Starting from Scratch in Timor-Leste: Establishing a Pharmaceutical and Medical Supplies System in Post-Conflict Context
(2009; 46 pages)

Based on a literature review of nearly 75 documents, interviews with over 50 stakeholders and key informants, direct observation, and analysis of financial and inventory data, this case study analyses the challenges of establishing a pharmaceutical and medical supplies system in a post-conflict context: Timor-Leste. 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.

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