East Timor striving for universal access to health care

Abstract

A small half-island on the equator came to independence in ruins with high-quality, free health care for all as a key goal. More than a decade on, East Timor is still working to leave behind centuries of oppression, but idealism is not dead in the capital Dili. The people developing East Timor’s health system still want a future without the pitfalls of medicine in more prosperous countries. When asked about his vision for East Timor’s health system, Health Minister Sergio Lobo says it is about access. He compares East Timor with its richer neighbours, Malaysia, Singapore, and Australia. In those countries, he says, not everyone can always access their world-class health services. “In Malaysia, Singapore, Australia, any problem, they will fix it. The services are there, but not for everybody”, Lobo told The Lancet. Lobo is a surgeon who trained in Indonesia, the country that brutally occupied East Timor for 24 years until 1999. As punishment for East Timor’s decision to vote for independence that year, Indonesia’s military and its East Timorese militia allies went on a rampage of violence, trashing the country and leaving nearly every house in ruins. After 2 years of UN-led administration, it achieved independence in 2002. Many buildings have still not been repaired today, but a lot has changed. East Timor now has oil wealth from mineral resources in the Timor Sea to the south. Dili has shopping complexes and advertising hoardings. At least a few people now are visibly wealthy, even if most are clearly not. Even a new round of internecine fighting in 2006 is receding into history. Much of the government’s new money has gone into building up the health system and results are starting to show. In September, WHO honoured East Timor for its rapid progress towards eradicating malaria, noting that only three deaths from malaria were recorded in 2013. During the conversation, Lobo returns several times to his vision. He talks about having a socialist attitude