Starting from Scratch in Timor-Leste : Establishing a Pharmaceutical and Medical Supplies System in a Post-Conflict Context
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World Bank, Washington, DC
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This case study analyses the challenges
of establishing a pharmaceutical and medical supplies system
in a Timor-Leste post-conflict context. In the aftermath of
its separation from Indonesia, the Timor-Leste health
infrastructure was in total disarray, with more than a third
of health facilities destroyed, and those remaining severely
damaged. The crisis in human resources was severe, as more
than 80 percent of qualified public-sector staff had
returned to Indonesia. The resultant heavy dependence on
expatriates was complicated by language incompatibility, and
nationals were not well integrated into planning and
implementation processes, as an entire public sector
infrastructure was being established de nouveau. Despite the
fledgling status of the public sector, a sophisticated
organizational framework was envisioned for the
establishment of the health sector supply system: an
autonomous agency that would be a non-profit wholesaler or
revolving drug fund and a public sector monopoly. The case
study reviews the development of the policy and legal
framework for the pharmaceutical sector, and the key phases
of the commodity supply system, including: product selection
through an essential drugs list; procurement hampered by use
of procedures that were not appropriate for purchasing drugs
for an entire country; the establishment of a centralized
warehousing and distribution system; projected financing of
the supply system through development of a business plan for
the autonomous agency. In its exploration of the transition
from post-conflict situation to health system development,
the case study identifies lessons that are broadly
applicable to foreign aid and external assistance in other
contexts, including the tendency to
'poly-prescribe' overly ambitious and overly
sophisticated solutions not pragmatically grounded in the
current realities of public sector institutional and human
resource constraints and capabilities.
Palabras clave
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