Rebuilding Timor-Leste's health system


More than 70 percent of Timor-Leste's health facilities were destroyed or badly damaged in the violence and conflict that followed the referendum on independence from Indonesia in 1999. Around 80 percent of the country's health managers left the country as did all but around 20 doctors.


In this context of devastation, the first health sector rehabilitation project aimed to build health institutions and develop a policy framework for a new health system, while providing basic health services. The basic service delivery system had two key features: to work with NGOs to deliver health services while the system was being built, and to start the process of district planning to build capacity and lay the foundations for inter-government relations and institutional linkages. The second project started a hospital restructuring program while continuing the activities begun under the first.


The coverage of basic health services within a two-hour traveling distance of settled populations increased from 75 percent to 86 percent.


- Use of the health system increased from an average one visit per year per person to at least 2.5 visits per year. In child and maternal health, immunization for the three-rounds of Diphtheria-Tetanus-Polio increased from 34 percent to 73 percent and for measles from 26 percent to 73 percent. Skilled attendance of births increased from 26 percent to 41 percent.

- Together the two projects helped establish a health policy framework, a legal framework for the health system, and a policy on private health provision.

- 28 new health centers were built, existing health centers and health posts were rehabilitated, and a new central medical supplies store and radio communication system linking all districts and hospitals were created.

- The projects resulted in a sector wide approach to assistance to the health sector being taken. This was very important in the early days of limited national capacity.

- The adoption of a Policy Framework for Health provided the basis for a dialogue among development partners on strategy and specific needs for support.

- The construction program, particularly the small works program, contributed to building business opportunities, capacity and local employment.

- A Demographic Health Survey helped develop the capacity of the new central office of statistics to undertake and manage national surveys. It also helped build a foundation for evidence-based policy development.

- A number of reviews, both internal and external, such as the ones done by the World Bank's Independent Evaluation Group or the European Commission rated the first Health Sector Rehabilitation and Development Project as Satisfactory, especially in policy development, long-term sustainability and management capacity building.

IDA Contribution

- The first project: US$12.7 million from the Trust Fund for East Timor (TFET), administered by IDA.

- The second project: US$12.6 million TFET and €16.5 million in additional funding in an IDA-administered trust fund financed by the EC - additional joint funding from the EC of €16.5 million.


In this post-conflict situation, donors turned to IDA to begin the longer-term development program. IDA was recognized for its capacity to manage a multi-donor trust fund and to bring multi-sector and multi-country experience to the task. As support was channeled through a Trust Fund, donors could provide funds through a single financing mechanism.

- In health, World Bank staff worked closely with major TFET donors interested in the sector to develop a sector-wide approach. Joint donor missions allowed the government to deal with one main interlocutor.

- This process encouraged government ownership of the program, created a forum for technical assistance from UN agencies (WHO, UNFPA, UNDP, UNICEF), brought NGOs into partnership with the emerging Ministry of Health, and leveraged additional funding from the European Commission's Humanitarian Office and from the EC itself.

Next Steps

Continued strengthening of basic services remains critical to sustained improvement of health, with particular needs in maternal health, nutrition and communicable diseases. The government is looking at "second generation" issues around health systems and personnel management, health financing and partnerships with the private sector. Continued support to the health program continues to be provided, post-TFET, by the EC and Australia.

Learn More

Health Sector Rehabilitation and Development Project (2000- 04) and Health Sector Rehabilitation (2001 - 07)
Project documents I
Project documents II

For more project information on this project, please visit:
http://web.worldbank.org/external/projects/main?Projectid=P070294, P072648&theSitePK=40941&pagePK=64283627&menuPK"8424&piPK=73230