On September 7, 2021, Timor-Leste’s Ministry of Health issued Ministerial Order No. 17/MS/IX/2021 to create audit committees to research and investigate maternal and neonatal deaths. (Despacho Ministerial No. 17/MS/IX/2021, de 7 de setembro de 2021.) These Audit Committees of Maternal and Neonatal Deaths (Comissões de Auditoria às Mortes Maternas e Neonatais, CAMMs) will research occurrences of maternal, infant, and fetal deaths throughout the country in response to the worrisome number of such deaths, particularly in COVID-19 isolation units.
CAMMs will be comprised of various stakeholders and will conduct investigations at either the national, regional, or municipal levels. (Ministerial Order No. 17/MS/IX/2021, No. 4.) The ministerial order states that addressing maternal and neonatal health requires an intersectional approach and thus provides that committee members will include health professionals, Ministry of Health staff, international partners, and civil society groups. (Nos. 4, 7.) As a result, CAMMs will also seek to identify social, economic, cultural, and institutional factors that contribute to health determinants and maternal and neonatal deaths. (No. 2(d).)
Key responsibilities of these CAMMs will include analyzing reported occurrences of maternal and neonatal deaths across the country. (No. 2(a).) CAMMs will also investigate all deaths of women in reproductive years to identify additional deaths related to maternal and neonatal health issues. (No. 2(b).) As part of this task, CAMMs are to ensure that death certificates are filled out correctly by medical professionals and accurately include the maternal and neonatal health factors that led to mortality. (No. 2(c).)
The ministerial order obligates CAMMs to submit monthly and annual reports presenting the committees’ findings to the Ministry of Health. (No. 2(k).) CAMMs should also prepare analyses of mortality cases, propose prevention measures, and recommend policies to mitigate maternal and neonatal deaths. (No. 2(j), (l).) Additionally, CAMMs are to contribute to making the country’s official statistics on maternal mortality more accurate through systematic evaluation of obstetric care process and impact indicators, thereby strengthening information systems tracking maternal deaths. (No. 2(h).) To raise awareness of these issues, CAMMs are also to promote seminars at the national, regional, and municipal levels in conjunction with civil society organizations. (No. 2(i).)
Data from the Maternal Mortality Estimation Inter-Agency Group shows significant reductions in maternal mortality ratios in Timor-Leste over the past two decades. The COVID-19 state of emergency in the country, however, has caused new problems for mothers and children in accessing maternal and children’s health services, including medical appointments and scheduled vaccinations.Ministerial Order No. 17/MS/IX/2021 considers maternal and neonatal mortality as both a public health and a societal challenge. CAMMs are necessary, the order states, to help develop interventions and preventive measures to deter future deaths.
Prepared by Elizabeth Marin, Law Library intern, under the supervision of Eduardo Soares, Senior Foreign Law Specialist