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 2010e2011. 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 keyinformants
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.