HEALTH SECTOR DEVELOPMENT IN TIMOR-LESTE Dr Joao Martins, Dean, Faculty Public Health, Universidade da Paz, Dili

Overview Historical context Historical context Health sector development Health sector development Current health sector issues Current health sector issues Future needs & opportunities for collaboration Future needs & opportunities for collaboration

Popular consultation, August 30, 1999.

East Timor 1999

Historical context Establishment of UNTAET 25 October 1999 Establishment of UNTAET 25 October May 2002: Independence day 20 May 2002: Independence day

Timor-Leste 2005 Population: 924, 642 Population: 924, district, 65 sub-district, 446 sucos 13 district, 65 sub-district, 446 sucos 67 CHCs, 6 hospitals, 174 health posts, 87 mobile clinics 67 CHCs, 6 hospitals, 174 health posts, 87 mobile clinics NCHET, SAMES, National Laboratory NCHET, SAMES, National Laboratory IMR 83/1000 indirect estimate CMR: 42/1000 survive at age 1 IMR 83/1000 indirect estimate CMR: 42/1000 survive at age 1 MMR: 800/100,000 live births MMR: 800/100,000 live births Low life expectancy Low life expectancy

Health Sector Funding April 2000: April 2000: –HSRDP I (USD 12.7 Million) –World Bank and UNTAET, witnessed by CNRT Objectives of HSRDP I Objectives of HSRDP I –Restoring health access to respond to the immediate health needs. –Laying foundation for health policies and health system development –Create a Project Management Unit

Objectives of HSRDP I –Restoring health access to respond to the immediate health needs. Transitional strategy for service provision Transitional strategy for service provision Rehabilitation and equipping health centers Rehabilitation and equipping health centers Goods Goods Capacity strengthening Capacity strengthening

Objectives of HSRDP I –Laying foundation for health policies and health system development Policy development Policy development System design/implementation plan System design/implementation plan Human resource development Human resource development –Create a Project Management Unit To run the project (in absence of MoH) To run the project (in absence of MoH)

Funding 2 HSRDP II (June 2001): HSRDP II (June 2001): –USD 12.6 million –EC Grant 16.5 million Euro (March 2004). Objectives: Objectives: –To rehabilitate and develop a cost-effective and financially sustainable health system in East Timor –To be responsive to the immediate basic needs of the population and, –To prepare the health system to meet future needs

Objectives of HSRDP II Support ongoing service delivery Support ongoing service delivery Improve range and quality of services, and develop/implement support systems Improve range and quality of services, and develop/implement support systems Health Sector Policy and the Management systems Health Sector Policy and the Management systems

Result of HSRDP I Restoration of basic services and the assumption of responsibility by the MoH staff Restoration of basic services and the assumption of responsibility by the MoH staff Development of Health Policy Framework Development of Health Policy Framework District Health Plan District Health Plan Construction of 28 new health centers and rehabilitation of 36 health posts Construction of 28 new health centers and rehabilitation of 36 health posts Construction of Central Medical Store and establishment of medical supply system Construction of Central Medical Store and establishment of medical supply system

Result of HSRDP I Development of a plan for hospital configuration for the country, strengthening of referral system through ambulance and radio supply Development of a plan for hospital configuration for the country, strengthening of referral system through ambulance and radio supply Support for the completion of medical training, maternal health and IMCI. Support for the completion of medical training, maternal health and IMCI.

Health service delivery

Health service support facilities

Policy & training

What next after HSRDP I Investment in infrastructure should be reduced Investment in infrastructure should be reduced Pay more attention to management issues and human resource development Pay more attention to management issues and human resource development Strengthen the health policy implementation Strengthen the health policy implementation Establish a functional health information system Establish a functional health information system Ensure that policy formulation should be based on local research & best practice Ensure that policy formulation should be based on local research & best practice

What next after HSRDP I This requires This requires –local collaboration between government agencies (MoH and MoE) and academics and researchers –Regional partnerships Academic (eg MSHR-UnPaz) Academic (eg MSHR-UnPaz) Government Government Non-government Non-government

Examples of collaboration KAP study on malaria in Timor-Leste. KAP study on malaria in Timor-Leste. RCT on food incentive for TB patients RCT on food incentive for TB patients Research seminar Research seminar

Regional cooperation