Timor-Leste was recognised as an Independent State on 20 May 2002 after a long struggle for
its independence. Toward the end of the Indonesia’s occupation, health service delivery
including malaria control programs collapsed. During the United Nation Administration in East
Timor (UNTAET), health sector development has been actively pursued and continues to this
present day.
This study, utilising a mixed methods approach, was designed to explore and examine a number
of features of malaria policy and control. This included examining malaria control reestablishment
after its brief collapse in 1999, the implementation of the Global Fund to fight
AIDS, TB and Malaria (the Global Fund) grant, the delivery of malaria interventions during
political instability in 2006, and the formulation and implementation of malaria treatment policy
in Timor-Leste over the past 10 years.
During the UNTAET period, the World Health Organization (WHO), international nongovernmental
organisations and the Interim Health Authority delivered malaria interventions,
re-established malaria control and developed the first Malaria Treatment Protocol (MTP) in
Timor-Leste.
Timor-Leste’s malaria program received more support with the award of the Global Fund’s first
grant in 2003. The Global Fund funded malaria programs was implemented by multiple
stakeholders, however, lack of infrastructure and human resources impeded the implementation.
Despite these constraints, there were important contributions made to health system
strengthening, capacity building and community.
The recent political instability in 2006 caused widespread violence, destruction and
displacement of around 150,000 country’s population. The Ministry of Health (MoH) responded
to the health needs of people affected by that crisis including malaria. Multifaceted interventions
were rapidly organised and delivered.
The MTP was changed in 2007 by replacing the first line treatment for falciparum malaria from
sulphadoxine-pyrimethamine to artemether-lumefantrine. The formulation of this new MTP was
undertaken by the MoH, WHO and other stakeholders. Lack of clear policy impeded the early
implementation of the new MTP. vi
Despite considerable achievements in malaria control over the last ten years, there has been a
lack of attention and underfunding for case management, vector control and operational
research. Lack of human resource, inadequate infrastructure, inconsistent policies, lack of
harmonisation of organisations engaged, and inadequate monitoring and evaluation undermined
government efforts to reduce malaria burden.
It is hoped that this thesis will contribute to building the Timorese health system and answering
one key question: Can Timor-Leste reduce malaria burden and meet malaria-related Millennium
Development Goals by 2015? Addressing this question requires a better coordination and
collaboration to build on from the achievements and learn from failures in malaria control.