Country Profile. Timor-Leste

Human Resources for Health Country Profile Timor-Leste + WHO TLS logo Ministériu da Saúde, Timor-Leste

Acknowledgement The Ministerio da Saude, Timor-Leste would like to thank World Health Organization, Country Office for Timor-Leste for its assistance in compilation of Human Resources for Health Country Profile for Timor Leste.

Content 1. Introduction... 3 2. Country context... 4 2.1 Geography and demography 4 2.2 Economic context 6 2.3 Political context 7 2.4 Health status 7 3. Country health system... 9 31 Governance 9 3.2 Organization of health care service delivery 10 3.3 Service provision 12 3.4 Health care financing 13 3.5 Health information system 13 4. Health Workforce Situation... 15 4.1 Health workforce stock and trends 15 4.2 Distribution of health workforce by category/cadre 18 4.2.1 Gender distribution by health workforce categories/cadre 24 4.2.2 Age distribution by occupation/cadre 26 4.2.3 Region/province/district distribution by occupation/cadre 28 4.2.4 Urban/rural distribution by occupation/cadre 32 4.2.5 Distribution by occupation/cadre 34 5 HRH Production... 36 5.1 Pre-service education 36 5.2 In-service and continuing education 42 5.3 Health workforce requirements 42 6. HRH Utilization... 43 6.1 Recruitment 43 6.2 Deployment and distribution mechanisms 43 7. Governance for HRH... 44 7.1 HRH policies and plans 44 7.2 Policy development, planning and managing for HRH 44 7.3 Professional Regulation 44 7.4 HRH information 45 7.5 HRH research 45 Annex 1: Classification of health workforce of the WHO South-East Asia Region... 46 Annex 2: Health workforce classification mapping of the WHO South-East Asia Region... 48 Annex 3: Health workforce classification mapping of Timor Leste... 57 Annex 4: Members of the taskforce... 63 2

1. Introduction The purpose of Human Resources for Health (HRH) profile for Timor Leste is to provide a comprehensive picture of the health workforce situation in the country; Systematically present the HRH policies and management situation to help monitoring the HRH stock and trends; Serve as communication with and between policy-makers and stakeholders; and Strengthen the HRH information system by establishing evidence for baselines and trends; Preparation of the HRH profile was posed with a number of challenges. Limited information on health workforce exists, particularly for private sector and policies related to motivation and incentives. Due to absence of single data source, multiple sources have been used to collect information on HRH. Secondary sources of information like key ministry documents were used to compile the information. The HRH profile begins with the country context, followed by description of health system, health workforce situation, Human Resource production, Human Resource utilization and Governance of Human Resources for Health. Data and tables are used in each section to support the findings. 3

2. Country context 2.1 Geography and demography Timor-Leste covers the eastern half of the island of Timor and includes Atauro Island located north of Dili, Jaco Island located on the easternmost end of the island and the enclave of Oecussi situated within Indonesia on the northwestern side of the island. It spans approximately 180km east-west and 75km northsouth and has a land mass of approximately 14,610 square kilometers. According to the 2010 Census, the population in 2010 was 1,066,409 1. The national capital is Dili. 1 Census 2010 4

Timor-Leste became independent on 28 November 1975 after being under Portuguese rule since the 16 th century. Nine days later, on 7 December 1975, it was invaded by Indonesian forces and incorporated as a province in Indonesia in July 1976. It is estimated that nearly one quarter of the population died during the occupation as a consequence of conflict, forced migration, malnutrition and unattended public health needs (MoH 2011). Between 1974 and 1999 there were an estimated 102,800 conflict-related deaths including 18,600 killings and 84,200 hunger and illness related deaths (UNESCO, 2009). On 20 May 2002, Timor-Leste became independent following a referendum in August 1999. The transition was marred by violence in 2006, civil unrest during elections in mid-2007 and an attempted assassination of the President in 2008. Elections are scheduled for 2012. Timor-Leste is divided into 13 administrative districts, 65 sub-districts, 442 sukus (villages) and 2,225 aldeias (hamlets). Suku (village) is the smallest administrative division. 2 Thirty percent of the population lives in urban areas. Seventy percent of the population lives in rural areas in small, dispersed villages isolated by mountainous terrain and poor roads (MOH 2011). Lack of roads and transportation poses challenges for access to health care. The two largest urban centres, Dili and Baucau, are home to 29 percent of the population. In 2004 the population was 923,198 and the annual population growth rate was 5.3% (NSD, 2006). The 2010 Census showed that the population of Timor-Leste to be 1,066,409 and the annual population growth rate of 2.4%. Forty six percent of the population is below the age of 15. Life expectancy at birth improved from 59 in 2004 to 62 in 2010 (DHS 2010). Table 2.1 Percent Population Distribution by Age Group and year Age Group 2004 2010 0 14 years 43.2% 41.4% 15 64 years 53.3% 53.9% 65+ years 3.5% 4.7% Total 100% 100% Total population 923,198 1,066,409 Source: Population distribution by Administrative Areas Volume 2, Population and Housing Census 2010, National Statistic directorate Timor Leste, 2010 2 http://timor-leste.gov.tl/?p=91&lang=en 5

2.2 Economic context Timor-Leste is a lower-middle income country. Gross National Income (GNI) per capita was US$1,980 in 2009 (although non-oil GDP is only US$536 per capita) and growth was estimated at 12.9 percent. The Petroleum Fund savings are estimated to exceed USD7 billion. Human development outcomes remain low. In 2010 Timor-Leste ranked 120 out of 177 countries on the United Nations Development Program (UNDP) Human Development Index (HDI). It had a Human Development Index (HDI) of 0.502 3. According to the 2007 Timor-Leste Survey of Living Standards, nearly 50 percent of the population lives below the national poverty line of $0.88 per capita per day. Between 2006-07 and 2011, total government health spending in monetary terms has increased by approximately 109%: from USD 18.3 million in 2006-07 to USD 38.2 million in 2011. However since 2007, the share of government health expenditure of the total government expenditure has exhibited a decline: 7% in 2007, 4.8% in 2009, 4.1% in 2010 and 2.9% in 2011 (MoH 2011). According to World Health Organization (WHO) estimates, private expenditure on health as percentage of total expenditure on health was approximately 20% in 2008. It includes out-of-pocket expenses. Donor commitment to the sector remains strong. The total support from development partners was USD 27.7 million in 2008, 36.2 million in 2009 and 23.9 million in 2010 (MoH 2010). According to WHO, external financing for the health sector dropped from 52.5 percent of total health expenditures in 2005 to 28 percent in 2008. Public spending on health including donor funds in 2008 was USD 51.2 per capita and predicted to be USD 58.9 in 2009 (MoF 2010). Per capita spending on health excluding donor funds increased from USD 18 dollars in 2006 to USD 31 in 2010 (MoF 2010). This increase can be explained by investment in rebuilding of health infrastructure that was destroyed during independence struggle. The Ministry of Health budgets reveal marked increase in spending on salaries and decreases in spending on goods and services at central and district level. At the central level between 2008 and 2011 the share of salaries and wages increased from 20% to 29%. The share of goods and 6

