The Democratic Republic of Timor-Leste has successfully launched its first national Health Financing Strategy (HFS) with the ongoing support of the World Health Organization (WHO), on 8 November 2019, reiterating its constitutional commitment in achieving Sustainable Development Goal 3.8 to provide Universal Health Coverage (UHC) that is free at the point of delivery for all. The series of activities that successfully led to the finalization of the national HFS were an integral part of WHO’s Biennial Plan 2018-2019, jointly agreed by the Ministry of Health (MoH) and the World Health Organization Country Office (WCO), Timor-Leste and supported through the UHC Partnership.

The launch of the first HFS is a remarkable achievement for Timor-Leste. Through strong country leadership and efforts to establish a sustainable economy, the Government has been working in close collaboration with WCO Timor-Leste to drive a major public health reform, despite the constraints faced over the last couple of years. The State budgets for 2018 and 2020 were not approved, which led to the introduction of duodecimal mechanisms where the system operates on monthly installments of one twelfth of the previous year’s budget. This system hampered the broader planning and capital investments.

In Timor-Leste, WHO has been technically supporting MoH in health finance related policy and analytics including institutional capacity building activities. WHO Regional Office for South East Asia commissioned technical expertise to provide strategic support to MoH in carrying out a Health Financing Diagnostic study in 2017 and a National Health Accounts review in 2013-2017. These exercises were followed by analytical work on options for the health financing policy which provided significant input to MoH in the development of the HFS.

In the context of Timor-Leste, the political and institutional environment holds the key to UHC policy, systems development and reform processes. The need to engage with sectors beyond the health sector was paramount to UHC efforts. Hence devising a robust multisectoral coordination mechanism was essential to ensure alignment and harmonization of efforts. Support from all three levels of WHO was coordinated in the provision of technical advice, field visits, analytics and policy dialogue.

Engaging multisectoral actors to forge strategic partnerships was imperative but challenging in moving forward with the HFS, therefore innovative approaches were devised. The HFS matured through a series of consultations with a heterogenous range of stakeholders comprising of health workers, development partners, several Ministries, parliamentarians, nongovernmental organizations, civil society and other stakeholders. The UHC partnership which is partly funded by the WHO, sustained the development of the HFS through financial assistance along with their extended support towards strengthening the health policy and systems in general in Timor-Leste.

WHO’s advocacy efforts and discussions were also underway with parliamentarians namely Commission F  the parliamentary Commission on Health and Social issues of the National Parliament, to champion for health and health financing issues. This initiative called for more informal engagement with relevant members of society including national influencers such as members of academia and religious institutions.

The Ministry of Finance’s (MoF) involvement and participation was fundamental to the development and finalization of the HFS. WHO facilitated the close collaboration and regular consultations between the Ministry of Health and the Ministry of Finance at all stages of the process.

This HFS will provide a strategic approach to sustainable health financing in Timor-Leste. It will not only help secure increased financial resources for health, but also strengthen mechanisms for revenue generation, pooling of resources and strategic purchasing in the health sector. It will enable transparent decision making in priority setting and resource allocation, and provide the strategic umbrella for the continuation of essential health services during the COVID-19 pandemic. This is in line with the priorities and vision identified within WHO’s Thirteenth General Programme of Work 2019- 2023 and Regional Flagship priorities, in achieving Universal Health Coverage. It will also support the institutionalization of health financing analytics and lays the foundation for several health financing initiatives such as pro-Health taxes and the development of an Essential Services Package for primary health care including regular publication of National Health Accounts.

The principle of UHC ‘to leave no one behind’, requires targeting resources to remove financial barriers for the most vulnerable when they need access to health services. Successful implementation of this first HFS will strengthen and facilitate this process.

Photo caption: A family being visited by health care providers during the second round of implementation of Saude na Familia – the flagship primary health care programme.

Photo Credit: WHO

Disclaimer: This image was taken during a time of no community transmission of COVID-19. Community transmission is defined as the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories). Preventative measures such as mask wearing and physical distancing should be used to prevent the spread of COVID-19.