Timor-Leste: Health Sector Strategic Plan Support Project

Overview

Currently scheduled to finish in June 2013, the Health Sector Strategic Plan Support Project in Timor-Leste is working to improve the quality and coverage of health services, particularly for women and children, in order to accelerate progress toward the health Millennium Development Goals (MDGs). Additionally, this project is also contributing to the improvement of health facilities, access to medicines, as well as increasing essential training for health personnel.

Challenge

Following independence, Timor-Leste faced a number of challenges in delivering healthcare to its people. Eighty percent of health centers had been badly damaged during the independence struggle, and health services suffered. The health sector subsequently made steady and significant progress in re-establishing much essential infrastructure, and rebuilding a system for delivering services—resulting in real improvements in coverage and people’s overall health. However, difficulties remain in ensuring access to and demand for health services across the districts. People living in rural areas often have to walk great distances to access critical health care. Mothers in some areas have to walk for hours carrying their babies to the nearest health post. Medicine is sometimes limited. Progress towards meeting the health-related Millennium Development Goals varies between rural and urban areas, and by wealth and other social factors. The Health Sector Strategic Plan Support Project (HSSP-SP) is working to address these issues.

Approach

The HSSP-SP is working to improve accessibility, demand and quality of Timor-Leste’s health services, particularly for women and children; strengthening support systems including human resource management; and improving planning and monitoring. In order to increase the quality of health service delivery, health facilities were rehabilitated; training was provided for various clinical and non-clinical health workers; and systems for effective drug management were developed to help ensure people can access medicines when needed. In an effort to ensure that people across the country have better access to health care, an innovative outreach program of integrated health services in the suco (village) level known as SISCa (Integrated Community Health Services, Sistema Integradu Saude Communitaria) was initiated by the government. This program has been supported by nongovernmental organizations (NGOs), volunteers and community leaders and receives financial support from the International Development Association (IDA)-supported project.

Results

• Direct delivery of health services to communities across Timor-Leste has increased.  Approximately 450 outreach visits are being provided every month through SISCa, partly supported by the project.
• Support for the Government of Timor-Leste to improve health infrastructure, including major work to three health posts; expansion of the national warehouse for medical equipment and supplies, and support for maintenance and repairs.
• Various short- and long-term training and professional development opportunities have been provided to health personnel for areas such as, midwifery, nursing, public health, health promotion, nutrition, and hospital management. In addition, funding has supported the reintegration of over 500 returning medical students from Cuba and other international institutions.
• Five NGOs have been contracted by the Ministry of Health to provide specific activities for service delivery and health promotion, supporting wider coverage of health services in Timor-Leste.

Bank Contribution

The HSSP-SP is being financed through an IDA grant of US$1 million, and a US$20 million equivalent contribution from the Australian Agency for International Development (AusAID) (Australian Dollar AUD23 million), managed by IDA through a multi-donor trust fund. Following decisions to restructure the project, there will likely be an estimated US$25.5 million additional funding from the European Union (EU) and AusAID for the continued, but more focused support from July 2012 to December 2015.

Partners

The Ministry of Health is responsible for overall implementation, including procurement, disbursement, and financial management. AusAID is a major partner in the HSSP-SP. To date, five NGOs—ChildFund International, CARE, Médicos Del Mundo, HealthNet International, and Oxfam International—and the European Union have had responsibility for supporting the government to implement SISCa activities under the project until it is restructured.

Toward the Future

The government has launched its new National Health Sector Strategic Plan (NHSSP) 2011-2030. The plan is proposes that the HSSP-SP is restructured as the NHSSP Support Project (NHSSP-SP) to best align with the government’s new plan. The restructured project will aim to help the Government of Timor-Leste to ensure that resources reach the districts and sub-districts where the majority of the population lives, where the poorest people live and where access to services is more limited. The restructured project will focus on three areas: continuing to improve public financial management and flows of funds for service delivery; strengthening pharmaceuticals and medical supplies management; and improving the use of evidence to inform decision making and health sector coordination.