services decreased from 59% to 39% in the same period. The same trend is reflected in district health budgets. Salaries received 34% of total district health resources in 2008, 38% in 2009, 58% in 2010 and 60% in 2011. This may pose as a major challenge to service delivery. 2.3 Political context The Democratic Republic of Timor-Leste is a Parliamentary republic. A Semi-Presidential system of government is followed. The Executive consists of the president (head of state), prime minister (head of government), and cabinet. The Legislative, the National Parliament or Parlamento Nacional, is a unicameral parliament. The Judiciary consists of courts and supporting hierarchy. The Supreme Court has not yet been formed; the Court of Appeal functions on an interim basis as the Supreme Court. 2.4 Health status Table 2.2 Selected health and demographic indicators 2010 Life expectancy at birth 60.2 (females) 58.6 (males) Total fertility rate 5.7 Maternal mortality ratio 557 per 100,000 live births Infant mortality rate 44 deaths per 1,000 live births Under-five mortality rate 64 deaths per 1,000 live births Children under-five with stunting (%) 53% Underweight children (%) 52% Source: National Health Sector Strategic Plan 2011-2030, Ministry of Health Table 2.3 Main causes of morbidity and mortality Main causes of morbidity Value /1,000 pop Main causes of mortality Value /1,000 pop 1.Acute Respiratory Tract 433 1. Bronchopneumonia 0.15 Infections 2. Malaria 104 2.All forms of TB 0.15 3. Diarrhoea 60 3.Diarrhoeal diseases 0.05 4. Pneumonia 46 4.Malaria 0.05 5. All forms TB prevalence 378 /100,000 pop 6. Injury not caused by 29 traffic accident 7. Scabies 19 Others Source and year: 2010 Annual Health Statistic Report, HMIS and Surveillance Cabinet, Ministry of Health Timor Leste, 2010 Notes: Mortality data obtained from hospital and health facility. The mortality data in Timor Leste is under-reported. 3 http://hdr.undp.org/en/statistics/ and http://hdrstats.undp.org/en/countries/profiles/tls.html 7

Table 2.4 Leading causes of mortality by patient age (patient admission in hospitals) in Timor- Leste, January December 2010 Disease <1 1-4 5-14 15-45 46 and older Total Hospital Deaths % of Total No. of Hospital deaths Deaths Bronchopneumonia/pneumonia 37 26 12 25 36 136 11.5 All forms of tuberculosis 3 5 18 75 75 176 14.9 Malaria 6 8 18 22 4 58 4.9 Cardiovascular disease 1 1 1 14 21 38 3.2 Injury 0 1 5 19 9 34 2.9 Liver disease 1 0 0 12 19 32 2.7 Cerebrovascular disease 0 0 0 11 20 31 2.6 Renal disorder 2 0 10 7 11 30 2.5 Diarrhoeal diseases 10 10 1 7 1 29 2.4 Asthma bronchiale/copd 1 0 1 7 17 26 2.2 Meningitis/encephalitis 2 4 4 7 0 17 1.4 Malnutrition 4 9 0 1 0 14 1.2 Anemia 1 2 0 10 0 13 1.1 Source: National Health Strategic Plan 2011-2030, Ministry of Health, Timor-Leste Table 2.5 Health indicators Indicators Both sex Male Female Source and year Life expectancy 58.8 58.0 59.7 Crude mortality rate 10.9 na na Under-5 mortality rate 64 85 76 Maternal mortality rate na na 557 HIV/AIDS prevalence rate < 0.2% na nc % with access to safe water 63% na na % with access to sanitation 1) 43% na na 8 Population Projection 2004-2050 page 28, National Statistic Directorate Timor Leste Population Projection 2004-2050 page 28, National Statistic Directorate Timor Leste Timor Leste DHS 2009-10; National Statistic Directorate, 2010 Timor Leste DHS 2009-10; National Statistic Directorate, 2010 HIV/AIDS unit, Department of CDC, Ministry of Health Timor Leste, 2010 Timor Leste DHS 2009-10; National Statistic Directorate, 2010 Timor Leste DHS 2009-10; National Statistic Directorate, 2010 According to the Census 2010,approximately r 66% of the population has access to improved drinking water sources (piped water, protected well, hand pump, tanker, bottled water). In 2001, the household survey reported this figure to be 48%. More than a third of Timorese families live ten or more minutes away from a water source..the main source of drinking water in urban areas

is household tap (42%) and in rural areas a well or spring (25%). Springs are the main water source for the rural eastern part of the country and the second main source in the rural central and western areas. The two leading causes of infant and child mortality in Timor-Leste lower respiratory infection and diarrhoeal disease are directly related to a lack of water supply, poor sanitation and hygiene. (Timor Leste, Strategic Development Plan 2011-2030). 3. Country health system 31 Governance Timor Leste is signatory to various human rights conventions/treaties. The conventions/treaties of relevance to the health sector are: International Covenant on Economic, Social and Cultural Rights; International Covenant on Civil and Political Rights; Second Optional Protocol to the International Covenant on Civil and Political Rights, aiming at the abolition of the death penalty; International Convention on the Elimination of All Forms of Racial Discrimination; Convention on the Elimination of All Forms of Discrimination against Women; Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment; Convention on the Rights of the Child; Convention concerning Forced or Compulsory Labour; Equal Remuneration Convention; Abolition of Forced Labour Convention. The Constitution of the Democratic Republic of Timor Leste protects the right to health, medical care and healthy environment. It also protects other human rights that have an impact on health: gender equality; non-discrimination; protection of persons with specific needs (people with disabilities, the elderly, women, children and youth; health protection at workplace like maternity protection, occupational health. Article 57 of the Constitution states, all Timorese citizens are entitled to health care and the State has a duty to promote and protect this right free of charge, in accordance with its capabilities and in conformity with the law. The Constitution also states that health services shall, as far as possible, run under a decentralized participatory management setting. Thus the Constitution provides an opportunity to translate human rights commitments through laws and policies. 9

3.2 Organization of health care service delivery The public sector in Timor-Leste plays an important role in providing healthcare at all levels of care. The private sector is expanding and includes international and national non-government organizations, non-profit private organisations (faith based institutions, coffee cooperatives) and for-profit organisations. Public sector health care provision Timor-Leste has a three-tiered referral system. The three tiers include one national tertiary hospital, five district referral hospitals and numerous community health centres and health posts. In 2008, the Ministry of Health introduced Servisu Integrado du Saude Comunidade - Integrated Community Health Services - (SISCa) in its bid to improve access to health services at the village level. Primary level of care At the district level primary health care is provided through a network of community health centres, health posts and SISCas. Currently, there are 66 community health centres, 210 health posts and 473 SISCas operating throughout the country. Services provided at the primary health care facilities vary with catchment areas. The health services provided by primary health care facilities include the basic health service package (BSP) and those under the national programmes including immunization, maternal and child health, malaria, nutrition, tuberculosis and HIV/AIDS. The health post is the first level of contact at the community. It is staffed with a nurse and a midwife and is designed to deliver a minimum package of curative, preventive and promotive care. The community health centre (CHC) provides inpatient and outpatient services. Selected CHCs also offer dental and laboratory services. CHC staff includes a physician (the district medical officer). CHCs organize mobile clinics for remote areas where health posts are not established. 10

