wall Paint (Internal and External) Maternity - 841.02 m2 -

Pre Natal room (60 M2 ) 1 1 1

Table 42: Equipment requirements of newly proposed BEmONC facilities in Lautem Municipality

Equipment CSI Lospolos CHC Iliomor CHC Luro







Equipment CSI Lospolos CHC Iliomor CHC Luro


Curtains/means of providing patient privacy 5 0 0

Cuscos speculum 0 6 6

Decontamination container 0 0 3



Functioning electric/gas refrigerator 0 0 1

Functioning solar refrigerator 1 1 1



Incinerator 1 1 1





Non-sterile protective clothing 0 0 5









Ultrasound 1 1 1

Vacuum aspirators/syringes 0 1 1




3.8.2 COST OF IMPLEMENTING IPA IN LAUTEM MUNICIPALITYTotal cost of IPA implantation in Lautem Municipality during 4-year period is around 621,205 US $.

Table 43: Cost of implementing IPA in Lautem Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Lautem era Municipality (cases managed in both BEmONC & CEmONC Facilities)

5,911 6,994 8,042 9,039 29,986

2. Cost of drugs and supplies for CEmONC cases* from Lautem Municipality s managed in HR Baucau

432 511 588 661 2,192

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Lautem Municipality

5,479 6,483 7,454 8,378 27,794


5. Equipment cost 65,559 62,373 88,706 - 216,638

6. Infrastructure construction cost (Pre Natal Room) 30000 30000 30000 - 90,000

7. Infrastructure rehabilitation cost 127,500 3664 - - 131,164

8. Infrastructure utility cost (Pre Natal Room) 1650 3,300 4,950 4,950 14,850

Total cost for the Municipality (Sum items 2 to 8) 242,428 136,420 180,070 62,288 621,206(*CEmONC case: Emergencies that requires blood transfusion and/or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone)


3.9 Liquica MunicipalityPopulation of Liquica Municipality is around 73027. CSI Liquica and CHCs Fatumasi and Maubara are situated in the Municipality and all 3 of these institutions are earmarked to be upgraded as BEmONC facilities. Around 22% of births in the Municipality s are currently occurring in these 3 institutions. Referral cases from Liquica Municipality are managed in HNGV Dili.

Case load estimates showed that CSI Liquica and CHC Maubara will start to have more than 300 deliveries with the expansion of coverages due to IPA. Hence infrastructure and HR requirement of these Municipality s were estimated accounting for these developments.

3.9.1 IPA RELATED RESOURCE INPUTS LIQUICA MUNICIPALITY

Table 44: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Liquica Municipality























Total 850 1103 1351 1585 4889


The HR inputs, infrastructure facilities and equipment proposed to be supplied for Liquica Municipality by IPA is as follows.

Table 45: Staff types to be newly employed in BEmONC facilities in Liquica Municipality


Number required for CHC Fatumasi (Less than 300 Deliveries)

Number required for CSI Liquica (300-600

Deliveries)

Number required for CHC Maubara (300-600

Deliveries)

Midwife 2 4 3

Laboratory technician 1 1 1

Table 46: Infrastructure requirements of newly proposed BEmONC facilities in Liquica Municipality


Number required for

CHC Fatumasi

Number required for CSI Liquica

Number required for

CHC Maubara

Provide new solar panel 1 - -

Repair Bathroom 2 - -

Install new door for toilet 4 - -

Install new Accessories door 6 10 -

Repair Bathroom - 2 -

Painting wall for Interior & Exterior - 841 -

Painting Existing ceiling - 131 -

Provide + install new watafel water tap - 2 -

Provide new Installation water + accessories - - 1,000 m2

saringan air bersih - - 1

Pre Natal Room (60 M2 ) 1 1 1


Table 47: Equipment requirements of newly proposed BEmONC facilities in Liquica Municipality

Equipment CHC Fatumasi CSI Liquica CHC Maubara


Ambu (ventilator) bag for newborn 250-400 ml 2 0 0


Back up generator 0 0 1







Incinerator 0 0 1



Infusion set for newborn 1 1 0




Non-sterile protective clothing 0 1 1








Ultrasound 1 1 1



3.9.2 COST OF IMPLEMENTING IPA IN LIQUICA MUNICIPALITYAround 547,967 US$ is estimated to be required for implementing IPA in Liquica Municipality.

Table 48: Cost of implementing IPA in Liquica Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Liquica Municipality (cases managed in both BEmONC & CEmONC Facilities)

5,855 7,750 9,595 11,367 34,567

2. Cost of drugs and supplies for CEmONC cases* from Liquica Municipality s managed in HNGV Dili

428 566 701 830 2,525

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Liquica Municipality

5,427 7,184 8,894 10,537 32,042


5. Equipment cost 30,946 36,377 99,082 - 166,405

6. Infrastructure construction cost (Pre Natal Room) 33,000 33,000 33,000 - 99,000


8. Infrastructure utility cost: (Pre Natal Room) 1,650 3,300 4,950 - 9,900

Total cost for the Municipality (Sum items 3 to 8) 107,163 133,081 231,306 76,417 547,967(* CEmONC case: Emergencies that requires blood transfusion and/or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone)


3.10 Manatuto Municipality Manatuto Municipality has a population of 45541. CSI Manatuto and CHCs Nattarbora, Laclubar are identified as proposed BEmONC facilities. Three other CHCs; Laleia, Laclo, and Soibada are also situated in the Municipality . At present 19% of estimated births are delivered in proposed BEmONC hospitals. The referral from Manatuto Municipality is directed at HNGV Dili.

Patient load estimates indicated that CSI Manatuto will have more than 300 deliveries with the planned period and hence resource requirements were adjusted accordingly.

3.10.1 IPA RELATED RESOURCE INPUTS IN MANATUTO MUNICIPALITY Table 49 presents the estimated numbers of EmONC conditions to be presented at 2 BEmONC institutions in Manatuto Municipality.

