Health Brief

Background

The Government has designed and implemented a health program that balances immediate and long term needs, and today the health sector is perhaps the best performing in the country. The 1999 violence left public health facilities largely destroyed and devoid of skilled personnel and managers, in the face of a high burden of illness related to communicable diseases, malnutrition, and maternal health.

Between 2000 and 2005, the major achievements are:

• Setting of performance targets (see Table 1) for a set of critical indicators and quarterly monitoring against these indicators;
• Formulation of a health policy framework;
• Alignment of all donors in the sector around these targets and policies;
• Restoration of basic services first in collaboration with international NGOs followed by the gradual assumption of responsibility by Ministry of Health staff;
• Development of a district health planning process and quarterly monitoring of key indicators in the districts;
• Construction of health centers and refurbishment of others, building of the Central Medical Store and the establishment of a medical supply system;
• Development of a plan for hospitals, rehabilitation of hospitals, strengthening of referral systems through ambulance, and radio supply;
• Support for the completion of medical training, and training in priority areas.

Table 1: Progress on key indicators

                      Source: MOH quarterly monitoring data; population data updated to reflect census estimates

Key Sector Issues

Despite these improvements, many health problems persist (see Annex 1 for details):

• Infant and under-five mortality are 60 and 83 per 1,000 live births, respectively;
• Prevalence of malnutrition among children under five is the highest in the world;
• Prevalence of TB and malaria among adults is high;
• HIV/AIDS cases are on the rise with very few people aware of the risks;
• The total fertility rate (TFR) is the highest in the world at 7.8 births per woman and the median age at first birth is decreasing, unlike the rest of Asia.

Blessed with a rapidly growing budget, the Ministry needs to make strategic choices to improve outcomes by addressing the following challenges:

• Increasing the utilization of available services through health promotion, education measures, and improvements in quality.
• Improving human resource capacity. Doctors from Cuba have been recruited and students have been sent to Cuba for medical training. This creates opportunities for improving both access to and quality of health care but has implications on the type and costs of services that will be delivered at lower level facilities.
• Enhancing the management skills of hospital directors. Hospitals have transferred from contract management by NGOs to autonomous institutions. Hospitals face the challenge to keep expenditures under control at 40 percent of all public expenditures on health.
• Maintaining a coordinated approach to donor assistance. Donor assistance risks becoming more fragmented, putting strains on the Ministry’s capacity to manage external financing in the health sector.

World Bank Program

Two TFET-funded Health Sector Reconstruction and Development Projects (HSRDP) and two EC Trust Fund have been very successful in assisting the Ministry for restoring basic services and health systems, developing policy, building capacity and ensuring a sector wide approach. Overall, 28 new Community Health Centers and one Central Medical Store have been constructed, 36 health posts rehabilitated, and four hospitals are under construction or rehabilitation. In the policy area, the development of the health policy framework, hospital configuration plan, and district health plans have all been supported by HSRDP. 

The ongoing Health Sector Review focuses on how to improve health outcomes in the medium and long term, given that the Government has been effective in restoring basic services and setting up the needed systems.  The review will be providing input to the Ministry’s new strategic plan and medium term expenditure framework.

Morbidity among children under five years of age is high. While evidence from the recent Demographic and Health Survey (DHS) points to notable improvements in child health, it also shows persistent health and nutrition problems in some geographic areas and socioeconomic groups. The common causes of illness are malaria, acute respiratory infection (ARI) or diarrhea. According to the 2002 Multiple Indicator Cluster Survey, children aged 12-23 months, from rural areas and especially the central region, and/or from poorer households have the highest risk of getting ill (Table 2). 

Table 2: Morbidity among children under five by disease and socio-economic indicators

Source: UNICEF: Multiple Indicator Cluster Survey. 2002

Note: ¹ Illness  estimate refers to any self-reported illness in the last two weeks

Table 3: TB, Malaria and HIV/AIDs among adults and knowledge of HIV/AIDs

Source:  WHO 2005, Demographic and Health Survey 2003

Timor-Leste has the highest total fertility rate (TFR) in the world at 7.8 births per woman.   The median age at first birth is decreasing, as opposed to other countries in the region. Contrary to international experience, there is no significant difference in TFR across women’s education levels; socioeconomic status has only a slight influence as does urban residence (Figure 1).

The prevalence of malnutrition among children under five years is among the highest in the world.  The prevalence of both stunting and underweight are significantly higher among children from underprivileged households – those from rural areas, poorer households, and households where mothers have little or no education.