In 2007/2008, Servisu Integrado du Saude Comunidade (SISCa) was introduced in a bid to improve access to basic health services package and preventive measures at the suco (village) level. A team of health care professionals (midwives, nurses and doctors) from the CHC organize a clinic on a monthly basis. Community involvement is an important feature of SISCa and community members are mobilized with the assistance of community health workers/volunteers who receive basic training on health issues and are paid a stipend. SISCa has six components: family registration; nutrition assistance and child health promotion; maternal health and family spacing; hygiene, sanitation and malaria prevention; ambulatory primary care; and health promotion activities. Tertiary and secondary levels of care A network of one national tertiary hospital and five district referral hospitals has been established. A national laboratory operates in the capital Dili. The district referral hospitals offer emergency, out-patient and in-patient care. The district hospital staff include general practitioners and specialists in four clinical areas: surgery, paediatrics, gyneco-obstetrics and internal medicine. Cases are referred from district health facilities to district hospitals. The national hospital is the top tier referral facility for specialized services. The national hospital has referral linkages for tertiary care with facilities in Australia, Indonesia and Singapore for services not available in the country. Ambulance services are available to transport referral cases. The referral mechanism needs to be strengthened and standard operating guidelines need to be developed. Private sector The private sector in Timor-Leste is expanding and includes non-profit private organisations (faith-based institutions, coffee cooperatives, international and national non-government organizations) and for-profit organisations. The size of the private sector is not known, however, the MoH estimates that the private sector provides approximately 25% of basic medical service delivery. Doctors, nurses, midwives and dentists operate for-profit private clinics mostly in the urban centers of Dili and Baucau. According to MoH records, 26 private clinics exist. Medicine is sold in pharmacies and retail shops however private clinics and pharmacies are yet to be regulated. 11

Figure 3.1 : Current National Health Service Configuration CLINICAL REFERRAL SYSTEM CLINICAL SUPPORT & TRANSFER MANAGEMENT SUPPORTSERVICES Dili National Hospital Regional Referral Hospitals Community Health Centres with beds (1 each District) National Diagnostic Services (Radiology, laboratory) Community Health Centres without beds (1 each Sub-district) Health Post village level, first point of contact Integrated Community Health Service (SISCa) (Suco based community participation for primary health care) A M B U L A N C E S E R V I C E S CENTRAL SERVICES DISTRICT HEALTH SERVICES SUB-DISTRICT HEALTH SERVICES COMMUNITY HEALTH SERVICES Clínica Café Timor (CCT), operated by the Café Timor network, runs eight clinics providing services akin to a CHC, and 24 mobile clinics in five districts and Dili. The NGO Caritas operates 27 mobile clinics. There are approximately 32 faith-based clinics. Traditional medicine also plays an important role in rural areas and a large section of people in these areas seek care from traditional healers. 3.3 Service provision The Ministry of Health, with support from its development partners, has embarked in strong infrastructure development consisting of rehabilitation and construction of health facilities, management offices and training centres, while focus was also given to resourcing these facilities with basic equipments, ambulances and vehicles, access to electricity and water supply. Table 3.1 : Summary of Existing Health Facilities in Timor-Leste Type/Level Public Private TOTAL Health Posts 192 0 192 Community Health Centres 66 26 92 12

Maternity Clinic 42 1 43 Hospitals 6 0 6 TOTAL 264 26 290 3.4 Health care financing Between 2006-07 and 2011, total government health spending in monetary terms has increased by approximately 109%: from USD 18.3 million in 2006-07 to USD 38.2 million in 2011. However since 2007, the share of government health expenditure of the total government expenditure has exhibited a decline: 7% in 2007, 4.8% in 2009, 4.1% in 2010 and 2.9% in 2011 (MoH 2011). According to World Health Organization (WHO) estimates, private expenditure on health as percentage of total expenditure on health was approximately 20% in 2008. It includes out-of-pocket expenses. Donor commitment to the sector remains strong. The total support from development partners was USD 27.7 million in 2008, 36.2 million in 2009 and 23.9 million in 2010 (MoH 2010). According to WHO, external financing for the health sector dropped from 52.5 percent of total health expenditures in 2005 to 28 percent in 2008. Public spending on health including donor funds in 2008 was USD 51.2 per capita and predicted to be USD 58.9 in 2009 (MoF 2010). Per capita spending on health excluding donor funds increased from USD 18 dollars in 2006 to USD 31 in 2010 (MoF 2010). This increase can be explained by investment in rebuilding of health infrastructure that was destroyed during independence struggle. 3.5 Health information system The Cabinet of Health Management Information System and Surveillance (HMIS-SE) holds the overall responsibility of Health Information System. The information on key health indicators is collected routinely by the MoH through the HMIS. At the district level health information is collected by the HMIS officer and District Public Health Officer. The HMIS-SE provides comprehensive data on quarterly and annual basis to the policy makers, programme managers, district level, health facility and other relevant stakeholders will provide feedback to respective programme managers on monthly basis Information is collected from public and private Health Facilities. Health facilities submit the data to 13

District Health Service Office (DHS) which in turn compiles and submits to HMIS-SE. Although a Data management and validation system exists, it is not working properly in all districts and health facilities.. At the national and district level the database management includes both paper based filing and electronic systems. Since 2005, at the national level data management is done using Epi Info while the process of importing HMIS data from Excel to Epi info is ongoing. At the CHC level paper based filing system is used. Majority of the CHCs only received computers in April-May 2010 and staff are being trained. At the HMIS-SE data verification is undertaken before data entry. In case of discrepancy, data is verified from the relevant District Health Service Office (DHS). The HMIS-SE staff and HMIS officers do not have formal training in statistics or epidemiology. Some national and district level staff has attended short term courses in epidemiology in Malaysia and Thailand. One HMIS-SE staff, currently undertaking a postgraduate programme at the FETP Gadjahmada University Yogyakarta,is expected to graduated in early2012. Although HMIS-SE has computers, the number is inadequate. A need for high speed internet access has also been identified. All districts and majority of the CHCs are equipped with computers. However, the internet connectivity is poor. The Cabinet of Health Management Information System and Surveillance (HMIS-SE) collects and compiles HRH data from the district health office and National Human Resources Directorate. However there is a lack of standardized data collection procedures. 14

4. Health Workforce Situation Timor-Leste faced a health workforce crisis following the 1999 referendum and declaration of independence in 2002. The health workforce shrunk from 3540 to 1500 with the withdrawal of Indonesian health workers. To cite an example, only 20 of the 135 doctors remained. The situation is improving and the health workforce is gradually expanding. The gap has been filled by hiring foreign medical personnel and sending nationals abroad for training. Since 1999, approximately 1,000 Timorese medical students have trained under an agreement of medical cooperation between the governments of Cuba and Timor-Leste (MoH 2011). Approximately 700 Timorese students are currently studying medicine in Cuba. Additionally, around 180 students are studying medicine locally under a program conducted by the Cuban Brigade in cooperation with the National University of Timor-Leste and the Ministry of Health (Dewdney et al. 2009). Despite an increase in the human resources for health a shortage remains of nurses, midwives, radiologists, physiotherapists, pharmacists, laboratory technicians and managers. Absorbing the newly trained doctors in the health system is one of the challenges facing Timor-Leste. By 2010, 18 of the 700 students had returned (MoH 2011) and a large influx is expected in the coming three years. This also entails higher costs and there is a skewed distribution of healthcare professionals favouring urban areas. Incentives in form of subsidies have been introduced to address the rural-urban mismatch (MoH 2011). The Faculty of Health Sciences, National University of Timor-Leste, Ministry of Education, the Institute of Health Science, Ministry of Health and a private university provide pre and in-service training for healthcare providers. National and referral hospitals offer training facilities and internships. A school of nursing and midwifery at the National University Timor Lorosa e (UNTL) is proposed. 4.1 Health workforce stock and trends In 2010, 1407 health personnel (physicians, nurses and midwives) were employed in the public health system (Tables 3.1 and 3.2). Health personnel are also employed by non-profit private organisations as well as for-profit private organisations. The numbers however are not available. The Cuban Brigade constitutes a major component of the clinical workforce providing two out of every three doctors in Timor-Leste. This will change in the coming years once Timorese medical students return from their training in Cuba. 15