Table 49: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Manatuto Municipality

























Total 481 643 801 952 2877

The HR inputs, infrastructure facilities and equipment proposed to be supplied for Manatuto Municipality by IPA is as follows.

Table 50: Staff types to be newly employed in BEmONC facilities in Manatuto Municipality


Number required for CSI Manatuto

Number required for CHC Laclubar

Number required for CHC Natarbora

Midwife 0 1 2

Table 51: Infrastructure requirements of newly proposed BEmONC facilities in Manatuto Municipality

Infrastructure items (Buildings, Vehicles Equipment)Number required for CSI

Manatuto

Number required for CHC Laclubar


Natarbora

Repair Water Tank + Sanyo + Accessories 1 - 1

Wall Paint (Internal and External) Maternity 841m2 841 m2 841 m2

Repair Accessories Stainless Steel Zink at Delivery room 1 - -

Repair Accessories for Hand Basin 1 2 2

Provide & install ceiling fan 1 - 4

Provide new Curtain Roll at Delivery Room 2 1 2

Lighting TL 1x14w - 1 -

Repair Wall Tile for Post-natal room and Delivery room 20x25cm - 2 -

Repair Concrete table ceramic 20x20 - 1 -

Repair water installation for toilet - 2 -

Repair pipe water at toilet - - 1

Pre Natal Room (60M2) 1 1 1


Table 52: Equipment requirements of newly proposed BEmONC facilities in Manatuto Municipality

Equipment CSI Manatuto

CHC Laclubar

CHC Natarbora


Newborn Ambu bag 1 0 1

Autoclave 0 1 0






Cusco’s speculum 0 0 1






Incinerator 2 2 0




Lubricant/ Oil for O-ring 1 1 1












Equipment CSI Manatuto

CHC Laclubar

CHC Natarbora

Ultrasound 1 1 1

Vacuum aspirators/syringes 1 0 1



3.10.2 COST OF IMPLEMENTING IPA IN MANATUTO MUNICIPALITY

Cost of IPA activities in Manatuto Municipality will be around 274,809 US$.

Table 53: Cost of implementing IPA in Manatuto Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Manatuto Municipality (cases managed in both BEmONC & CEmONC Facilities)

3,210 4,275 5,313 6,309 19,107

2. Cost of drugs and supplies for CEmONC cases* from Manatuto Municipality s managed in HNGV Dili

235 313 389 461 1,398

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Manatuto Municipality

2,975 3,962 4,924 5,847 17,708

4. Human resource costs 0 6,120 18,360 18,360 42,840

5. Equipment cost 12,386 42,937 42,334 - 97,657

6. Infrastructure construction cost (Pre Natal Room) 30,000 30,000 30,000 - 90,000


8. Infrastructure utility cost 1,650 3,300 4,950 4,950 14,850

Total cost for the Municipality (Sum items 3 to 8) 51,920 89,540 104,192 29,157 274,809(*CEmONC case: Emergencies that requires either /or blood transfusion or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone)


3.11 Manufahi Municipality The population of Manufahi Municipality is around 52246. The Municipality has 4 facilities, CSI- Same, and CHCs, Alas, Fatuberlio and Turiscai. The planned BEmONC facilities, CSI Same and CHC Fatuberlio currently receives 28 % of births in the Municipality . The patients who need to be referred to CEmONC care are referred to the HR Maubisse.

3.11.1 IPA RELATED RESOURCE INPUTS IN MANUFAHI MUNICIPALITYTable 54 presents the estimated numbers of EmONC conditions to be presented at 2 BEmONC institutions in Manufahi Municipality.

Table 54: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Manufahi Municipality























Total 630 762 893 1017 3302


The HR inputs, infrastructure facilities and equipment proposed to be supplied for Manufahi Municipality by IPA is as follows.

Table 55: Staff types to be newly employed in BEmONC facilities in Manufahi Municipality

Staff type to be newly employed CSI Same (300-600 deliveries)

CHC Fatuberlio (Less than 300

deliveries)

Midwife 0 1

Laboratory technician 1 1

Table 56: Infrastructure requirements of newly proposed BEmONC facilities in Manufahi Municipality


required for the CSI Same

Number required

for the CHC Fatuberlio

Extension Delivery room (11 m x 3 m) 33 m2 -

Extension Post Natal Room (6,5 m x 3 m) 19.5 m2 -

Provide New light TL Neon 7 6

Provide + install new panel door + Accessories 2 -

Provide + install New Door Accessories 3 -

Provide + install New Ceiling Fan 3 5

Painting Wall for Internal & External 841.04 m2 841.04 m2

Provide + install New Wastafel - 1

Provide new Tower Tank + Sanyo + Accessories - 1

Prenatal room 1 1

Ambulance - 1

Table 57: Equipment requirements of newly proposed BEmONC facilities in Manufahi Municipality

Equipment CSI Same CHC Fatuberlio

Autoclave 0 1

Back up generator 0 1

Blood pressure apparatus 0 2

Functioning solar refrigerator 1 1

Hot air sterilizer (dry oven) 0 1

Incinerator 1 1


Equipment CSI Same CHC Fatuberlio

Infant laryngoscope with spare bulb and batteries 2 2

Newborn resuscitation table 0 2

Radiant warmer 1 0



Sterilizer /Kerosene 1 1

Small cups for breast milk expression 5 5

Thrash bin 0 2


Vacuum aspirator/syringes 0 2

Volsullum forceps 0 6

Ultrasound machine 1 1

3.11.2 COST OF IMPLEMENTING IPA IN MANUFAHI MUNICIPALITY Total cost of IPA activities for the period 2016 to 2019 in Manufahi is around 350,748 US$.

