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Title page 1

Contents 4

ABBREVIATIONS 12

MESSAGE 13

FOREWORD 14

ACKNOWLEDGEMENT 15

EXECUTIVE SUMMARY 18

I. INTRODUCTION 23

II. METHODS 28

III. RESULTS 40

IV. DISCUSSION 139

V. CONCLUSION AND RECOMMENDATIONS 144

VI. REFERENCES 146

VII. ANNEX 148

Annex I: Sampling methodology 148

Annex II: Survey instrument used in household survey 155

Annex III: Tool- Facility survey for availability and readiness of NCD services in health facilities 210

Annex IV: Detailed results - Household survey 260

Annex V: Detailed results- Availability and readiness of NCD services in health 301

Tables 10

Table 2.1. Municipality-wise distribution of household selected and response rate 30

Table 2.2. Summary of the data collection process planned for the household survey 31

Table 2.3. Indicators and the details of computations of readiness scores 39

Table 3.1. Characteristics of the study respondents 41

Table 3.2. Estimated mean intake of salt per day (in grams) 63

Table 3.3. Number of facilities included in the survey by type, Timor-Leste 2023 87

Table 3.4. Availability and functionality status of the different departments in the National Hospital and Referral Hospitals, Timor-Leste 2023 88

Table 3.5. Cancer treatment services availability in the National Hospital, Timor-Leste 2023 100

Table 3.6. Mental health services availability in the National Hospital, Timor-Leste 2023 100

Table 3.7. Availability of medical devices In the National Hospital, Timor-Leste 2023 116

Table 3.8. Domains and selected tracer items for each level of health facilities for each of the NCD services evaluated for readiness, Timor-Leste 2023 117

Table 3.9. Availability of services for integrated screening services of Non-Communicable Diseases, Timor-Leste 2023 120

Table 3.10. Readiness scores for the availability of equipment for integrated screening services of Non-Communicable Diseases, Timor-Leste 2023 121

Table 3.11. Readiness scores for the availability diagnostics for integrated screening services of Non-Communicable Diseases, Timor-Leste 2023 121

Table 3.12. Overall Readiness Scores for integrated screening services of Non-Communicable Diseases, Timor-Leste 2023 122

Table 3.13. Readiness Scores for availability of trained staff and guidelines for screening of Chronic Respiratory Disease, Timor-Leste 2023 124

Table 3.14. Readiness scores for the availability of equipment for screening of Chronic Respiratory Disease, Timor-Leste 2023 124

Table 3.15. Readiness scores for the availability of diagnostics for screening of Chronic Respiratory Disease, Timor-Leste 2023 124

Table 3.16. Overall readiness scores for screening of Chronic Respiratory Disease, Timor-Leste 2023 125

Table 3.17. Percentage of facilities with availability of all tracers by domains for screening of Chronic Respiratory Disease by health facility,... 126

Table 3.18. Readiness scores for availability of trained staff, guidelines and registers for follow up and management of Diabetes, Timor-Leste 2023 127

Table 3.19. Readiness scores for the availability of equipment for follow up and management of Diabetes, Timor-Leste 2023 127

Table 3.20. Readiness scores for the availability of diagnostics for follow up and management of Diabetes, Timor-Leste 2023 128

Table 3.21. Readiness scores for the availability of medicines and commodities for follow up and management of Diabetes, Timor-Leste 2023 128

Table 3.22. Overall Readiness Scores for follow up and management of Diabetes, Timor-Leste 2023 128

Table 3.23. Percentage of facilities with availability of all tracers by domains for follow up and management of Diabetes, Timor-Leste 2023 130

Table 3.24. Readiness Scores for availability of trained staffs, guidelines and registers for follow up and management of hypertension,... 131

Table 3.25. Readiness scores for the availability of equipment for follow up and management of Hypertension, Timor-Leste 2023 131

Table 3.26. Readiness scores for the availability diagnostics for follow up and management of Hypertension, Timor-Leste 2023 131

Table 3.27. Readiness scores for the availability of medicines and commodities for follow up and management of hypertension,... 132

Table 3.28. Overall Readiness Scores for follow up and management of hypertension, Timor-Leste 2023 132

