Publication: Health Service Delivery and Utilization in Timor-Leste : A Qualitative Study
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2005-05
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2005-05
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This report was written as part of a broader Health Sector Review in Timor-Leste currently being undertaken by the World Bank. Timor-Leste struggles with a burden of disease since independence. Poor health is related to environmental sanitation, poverty, food security, a shortage of doctors, and the difficulty of reaching some rural communities. Some problems are specific to Timor-Leste: violence during the Indonesian occupation, the destruction of the health care sector, and a situation of medical pluralism in which long-established practices of traditional healers co-exist with recent biomedical services. One obstacle the health sector faces is client low utilization of health services. The 2003 Demographic and Health Survey (DHS) reports that about a fifth of poor households have never used the health care facility closest to their house. While it is clear that many households are unwilling or unable to access health care, the reasons for these barriers are poorly understood. One aim of this report is to help fill this gap in knowledge by providing contextual information on health seeking behavior. A second aim is to shed light on human resource challenges in the health sector.
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“World Bank. 2005. Health Service Delivery and Utilization in Timor-Leste : A Qualitative Study. © World Bank. http://hdl.handle.net/10986/8257 License: CC BY 3.0 IGO.”
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Underutilization of services, and poor quality of services when available, are also reasons for the poor health quality indicators. Improving the quality or effectiveness of health services is difficult. However, now that most of the basic health care infrastructure is in place, the time is right for the Ministry of Health (MOH) to develop a system to monitor and upgrade the quality of health care services, starting with public sector services. One initiative put forth is health education delivered through various channels, which would make households better aware of the risks associated with certain health conditions or symptoms and the importance of using the available health services from government and NGO facilities. A second type of potential intervention is the introduction of conditional cash transfers, whereby the Government pays a subsidy to households in exchange for certain behaviors beneficial to society, such as having their children immunized. 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