Table 58: Cost of implementing IPA in Manufahi Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Manufahi Municipality (cases managed in both BEmONC & CEmONC Facilities)

4,091 4,956 5,794 6,592 21,433

2. Cost of drugs and supplies for CEmONC cases* from Manufahi Municipality s managed in HNGV Dili

2,209 2,675 3,127 3,557 11,568

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Manufahi Municipality

1,883 2,281 2,667 3,035 9,866


5. Equipment cost 77,620 73559 - - 151,179

6. Infrastructure construction cost (Pre Natal Room) 33000 33,000 - - 66,000

7. Infrastructure rehabilitation cost 32,899 7299 - - 40,198

8. Infrastructure utility cost (Pre Natal Room) 1650 3,300 3,300 3,300 11,550

Total cost for the Municipality (Sum items 3 to 8) 154,708 140,872 27,400 27,768 350,748(* CEmONC case: Emergencies that requires blood transfusion and/ or surgery in addition to basic signal functions; **BEmONC case: Emergencies that can be managed with 7 signal functions alone)


3.12 Oecusse Municipality Around 72230 people are living in Oecusse Municipality. The referral hospital of the Municipality HR Oecusse can be considered as the CEmONC hospital. In addition, 4 CHCs are situated in the Municipality and of them CHC Passebe is to be upgraded as a BEmONC facility. HR Oecusse and Passabe together cover nearly 13 % of estimated births in from the Municipality.

3.12.1 IPA RELATED RESOURCE INPUTS IN OECUSSE MUNICIPALITY

Table 59: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Oecusse Municipality























Total 711 1041 1365 1678 4795

The HR inputs, infrastructure facilities and equipment proposed to be supplied for Oecusse Municipality by IPA is as follows.


Table 60: Staff types to be newly employed in BEmONC facilities in Oecusse Municipality


Number required for CSI Passabe

Number required for HR Oecusse

Midwife 3 4

Anesthesiologist 0 1

Table 61: Infrastructure requirements of newly proposed BEmONC facilities in Oecusse Municipality


required for CSI Passabe

Number required for HR

Oecusse

Training facility 0 1

Pre-natal room 1 1

Adult ventilator bag and mask 2 0

Ambu (ventilator) bag for newborn 250-400 ml 2 0

Backup generator 1 0

Bleach or bleaching powder 20 0

Blood pressure apparatus (mercury) 2 0

Cell phone (own by facility) 1 0

Covered contaminated waste trash bin 2 0

Decontamination container 5 0

Disposable uncuffed/cuffed tracheal tubes, for newborn 2 0

Fetal stethoscope 5 0

Filled oxygen cylinder with cylinder carrier and key to open valve 1 0

Functional fan/air conditioning 2 0

functioning solar refrigerator 1 0

Heavy duty gloves 10 10

Infant face masks, sizes 0, 1 5 0

Infant laryngoscope with spare bulb and batteries 2 0

Infusion set for newborn 2 0

Newborn resuscitation table 1 0

Radiant warmer 0 0

Small cup for breast milk expression 5 5

Steam instrument sterilizer/pressure cooker, electric 0 1




required for CSI Passabe

Number required for HR

Oecusse

Sterilization drum 0 1


Sterilizer/pressure cooker, kerosene heated 1 1

Ultrasound 1 0

Vacuum aspirators/syringes 2 0


3.12.2 COST OF IMPLEMENTING IPA IN OECUSSE MUNICIPALITYAround 472,678 US $ will be required for the implementation of EmONC IPA in Oecusse Municipality for the 4 years planned. Construction of a new training facility is proposed for the HR Oecusse.

Table 62: Cost of implementing IPA in Oecusse Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Oecusse Municipality (cases managed in both BEmONC & CEmONC Facilities)

5,059 7,420 9,727 11,953 34,159

2. Cost of drugs and supplies for CEmONC cases* from Oecusse Municipality managed in HR Oecusse

345 506 663 814 2,328

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Oecusse Municipality

4,714 6,914 9,064 11,139 31,831


5. Equipment cost 31,359 - - - 31,359

6. Infrastructure construction cost: (PRE NATAL ROOM) 148,500 - - - 148,500

7. Infrastructure rehabilitation cost*** NA NA NA NA NA


Total cost for the Municipality (Sum items 2 to 8) 249,583 72,085 74,392 76,618 472,678

(*CEmONC case: Emergencies that requires blood transfusion and/ or surgery in addition to basic signal functions; ** BEmONC case: Emergencies that can be managed with 7 signal functions alone; *** the engineering unit of the ministry of health was unable to collect data


3.13 Viqueque MunicipalityPopulation of Viqueque Municipality has access to one CSI (Viqueque) and 4 CHCs (Uatucarbau, Ossu, Uatolari, and Lacluta). All these facilities except Ossu are planned to be upgraded as BEmONC facilities with in next 4 years. CSI (Viqueque) and CHC Utolari will be upgraded in 2016, while CHCs Lacluta and Uatucarbau will be upgraded in 2017 and 2018 respectively.

Around 26% of births in Municipality are reported to be present to proposed BEmONC facilities at present. The designated CEmONC facility for this Municipality is HR Baucau.

3.13.1 IPA RELATED RESOURCE INPUTS VIQUEQUE MUNICIPALITY The following table presents the expected number of various EmONC conditions and normal vaginal deliveries to be presenting at proposed BEmONC facilities in Viqueque Municipality from 2016 to 2019.

