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"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. ... [East Timorese] 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." Forum Nacional ONG Timor Lorosa'e / The East Timor National NGO Forum

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


BD: East Timor National NGO Forum / Forum Nacional ONG Timor Lorosa'e - A collection of recent media releases, position-statements, speeches, petitions, reports, and news


BACK DOOR Newsletter on East Timor      home June news
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