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Health workforce assessment in East Timor

Trainee doctors visit the village of Camallelara to talk about sanitationr (Flickr - Dean Sewell, Wateraid, 2010)

We recently conducted an assessment of the health workforce situation in East Timor. This will contribute to the development of a new Health Workforce Plan in 2016. 

This was done in close collaboration with the Department of Administration, Ministry of Health (MoH) and the WHO Country Office.

The project included:

  • A review of relevant documentation, including strategies, policies and existing published analysis of the human resources for health in East Timor.
  • An assessment of the implementation of the existing Health Workforce Plan 2005-2015
  • An assessment of the experiences and lessons learnt from ongoing health workforce development initiatives.
  • Key informant interviews with the MoH, healthcare workers and stakeholders relevant for the development of human resources for health, such as the Ministry of Education, Ministry of Finance and other partner organisations involved in training programmes of healthcare workers such as the Cuban Medical Brigade and others.
  • Field visits to observe all levels of health services, including the private sector.
  • Preparing a report to consolidate all the information gathered that could be used as key reference documentation for the preparation of the new Health Workforce Plan in 2016.

Background

East Timor faced a health workforce crisis following the 1999 referendum and declaration of independence in 2002. The health workforce shrank from 3,540 to 1,500, with the withdrawal of Indonesian health workers. Only 20 of the 135 doctors remained.

The situation has substantially improved in recent years. The gap has been partially filled by hiring foreign medical personnel and sending nationals abroad for training. Since 1999, a total of 886 Timorese medical doctors have been trained and 256 students are pursuing training under an agreement of medical cooperation between the governments of Cuba and East Timor. Initially they were trained in Cuba and more recently in East Timor, under a program conducted by the Cuban Medical Brigade in cooperation with the National University of East Timor and the Ministry of Health (MoH).

Many professionals (doctors, nurses and midwives) trained overseas are now working at district level, to strengthen services in villages. Standard Operating Procedures have been developed for clinical care and public health, to improve the quality of health services. The National Institute for Health also participates in continuing training programmes for healthcare professionals.

Despite an increase in the human resources for health a shortage remains of nurses, midwives, radiologists, physiotherapists, pharmacists, laboratory technicians and managers. There are reports of inadequate distribution and mix of human resources (midwife/nurse to doctor ratios) in districts. There is a need to provide continuing capacity building and specialisation training opportunities to young doctors joining the health workforce.

The MoH developed a Health Workforce Plan 2005-2015, which intended to provide strategic direction for the management and training of health workers and to promote effective collaboration between the MoH and other agencies involved in training and the allocation of scholarships. More recently the MoH developed a comprehensive National Health Sector Strategic Plan (NHSSP) 2011-2030, which addresses the issue of health workforce aiming to ensure availability of human resources needed for the implementation of the Health Sector Plan providing specific expected outcomes and indicators to monitor the development of human resources for health.

Based on the above, the MoH requested WHO technical support for conducting an assessment of the current situation of the health workforce in East Timor, as a first step towards the development of a new Health Workforce Plan expected to be developed during the first part of 2016.