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East Timor: working towards sustainable agency health assistance

01-02-2000by Ann Aerts

Extract from FORUM: war, money and survival, p. 58-59.

In September 1999, while the town of Dili and the East Timor countryside were still burning, around 270,000 East Timorese were displaced to the Indonesian part of the island, West Timor. With them went most of the East Timorese health professionals. Some later returned to their place of origin, but only once the INTERFET [1 ] troops had secured the regions in question.

In East Timor, Indonesian staff had held the key positions in the health sector, but Indonesian nationals left the country when violence broke out in the wake of the referendum. So, in October 1999, the East Timorese medical corps was reduced to a mere handful of doctors and nurses. Humanitarian agencies trying to reinstate the disrupted health-care system were confronted with an additional problem: the absence of any health authorities. Their dilemma was how to remunerate the health staff remaining in the structures they were assisting. Most of these staff were absorbed by the ICRC-run central referral hospital in Dili and the Baucau hospital run by Médecins sans frontières.  

From the outse t, meetings between humanitarian organizations and local partners were held in the central hospital of Dili to coordinate the response to the crisis and work towards sustainable solutions. These meetings were chaired by representatives from the various international agencies, in collaboration with their counterparts from the National Council of Timorese Resistance (CNRT), the umbrella organization of East Timorese political parties. At the request of the major agencies working in the health sector, a CNRT-led working group for health was set up. Its first task was to draw up recommended salary scales for health professionals in East Timor and propose them to all the humanitarian agencies involved in health care. Once applied, this initiative avoided health professionals being attracted to the agency offering the best pay.

It was also agreed at the interagency meetings that no official job contracts would be signed between individual health personnel and agencies until the health authorities yet to be set up were capable of officially assigning their health professionals to the various services.

In the meantime, agencies were to remunerate health personnel with daily incentives, which corresponded more or less to their previous salaries. As soon as the new health authorities were in place, staff would receive official contracts from the Ministry of Health. Agencies would still be prepared to pay salaries under a Ministry of Health contract until the authorities had the financial capacity to remunerate their staff.

Thus, right from the outset of the East Timorese crisis, the sustainability of assistance to the health sector was ensured through joint action.

 Ann Aerts  is a doctor working in the Health Services Unit of the ICRC in Geneva. She has participated in humanitarian missions for various agencies in Angola, Rwanda, Mozambique, Burundi, Côte d'Ivoire, Georgia, Armenia, Azerbaijan and, most recently, Indonesia.  


1. INTERFET: International Forces for East Timor