Health workers rise to challenge of social crisis in Timor-Leste,
22 June 2006
Timor-Leste's Community Health Centres and local health posts
remained fully operational from April 29 when the first internally
displaced people appeared in the capital Dili, until today when
over 148,000 people rely on health workers organized through the
Ministry of Health. In Dili with 69,000 people in 57 IDP centres,
the Dili District Health Service at first provided mobile health
clinics, then set up 24 hour health posts in 19 centres, each
with doctors and nurses.
Health Ministry staff continued to work despite many of them
also having to live in IDP centres because of threats to their
homes. Since June 17, the case load at the IDP centres has declined
and the service is now reverting to mobile clinics, with 24-hour
posts continuing for the two largest IDP centres.
The health sector is one of Timor-Leste's many success stories,
because it has succeeded in providing a basic level of service
to all the people of the country, even in remote locations, and
it is improving the quality and availability of these services.
In the public sector, these midwives, nurses, GP and hospital
visits, medicines and educational programs are free - a primary
reason why all people in this very poor country can use them.
Rui Maria de Araújo, a Timorese doctor who trained in
Bali and then worked as a support surgeon at Dili Hospital, was
head of the Health Department under the UN administration up to
May 20, 2002, and then the Health Minister in the first independent
government. He says that success has been about being able to
spend the available money effectively. "The issue has not
been money, but having good health policies and good methods of
implementation so that we achieve our targets," he said.
Under the first National Health Policy Framework developed under
UNTAET, the health sector has a focus on primary health care to
help cure the most common diseases, to prevent illness and to
provide community education. "We deliver our services through
programs aimed at mothers and children, tuberculosis, malaria
and HIV / Aids. The point of contact for people is a Community
Health Centre in each Sub-District, or a Health Post in population
centres isolated from the Community Health Centre," said
Each of the 65 Community Health Centres has 6 - 10 nurses or
midwives, and 1 - 2 general practice doctors. Each of the 175
Health Posts has one nurse and / or one midwife.
The Health Ministry and its 13 District Health Management Teams
is fully managed by Timorese, and employs 1,700 people. However,
there are only 55 trained Timorese doctors and under a formal
aid program the Cuban government provides 220 Cuban doctors and
30 Cuban health technicians. Several of the Cuban doctors are
teachers at the National Institute of Health.
Training doctors, nurses and technicians at the National Institute
of Health is a major priority to ensure that availability and
quality of health services continues to improve. A one-year Nursing
Diploma course is now provided in exchange for a three-year contract
to work in a remote Health Post. "With our expanded budget
next year, we will really improve facilities, equipment and communications
at our Community Health Centres and Health Posts, and thus retain
our staff and really improve our services," concluded Minister