Despite an increase in the human resources for health a shortage remains of nurses, midwives, radiologists, physiotherapists, pharmacists, laboratory technicians and managers. Absorbing the newly trained doctors in the health system is one of the challenges facing Timor-Leste. By 2010, 18 of the 700 students had returned (MoH 2011) and a large influx is expected in the coming three years. This also entails higher costs and there is a skewed distribution of healthcare professionals favouring urban areas. Incentives in form of subsidies have been introduced to address the rural-urban mismatch (MoH 2011). Table 4.1.1 Distribution of health personnel by district 2009 2010 Districts Physicians Nurses Midwives Total Physicians Nurses Midwives Total Aileu 5 30 19 54 6 31 18 55 Ainaro 15 27 16 58 14 29 17 60 Baucau 23 134 55 212 27 129 55 211 Bobonaro 13 61 20 94 20 39 22 81 Covalima 15 54 22 91 17 52 22 91 Dili 97 266 84 447 98 266 84 448 Ermera 7 68 20 95 8 42 19 69 Lautem 6 39 19 64 5 20 13 38 Liquiça 5 25 16 46 8 34 22 64 Manatuto 6 40 33 79 8 40 33 81 Manufahi 5 36 18 59 8 36 18 62 Oecussi 9 23 23 55 9 23 23 55 Viqueque 4 64 22 90 6 64 22 92 Total 210 867 367 1 444 234 805 368 1407 Source: Ministério da Saúde/Ministry of Health Table 7.2 Timor-Leste in Figures, 2010 Table 4.1.2: Physicians, nurses and midwives per 1,000 inhabitants 2009 2010 Districts Physicians Nurses Midwives Physicians Nurses Midwives Aileu 0.1 0.7 0.4 1 0.7 0 Ainaro 0.2 0.4 0.3 0.2 0.5 0.3 Baucau 0.2 1.2 0.5 0.2 1.2 0.5 Bobonaro 0.1 0.6 0.2 0.2 0.4 0.2 Covalima 0.2 0.8 0.3 0 0.9 0.4 Dili 0.4 1.1 0.3 0.4 1.1 0.4 Ermera 0.1 0.6 0.2 0.1 0.4 0.2 Lautem 0.1 0.6 0.3 0.1 0.3 0.2 Liquiça 0.1 0.3 0.2 0.1 0.5 0.3 Manatuto 0.1 1 0.8 0.2 0.9 0.8 Manufahi 0.1 0.7 0.3 0.2 0.7 0.4 Oecussi 0.1 0.3 0.3 0 0.4 0.4 Viqueque 0.1 0.9 0.3 0 0.1 0.3 Total 0.2 0.8 0.3 0.2 0.8 0.3 Source: Ministério da Saúde/Ministry of Health and DNE calculations. Table 7.3 Timor-Leste in Figures, 2010 16

The Faculty of Health Sciences, National University of Timor-Leste, Ministry of Education, the Institute of Health Science, Ministry of Health and a private university provide pre and in-service training for healthcare providers. National and referral hospitals offer training facilities and internships. A school of nursing and midwifery at the National University Timor Lorosa e (UNTL) is proposed. 17

4.2 Distribution of health workforce by category/cadre Table 4.1 Distribution of health workers Category Sub-category Cadre* 2001 2007 2008 2009 2010 2011 General Practitioner General 3 34 37 45 75 75 Specialists Specialists 0 1 1 1 9 9 Dental Dentists Dentists SI 1 2 2 6 7 7 Dental nurses DIII 0 0 0 0 0 1 Dental Nurse SPRG 9 28 29 34 37 37 Dental lab technicians DI 0 0 0 0 0 1 Pharmacy practitioners Pharmacists Pharmacist DIII 0 4 4 8 15 15 Pharmaceutical technicians/ assistants Junior Pharmacy Technician (D1) Pharmacy Technician (SMF) 0 8 32 33 94 95 3 12 12 20 21 21 Nursing and Midwifery practitioners Nursing professionals Nurse SPK/DI 315 679 703 770 788 800 Nurse D III 6 48 57 67 78 82 Nurse SI 0 1 1 1 1 1 Midwifery Professionals Midwife DI 141 301 316 351 360 370 Midwife D III 10 26 24 25 26 28 Midwife D IV 2 2 2 2 2 2 Non- Public Health Public Health Generalists Public Health Specialists Public Health Generalists Public Health 12 27 37 42 46 47 5 16 16 16 17 17 Specialists Nutrition Professionals Nutritionist D I 0 2 2 4 6 6 Nutritionist D III 4 12 12 13 25 25 Environmental Health Officer Community Health Volunteers Environment Health Officer DI Environment Health Officer DIII Environment Health Officer SI Promotores Saude Familia (PSF) 2 3 5 6 7 7 1 4 12 16 18 19 1 1 1 1 1 1 18

Category Technologists Sub-category Imaging Technicians Cadre* 2001 2007 2008 2009 2010 2011 Radiographer DI 10 13 13 14 15 15 Radiographer DIII 1 12 12 13 25 25 Radiographer SI 0 0 0 0 1 1 Electromedik DIII 0 7 7 7 7 7 Laboratory Assistants Laboratory Assistant SMAK/SPK Laboratory Assistant DI Laboratory Assistant DIII Laboratory Assistant SI 14 28 28 30 30 30 0 4 28 60 62 69 9 16 18 23 30 32 0 1 1 1 1 1 Traditional Medicine Practitioner Traditional Medicine Practitioner No cadre, not in government service. NOT recognized in indigenous system of medicine Other Health Workers Optometrists Optometrist DI 1 2 3 3 13 13 Physiotherapists Physiotherapist DIII 0 1 1 1 1 1 Health management and support staff Health Service Manager Records Technicians Health Service Manager Records Technicians 65 65 65 65 65 65 0 0 0 0 1 1 Support staff Support staff 27 436 476 535 549 555 TOTAL 642 1796 1957 2213 2433 2481 Source: Human Resources Department, Ministry of Health, Timor-Leste Note: * Please provide names of all cadres, additional rows may be added to accommodate all cadres under each sub-category. 19