Table 63: Estimated number of EmONC conditions and normal deliveries expected at proposed BEmONC facilities in Viqueque Municipality

























Total 1062 1284 1500 1708 5554

Table 64: Staff types to be newly employed in BEmONC facilities in Viqueque Municipality


Number required for

CHC Uatucarbau (<300 deliveries)


Uatolari (300-600 delivaries)

Number required for CSI Viqueque (> 600

deliveries)


Lacluta (< 300 deliveries)

Midwives 2 2 1 2

Lab Technician 0 0 1 0

Table 65: Infrastructure requirements of newly proposed BEmONC facilities in Viqueque Municipality



Uatucarbau

Number required for CHC Uatolari


Viqueque

Number required for CHC Lacluta

Repair Wall Tile for Post natal room and Dilivery room 20x25cm 4 - - -

Provide new Curtain Roll at Delivery Room 2 - 2 2

Repair Accesories Hand Basin 2 - 2 2

Repair windows glass 1 1 1 -

Wall Paint (Internal and External) Maternity 841 m2 - 841 m2 841 m2

Renovation ( 18 m x 6 m ) - 180 m2 - -

Provide & install ceiling fan - - 3 1

Repair stop kran water for toilet - - 1 -

Repair lighting at delivery room & post delivery room - - 1 -

Repair Tower Tank 1100 L + Sanyo + Accessories - - - 1

Repair Switch / outlet - - - 3




Uatucarbau

Number required for CHC Uatolari


Viqueque

Number required for CHC Lacluta

Repair installation water from tower tank to maternity room - - - 1

Provide new Curtain Roil at Delivery Room - - - -

Pre Natal Rooms 1 1 1 1

Table 66: Equipment requirements of newly proposed BEmONC facilities in Viqueque Municipality

Equipment CHC Uatucarbau

CHC Uatolari

CSI Viqueque CHC Lacluta


Functional fan/air conditioning 0 1 1 1









Incinerator 1 1 1 1


Filled oxygen cylinder with cylinder carrier and key to open valve 1 1 0 1

Ultrasound 1 1 1 1

Blood pressure apparatus (mercury) 2 0 0 0

Stethoscope 2 0 0 0

Fetal stethoscope 2 2 2 2

Adult ventilator bag and mask 2 0 2 2




Equipment CHC Uatucarbau

CHC Uatolari

CSI Viqueque CHC Lacluta

Cusco’s speculum 6 6 0 6




3.13.2 COST OF IMPLEMENTING IPA IN VIQUEQUE MUNICIPALITYTotal cost of IPA implementation in Viqueque Municipality amounts to 707,282 US$.

Table 67: Cost of implementing IPA in Viqueque Municipality from 2016 to 2019 (US$)Cost item Year 1 Year 2 Year 3 Year 4 Total

1. Cost of drugs and supplies for all EmONC cases and normal deliveries from the Viqueque Municipality (cases managed in both BEmONC & CEmONC Facilities)

7,056 8,523 9,944 11,300 36,823

2. Cost of drugs and supplies for CEmONC cases* from Viqueque Municipality s managed in HR Baucau

516 623 727 826 2,692

3. Cost of drugs and supplies for BEmONC cases** and normal deliveries from Viqueque Municipality

6,540 7,900 9,217 10,474 34,131

4. Human resource costs 24000 36,240 48,480 48480 108,720

5. Equipment cost 137,087 58,486 74,351 - 269,924

6. Infrastructure construction cost (Pre Natal Room) 66000 33,000 33,000 - 132,000


8. Infrastructure utility cost 3300 4,950 6,600 6,600 21,450

Total cost for the Municipality (Sum items 3 to 8) 321,427 145,500 174,801 65,554 707,282(*CEmONC case: Emergencies that requires either/ blood transfusion or surgery in addition to basic signal functions; ** BEmONC case: Emergencies that can be managed with 7 signal functions alone)


4. PROGRAM MANAGEMENT COST In this section all costs associated with conducting program management activities such as cost pertaining to a) Norms and guideline development, b) Capacity development, c) System reorientations, d) Public communication e) Updating M& E systems in relation to EmONC g) costs associated with National level EmONC coordination are presented.

As most of these activities are organized and implemented at national level they were costed as an overall sum without assigning to Municipality s.

Detailed data required for estimating EMONC specific logistic costs were not available,. Hence, logistic costs were computed as a gross estimate. Logistic relate cost were assumed to be 30% of the total cost of drugs and supplies required for the period of IPA implementation.

The following section describes the methods of implementing different program activities. Summarized costs are included in the table 54. Detailed calculations are given in the annexure 5.

4.1 Norms & Guidelines Development (Scheduled in Year 1) IPA proposes the development of the following norms and guidelines:

1. National norms, standards and protocols for the management of EmONC;2. Develop guidelines for health posts on integrating EmONC in to PHC program;3. Training Package for EmONC in-service curricula.

In costing these activities, it was assumed that the relevant documents are developed as a single package of IEC materials. The following procedure will be adopted in the process:

1. An international consultant in collaboration with a national consultant will develop an initial drafts of documents based on international and local guidelines;

2. Then these drafts will be presented for the review of the National Technical Team on EmONC. The document will be updated based on the technical team’s opinion;

3. Then each document will be translated in to local languages;4. Printing of documents.


4.2 Capacity Building (Scheduled in Year 2) The following capacity building activities are recognized as important capacity building actions in the IPA.

1. BEmONC in-service training for doctors & PHMS.

Costs associated with the development of relevant training package is identified in the norms and guidelines section.

Master trainingA mixed group comprising of 15 medical officers and midwives will be trained as the master trainer group on EmONC in-service training. They will be trained by 2 international and 4 local consultants. The duration of training will be for 15 days.

Roll out trainingBased on proposed norms, the estimated number of doctors and midwives in 36 proposed BEmONC facilities will be around 276. Provided that each in-service BEmONC training programme is conducted by 5 master trainers, a program extends up to 15 days, and 3 simultaneous in-service trainings are carried out in 3 places in the country each month, then training of this group could be covered within 6 months. These training programs could be organized in 3 HR hospitals that are strategically selected based on the presence of adequate number of EmONC cases for reference and their geographical placement so that logistics related to transport of trainees are facilitated.

2. Training of ambulance drivers on First Aids.This activity is supposed to be carried out by external NGO and therefore not costed.