Table 3.29. Percentage of facilities with availability of all tracers by domains for follow up and management of Hypertension, Timor-Leste 2023 134

Table 3.30. Readiness Scores for availability of trained staffs and guidelines for follow up and management of chronic respiratory disease,... 135

Table 3.31. Readiness scores for the availability of equipment for follow up and management of chronic respiratory disease, Timor-Leste 2023 135

Table 3.32. Readiness scores for the availability diagnostics for follow up and management of chronic respiratory disease, Timor-Leste 2023 135

Table 3.33. Readiness scores for the availability of medicines and commodities for follow up and management of chronic respiratory disease,... 136

Table 3.34. Overall Readiness Scores for follow up and management of chronic respiratory disease, Timor-Leste 2023 136

Table 3.35. Percentage of facilities with availability of all tracers by domains for follow up and management of chronic respiratory disease,... 138

Figures 5

Figure 3.1. Percentage of current tobacco users among respondents, by sex and type of tobacco, Timor-Leste 2023 42

Figure 3.2. Percentage of current tobacco smokers among respondents, by sex and age group, Timor-Leste 2023 43

Figure 3.3. Proportion of never smokers, ever smokers, non-daily and daily smokers among respondents, by sex, Timor-Leste 2023 43

Figure 3.4. Mean age of initiation of smoking among current daily smokers, by sex, Timor-Leste 2023 44

Figure 3.5. Mean duration of smoking among current daily smokers, by sex and age group, Timor-Leste 2023 44

Figure 3.6. Percentage of current smokers who have tried to stop smoking, by sex and age group, Timor-Leste 2023 45

Figure 3.7. Percentage of current smokeless tobacco users, by sex and age group, Timor-Leste 2023 45

Figure 3.8. Proportion of never users, former users, non-daily and daily users of smokeless tobacco products among respondents, by sex,... 46

Figure 3.9. Exposure to second hand smoke among respondents, by sex, Timor-Leste 2023 47

Figure 3.10. Percentage of respondents who noticed information during the past 30 days on the media about the dangers of smoking that... 48

Figure 3.11. Percentage of respondents who noticed cigarette promotions during the past 30 days, Timor-Leste 2023 48

Figure 3.12. Percentage of alcohol consumption status among respondents, by sex, Timor-Leste 2023 49

Figure 3.13. Frequency of alcohol consumption in the past 12 months among current drinkers, by sex, Timor-Leste 2023 50

Figure 3.14. Frequency of alcohol consumption in the past 7 days among current drinkers, by sex, Timor-Leste 2023 51

Figure 3.15. Proportion of drinkers by amount and sex among current drinkers, Timor-Leste 2023 51

Figure 3.16. Percentage of consumption of unrecorded alcohol during the past 7 days among current drinkers, by sex and age group,... 52

Figure 3.17. Mean number of standard drinks and standard drinks of unrecorded alcohol on average per day in the past 7 days among current... 53

Figure 3.18. Mean maximum number of standard drinks consumed on one occasion in the past 30 days among current drinkers, by sex and... 53

Figure 3.19. Percentage of respondents consuming six or more drinks on a single occasion at least once during the past 30 days, by sex and... 54

Figure 3.20. Mean number of Times with six or more drinks during a single occasion in the past 30 days among current drinkers, by sex and... 55

Figure 3.21. Percentage of former drinkers (those who did not drink during the past 12 months) who stopped drinking due to health reasons,... 55

Figure 3.22. Percentage of respondents reporting the affordability of buying the same quantity of alcohol now compared to the past year... 56

Figure 3.23. Percentage of respondents who currently smoke and drink, by sex and age group, Timor-Leste 2023 57

Figure 3.24. Mean number of fruit, vegetables and combined fruit and/or vegetables servings on average per day among respondents,... 58

Figure 3.25. Percentage of respondents who ate less than 5 servings of fruit and/or vegetables on average per day, by sex, Timor-Leste 2023 58

Figure 3.26. Frequency of consumption of carbonated soft drinks during the past 7 days among the respondents, by sex, Timor-Leste 2023 59

Figure 3.27. Frequency of consumption of sugar sweetened drinks during the past 7 days among respondents, by sex, Timor-Leste 2023 59