Details of qualification of each Cadre in Timor Leste: I. 1. General Practitioner: Professionals with minimum of 7 years of university education in the field of medicine with minimum of 1 year internship. (Doctors Trained in Indonesia). OR Professionals with minimum of 6 years of university education in the field of medicine. (Doctors trained in Cuba and Timor Leste) 2. Specialists: doctors with minimum of 2 year of postgraduate education/ training. II. Dental 1. Dentists SI: 12 years of education in school + 6 years university education in dental medicine in Indonesia (Bachelor s degree) 2. Dental nurses DIII: 12 year of education in school + 3 years university education in dental nursing in Indonesia 3. Dental nurse SPRG: 9 years of education in school + 3 years of university education in dental nursing in Indonesia 4. Dental laboratory technicians DI: 12 years of education in school + 1 years training in dental laboratory technician in Indonesia III. Pharmacy practitioners 1. Pharmacist DIII: 12 year of education in school + 3 years of university education in Pharmacy in Indonesia 2. Pharmacist SI: 12 years of education in school + 4 years of education in Pharmacy 3. Junior Pharmacy Technician DI: 12 years of education in school + 3 year of education in pharmacy science in Indonesia 4. Pharmacy Technician SMF: 12 years of education in school + 3 year of education in pharmacy science in Indonesia IV. Nursing and Midwifery practitioners Nursing 1. Nurse SPK/DI: 9 years of education in school + 3 years education in nursing in Indonesia 20

2. Nurse D III: 12 years of education in school + 3 years education in nursing or 9 years of education in school + 3 years of education in nursing + additional 2 years education in nursing in Indonesia 3. Nurse SI: Nurse SPK/DI + Nurse DIII + 2 and half year training in Nursing OR Nurse DIII + 2 and half year training in Nursing OR 12 years of education in school + 4 and half years training in Nursing Midwifery 1. Midwife DI: Nurse SPK + 1 year training in Midwifery 2. Midwife D III: Nurse SPK + Midwife DI = 2 years additional training in midwifery 3. Midwife D IV: Nurse SPK + Midwife DIII + 1 year additional training in midwifery OR 12 years of education in school + Midwife DIII OR 12 years of education in school + Midwife DIII + 1 year additional training in midwifery V. Non- Public Health 1. Public Health Generalists: 12 years of education in school + 4 years of education in university in public health (Bachelor s of Public Health) 2. Public Health Specialists: Public Health Generalists + 2 years of post graduate education in university in any speciality of public health (epidemiology, public health nutrition etc..) 3. Nutrition Professionals Nutritionist D I: 12 years of education in school + 1 year training in nutrition Nutritionist D III: 12 years of education in school + 3 years training in nutrition 4. Environmental Health Inspectors Environment Health Inspectors DI: 12 years of education in school + 1 year education in environmental science Environment Health Inspectors DIII: 12 years of education in school + 1 year education in environmental science Environment Health Inspectors SI: Environment Health Inspectors DIII + 2 years education in environmental science (Bachelor s degree) 5. Community Health Volunteers Promotores Saude Familia (PSF): People chosen by the community and trained to deal with health problems of individuals and the community 21

VI. Technologists Imaging Technicians 1. Radiographer DI: 12 years of education in school + 1 year of training in radiography 2. Radiographer DIII: 12 years of education in school + 3 years of training in radiography 3. Radiographer SI: Radiographer DIII + 1 year additional training in radiography 4. Electromedik DIII: 12 years of education in school + 3 years of training in electro medical science Laboratory Assistants 1. Laboratory Assistant SMAK/SPK : 9 years of education in school + 6 months training in laboratory technology 2. Laboratory Assistant DI: 9 years of education in school + 3years of training in laboratory technology or 12 years of education in school + 3 years of training in laboratory technology 3. Laboratory Assistant DIII: Laboratory Assistant DI + 3 years of education in laboratory technology 4. Laboratory Assistant SI: Laboratory Assistant SMAK/SPK + DIII + 2 and half additional education in laboratory technology or 12 years of education in school + 4 years of education in laboratory technology (Bachelor s degree) VII. Other Health Workers Optometrists 1. Optometrist DI: 12 years of education in school + 1 year of training in optometry at IHS, Timor Leste 2. Optometrist SI (Bachelor s degree): 12 years of education in school + 4 years of education in Optometry Physiotherapists 1. Physiotherapist DIII: 12 years of education in school + 3 years of education in physiotherapy (Indonesia) VIII. Health management and support staff 1. Health Service Manager: 9 years of education in school + 3 years of training in nursing + some training in health service managment 22

2. Records Technicians: 12 years of education in school + 2 years of training in any health area + 2 years training in records (Indonesia) 3. Support staff: 9 or 12 years of education in school with some training in support functions 23

4.2.1 Gender distribution by health workforce categories/cadre Table 4.2 Gender distribution by health workforce category/cadre Category Sub-category Cadre* Total (2011) Female % Female General Practitioner General 75 38 50.7 Specialists Specialists 9 1 11.1 Dental Dentists Dentists SI 7 4 57.1 Dental nurses DIII 1 0.0 Dental Nurse SPRG 37 14 37.8 Dental lab technicians DI 1 0.0 Pharmacy practitioners Pharmacists Pharmacist DIII 15 7 46.7 Pharmaceutical technicians/ assistants Junior Pharmacy Technician (D1) 95 51 53.7 Pharmacy Technician (SMF) 21 13 61.9 Nursing and Midwifery practitioners Nursing professionals Nurse SPK/DI 800 241 30.1 Nurse D III 82 42 51.2 Nurse SI 1 0.0 Midwifery Professionals Midwife DI 370 370 100.0 Midwife D III 28 28 100.0 Midwife D IV 2 2 100.0 Non- Public Health Public Health Generalists Public Health Specialists Public Health Generalists Public Health Specialists 47 0.0 17 2 11.8 Nutrition Professionals Nutritionist D I 6 1 16.7 Nutritionist D III 25 9 36.0 Environmental Health Officer Environment Health Officer DI Environment Health Officer DIII Environment Health Officer SI 7 1 14.3 19 4 21.1 1 0.0 24

Category Sub-category Cadre* Total (2011) Female % Female Community Health Volunteers Promotores Saude Familia (PSF) Technologists Imaging Technicians Radiographer DI 15 0.0 Radiographer DIII 25 0.0 Radiographer SI 1 0.0 Electromedik DIII 7 0.0 Laboratory Assistants Laboratory Assistant SMAK/SPK Laboratory Assistant DI Laboratory Assistant DIII Laboratory Assistant SI 30 9 30.0 69 28 40.6 32 18 56.3 1 0.0 Traditional Medicine Practitioner Traditional Medicine Practitioner No cadre, not in government service. NOT recognized in indigenous system of medicine Other Health Workers Optometrists Optometrist DI 13 8 61.5 Physiotherapists Physiotherapist DIII 1 0.0 Health management and support staff Health Service Manager Records Technicians Health Service Manager Records Technicians 65 4 6.2 1 0.0 Support staff Support staff 555 57 10.3 TOTAL 2481 952 38.4 Source: Human Resources Department, Ministry of Health, Timor-Leste Note: * Please provide names of all cadres, additional rows may be added to accommodate all cadres under each sub-category. 25

