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

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IDP camp at SAMES, February 2007 Photo: Tinuko’o J. VasCommunity members in some IDP camps had enhanced access through mobile services and in-camp clinics, aswell as being able to use non-government clinics such as Bairo Pite, private clinics and pharmacies when thesecurity situation allowed. High levels of utilisation were observed in these services at early stages of the emergency.The graph below indicates diagnoses for three common conditions: malaria and diarrhea (graphed together) andupper respiratory tract infections. No major outbreaks of communicable diseases were identified, although a numberof possible outbreaks were identified and investigated. As described later there was some confusion regardingsurveillance data. Where cases of diarrhoea and poor water supplies were identified this was corrected by chlorination.Cases detected450040003500300025002000150010005000URTI Disease Trend 29 May to 24 Dec 200622 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52Reporting weekFigure 9: URTI Disease Trend 29 May - 24 December 2006.Source Timor-Leste Ministry of HealthCases reported500450400350300250200150100500Disease trends 29 May to 24 Dec 06DiarrhoeaMalaria22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51Reporting weekFigure 10: Disease Trends 29 May - 24 December 2006.Source Timor-Leste Ministry of HealthHowever, the effort that went into providing IDPs and the general community in Dili with access to services was notreplicated in the Districts where services were placed under considerable additional strain as they sought to copewith larger numbers of population fleeing from Dili in search of safety and family support.Until now, we never get money or ‘rent’ for this… to solve some problems … you know the IDPs come hereand maybe something happens and we can’t help… we don’t have the money for that – District Administrator22 TIMOR-LESTE HEALTH SECTOR RESILIENCE AND PERFORMANCE IN A TIME OF INSTABILITY
Some districts, such as Lautem, went to the trouble of arranging for the District Administrator and others to visit theIDP camps in Dili and inviting people with family ties in the district to come home. Transport and support wereprovided. The District established two “Commissions” to provide emergency support, to coordinate all the availablecommunity resources, and to reassure people of their commitment to impartiality and non-discrimination.Most district services coped with the additional load, at times using innovative strategies to keep services functioning,such as sharing drugs between clinics. There were strains, however, often relating to lack of fuel supplies forcommunity-based activities:During the crisis our health services ran as normal, we gave treatment as usual to inpatient and outpatientservices; everyday we still attended the patients. The drugs was still sufficient, … Also we maintained ourimmunization program for several sucos but some sucos we didn’t do because the situation did not allow. Butthe services at Health Posts and Health centers still functioned as in normal time.- Senior health manager, Ermera districtPregnant women were identified as a group requiring particular attention. UN agencies, working with governmentand NGOs promoted the establishment of a Maternity Waiting Camp (MWC) within the national hospital. Althoughthis was an innovative idea, seeking to improve access and safety, it also had some unanticipated negative effects(Box 3).Although routine services continued to be provided, immunisation activity through the Dili district CHCs declineddramatically in May and for the rest of the year, in respect of DPT-3 immunisation (Figure 11). For measles, activityincreased in the third quarter and then spiked, reflecting major measles immunisation campaign activities in November(Figure 12).Figure 11: DPT-3 immunisation in Dili CHCs Centro, Becora andComoro. Source Timor-Leste Ministry of HealthFigure 12: Measels immunisation in Dili CHCs Centro, Becora andComoro. Source Timor-Leste Ministry of HealthDemonstrating that the government is in charge: leadership, coordination andflexibilityIn times of crisis, effective government leadership can help ensure that emergency and humanitarian issues areaddressed within the context of existing policies and strategies. It may also help ensure that national capacity isdeveloped during the emergency and that lessons can be learned and fed back into the system. Failure to demonstrateleadership may result in the international community (United Nations and international NGOs and others) assumingresponsibility for addressing basic needs and providing services. The Government and public sector may be sidelinedand unable to control how the international community engages locally. One effect of this may be that additionalresources bypass and even undermine national and local systems. Where fragile and weak states lack the resourcesand the capacity to respond to essential needs, the intervention of the international community is justifiable. Butwhere national government is able to demonstrate its sovereignty and ability to respond, the international communityTIMOR-LESTE HEALTH SECTOR RESILIENCE AND PERFORMANCE IN A TIME OF INSTABILITY 23
Page 4: “a process of reflection, is need
Page 10 and 11: The key challenge for the Ministry
Page 12 and 13: IntroductionEstimates suggest that
Page 14 and 15: Box 1: Chronology of the current cr
Page 16 and 17: MethodsThe study employed both qual
Page 18 and 19: second half of the year attendancel
Page 20 and 21: However, it is apparent that there
Page 22 and 23: Fuel was not able to be procured du
Page 26 and 27: Box 3: Maternity Waiting Camp - Som
Page 28 and 29: maintain our work. The Health Minis
Page 30 and 31: Senior MoH staff identified the ser
Page 32 and 33: The Minister implored staff to reta
Page 34 and 35: I don’t think there is a problem
Page 36 and 37: Box 4: Malaria: impact, response an
Page 38 and 39: ecause we understood the implicatio
Page 40 and 41: doctors are not able to diagnose di
Page 42 and 43: Although not thoroughly explored, s
Page 44 and 45: has been one of these planning exer
Page 46 and 47: At least there should be some coord
Page 48 and 49: a weakness exacerbated by poor comm
Page 50 and 51: tabulated and reported prior to car
Page 52 and 53: Observations and RecommendationsThe
Page 54 and 55: It is important to ensure that addi
Page 56 and 57: Donors:11. a. Ensure that funding p
Page 58 and 59: Appendix 1: Health SystemThe Timor-
Page 60: Team ProfileProfessor Anthony Zwia.

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