3. Integrate BEmONC in to preservice training of doctors and midwives. This activity will be coordinated by t national coordinator on EmONC. Local consultants from training centers will prepare the concept notes and curriculum and it will be reviewed by the National Technical Committee on EmONC.

4. EmONC awareness training such as nurses, OT staff, lab technicians, managers, ambulance drivers. One day awareness training will be conducted for these personnel by local medical officers who have been exposed to BEmONC in-service training. The training will be conducted in each institution separately.

5. Train Suco and Aldeia chiefs, village committee members, and local NGOs on improving EmONC related health seeking behavior. One-day awareness training will be conducted for these personnel by local medical officers, who have been exposed to BEmONC in-service training. The training will be conducted in each BEMONC institution separately and relevant community leaders will be invited.

Administrators (DSM and DPHO-SMI, Municipality level) & EmONC coordinator on EmONC planning, management and monitoring EmONC services – One-day training for these


personnel will be organized by national Master trainers. An assistance of administrative experts also will be included The training will be conducted in Dili

4.3 System Reorientations (Scheduled in Year 1) The following activities are recognized in the IPA as system reorientation actions that are required for improving the quality of EmONC management. These will require several advocacy meetings (3 meetings for each subject item), formulating legislations ad guidelines and monitoring of actions. These activities should be organized and implemented by the National EmONC coordinator.

1. Review and redistribute staff according to norms 2. Review of the legislation supportive of incentives for retention of professional staff

in remote posts3. Referral system & facilities 4. Improvement of the capacity and authority of midwives to decide referral and to

actually refer

4.4 Public Communication (Annually) In order to get public attention and interest in EmONC activities and thereby increase the public attention on EmONC concerns and improve the health seeking and system interest national days and public events with higher political participations planned.

1. National Safe Motherhood Day (Every year)

4.5 Monitoring & Evaluation The following activities are prosed in IPA in relation to monitoring and evaluation. Update of HIMS will be coordinated by the national EmONC coordinator. A local EmONC expert and HMIS expert will be requested to study and prepare a draft revision to HMIS in relation to EmONC. Then these proposed draft will be reviewed by the National Technical Committee on EmONC. Maternal /newborn death reviews will be conducted biannually while National EmONC review will be held once a year. Both of these review meetings will be participated by 2 representatives from BEMONC hospitals, 2 representatives from Municipality administration and National Ministerial and expert groups.

1. Update HMIS to ensure EmONC conditions are correctly identified and reported. (Scheduled in year 1)

2. Patograph review studies C Scheduled in year 2) 3. Maternal death /near miss reviews and newborn death reviews ( 2 wise in ever year) 4. Annual National Review on EmONC (once in every year)


4.6 Logistics Cost The total drug and supplies cost was summated over 13 Municipality s and 30% of this amount was considered as logistic costs. Total logistic cost over 4 year period was 164, 314 US$.

4.7 Summary of Program Activity CostsThe cost of these activities will be as follows. Detailed calculations are given in the annexure 4:

Table 68: Program cost related to IPA

Program activity cost item Annual cost Total

Cost Year 1 Year 2 Year 3 Year 4

1. EmONC Coordinator 52,000 52,000 52,000 52,000 208,000

2. Development of EmONC norms, and guidelines 60,860 - - - 60,860

3. Capacity building - 135,172 - - 135,172

4. System reorientation 9,300 - - - 9,300

5. Public communication 6,720 6,720 6,720 6,720 26,880

6. M & E 21,400 20,600 15,600 15,600 73,200

7. Logistic costs 31,610 37,917 43,975 49,693 163,195

Total program cost 181,890 252,409 118,295 124,013 676,607


5. ANNEXES

Annex 1: One Health Tool and Costing ApproachesOHT is primarily organized in to 3 main modules (Figure 1): a) Health services module b) Health systems modules, c) Impact modules.

Health Service Module: The health services module is programed to estimate the cost of items that varies by the number of intervention recipients. These items include drugs, commodities and other supplies such as nutrient supplements and medical investigations. The tool utilizes user defined inputs such as type of interventions, target populations that interventions focus, populations in need of interventions (i.e. proportions of target populations that actually eligible for interventions), percentage coverage of intervention and the delivery channel.

In addition, various treatment inputs (Drugs, injection supplies, blood or urine tests etc...) related to interventions that are provided by different types of health staff have to be specified to the tool. The unit costs of these items also have to be indicated.

Annex 1 Figure 1: Schematic representation of OneHealth Tool organization


The tool estimates the size of the target population to be used in the costing using DemProj software integrated in to OHT. The number of target recipients (cases) for each intervention in a particular delivery channel at a given year, who actually receive an intervention, is calculated by serial multiplications of the respective target population, percent of population who requires the intervention, intervention coverage and the percentage of interventions delivered by a particular delivery channel.

Then, the number of target population will be multiplied by an average cost of providing treatment inputs (drugs, supplies, and investigations) specified for each intervention. This will result in the total material cost of providing a particular intervention in a given delivery channel, at a given year.

Health systems module: Health systems module consists of several other sub modules. They include Infrastructure module, human resource module, logistic module, health information systems module and governance module.

Infrastructure module: Infrastructure module estimates the cost incurred on buildings (construction, rehabilitation/maintenance, and utility costs). It also estimates the cost involved in vehicle purchase, maintenance and operational costs and cost for ICT equipment. The user has to specify the baseline number of institutions, and baseline parameters used for assessing the cost (average construction, maintenance, utility costs) of infrastructure components as well as targets for infrastructure developments. Infrastructure development targets could be based on existing plans or population norms. This study targets were based on existing plans.

Human resource module: Human resource module calculates the cost of paying emoluments to health staff, cost of their basic training and cost of providing retention incentives, if any. Context specific human resource types have to be specified by the user and staff baseline and their distribution by various levels of care, annual salary and incentives and increment patterns and numbers and unit cost of different types of staff who are enrolled for pre service training have to be identified. The human resource development targets can be specified, either according to the existing plans or based on population norms. This study chose the existing plans to set the human resource targets.