4.2.2 Age distribution by occupation/cadre Table 4.3 Workers by age group and cadre Category Sub-category Cadre* Total (2011) 30 Yrs 31-40 yrs 41-50 51 General Practitioner General 75 21 42 12 Specialists Specialists 9 1 8 Dental Dentists Dentists SI 7 2 2 3 Dental nurses DIII 1 1 Dental Nurse SPRG 37 1 22 12 2 Dental lab technicians DI 1 1 Pharmacy practitioners Pharmacists Pharmacist DIII 15 10 4 1 Pharmaceutical technicians/ assistants Junior Pharmacy Technician (D1) Pharmacy Technician (SMF) 95 89 4 2 21 1 15 5 Nursing and Midwifery practitioners Nursing professionals Nurse SPK/DI 800 43 323 304 130 Nurse D III 82 12 58 9 3 Nurse SI 1 1 Midwifery Professionals Midwife DI 370 15 256 86 13 Midwife D III 28 16 12 Midwife D IV 2 2 Non- Public Health Public Health Generalists Public Health Specialists Public Health Generalists Public Health Specialists 47 10 22 10 5 17 4 12 1 Nutrition Professionals Nutritionist D I 6 2 4 Nutritionist D III 25 2 19 4 Environmental Health Officer Community Health Volunteers Environment Health Officer DI Environment Health Officer DIII Environment Health Officer SI Promotores Saude Familia (PSF) 7 6 1 19 1 17 1 1 1 26

Category Sub-category Cadre* Total (2011) 30 Yrs 31-40 yrs 41-50 51 Technologists Imaging Technicians Radiographer DI 15 2 6 5 2 Radiographer DIII 25 5 10 7 3 Radiographer SI 1 1 Electromedik DIII 7 1 4 2 Laboratory Assistants Laboratory Assistant SMAK/SPK Laboratory Assistant DI Laboratory Assistant DIII Laboratory Assistant SI 30 1 18 10 1 69 59 5 5 32 14 12 6 1 1 Traditional Medicine Practitioner Traditional Medicine Practitioner No cadre, not in government service. NOT recognized in indigenous system of medicine Other Health Workers Optometrists Optometrist DI 13 10 3 Physiotherapists Physiotherapist DIII 1 1 Health management and support staff Health Service Manager Records Technicians Health Service Manager Records Technicians 65 15 27 15 1 1 Support staff Support staff 555 101 216 157 81 TOTAL 2481 402 1108 707 256 Source: Human Resources Department, Ministry of Health, Timor-Leste Note: * Please provide names of all cadres, additional rows may be added to accommodate all cadres under each sub-category. 27

4.2.3 Region/province/district distribution by occupation/cadre Please discuss major variations in the distribution of workers by region/sub-national level. Table 4.4 Regional/District/province distribution of workers Category Subcategory Cadre* Total (2011) Aileu Ainaro Baucau Bobonaro Covalima Dili Ermera Lautem Liquisa Manatuto Manufahi Oecusse Viqueque General Practitioner General 75 3 4 3 3 53 1 1 1 1 3 2 Specialists Specialists 9 9 Dental Dentists Dentists SI 7 1 6 Dental nurses DIII 1 1 Dental Nurse SPRG Dental lab technicians DI 37 3 2 3 2 2 11 2 2 1 1 2 2 4 1 1 Pharmacy practitioners Pharmacists Pharmacist DIII 15 2 11 1 1 Pharmaceuti cal technicians/ assistants Junior Pharmacy Technician (D1) Pharmacy Technician (SMF) 95 6 5 11 8 8 10 8 7 8 6 5 4 9 21 1 2 11 4 2 1 Nursing and Midwifery Nursing professionals Nurse SPK/DI 800 26 28 125 63 59 230 44 35 27 42 26 27 68 Nurse D III 82 3 5 5 3 35 1 2 1 1 4 4

Category Subcategory Cadre* Total (2011) Aileu Ainaro Baucau Bobonaro Covalima Dili Ermera Lautem Liquisa Manatuto Manufahi Oecusse Viqueque practitioners Nurse SI 1 1 Midwifery Professionals Midwife DI 370 18 19 49 21 22 103 15 19 15 31 16 21 21 Midwife D III 28 1 1 4 3 1 12 1 1 2 1 1 Midwife D IV 2 2 Non- Public Public Health 47 2 1 1 2 1 32 1 2 3 2 Public Health Health Generalists Generalists Public Public Health 17 1 1 15 Health Specialists Specialists Nutrition Professionals Nutritionist D I 6 1 1 1 1 1 1 Nutritionist D III 25 1 2 2 2 8 1 3 1 2 2 1 Environment al Health Officer Community Health Volunteers Environment Health Officer DI Environment Health Officer DIII Environment Health Officer SI Promotores Saude Familia (PSF) 7 1 1 1 3 1 19 2 3 2 1 6 1 1 1 2 1 1 Technologists Imaging Radiographer DI 15 2 2 1 1 1 2 1 1 2 2 Radiographer DIII 25 3 4 2 2 5 2 1 1 3 2 29

Category Subcategory Cadre* Total (2011) Aileu Ainaro Baucau Bobonaro Covalima Dili Ermera Lautem Liquisa Manatuto Manufahi Oecusse Viqueque Technicians Radiographer SI 1 1 Electromedik DIII 7 1 1 1 1 2 1 Laboratory Assistants Laboratory Assistant SMAK/SPK Laboratory Assistant DI Laboratory Assistant DIII Laboratory Assistant SI 30 1 2 1 2 13 2 3 2 2 2 69 5 4 6 6 7 13 4 4 3 4 3 6 4 32 3 1 2 22 1 2 1 1 1 Traditional Medicine Practitioner Traditional Medicine Practitioner No cadre, not in government service. NOT recognized in indigenous system of medicine Other Health Workers Optometrists Optometrist DI 13 1 2 1 2 1 1 1 1 2 1 Physiotherap Physiotherapist 1 1 ists DIII Health Health Health Service 65 4 3 5 7 7 6 6 5 3 6 4 4 5 management and Service Manager support staff Manager Records 1 1 Records Technicians 30

Category Subcategory Cadre* Total (2011) Aileu Ainaro Baucau Bobonaro Covalima Dili Ermera Lautem Liquisa Manatuto Manufahi Oecusse Viqueque Technicians Support staff Support staff 555 23 34 69 25 37 159 34 39 28 17 34 35 21 Total 2451 90 121 302 162 159 786 123 130 90 121 100 126 153 Source: Human Resources Department, Ministry of Health, Timor-Leste Note: * Please provide names of all cadres, additional rows may be added to accommodate all cadres under each sub-category. 31

