Forum
Nacional ONG Timor Lorosa'e
The
East Timor National NGO Forum
Kaikoli Street, Dili-East Timor telephone 322772/ etngocentre@hotmail.com
HEALTH
BRIEFING PAPER TO DONORS
MEETING
CANBERRA June 2001
NGOs have played a critical role in the
health sector in East Timor, in the pre ballot period, then as an immediate
response to the crisis and currently supporting the new East Timorese government
and communities in the transitional period. NGOs are committed to a sustainable
and integrated health system in East Timor. This is demonstrated through
a commitment to capacity building and collaboration with the Division of
Health Services (DHS) in the design and implementation of integrated district
based health systems. NGOs work in all 13 districts in East Timor. NGOs
have lent their expertise for the development of health policy at a national
level.
POLITICAL TRANSITION
As detailed above NGOs share the goal for a sustainable East Timorese health system for East Timor, however believe that critical factors need to be taken into account in order to achieve this goal. The dramatic upheaval in the health sector as a result of the post ballot violence has resulted in an almost total destruction of infrastructure, severely reduced human resource capacity particularly at management level and there is the continuation of poor health status . The pace of transition and the resources required for an effective transition from the post conflict situation to the development of a sustainable health system needs to realistic. NGOs are concerned that if pace is too rapid the process of strengthening of institutional and human resource capacity may be impeded and jeopardise what valuable mentoring and skills transfer has already taken place.
NGOs recommend that donors ensure that
the funding focus is to ensure implementation of a realistic and effective
transitional strategy from a post conflict to a viable health system.
ADMINISTRATIVE TRANSITION
The need for a comprehensive strategy for human resource development in East Timor is recognised by all as a priority. As detailed above, NGOs fear the time period allocated to develop a sufficient level of expertise in the health professionals in East Timor is unrealistic. The national recruitment process is expected to be ongoing for several more months. There is a risk that the handover of the management of the district health systems to the newly recruited staff could to be premature, thus undoing much of the benefits from the mentoring and training activities carried out to date.
NGOs have a focus on strengthening the capacity of East Timorese involved in the health sector – this includes both the national staff of the DHS but also other East Timorese involved in the health sector through civil society organisations. NGOs recognise that sufficient time is needed to consolidate and ensure the transfer of both management and technical skills to East Timorese both within the DHS employed staff and other civil society organisations.
NGOs recommend that human resource development
within a realistic time frame must a primary goal. Clear performance indicators
must be established to measure that both technical and management skills
are indeed being transferred.
FINANCIAL SUSTAINABILITY
The NGOs appreciate the need for a sector
wide approach to health services and the importance of all stakeholders
implementing activities within the one integrated strategy. However NGOs
are concern that the proposed model of single funding source may prove
to be problematic in the following ways:
- As funding moves from the emergency
(such as ECHO) to TFET (development) procedures had not been put in place
in time to enable key NGOs that are service providers to access funds in
a timely manner. This has already been an issue and could have led to a
gap in health care provision if the NGOs involved had not been in a position
to use their own resources. This has applied to both service providers
and NGOs involved in health promotion work.
- East Timor continues to have an uncertain
operating environment. The guidelines to access the trust funds do not
have the flexibility to cover costs that are required to meet unforeseen
events.
- Implementation of key activities for
the health sector such as the building of referral health facilities, have
been directly tendered out under the TFET guidelines. There have been significant
delays in this area which have had a negative impact in the provision of
health throughout East Timor. It is critical that not only can the Trust
Funds be accessed and disbursed on a timely basis, but that there is accountability
that commitments are carried out on a timely basis.
- The Trustees of TFET produce a monthly
report which provides an overview of the activities of the Trust Funds.
However in addition to this general information, NGOs are calling for a
closer dialogue and consultation between the trust fund managers and all
stakeholders involved in the health sector. In any health system there
are the different levels of information and perspectives regarding key
health priorities and information regarding implementation of projects.
The recent Joint Donor Health Assessment mission to East Timor briefed
NGOs on their objectives at the beginning of the visit and presented the
aide memoire at the completion of their visit, however did not organise
time to consult with NGOs either individually or as a group during the
mission.
- There is a risk that funding decisions
may be taken on the basis of a “blueprint” for a financially sustainable
health system without taking into account the reality of the situation
in East Timor. As detailed above, NGOs share the goal for a sustainable
health system. Critical issues such as the high rates of TBC, high rates
of maternal mortality and the need to establish a sustainable community
based health promotion system must be addressed in the short term.
To ensure a financially sustainable health system there needs to be considered
not only the short to medium term budgetary implications but a long term
strategy. This strategy must address not only financial sustainability,
but also provide for an integrated health system with the objective of
improving the health levels of the East Timorese people. This may require
increased resources in the short to medium term for longer term sustainability.
