2006年-世界发展银行全球_Timor-Leste_Health_Sector_Review___Meeting_Challenges_and_Improving_Health_Outcomes_133页_1mb

Summary of Timor-Leste Health Sector Review

Core Content

This report provides a comprehensive analysis of the health sector in Timor-Leste, focusing on health challenges, service utilization, service delivery, expenditure patterns, and future directions. It was prepared by the World Bank in 2006, with the aim of supporting the Ministry of Health in developing a Medium-Term Strategic Plan. The report highlights both the progress made and the ongoing challenges in improving health outcomes, particularly among under-five children and women of reproductive age.

Main Issues and Challenges

1. Health Status and Outcomes

• Infant and Child Mortality: The infant mortality rate (IMR) and under-five mortality rate (U5MR) remain high, with 60 and 83 deaths per 1,000 live births, respectively. These rates are still unacceptably high despite being comparable to other countries with similar per capita incomes.
• Child Morbidity: Acute respiratory infections (ARI), diarrhea, and tuberculosis are the leading causes of illness among children under five. Data from the 2003 Demographic and Health Survey (DHS) show that 56% of children under five had experienced illness in the two weeks before the survey.
• Fertility and Maternal Health: The total fertility rate (TFR) is among the highest in the world (7.7 children per woman), leading to high maternal mortality risks. Only 61% of pregnant women received antenatal care from qualified providers, and only 18% of births were assisted by skilled attendants.
• Nutritional Status: A significant proportion of under-five children are underweight, stunted, or wasted, indicating severe undernutrition. These levels are higher than those in other countries with similar per capita incomes. Micronutrient deficiencies, such as anemia, Vitamin A deficiency, and iodine deficiency, are also widespread.

2. Health Service Utilization

• Immunization Coverage: In 2003, only 56% of children aged 12–23 months were immunized against measles, and only 18% were fully immunized (BCG, polio, measles, and three doses of DPT).
• Utilization of Curative Services: Less than 63% of children with ARI and 68% with fever were taken to health facilities. Only 10% of live births occurred in health facilities, with the majority taking place at home.
• Access and Distance: The average travel time to health facilities varies significantly by region, with some areas being more than 30 minutes away. This contributes to low utilization of services.
• Reasons for Non-Utilization: Common reasons include perceived lack of severity of symptoms (48%), access issues (42%), and financial constraints. Many people prefer traditional healers or home-based care, especially in rural areas.

3. Service Delivery

• Public Sector Services: The Ministry of Health (MOH) has made efforts to improve the quality and accessibility of health services, including the rehabilitation of facilities and the development of a health policy framework.
• Private Sector Role: Private providers, including NGOs and community health workers, play a significant role in primary health care, estimated to account for about 25% of basic health service delivery.
• Human Resources: There is a severe shortage of health workers, particularly in rural areas. The health workforce is unevenly distributed, and there are concerns about the quality, motivation, and training of health professionals.
• Hospital Sector: The hospital sector faces challenges in service delivery, including inadequate infrastructure, limited capacity, and poor access to emergency obstetric care.

4. Health Expenditure and Financing

• Sources of Funding: The health sector is primarily funded by the government, development partners, and NGOs. Out-of-pocket expenditures by households are a major component of health financing.
• Cost and Accessibility: The cost of health services is a barrier for many, especially in rural areas. The average cost of outpatient consultations and hospitalizations is relatively high, contributing to low utilization.
• Public vs. Private: Public facilities are more accessible but often under-resourced. Private providers, including NGOs, offer more specialized care but are not universally available.

Key Findings

• Progress: The Government of Timor-Leste has made significant strides in establishing a functional health sector, including policy development, facility rehabilitation, and increased public health spending.
• Challenges: Despite progress, there are major gaps in the utilization of essential health services, particularly in maternal and child health. Undernutrition remains a critical issue, exacerbated by poverty, poor dietary practices, and limited access to health care.
• Determinants of Utilization: Socioeconomic status, geographic location, and education levels significantly influence the use of health services. Poorer and less-educated populations are less likely to access health care, even when it is available.
• Future Directions: The report emphasizes the need for continued investment in the health sector, improved workforce planning, and better integration of public and private services to enhance health outcomes.

Recommendations

• Strengthen the health workforce through better training, recruitment, and retention strategies.
• Improve access to health facilities, especially in rural and remote areas.
• Enhance the quality of care in both public and private sectors.
• Increase the proportion of households with adequate health insurance and reduce out-of-pocket expenditures.
• Expand the use of preventive health services, such as immunization and antenatal care.
• Address the root causes of undernutrition, including poverty, inadequate dietary practices, and poor access to health services.

Conclusion

Timor-Leste has made important progress in building its health sector since independence, but significant challenges remain. The country must continue to prioritize primary health care, invest in human resources, and improve access to essential services to further reduce morbidity and mortality rates and achieve better health outcomes.