4.2.4 Urban/rural distribution by occupation/cadre Table 4.5 Urban/Rural distribution of workforce Category Sub-category Cadre* Total (2011) % Urban % Rural General Practitioner General 75 64 11 Specialists Specialists 9 9 0 Dental Dentists Dentists SI 7 3 4 Dental nurses DIII 1 1 0 Dental Nurse SPRG 37 14 23 Dental lab technicians DI 1 1 0 Pharmacy practitioners Pharmacists Pharmacist DIII 15 13 2 Pharmaceutical technicians/ assistants Junior Pharmacy Technician (D1) Pharmacy Technician (SMF) 95 44 51 21 17 4 Nursing and Midwifery practitioners Nursing professionals Nurse SPK/DI 800 436 364 Nurse D III 82 69 13 Nurse SI 1 1 0 Midwifery Professionals Midwife DI 370 130 240 Midwife D III 28 15 13 Midwife D IV 2 2 0 Non- Public Health Public Health Generalists Public Health Specialists Public Health Generalists Public Health Specialists 47 38 9 17 17 0 Nutrition Professionals Nutritionist D I 6 4 2 Nutritionist D III 25 23 2 Environmental Health Officer Community Health Volunteers Environment Health Officer DI Environment Health Officer DIII Environment Health Officer SI Promotores Saude Familia (PSF) 7 7 0 19 16 3 1 1 0

Category Sub-category Cadre* Total (2011) % Urban % Rural Technologists Imaging Technicians Radiographer DI 15 10 5 Radiographer DIII 25 18 7 Radiographer SI 1 1 0 Electromedik DIII 7 7 0 Laboratory Assistants Laboratory Assistant SMAK/SPK 30 15 15 Laboratory Assistant DI 69 17 52 Laboratory Assistant DIII 32 30 2 Laboratory Assistant SI 1 1 0 Traditional Medicine Practitioner Traditional Medicine Practitioner No cadre, not in government service. NOT recognized in indigenous system of medicine 0 0 0 Other Health Workers Optometrists Optometrist DI 13 7 6 Physiotherapists Physiotherapist DIII 1 1 0 Health management and support staff Health Service Manager Records Technicians Health Service Manager Records Technicians 65 65 0 1 1 0 Support staff Support staff 555 310 245 TOTAL 2481 1408 1073 Urban health workforce = All health workers working in cities, municipalities, and district centres/head offices (including those health workers in other sectors outside health ministries). Rural health workforce = All health workers working outside cities, municipalities, and district centres/head offices (including those health workers in other sectors outside health ministries). Source: Human Resources Department, Ministry of Health, Timor-Leste 33

4.2.5 Distribution by occupation/cadre Private sector in Timor-Leste exists. The size of the private sector is not known. It consists of non-profit private clinics (faith based institutions, Coffee Cooperatives, international and national non-government organizations); and for-profit private. Table 4.6 Public/Private for profit/faith based organization/private not for profit distribution of health workers Category Sub-category Cadre* Total (2011) % Public sector % Private sector % Faith based organization % Private not-forprofit General Practitioner General 75 75 Specialists Specialists 9 9 Dental Dentists Dentists SI 7 7 Dental nurses DIII 1 1 Dental Nurse SPRG 37 37 Dental lab technicians DI 1 1 Pharmacy practitioners Pharmacists Pharmacist DIII 15 15 Pharmaceutical technicians/ assistants Junior Pharmacy Technician (D1) Pharmacy Technician (SMF) 95 95 21 21 Nursing and Midwifery practitioners Nursing professionals Nurse SPK/DI 800 800 Nurse D III 82 82 Nurse SI 1 1 Midwifery Professionals Midwife DI 370 370 Midwife D III 28 28 Midwife D IV 2 2 Non- Public Health Public Health Generalists Public Health Specialists Public Health Generalists Public Health Specialists 47 47 17 17 Nutrition Professionals Nutritionist D I 6 6 Nutritionist D III 25 25 Environmental Health Officer Environment Health Officer DI 7 7 34

Category Sub-category Cadre* Total (2011) % Public sector % Private sector % Faith based organization % Private not-forprofit Environment Health Officer DIII Environment Health Officer SI 19 19 1 1 Technologists Community Health Volunteers Imaging Technicians Promotores Saude Familia (PSF) Radiographer DI 15 15 Radiographer DIII 25 25 Radiographer SI 1 1 Electromedik DIII 7 7 Laboratory Assistants Laboratory Assistant SMAK/SPK Laboratory Assistant DI Laboratory Assistant DIII Laboratory Assistant SI 30 30 69 69 32 32 1 1 Traditional Medicine Practitioner Traditional Medicine Practitioner No cadre, not in government service. NOT recognized in indigenous system of medicine Other Health Workers Optometrists Optometrist DI 13 13 Physiotherapists Physiotherapist DIII 1 1 Health management and support staff Health Service Manager Records Technicians Health Service Manager Records Technicians 65 65 1 1 Support staff Support staff 555 555 TOTAL 2481 2481 Public sector: Includes all government owned/funded health facilities under health ministry and other related ministries. Source: Human Resources Department, Ministry of Health, Timor-Leste 35

5 HRH Production 5.1 Pre-service education The Faculty of Health Sciences, National University of Timor-Leste, Ministry of Education, the Institute of Health Science, Ministry of Health and a private university provide pre and in-service training for healthcare providers. National and referral hospitals offer training facilities and internships. A school of nursing and midwifery at the National University Timor Lorosa e (UNTL) is proposed. Twinning arrangements exist with institutions in Portugal for nursing and midwifery. These arrangement were made to overcome barriers imposed by a lack of qualified teachers. An MOH policy for admissions of students from sub-district to the nursing and midwifery under UNTL could not materialize due to a lack of concurrence from the Ministry of Education. In 2003 a bilateral cooperation agreement between the governments of the Democratic Republic of Timor Leste and the Republic of Cuba was signed. Under this agreement the first group of 20 students went to study medicine in Cuba in 2005. A medical school was established in Timor-Leste under the National University of Timor Leste (Univercidade Nacional de Timor Lorosae - UNTL). It is managed by Cuban medical professors and the medium of instruction is Spanish. As part of the collaboration, 162 Cuban medical doctors, 30 nurses and 32 technicians are currently working in Timor-Leste as health-care providers and teachers in the medical school. On completing the 4th year of the medical school, the Timorese medical students return to Timor Leste for clinical training. This forms part of years 5 and 6 of the curriculum. Students have also been sent to other countries like Indonesia, Papua New Guinea, Fiji, Malaysia and Australia. Details of the number of students is given in Table 4.2 36

Table 5.1 Number of Training Institutions by type of ownership Type of training institution Medicine Name of the training institution in Timor- Leste The National University of East Timor (Portuguese: Universidade Nacional de Timor Leste; Tetum: Universidade Nasionál Timór Lorosa'e), (UNTL), Dili Public Type of ownership Total Private not Private for for profit, Profit FBOs 1 0 0 1 Dentistry 0 0 0 0 Pharmacy 0 0 0 0 Nursing & Midwifery* Public: 1 1 0 2 The National University of East Timor (UNTL), Dili Private: Institute of Christil., Dili Health sciences 0 0 0 0 Public health 1. Peace University, 0 2 0 2 (Bachelor s degree in Public Health, 5 years course). Government accreditated 2. University of Dili (Bachelor s degree in Public Health, 5 years course). No government accreditation technology 0 0 0 0 Traditional Medicine 0 0 0 0 Other Allied Health 0 0 0 0 (indicate the type of cadre) TOTAl 3 2 0 5 FBO = Faith based Organization Public = All government owned/funded training institutes under health, education and other related ministries. Note: * to report midwifery separately if midwifery programme is not an integral part of the nursing programme and there is a separate midwifery school for this purpose. 37