In addition it may require a move from traditional “blueprint” health systems,
with an innovative look at strategies to deal with all the challenges faced.
- NGOs have invested a significant amount
of their own resources into health activities in East Timor particularly
to ensure that district based health systems continue to operate when donor
resources have not been available, ensuring ongoing capacity building and
also health promotion projects at community level. NGOs strongly believe
that the East Timorese health professionals in conjunction with the East
Timorese people need to be actively participating in strategies for an
integrated health system in East Timor. Many of those health professionals
are currently working closely and in partnership with NGOs. However NGOs
themselves have had little input into developing the strategy of HSRDP
II, this is an unusual approach given that NGOs are currently a major stakeholder
in the sector.
- There is high degree of commitment by
NGOs working in the health sector, however in the current uncertain funding
environment it is not certain as to the role that NGOs will play in the
future and who will take responsibility for the activities that NGOs are
currently implementing. At the past two Donor Conferences, NGOs have expressed
concern at the uncertain funding environment. The result is a very uncertain
environment in which NGOs can adopt a strategic approach to improving the
health of East Timorese people.
NGOs recommend:
- that East Timorese health professionals and community representatives are actively involved in developing a strategic plan for a health system in East Timor. Key stakeholders in the health system including UN agencies, NGOs, and DHS international staff, can provide technical support to East Timorese working groups to develop an integrated strategy based on the realities facing East Timor. Budgetary constraints are recognised as a reality, however innovative strategies are needed to effective address the critical health issues while maintaining the goal of a financially sustainable health system. The result may require additional funding in the shorter period to ensure a longer term financial sustainability.
- although the TFET provides the main funding
source, alternative funding sources are required to ensure flexibility
to respond to health care needs in East Timor.
SOCIAL AND ECONOMIC ISSUES
It is agreed by all stakeholders that there needs to be a sector wide approach to health, with a strategy to develop an integrated health system in East Timor. Given the realistic constraints of the East Timorese budget, resources are limited across all sectors. The result for the health sector has been reduced health care facilities and reduced staff. As a result, resources have been focused on curative health systems with reduced resources for health promotion activities . This is of great concern where major illnesses in East Timor are avoidable with improved health practices . It is recognised that if the DHS is unable to be resourced in to implement health promotion activities that other resources may need to be provided in the short term to civil society organisations to facilitate community based health promotion projects. The DHS would be responsible for co-ordination and policy issues relating to all aspects of health promotion. Although this may involve extra funding in the short term, it is envisaged that the improvement in health status of the East Timorese population would result in significantly reduced costs of health care in the future .
NGOs recommend that donors provide resources for cost effective and community managed health promotion projects over a wide area: reproductive health, communicable disease control and environmental health, IMCI and EPI.
See also:
Tetum:
Boletim La’o Hamutuk: [Tetum
PDF format]
Vol. 1, No. 3. 17 Novembro
2000 Hari Sistema Saude Nasional iha Timor Lorosa’e: http://www.etan.org/lh/PDFs/LHbul3tm.pdf
Nov
17 2000 BLH: Saude, Oekusi, Deskulpas, no Mina: Koneksaun Timor Lorosa’e
ho Australia Editorial added Jan 23
"Tanba ne’e
maka Lao Hamutuk husu ba Governu
Australianu atu halo kotu sira nia tuntutan ba direitu ruma kona ba mina
no gas natural iha Timor Gap. La haré ba meritus legais nebe Timor
Lorosa’e iha (ne’e be makas tebes), justisa basika haruka atu Canberra
rekonhece no husu deskulpa tan sira nia passadu nebe halo moe tebes. Manifestasaun
konkretu kona ba akto ida ne’e sei fo fatin ba Timor Lorosa’e atu menikmati,
tanpa sanksi, beneficius hotu nebe sei hetan husi depositu mina no gas
natural iha Timor Gap." BLH
Portuguese:
Mar
12 OTL: Sistema de saúde: sustentável no futuro?
Report added Apr 14
"O sistema de saúde actual corre
o risco de ser pautado por metodologias e equipamentos inadequados à
realidade timorense, sobretudo após a retirada dos técnicos
e organismos estrangeiros. O desenvolvimento não tem de passar obrigatoriamente
pela implementação de sistemas sofisticados de topo de gama.
