The politics of ownership in policymaking: lessons from healthcare delivery in post-conflict Timor-Leste

Abstract

This article examines the political economy of national ownership, focusing on the reconstruction of the healthcare system in post-conflict Timor-Leste in relation to the shift from aid dependence to oil dependence. Considering three main approaches to development policymaking, it argues that, from 2002, the government generally used patronage-based strategies that benefitted elite political networks, increasing corruption. Based on empirical research, the study demonstrates that, in several areas, the government of the Revolutionary Front for an Independent East Timor (2002–2007) could exercise some autonomous decision-making despite being heavily aid dependent. Later, under the National Congress for Timorese Reconstruction government (2007–2017), empowered by oil resources, elites had greater control over development. However, the creation of a ‘modern’ healthcare system was central to the elites’ political ideology, involving populist rather than patronage-based politics. Analysis of this research indicates that ownership regarding healthcare has become concentrated among powerful groups, while health professionals, who advocate a neoliberal approach, lack a political voice. Thus, the paper problematises the Paris Declaration’s focus on country ownership to ensure better aid delivery as unrealistic because ‘ownership’ becomes subject to contestation.