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Scaling-up the medical workforce in Timor-Leste: Challenges of a great leap forward

Author

Listed:
  • Cabral, Jorge
  • Dussault, Gilles
  • Buchan, James
  • Ferrinho, Paulo

Abstract

The health services system of Timor-Leste (T-L) will, by 2015, add 800 physicians, most of them trained in Cuba, to the 233 employed by the national health system in 2010–2011. The need for more physicians is not in discussion: poor health indicators, low coverage and utilization of services, and poor quality of services are well documented in T-L. However, the choice of this scaling-up, with a relatively narrow focus on the medical workforce, needs to be assessed for its relevance to the health profile of the country, for its comprehensiveness in terms of other complementary measures needed to make it effective. This article discusses the potential effects of the rapid scaling-up of the medical workforce, and the organizational capacity needed to monitor the process and eventually mitigate any deleterious consequences. The analysis is based on a review of documentation collected on site (T-L) and on interviews with key-informants conducted in 2011. We stress that any workforce scaling-up is not simply a matter of increasing numbers of professionals, but should combine improved training, distribution, working conditions, management and motivation, as a means towards better performing health services' systems. This is a major challenge in a context of limited organizational and managerial capacity, underdeveloped information systems, limited training and research capacity, and dependency on foreign aid and technical assistance. Potential risks are associated with funding the additional costs of recruiting more personnel, associated expenditures on infrastructure, equipment and consumables, the impact on current staff mix, and the expected increased demand for services. We conclude that failing to manage effectively the forthcoming “great leap forward” will have long term effects: formal policies and plans for the balanced development of the health workforce, as well as strengthened institutions are urgently needed.

Suggested Citation

  • Cabral, Jorge & Dussault, Gilles & Buchan, James & Ferrinho, Paulo, 2013. "Scaling-up the medical workforce in Timor-Leste: Challenges of a great leap forward," Social Science & Medicine, Elsevier, vol. 96(C), pages 285-289.
  • Handle: RePEc:eee:socmed:v:96:y:2013:i:c:p:285-289
    DOI: 10.1016/j.socscimed.2013.07.008
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    References listed on IDEAS

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    1. Mullan, F. & Epstein, L., 2002. "Community-oriented primary care: New relevance in a changing world," American Journal of Public Health, American Public Health Association, vol. 92(11), pages 1748-1755.
    2. World Bank, 2010. "Timor-Leste," World Bank Publications - Reports 27847, The World Bank Group.
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    Cited by:

    1. World Bank & Oxford Policy Management, 2015. "Health Worker Survey in Timor-Leste," World Bank Publications - Reports 23879, The World Bank Group.
    2. Marc-Francois Smitz & Sophie Witter & Christophe Lemiere & Patrick Hoang-Vu Eozenou & Tomas Lievens & Rashid U Zaman & Kay Engelhardt & Xiaohui Hou, 2016. "Understanding Health Workers’ Job Preferences to Improve Rural Retention in Timor-Leste: Findings from a Discrete Choice Experiment," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-14, November.

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