Logistic Module: Logistic module estimates the expenditure incurred on the logistic activities related to a health program. The module estimates the cost of warehouses (construction, maintenance and utilities), cost of transport (vehicle purchase, maintenance and operational cost, third party contracts) cost of paying warehouse workers (e.g. Managers, store keepers, clerks, drivers, manual laborers etc…). In addition, this module assesses the cost incurred on the material items that are usually not based on the target recipients. For example, items given to health staff, (e.g. uniforms, midwife kits, bicycles etc...) could be costed in this section. As in the case of infrastructure and human resource modules, baseline levels and future targets of each element and unit cost have to be pre specified by the user.


Health information system module: Health information system (HIS) module is designed to estimate the cost of maintaining the management information system related to a health program. In this module the cost of personnel involved in MIS, printing cost of hard formats, cost of ICT equipment’s and software development and application can be estimated. The MIS related management functions such as training, supervision, review and updating of the MIS etc... are also be considered in the HIS module.

Governance module: Governance module is used to estimate the cost of activities related to optimizing strategic vision and ethics, responsiveness, participation and consensus, legal reforms and maintaining the transparency and accountability of a health program. However, in the NCHDSP only a very limited activities related to these items were focused. Hence they were considered as program management functions and accordingly included as components of the program management costing module.

Program management costing modules: Program management /cost modules of OHT are used to cost the program management activities such as advocacy, awareness building, in-service training, development of guidelines, supervision, health system development exercises, monitoring and evaluation and research. Separate program management modules are linked to all modules of the OHT. (E.g. program cost sub module in the health services, program management sub modules of the infrastructure, human resource, logistic and HIS modules, administration sub module of the governance modules).

The user has to identify and specify the relevant program activities along with their unit costs. These modules can also be used to calculate the cost of program specific human resources such as project consultants who may not be permanent employees of the health system.

OHT is originally developed for costing entire health systems at national level. However, it can be adapted to cost sub programs or costing sub national levels programs provided careful context specific adjustments are made to costing parameters so that generic costing calculations could be used to achieve the cost objectives related to specific program contexts.


Annex 2: Infrastructure Cost Parameters in BEmONC Facilities

Annex 2 Table 1: Infrastructure cost parameters in BEmONC facilitiesInfrastructure Surface Cost per Square meter Construction cost Utility cost

Pre Natal Room 60 550 33000 1650

Training facility 150 550 82500 4125

Annex 2 Table 2: List of medical equipment and furniture for BEmONC facility

Equipment Unit Cost $

# units/ facility


# units /facility

Adult ambu bag and mask 36 2 Metal tray 12 4

Adult weighing scale 20 1 Mobile battery operated incubators 17025 1

Ambu (ventilator) bag for newborn 250-400 ml 35 2 Mucus extractor 208 2

Autoclave (24l) 1500 1 Newborn Incubator 18738 1

Baby cots 235 5 Newborn resuscitation table 250 1

Baby weighing scale (electronic) 135 1 Newborn resuscitation table (with accessories) 11000 1

Backup generator 10000 1 Non toothed dissecting forceps 55 4

Bed side cupboards 150 6 Non-sterile protective clothing 100 5

Beds 480 6 Obstetric Forceps 58 3

Blankets/ linen 25 20 Placenta bowl 10 4

Blood pressure apparatus (mercury) 100 2 Plastic apron 2 6

Blunt uterine curettes 4 6 Plastic sheets 10 6

Cell phone 250 1 Puncture-proof sharps container 5 5

Chairs 150 10 Radiant warmer 17000 1

Clinical thermometer 2 2 Refrigerator 2704 1

Cloths for baby 15 6 Regular trash bin 10 2

Covered contaminated waste trash bin 10 2 Round body needles 0 12



# units/ facility


# units /facility

Cupboards 500 6 Saline stands 67 12

Curtains 125 5 Sharp uterine curettes 4 6

Cuscos speculum 6 6 Sharpe bins 5 4

Decontamination container 188 5 Small cup for breast milk expression 1 5

Delivery beds 530 3 Soiled linen spectacles 188 6

Delivery table 530 3 Sponge forceps 11 4

Disposable uncuffed/cuffed tracheal tubes, for newborn 2 2 Sponge holding forceps 11 4

Draping cloths 10 6 Staff tables 300 4

Emergency trolley 400 1 Steam sterilizer 685 1

Endotracheal tube 3 5 Sterilization drum 45 1

Episiotomy scissors 100 4 Sterilization drum stand 50 1

Fetal stethoscope 1 5 Sterilizer, pressure cooker, kerosene heated 35 1

Filled oxygen cylinder with cylinder carrier and key to open valve 70 1 Stethoscope 150 2

Fluorescent tubes for phototherapy 1710 2 Stich scissors 2 2

Foetal stethoscope 1 5 Suction catheter for newborn 6 2

Foley bladder catheter 1 2 Tape 0 2

Functional fan/air conditioning 2500 2 Thermometers 2 2

functioning electric/gas refrigerator 2704 1 Towel clip 1 30

functioning solar refrigerator 4895 1 Towel clips 1 20

Galipot bowls 10 4 Towels/ cloths to wrap and dry neonate 10 20

Glucometer 50 1 Trash bin 10 6

Head covers / Masks 1 20 Trolleys 400 4

Heavy duty Glouses 5 10 Ultrasound 4500 1

Height measuring tape 2 1 Ultrasound Doppler 206 1

Hemostats to clamp cords 3 4 Uterine dilators 56 6



# units/ facility


# units /facility

Hospital beds 480 7 Vacuum aspirators/syringes 100 2

Hot air sterilizer (dry oven) 1000 1 Vacuum extractor 978 1

Incinerator 50000 1 Vacuum extractor with cups 50 2

Incubator 18737 2 Vaginal speculum, (Sims) 9 6

Infant face masks 2 5 Volsullum forceps 9 6

Infant laryngoscope with spare bulb and batteries 250 2 Wall clock 10 1

Instrument tray 20 2 Wheel chairs 152 2

Instrument trolley 200 2 - - -

Long strait artery forceps 3 4 - - -

Mayo Stand 210 2 - - -


Annex 3: Human Resource Requirement by Type of EmONC Facility

Annex 3 Table 1: Human resource requirements and salary details

HR type BEmONC (< 300 D)