Figure 3.28. Frequency of consumption of energy drinks during the past 7 days among respondents, by sex, Timor-Leste 2023 60

Figure 3.29. Frequency of consumption of 100% fruit juices during the past 7 days among respondents, by sex, Timor-Leste 2023 60

Figure 3.30. Salt consumption habits among respondents, by sex, Timor-Leste 2023 61

Figure 3.31. Self-reported quantity of consumed salt among respondents, by sex, Timor-Leste 2023 62

Figure 3.32. Percentage of respondents who knew the WHO recommendation of maximum intake of salt, by sex and age group, Timor-Leste 2023 62

Figure 3.33. Percentage of respondents not engaged in vigorous physical activity, by sex and age group, Timor-Leste 2023 64

Figure 3.34. Mean and median minutes spent in sedentary activity on a typical day by respondents, by sex, Timor-Leste 2023 65

Figure 3.35. Percentage of respondents (excluding pregnant women) according to the body mass index classification, by sex, Timor-Leste 2023 66

Figure 3.36. Mean waist and hip circumference in centimeters in respondents, by sex, Timor-Leste 2023 66

Figure 3.37. Percentage of blood pressure measurement and diagnosis among respondents, by sex, Timor-Leste 2023 67

Figure 3.38. Percentage of previously diagnosed hypertensive respondents who reported to be on medication for raised blood pressure... 68

Figure 3.39. Mean systolic and diastolic blood pressure (mmHg) among respondents, Timor-Leste 2023 68

Figure 3.40. Percentage of respondents with raised blood pressure, by sex, Timor-Leste 2023 69

Figure 3.41. Percentage of respondents with raised blood pressure by the level of blood pressure and the details of being on medication... 70

Figure 3.42. Hypertension care cascade among respondents with raised blood pressure, by sex, Timor-Leste 2023 71

Figure 3.43. Blood sugar measurement and diagnosis among respondents, by sex, Timor-Leste 2023 72

Figure 3.44. Percentage of respondents with impaired fasting glycaemia and raised fasting blood glucose, by sex, Timor-Leste 2023 73

Figure 3.45. Diabetes care cascade among respondents with raised blood sugar, by sex, Timor-Leste 2023 74

Figure 3.46. Percentage with raised blood pressure and with raised blood sugar, by sex and age group, Timor-Leste 2023 74

Figure 3.47. Total cholesterol measurement and diagnosis among respondents, by sex, Timor-Leste 2023 75

Figure 3.48. Percentage of respondents with three or more risk factors, by sex and age group, Timor-Leste 2023 76

Figure 3.49. Percentage of respondents according to the level of 10-year CVD risk, by sex, Timor-Leste 2023 77

Figure 3.50. Percentage of respondents with a 10-year CVD risk ≥20% or with existing CVD, by sex and age group, Timor-Leste 2023 78

Figure 3.51. Percentage of respondents involved in a road traffic accident (as a driver, passenger, pedestrian, cyclist) in the past 12 months,... 79

Figure 3.52. Percentage of respondents who always wore a seat belt as a driver or passenger of a motor vehicle in past 30 days, by sex and... 79

Figure 3.53. Percentage of respondents who always wore a helmet as a passenger on a motorcycle or motor scooter in past 30 days, by sex and... 80

Figure 3.54. Percentage of respondents who ever visited a dentist, by sex and age group, Timor-Leste 2023 81

Figure 3.55. Percentage of respondents who cleaned teeth daily cleaning of teeth, by sex and age group, Timor-Leste 81

Figure 3.56. Percentage of respondents using tooth paste containing fluoride, by sex and age group, Timor-Leste 2024 82

Figure 3.57. Percentage of respondents whoever had vision/eyes checked by a doctor or other health worker, by sex and age group, Timor-Leste 2023 82

Figure 3.58. Percentage of respondents whoever had hearing checked by a doctor or other health worker, by sex and age group, Timor-Leste 2023 83

Figure 3.59. Percentage of respondents who reported as suffering from one or more major NCDs, by sex and age group, Timor-Leste 2023 84

