Poverty and ill health are closely associated



Timor-Leste Health Sector Review

Meeting Health Challenges and Improving Health Outcomes

Report by the World Bank

Final Draft

October 6, 2006

Acknowledgements: The findings, interpretations and conclusions expressed in this paper are entirely those of the authors, and do not necessarily represent the views of the World Bank, its Executive Directors, or the countries they represent.

Table of Contents

Abbreviations 4

PREFACE 5

EXECUTIVE SUMMARY 7

Chapter I: Health Situation Assessment 21

1.1. Infant and Child Mortality 21

1.2. Child and Adult Morbidity 25

1.3. Fertility 30

CHAPTER II: Utilization of Health Services 43

2.1 Levels and Trends of Health Service Utilization 43

2.2 Determinants of Health Service Utilization 53

CHAPTER III: Service Delivery in the Health Sector 62

3.3. Brief Description of Public Sector Services 66

3.4. Role of the Private Sector in Primary Health Care 68

3.5. ISSUES IN GOVERNMENT PRIMARY HEALTH CARE SERVICES 71

3.6. Issues in the Hospital Sector 74

3.7. Human Resources in the Health Sector 77

Background 77

The size and composition of the health workforce in Timor-Leste 78

How many health workers is enough? The challenge of health workforce planning 83

Changes in the health workforce over time 87

Performance, incentives, and motivation 90

Financial and non-financial incentives 91

CHAPTER IV: Health Sector Expenditure and Financing 93

4.1. Sources of Financing for Expenditures on Health Goods and Services 93

4.2. Out-of-Pocket Expenditures by Households 93

4.3. Non-Governmental Organizations Expenditures and Financing 99

4.4. Public Sector Expenditure and Financing 100

CHAPTER V: THE CHALLENGES AND RISKS MOVING FORWARD 113

Table of Figures, Tables, and Boxes

Figure 1-1:　IMR and U5MR in relation to GDP per capita, selected countries 22

Figure 1-2: ARI and diarrhea prevalence rate among children under five, in relation to GDP per capita, selected countries 27

Figure 1-3: Percent of children under-five with ARI or fever taken to health facility, 27

Figure 1-4: Percent of children under-five with diarrhea who received either ORS or RHF, 28

Figure 1-5: Incidence of TB, in relation to GDP per capita, selected countries 28

Figure 1-6: Total fertility rate in relation to GDP per capita, selected countries 30

Figure 1-7: Total fertility rate by mothers’ education level, selected countries 31

Figure 1-8: Contraception coverage in relation to GDP per capita, selected countries 31

Figure 1-9: Percent of currently married women and men who are not using a contraceptive method and do not intend to use in the future, by main reason 32

Figure 1-10: Trend of underweight prevalence among children under five 33

Figure 1-11: Prevalence of stunting, underweight and wasting among children under five 33

Figure 1-12: Prevalence of stunting and underweight in relation to GDP per capita, selected countries 34

Figure 1-13: Timing of undernutrition 34

Figure 1-14: Timing of stunting and underweight by maternal nutritional status 35

Figure 1-15: Prevalence of anemia among children under-five by selective background characteristics 37

Figure 1-16:Prevalence of anemia among children under-five by selective background characteristics 37

Figure 1-17: Prevalence of anemia and iron supplementation during pregnancy among women aged 15-49 years by selective background characteristics 38

Figure 1-18: Prevalence of night blindness during pregnancy and vitamin A supplementation among 39

Figure 1-19: Prevalence of vitamin A deficiency, under-five mortality and vitamin A supplementation status, selected countries 39

Figure 1-20: Children’s feeding status and prevalence of diarrhea 41

Figure 1-21: Feeding during diarrhea among children ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download