BEmONC (300-600

D)BEmONC (>600 D) CEmONC

Monthly Salary (US$)

Annual Salary

(US$)

Midwives 4 8 12 12 510 6120

Doctors 2 4 6 6 610 7320

Lab Technician 1 2 2 2 470 5640

Cleaner 2 4 6 6 120 1440

Security guard 2 4 8 8 200 2400

Driver 2 2 2 4 200 2400

Auxiliaries 0 8 12 12 120 1440

Infection control officer 0 1 1 1 470 5640

Lab Technician 0 2 2 2 470 5640

Lab Assistant 0 2 2 2 470 5640

Pharmacist 0 2 2 2 470 5640

Nurse Anesthetist 0 0 0 1 500 6000

Obstetrician 0 0 0 1 1200 14400

Anesthetist 0 0 0 1 1200 14400

Gen Surgeon 0 0 0 1 1200 14400

Theater Nurse 0 0 0 2 500 6000

Nurse assistant 0 0 0 1 470 5640

Circulation Nurse 0 0 0 2 500 6000

Anesthetist 0 0 0 1 1200 14400

Nurse Anesthetist 0 0 0 1 500 6000

Coach 0 0 0 1 1200 14400


Annex 4: Detailed cost estimates for program management activities

Annex 4 Table 1: Development of Norms, standards and protocols on EmONC (Year 1)

Required Line Items Measurement Unit

Unit Required

Cost Per Unit (US$)

Total Amount

(US$)

International consultant ( fees) per day 60 450 27000

Perdiem per day 60 156 9360

Air fare 1 return ticket 1 2500 2500

Local consultant per day 60 100 6000

Review meeting by National Technical Team on EmONC Meeting 1 1000 1000

Translation of document word 100000 0.1 10000

Printing of documents IEC package 500 10 5000

Total 60,860

Annex 4 Table 2: In-Service Training On Emonc For Doctors And Midwives - Master Training (Year 2)


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)

Per diem for day first per day 15 40 600

Per diem for day 2-15 (12% deduct for lunch) (15 trainees) per 14 days 15 492.8 7392

Refreshment ( 15 days /25 people) per day 375 15 5625

Facilitator fee (5 personnel x 15 days) per day 75 50 3750

Training materials and stationaries package 1 1 500

International master trainers fee (2 x 15) per day 30 450 13500

International master trainers Perdiem per day 30 156 4680

International master trainers Air ticket Return ticket 2 2500 5000

Total 41047


Annex 4 Table 3: Integrate upgraded standards and treatment protocols into preservice training of doctors and midwives

Local consultant for concept note and curriculum ( one month assignment ) per day 30 100 3000

Review meeting by National Technical Team on EmONC Meeting 1 1000 1000

Total 4000

Annex 4 Table 4: EmONC awareness training such as nurses, OT staff, lab technicians, managers, ambulance drivers


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)

Perdiems for participants per day 15 15 225


Facilitator fee (2 personnel) per day 2 50 100

Stationary per person 20 10 200

Total per one program in an institution 825

Total for all 36 institutions 29700

Annex 4 Table 5: Train Suco and Aldeia chiefs, village committee members, and local NGOs on improving EmONC related health seeking behavior


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)


Refreshment) per day 20 15 300






Annex 4 Table 6: Train Suco and Aldeia chiefs, village committee members, and local NGOs on improving EmONC related health seeking behavior


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)







Annex 4 Table 7: Administrators (DSM and DPHO-SMI, Municipality level) & EmONC coordinator on EmONC planning, management and monitoring EmONC

services


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)


Refreshment) per day 20 15 300



Total per the program 1025

Annex 4 Table 8: System reorientation (Year one)

1 Advocacy meetings


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)


Refreshment per day 20 15 300

Resources fee for coordinator per day 3 50 150


Cost for one meeting 775

Cost for 12 meetings 9300


Annex 4 Table 9: Public Communication (Annual Activity)

1. National Safe motherhood day


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)

Public event meeting venue and refreshments 1 6000 6000

Media conference ( refreshment personnel 60 5 300

Media conference ( reading material) package 60 2 120

Media conference ( resources for presenters) per day 6 50 300

Total 6720

Annex 4 Table 10: M & E (Timing under sub activities)

1. Update HMIS and integrate quality indicators ( Year one)


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)

Consultancy to local EmONC and HMIS experts to prepare a concept note and draft indicators ( 2 persons each 2 weeks)

Perdiems 28 100 2800

Review meetings by technical groups meeting 3 1000 3000

Total 5800

Annex 4 Table 11: Partograph review studies (Year two)


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)

Conduct studies lump sum 5000


Annex 4 Table 12: Review meetings (Bi Annual)


Unit Required

Cost Per Unit (US$)

Total Amount

(US$)

Bi annual Maternal & newborn death/near miss reviews



Resource fee for coordinator per day 10 50 500


Cost per meeting 5200

Cost for 2 meetings per year 10400

Annex 4 Table 13: NATIONAL EMONC REVIEW (ANNUAL)

National EmONC review ( Annual)



Resource fee for coordinator per day 10 50 500


Cost per meeting 5200


Annex 5: Priority order of upgrading of different institutions (based on EmONC IPA)

Annex 5 Table 1: Priority order of upgrading of different institutions (based on EmONC IPA).