Figure 3.60. Percentage of respondents with NCDs who were hospitalized due to NCDs in last 12 months, by sex and age group, Timor-Leste 2023 85

Figure 3.61. Mean out of pocket expenditure [direct (medical and non-medical) and indirect] on hospitalization due to NCD in the past 12 months... 85

Figure 3.62. Mean out of pocket total expenditure [direct (medical and non-medical) and indirect] on outpatient care due to NCDs in the past... 86

Figure 3.63. Availability of selected manpower in health facilities, Timor-Leste 2023 89

Figure 3.64. Existence of basic infrastructure and systems in health facilities, Timor-Leste 2023 90

Figure 3.65. Existence of NCD related basic laboratory and diagnostic services across facilities, Timor-Leste 2023 92

Figure 3.66. Percentage of facilities providing education services for prevention of NCDs and type of health education provided, Timor-Leste 2023 93

Figure 3.67. Availability of integrated screening services for diabetes, hypertension, CVD and CRD and screening of all adults aged above 40 years... 94

Figure 3.68. Next step if patients are screened positive for NCDs, Timor-Leste 2023 95

Figure 3.69. Availability of services to follow up and manage patients with long term NCDs across facilities, Timor-Leste 2023 96

Figure 3.70. Availability of services to manage patients with acute NCDs across facilities, Timor-Leste 2023 97

Figure 3.71. Availability of services to prevent rheumatic heart diseases across facilities, Timor-Leste 2023 97

Figure 3.72. Availability of cancer screening across facilities, Timor-Leste 2023 98

Figure 3.73. Availability of detailed cancer screening services across facilities, Timor-Leste 2023 99

Figure 3.74. Availability of selected mental health services across facilities, Timor-Leste 2023 101

Figure 3.75. Availability of oral health services across facilities, Timor-Leste 2023 103

Figure 3.76. Availability of eye health services across facilities, Timor-Leste 2023 104

Figure 3.77. Availability of registers for patients screened/managed for diabetes and hypertension, Timor-Leste 2023 105

Figure 3.78. Availability of NCD related guidelines and protocols across facilities, Timor-Leste 2023 106

Figure 3.79. Doctors trained in NCD services in last 5 years across facilities, Timor-Leste 2023 107

Figure 3.80. Nurses trained in NCD services in last 5 years across facilities, Timor-Leste 2023 108

Figure 3.81. Percentage of facilities with at least one unexpired dose of key medicines to treat cardiovascular diseases/hypertension observed,... 109

Figure 3.82. Percentage of facilities with at least one unexpired dose of key medicines to treat diabetes observed, Timor-Leste 2023 110

Figure 3.83. Percentage of facilities with at least one unexpired dose of key medicines to treat asthma/CRD observed, Timor-Leste 2023 111

Figure 3.84. Percentage of HPs with doctors where the diagnostic devices/equipments, Timor-Leste 2023 112

Figure 3.85. Percentage of CHC-1 & 2s with doctors where the diagnostic devices/equipments, Timor-Leste 2023 113

Figure 3.86. Percentage of CHC-3's with doctors where the diagnostic devices/equipments, Timor-Leste 2023 114

Figure 3.87. Percentage of RHs with doctors where the diagnostic devices/equipments, Timor-Leste 2023 115

Figure 3.88. Readiness score for integrated screening services of NCDs, by type of health facility, Timor-Leste 2023 122

Figure 3.89. Readiness score for screening services of CRD, by type of health facility, Timor-Leste 2023 125

Figure 3.90. Readiness score for screening services of diabetes, by type of health facility, Timor-Leste 2023 129

Figure 3.91. Readiness score for follow up and management of hypertension, by type of health facility, Timor-Leste 2023 133

Figure 3.92. Readiness score for follow up and management of chronic respiratory disease, by type of health facility, Timor-Leste 2023 137

Annex Tables 148

Table A3.1. Population distribution by municipalities and administrative posts and number of Sucos in each administrative post, Timor-Leste 2022 148

Table A3.2. List of administrative posts (FSUs) selected for survey from each municipality and their population distribution, Timor-Leste 2022 150

Table A3.3. Allocation of Sub-districts in each Municipality 152

Table A3.4. Allocation of EAs in each administrative post 153