Ten years after the holocaust: The evolution of the NGO role in Timor-Leste

In 1999 after the referendum on independence, East Timor emerged from the ashes of 24 years of brutal occupation by Indonesia with 70% of health infrastructure destroyed. Health status among Timorese was extremely poor and the use of health services was low. Ten years later, the country has made great strides in improvement both in health status and coverage with health services. The role of NGOs in support of the development of the new Ministry of Health evolved substantially during those years. During the emergency period of approximately one year, international NGOs stepped in to fill the gap in health services provision under UN oversight. However, one year before formal restoration of independence, NGOs were requested to handover the service provision role to nationally established heath authorities in the Department of Health. That department was still under UN supervision, but was part of a process of 'Timorizing' health policy development, health management and health care provision in Timor-Leste. It became clear as formal independence approached that the NGOs' roles needed to evolve from service provision to support of the new national health authority. This transition proved difficult for some organizations and for overall coordination, but by May 2002 the Ministry of Health of the now independent Timor-Leste assumed full responsibility for health services provision. Since then several international NGOs have developed supportive relationships with the MOH, supporting further development of the health system. Key elements in MOH-NGO collaboration that contributed to strengthening the post-conflict health system in Timor-Leste are described.