Municipality

Year 1 Year 2 Year 3 Year 4

Priority 1 Priority 2 Priority 3 Priority 4

HR CSI CHC CHC CHC CHC

Alieu Maubisse Aileu Vila Remexio - - -

Liquica HNGV Liquica Fatumasi Maubara - -

Ainaro Maubisse Ainaro Vila Hautio (Koika) - - -

Baucau Baucau* - Quelicai** Baguia - -

Bobonaro Maliana* - Lolotoe Atabae Bobonaro Marco (Caliaco)

Covalima Suai* - Zumalai Tilomar Fohorem

Dili** HNGV - Atauro Becora Vera Cruz Centro

Ermera - Gleno Atsabe Hatolia - -

Lautem Baucau LosPalos Iliomar Luro - -

Manatuto HNGV Manatuto Laclubar Natarbora - -

Manufahi Maubisse Same Fatuberlihu - - -

Oecusse Oecussi* - Passabe - - -

Viqueque Baucau Viqueque Uatulari Lacluta Uatucarbau -

* New Training facilities to be established.

** Comoro CHC was found to be a fully functional BEmONC facility during EmONC Needs Assessment


6. REFERENCES1. Central Statistical Office Ministry of Finance. 2011 Population and Housing Census

Preliminary Results [Internet]. 2011. Available from: http://www.statistics.gov.tl/wp-content/uploads/2015/10/1-Preliminary-Results-4-Printing-Company-19102015.pdf

2. Dao B. Guidelines for In-Service Training in Basic and Comprehensive Emergency Obstetric and Newborn Care ( Jhpiego). 2012;

3. Futures Institute. OneHealth tool: Technical manual [Internet]. 2012. Available from: http://www.avenirhealth.org/software-onehealth.php

4. Ministry of Health C. Cambodia EmONC improvement plan. 2009;(December):1–77.

5. National Statistics Directorate. Timor-Leste Demographic and Health Survey 2009-10. 2010. 136 p.

6. Ministry of Health Timor Leste. Emergency Obstetric and Newborn Care EmONC Needs Assessment, Timor Leste, 2015. 2015.

7. Ministry of Health Timor Leste. Emergency Obstetric and Newborn Care EmONC Improvement Plan of Action in Timor-Leste 2016-2019. 2016.


7. ACKNOWLEDGEMENTSCosting of the EmONC improvement Plan of Action was carried out by the Ministry of Health with technical support from WHO and inputs from a working group comprised of technical personnel. We would like to extend our sincere thanks to institutions and individuals without whose support, commitment and cooperation this assessment would not have been accomplished.

Our gratitude goes to:

• First and foremost H.E. Dr. Maria do Ceu Sarmento Pina da Costa, Minister of Health and Dr. Odete da Silva Viegas, Director General for Service Delivery for providing leadership

• Dr. Neil Thalagala, WHO consultant who very competently conducted the costing exercise

• Dr Vincent Fauveau, UNFPA consultant for assistance in finalisation of the report

• UNFPA Representative Mr. John M. Pile and WHO Representative Dr Rajesh Pandav for the excellent support

• Mr. Francisco Borges, National Director of Logistic, Procurement and Assets MoH for allocating the engineering teams to estimate the infrastructure rehabilitation costs in the CHCs that are identified for upgrading.

• Mr. Marcelo Amaral, National Director of Finance, MoH for providing the unit cost for drugs, equipment and supplies.

• All Delegacia Saúde Municipio , District Public Health Officers (DPHO) MCH, hospital directors, heads of CSIs and CHCs, doctors, midwives, nurses and all health workers working at each assessed facility, for their cooperation in providing the best possible information for the study.

• Dr Chandani Galwaduge, Reproductive Health Specialist and Dr. Domingas Sarmento, National programme Analyst of UNFPA and Dr Sudath Perirs, Medical Officer of WHO for providing constructive inputs and guidance and coordinating activities related to this cost assessment.


8. CONTRIBUTORSTeam of Consultants

1. Dr Neil Thalagala, WHO Consultant 2. Dr Vincent Fauveau, UNFPA Consultant

Core Team1. Dr. Triana do Rosario, Head of MCH Department, MoH2. Ms. Florencia Corte-Real Tilman, Safe Motherhood Officer, MoH3. Ms. Norberta Belo, Advisor, MoH4. Dr. Carla Jesuina do Carmo Quintão, Health Officer UNICEF5. Dr. Sudath Peiris, WHO6. Ms. Nelinha do Santos, INS7. Dr. Amita Pradhan Thapa, OBGyn-MoH/HNGV8. Ms. Lurdes Vidigal-MoH/HNGV9. Ms. Antonia Mesquita Fernandes, HADIAK10. Ms. Teresinha Quevedo Sarmento, HAI11. Dr. Domingas Ângela Sarmento-UNFPA12. Dr Chandani Galwaduge- UNFPA

Data Collection Coordination:1. Mr. Francisco Borges, National Director of Logistic, Procurement and Assets MoH 2. Mr. Marcelo Amaral, National Director of Finance, MoH 3. Dr. Domingas Ângela Sarmento-UNFPA

Engineering team members: 1. Mr. João Bras Belo, ST – Engineer MoH 2. Mr. Floriano Isac Horacio, B. Eng – Engineer MoH3. Mr. Berta Gratia C.C.Vital Ximenes ,ST – Engineer MoH 4. M Emanuel Bas Fernandes Lelan , Lic,Tec – Engineer MoH

ESTIMATED COST OF THE EMERGENCY OBSTETRIC · PDF fileThis Plan of Action is in line with the...

Documents

Transcript of ESTIMATED COST OF THE EMERGENCY OBSTETRIC · PDF fileThis Plan of Action is in line with the...