Timor-Leste. Health Sector Resilience and Performance in a Time of ...

Fuel was not able to be procured due to bureaucratic impediments: district health services had vouchers to obtainfuel from one particular company, Belak, which had closed down because of the crisis. Districts had no cash withwhich to approach other providers, and the vouchers they had were not transferable.Outreach and mobile services were affected not only by a lack of fuel, but in Aileu and Ermera, also as a result of fearof armed groups operating in the area. Although health facilities or personnel were never specifically attacked,health workers were anxious about traveling to peripheral areas, and fears for the safety of female health workers,given the armed groups operating in the area, were reportedly present.Instability in Dili affected training across the country. Health workers from peripheral districts were scared to travelto Dili and supervisors unable to go to the districts.Training activities were not able to be implemented or had to be postponed … those activities like trainingswhere we have to go down [to districts] or those activities that required assistance from national level… Wecould not go down because of this crisis, people from East could not go to West and people from West couldnot go to East, these were the things that did not happen. - Senior MoH policy-maker and directorCommunication limitations added to the difficulties of getting things done. During the height of the unrest mobilephones were not functioning and MoH staff were advised to use radio contact. This form of communication waslimited as only a fraction of staff had access to radios, and even those senior staff who had access found relaying amessage difficult and time consuming.At that time the mobile was not functioning at all. The Minister advised us to use radio contact, ah our radiocontact was limited as well, but lucky for us we could find our logistician. [It was] even difficult just to send themessage, it took about a half an hour or even one hour to deliver messages. And our logistician was tryinghard for each of us to get one contact radio each. So at that time our communication went through the Contactradio, SAMES, Ministry, Ambulance and the National Hospital - Senior Health Manager, MoH.Key challenges facing the health sector and the responseThe health sector faced, and continues to face, numerous challenges as a result of the Crisis. These related largelyto maintaining health service delivery and reassuring the community that health care would be available and accessible;demonstrating that the government was in charge and able to lead and coordinate; promoting health sector neutralityand professionalism despite a divided community; maximizing the use of the resources available; and balancingemergency needs with longer term development and system improvements. We describe each of these challengesbelow and then turn to how the health sector responded. The perspectives of the wider community towards theseresponses will then be highlighted and discussed.Maintaining service delivery and reassuring the community that health serviceswould be available and accessiblePeriods of instability and violence pose heightened risks to health as a result of population displacement, disruptedshelter, lack of adequate water, sanitation and food, and increased exposure to infectious diseases, injuries anddistress. Not only is risk increased, but the ability to respond is often undermined. Public services are typicallydisrupted, resources such as people, money, and supplies, may be unavailable, logistical support for training andtransport compromised, and the morale and capacity of service providers undermined. In Timor-Leste there weresubstantial fears and risks of epidemic disease given the number of people displaced and housed in camps, theongoing fear and insecurity, and disruptions to service provision.20 TIMOR-LESTE HEALTH SECTOR RESILIENCE AND PERFORMANCE IN A TIME OF INSTABILITY