Civic Engagement Is Creating A More Equitable Health System In Timor-Leste

CSO and community leaders in the municipality of Oecusse discuss the need for improved CSO engagement and advocacy at November 2021 workshop.

CSO and community leaders in the municipality of Oecusse discuss the need for improved CSO engagement and advocacy at November 2021 workshop.

Civil society was a key force behind Timor-Leste’s independence in 2002 from Portuguese colonization and Indonesian occupation and continues to play a crucial role in the country’s development. After independence, civil society organizations (CSOs) helped rebuild the country by providing humanitarian assistance and serving Timorese families. Today, they are helping revitalize Timor-Leste’s health system.

The country’s vibrant CSO landscape includes as many as 250 municipal and national non-governmental organizations (NGOs) belonging to the Forum of Nongovernmental Organizations of Timor-Leste (FONGTIL). Fifty-two of these are engaged in health-related activities, and 43 are actively working in the four priority health areas of water, sanitation, and hygiene; maternal and child health; nutrition; and TB prevention and care. With their deep understanding of and close ties to communities, these CSOs are well positioned to identify health system problems and solutions, contribute ideas to the Ministry of Health’s (MOH) annual action plan, and participate in monitoring that holds the government accountable.

These contributions are sorely needed. A political economy analysis conducted by the Abt-led USAID Local Health System Sustainability Project (LHSS) in 2022 revealed that despite attempted reforms, social accountability remained weak within Timor-Leste’s MOH. Citizens and communities were not active participants in health system governance, demand from the public for quality health care was tepid, and national health leaders had limited understanding of community health priorities. As a result, the health system’s failures have had an outsized effect on underserved and vulnerable populations, including people with disabilities, young women, and those living in distant, rural villages.

Launch of the Rede Ba Saúde Timor-Leste (REBAS-TL) health network

Launch of the Rede Ba Saúde Timor-Leste (REBAS-TL) health network

At the local level, Asosiasaun Feto ba Futuru, a REBAS-TL member, engaged with the municipal health director in Manatuto municipality to discuss malnutrition in the community and a lack of medical supplies at the health post – issues that health authorities are often unaware of. Similarly, Asosiasaun Rede Covalima engaged with the health director of Covalima municipality to raise awareness about malnutrition, infant mortality, and the absence of doctors at some of health posts. The organization will continue to monitor the actions that were agreed upon with the director. Elsewhere, two other CSOs in the REBAS-TL network advocated for inclusion in municipal health consultative meetings in accordance with the national partnership manual and now consistently receive invitations from health authorities to report on key health issues in the community and identify potential solutions.

In the coming year, LHSS will continue to support REBAS-TL in advocating for health policies and services that are evidence-based, patient-centered, and culturally appropriate. We will also facilitate engagement between the MOH and REBAS-TL to define mechanisms for the MOH to openly and regularly share health data with the CSOs.

By taking a whole-of society-approach and embracing health system complexity, LHSS identified a novel solution that brings CSOs together and uses their collective strength to help improve the health system. The REBAS-TL network represents an innovative and important step toward a locally led, accountable, transparent, and inclusive health system.