HAI recognizes 10 years of Timor-Leste independence
Aug 30, 2009
Dili, Timor-Leste – August 30, 2009 – Ten years ago, fires swept the city of Dili as the Indonesian military retaliated against the East Timorese vote for independence. Several nongovernmental organizations (NGOs), including U.S.-based Health Alliance International, were there to witness the destruction—and also the renewal. A decade later, Timor-Leste serves as a good example of how a post-conflict country can transition from relying on emergency health services to rebuilding a nationally managed health system that is reducing maternal deaths and improving infant survival.
As Timor-Leste celebrates the tenth anniversary of the referendum on independence, Health Alliance International (HAI) is also celebrating ten years of partnership and progress in improving the health of Timorese women and children.
“HAI is one of the health NGOs doing impressive and outstanding work in Timor-Leste,” says Dr. Rui Araujo, Timor-Leste’s first Minister of Health after independence. “From the beginning, HAI’s deep commitment to collaborative partnership in the development of the health sector in Timor-Leste has helped our country to recover and rebuild.”
On August 30, 1999, 98% of East Timor’s registered voters turned out for a referendum on whether to remain a province of Indonesia or become an independent nation. The Timorese people overwhelmingly voted for independence, sparking retribution from the Indonesian government and pro-Indonesia militias. For weeks after the vote, departing Indonesian military and allied militias destroyed infrastructure, killed innocent civilians and forced thousands more to evacuate to Indonesian territory in West Timor. United Nations troops stepped in to restore calm, finding a traumatized population and a decimated health system with most clinics and hospitals burned and few doctors or health managers left in the country.
NGOs stepped in to provide much-needed emergency health care services. One year later, 15 international NGOs, 6 national NGOs, 23 Catholic clinics and 4 peace-keeping contingents were still providing this care in a fragmented way, and at a cost that could not be sustained by the new nation. As East Timor moved toward official independence (anticipated for May 2002) and set up interim governance structures with the United Nations, Timorese leaders realized the need for a more coordinated and nationally managed health system.
East Timor’s Division of Health Services (which later became the Ministry of Health) organized a transition process for NGOs to phase out their health service delivery in all districts. One lead NGO per district ensured coordination of service delivery according to a district health plan, with the eventual hand-over to Timorese government District Management Teams by the end of 2001. The Ministry of Health also developed principles for NGOs that wanted to continue working in Timor-Leste, to ensure community involvement in health interventions and services, and a close relationship with the Ministry of Health that would allow tracking of NGO activities.
This new kind of partnership between NGOs and the Ministry of Health allowed the new government to chart the course for rebuilding the health system, while effectively using the coordinated support of NGOs. HAI was one of the first NGOs to enter into such an agreement with the Ministry of Health. Immediately following the referendum and ensuing violence, HAI supported the development of maternal care services at a clinic in Dili. After consulting with the Ministry of Health, HAI began work with a clinic run by Salesian sisters in Venilale to train and organize village health promoters. In 2004, thanks to a grant from USAID, HAI began a direct partnership with the Ministry of Health to improve maternal and newborn health by supporting improved care for women during and after pregnancy. That funding was later supplemented by a grant to promote child spacing.
The results of the Timorese government’s actions and NGO partnerships are encouraging. Today, 82% of Timorese woman in districts where HAI supports the Ministry of Health have at least one prenatal care visit, compared to 50% in 2003. The use of doctors or midwives for a delivery has more than doubled, going from 16% to 37% in HAI districts. Over two-thirds of women say they exclusively breastfeed their infants for the first five months, compared to less than one-third in 2003.
According to Mary Anne Mercer, HAI’s Director of Timor-Leste Operations, “These changes are a testament to the commitment of many health workers and the government of Timor-Leste to improve life for women and families. There is still a long way to go, but women and children are safer and healthier than they were ten years ago.”
Contact:
Mary Anne Mercer (Seattle),
mamercer@u.washington.edu, (206) 543-8382
Dominique Freire (Dili),
domfreire@gmail.com, mobile phone: +670 7250671