Photo: East Timor Human Rights Centre - PowerPoint PPT Presentation

From emergency to development

Initial steps in the rebuilding

of the health system in East Timor

Global HealthCouncil

29th Annual Conference

May 2002

Photo: East Timor Human Rights Centre

• 35% of health facilities totally destroyed
• Only 23% without major damage
• Virtually all equipment/supplies looted or destroyed
• Most doctors/dentists/senior management staff gone
• No central administration infrastructure

• International NGOs providing emergency services
• Some UNOCHA coordination
• ET Health Professionals WG, Joint Health WG
• Essentially no “government” role

• International NGOs providing emergency services
• Some UNOCHA coordination
• ET Health Professionals WG, Joint Health WG
• Essentially no “government” role
• February 2000: Interim Health Authority formed: 29 East Timorese and 6 UN staff (one borrowed vehicle, a few tables and chairs)

• Good sector-wide approach/collaboration
• Fully East Timorese MoH in place
• 800+ staff recruited with delays but no major unrest
• All health centres and most posts open
• Most essential drugs provided from approved list by MoH
• Development of Autonomous Medical Supply System contracted out
• Central medical warehouse almost constructed

• Health infrastructure surveyed and 22 new health centres under construction
• 4 and 2-wheel vehicle fleet mostly in place
• Radio network installation contracted
• Medical equipment needs assessed, major procurement underway
• Policy/regulation development started on pharmaceuticals and medical practice
• Activities initiated on TB, HIV/AIDS prevention, IMCI, reproductive, mental and dental health

• No effective policy dialogue/consultation
• No human resource development plan
• No definitive hospital development plan
• Delayed civil works program
• Inadequate support to National Centre for Health Education and Training

• Strengths
• Legitimacy
• Multinational nature
• Constraints
• Multinational nature
• The mission ‘vs’ the Mission
• Peace-keeping ‘vs’ development
• Centralization/control
• High turnover/short-term staff Lack of accountability
• Grossly deficient procurement

• Consistent and informed support to the Interim Health Authority
• Mostly helpful, expert technical assistance
• Strong Sector-wide Approach advocates as trustees of pooled funding
• Defined (if complex) procedures
• Task and country team committed to results

“Procurement rules”

Procurement rules - Obsession with avoiding misprocurement

Procurement procedures - Not adapted to the post-conflict situation

“Procurement games” - To satisfy the procedures

Procurement capacity - Insufficient for the broad range of goods and services

• Strengths
• Rapid response/self-sufficiency
• Commitment/willingness to work in remote areas and tough conditions
• Ultimately good cooperation with government
• Constraints
• Lack of staff experienced in development
• High staff turnover
• Overstatement of capacity
• Expensive “needs”

• No compromise on:
• Sector-wide approach
• National control
• Focus on sustainability
• Compromise on:
• Procedures (adapt to context)
• Speed
• Control (within the un system)
• Immediate improvements in quality

• Ensure national control
• Assess and control the infrastructure early – make a crude/conservative coverage plan and use it
• Develop a temporary (transition) policy addressing conflicting demands - explain choices
• Accept all competent partners but coordinate actively (use time-limited MoU)

• Secure key government functions with (uni-national?) expert teams (legal, civil service recruitment, procurement)
• Recruit senior national staff early in all sectors
• Better cross-sectoral collaboration
• Decentralize decision making and some spending control
• Dedicated problem-solving/lessons team

• Free up procedures – agree on acceptable adaptations. Or accept greater bilateral role
• Provide more implementation support
• Ensure adequate procurement capacity, especially early, especially for civil works - as much as is needed.
• Transparent and frequent explanation of where the money is going
• Less focus on disbursement

• Re-examine emergency funding policies – remember transition takes time
• Honest, self-critical evaluation of funded activities
• Respect a sector-wide approach
• Consider “banking” of funds until absorptive capacity expands

• Bring expertise and identify funding before coming - or reconsider
• Brief staff on need for transition from emergency to sustainable development
• Recognize challenges and constraints of transition government – seek to help
• After the emergency, use longer term staff

• Focus on (transition to) development
• Early and sustained support for: human resource management, health system assessment and planning, supply and logistics systems, EPI, IMCI, EOC, HIV/AIDS
• Reassess priority of communicable disease reporting

• Know, understand and accept the different roles, strengths and weaknesses of different institutions
• From that base collaborate to solve problems