A preocupação deverá ir antes de encontro às
reais necessidades e capacidades da população, de forma a
poderem ser os timorenses a criarem as suas própria instituições
e a definirem as suas prioridades. Provavelmente, os resultados seriam
mais lentos e menos brilhantes a curto-prazo, mas com certeza mais sólidos
e duradouros." Observatório Timor
Leste
English:
Mar
13 ETO: The health service: sustainable in the future?
Report added Apr 13
"The present health system is in danger
of being hindered by methodologies and equipment that are quite unsuited
to the Timorese context, particularly after the foreign technicians and
agencies leave. Development does not necessarily have to involve implementing
sophisticated state of the art systems. The focus should be on addressing
the population’s real needs and building its capacity, so that the Timorese
themselves are able to create their institutions and set their own priorities.
This may mean that it takes longer to achieve results, and these might
be less spectacular in the short-term, but they would certainly be more
solid and long lasting." East Timor Observatory
Nov
30 2000 TimAid: Health and Nutrition in Coleate Leotelo
Added Dec 17
"This report shows that the people of
Coleate Leotelo are not only vulnerable, but already suffering from widespread
illness, weakness, and lack of nutrition ... Organisations responsible
for health and nutrition (such as WHO, WFP and INGOs) should take seriously
their responsibility to publish in their monthly reports not only their
activities (mobile clinics, data collected, the rebuilding of clinics,
etc.) but also those health problems in their districts which they have
not yet addressed, or which they doubt they will be able to improve." Mr.
Borges, Mrs. Fernandes, Mrs. Santos, and the people of Coleate Leotelo
Nov
17 2000 LHB: Building a National Health System for East Timor
Feature article added Jan 27
"the lack of significant
inclusion of local businesses and organizations in the construction of
health centers is a manifestation of a larger problem: the marginalization
of local interests in the development of the national health sector." LHB
Nov
17 2000 LHB: Health, Wealth, Apologies and Oil: The East Timor-Australia
Connection Editorial added Jan 20
"La’o
Hamutuk calls upon the Australian government to cease its demand
for any rights to the oil and natural gas in the Timor Gap. ... basic justice
requires that Canberra recognize and apologize for its shameful past. A
concrete manifestation of such an act would be to allow East Timor to enjoy
without sanction the full benefits of the oil and natural gas deposits
in the Timor Sea. Such a gesture would be good for Australia’s political
health." LHB
Nov
17 2000 LHB: Lessons from Indonesia’s Health System Added
Dec 26
"When the transitional period
is through, the people should be able to stand on their own two feet and
should not be dependent on other countries. For this reason, there must
be more comprehensive training for indigenous health practitioners. We
need the help of the internationals for this. We are very grateful for
the INGOs coming to help us, but we must have the opportunity to improve
our skills so that we are not constantly dependent on the international
community." Maria Dias, Director of Pronto
Atu Servir (PAS - Ready to Serve)
Nov
17 2000 LHB: Vision for a People-Centered Health System in East Timor
"Preventative [health], rather than curative,
strategies are at the center. Local involvement and empowerment is the
key. Village women are the number one health resource of East Timor. They,
more than anyone, exhibit concern for health in the community."
Dan Murphy, Bairo Pite Clinic, Dili
Nov
17 2000 LHB: Health Care and Privatization: Lessons from Mozambique
"It is unlikely that East Timor will be
able to sustain any of its social programs on its own for many years to
come, and will have to rely on foreign aid. The major question is whether
that aid will be used to eliminate resource constraints in order to build
a free, strong, universal health care system, or will it be diverted to
a plethora of foreign agencies and privatization schemes?" James Pfeiffer,
Case Western Reserve University in Cleveland, USA
East
Timor National NGO Forum / Forum Nacional ONG Timor Lorosa'e
Updated June 14
Umbrella agency for East Timorese Non-Government
Organisations (NGOs)
VISION: To contribute to the building
of a pluralist, democratic, just and sustainable East Timor through the
development of a strong, independent and responsible civil society committed
to upholding and making real in the daily life of the community, both village
and urban, the full range of human rights so that all East Timorese, particularly
the poor and disadvantaged, can enjoy the fruits of liberation and development
in an East Timor forever free.
MISSION: To realise its vision
by promoting a culture of learning, cooperation, partnership with the community
and respect for human rights and good practice amongst East Timorese NGOs
and between them and other development actors, both domestic and international,
and by serving as a collective, independent voice for the rights and needs
of the community.
VALUES AND PRINCIPLES: a rights
approach to development; inclusiveness, participation; accountability;
gender balance; respect for the environment; non-party political; non-sectarian;
good governance; volunteerism.
Kaikoli Street, Dili-East Timor
Telephone +670(390)322772
E-mail: etngocentre@hotmail.com
Homepage: http://www.geocities.com/etngoforum/index.html
Jun 7 ETNGO Forum: Donors Meeting must
be for Rural People: http://www.pcug.org.au/~wildwood/01junrural.htm
Jun 13 ETNGO Forum: The voice of Civil
Society calls the Donors: http://www.pcug.org.au/~wildwood/01jundonors.htm