Table 5.2 Number of entrants and graduates by year Number of entrants Total Input Number of graduates Total Output Category Sub-category STUDENTS IN CUBA Nursing and Midwifery practitioners General Practitioner (Medicina Jeral Basik) Nursing professionals 2003 2004 2005 2006 2007 2008 2009 2010 2011 2009 2010 2011 2012 2013 2014 2015 2016 2017 18 8 453 198 677 18 8 453 198 677 1 1 2 1 1 2 Technologists Technicians 3 3 3 3 6 Other Health Workers Optometrists 1 1 Other health professionals not elsewhere classified (Psychologist) 1 1 1 1 STUDENTS IN TIMOR LESTE at The National University of East Timor (Portuguese: Universidade Nacional de Timor Leste; Tetum: Universidade Nasionál Timór Lorosa'e), (UNTL) Nursing and Midwifery practitioners General Practitioner (Medicina Jeral Basik) Nursing professionals 55 47 47 19 60 42 270 55 47 47 19 60 42 270 40 75 75 75 265 39 75 75 75 264

Midwifery Professionals 40 75 75 75 265 37 75 75 75 262 STUDENTS IN TIMOR LESTE at Institute of Health Sciences (Instituo de Cliencias de Saude ICS), Dili Nursing and Midwifery practitioners Nursing professionals Midwifery Professionals 38 38 38 38 21 31 52 21 31 52 Pharmacy practitioners Pharmaceutical assistants (Diploma in Pharmacy) 66 66 66 66 Other Health Workers Optometrists 17 17 17 17 STUDENTS IN INDONESIA Specialists 3 14 17 2 14 16 Pharmacy practitioners Pharmacists 6 6 6 6 Non- Public Health Technologists Public Health Generalists Technicians 7 6 9 22 7 2 9 5 6 11 5 6 11 (Electromedic) Health management and support staff Health Service Manager 6 6?? 39

STUDENTS IN Papua New Guinea Specialists 2 2 2 2 STUDENTS IN Malaysia Specialists 2 2 2 2 STUDENTS IN Phillipines STUDENTS in Australia Technologists STUDENTS in Fiji Technologists Specialists 3 3?? Laboratory Technician Laboratory Technician 1 1?? 1 1 1 1 Pharmacy practitioners Pharmacists 1 1 1 1 Physio- and Occupational Therapists Physiotherapists 1 1 1 1 TOTAL 3 19 30 521 338 225 181 224 209 1709 135 156 679 198 201 37 60 42 1704 Source: Human Resource Department, Ministry of Health, Timor Leste 40

The overall need of human resources for health has been defined in the the National Health Sector Strategic Plan.. The experience shows that it is difficult to retain health professionals in remote areas. due to inadequate accommodation facility and poor basic infrastructure such as electricity, water supply, and access to public transportation. In response the MoH has decided to recruit local people health professionals training with the expectation they could return to their home district, sub-district and village on graduating.

5.2 In-service and continuing education The National Health Institute (Instituo Nacional Saude INS) under the MoH is responsible for provision of in-service education. UN agencies (UNICEF, UNFPA and WHO); Royal Australian College Surgeons; NGOs both national and international provide financial support for specific short term trainings for health professionals in public and private sector. The trainings are not planned.and are based on requests from different departments of MoH and on financial support.. There is also a lack of technical material and experts at INS. The curricula and training modules are developed by relevant departments of MoH in collaboration with development partners 5.3 Health workforce requirements The National Health Sector Strategic Plans (2011-2030) vision for the future includes expansion of health posts from the existing 193 to 442. i.e. one health post in every suco over 20 years, with a minimum level of staffing one medical doctor, two nurses, two midwives and one laboratory technician serving around thousand to two thousand population; 66 health centres with average 10.000 20.000 population, with two medical doctors, one dentist, ten nurses and ten midwives, one eye care nurse and one dental nurse, one pharmacist, two laboratory technicians, four public health staff for nutrition, environmental health, health promotion and health information system and others support staff including one manager, administration and cleaning services staffs. Currently there are five referral hospital and one national hospital. It is proposed to develop 13 district hospitals, three regional referral hospitals and one national hospital. Districts hospitals will be staffed with with 4 specialists, one anaesthetist with others professionals including general practitioners, dentist, nurses, midwives and others allied health professionals and administration and supporting staffs. The regional hospitals will provide a minimum of 16 specialists, with others professionals staffing both medical staffing, nurses, midwives, others allied health professionals and administration support staffs. The national hospital will provide 37 general, supra and sub-specialist services, with others medical and nursing staffs and other allied health professionals and administrative staffs. Detailed health workforce projections by category are in the process of development. 42

6. HRH Utilization 6.1 Recruitment The recruitment process is centralized with Civil Service Commission. There are two types of staff, the permanent and short term staff. The Ministry of Health has estimated the staff requirement: health services, administration, and other support services. For all posts minimum eligibility criteria has been defined and the posts are advertised for 2 weeks. Candidates who meet the eligibility criteria are invited for a written test. Only those with more than 60% marks are invited for interview. Health professionals need to qualify only in the written test. Written test includes questions on technical area and knowledge about civil service rules and regulations. All graduates who possess a health degree and supported by MoH for training are recruited..during the period 2011 to2015 between 200 500 candidates supported by government will graduate. New posts will need to be created to accommodate both clinical and non-clinical staff. 6.2 Deployment and distribution mechanisms The National Health Strategic Plan gives the overall direction of the needs of the health staffs for health posts, health centres, and hospitals. And with the local need driven selection it is expected that a health professional after he graduated and recruited primarily will be deployed to he or her origin district, subdistrict and village in line with the needs. Under the Civil Servant Law, all civil servants are subject to annual performance appraisal which determines promotion. 43

7. Governance for HRH 7.1 HRH policies and plans All public sector personnel are governed by the Public Service Commission rules and regulations. There is no national health workforce policy document. However a National Health Workforce Plan 2007-2015 exists. This is a revision to Human Resources Master Plan 2002-2011, developed by MOH in 2002, which was not approved as it was found lacking in strategic directions. The National Health Workforce Plan 2007-2015 aims to provide strategic directions for the management and training of health workers. The National Health Workforce Plan draws upon the: The Health Sector Strategic Plan; The National Development Plan; The Health Policy Framework Paper; and The Basic Services Package. 7.2 Policy development, planning and managing for HRH The primary responsibility of HRH management rests with National Directorate of Human Resource, Ministry of Health. Key responsibilities of the Directorate include: Human resource Planning, Personnel Management and Health professional Registration. The Director General overseas MOH at the central level. The District Health Management Team is responsible for district level management. The roles and responsibilities are yet to be defined for health personnel at all levels. A need for clear direction on HRH management has been identified. It is particularly important in light of coming expected influx of national health care force studying medicine, nursing and other allied courses in the coming years. 7.3 Professional Regulation The accreditation and registration of medical doctors and other health professionals is governed by Decree-Law No 14/2004 dated 1 September 2004. The MOH accredits and registers health professionals. The Disciplinary Council of Health Professions (comprising of H.E. Health Minister or 44

reprehensive, health inspector, representatives of professional associations duly registered under the law, and one representative of the association of health service users) is responsible for the disciplinary oversight. MoH issues professional cards to professionals (diploma holders) registered with the MoH. It is mandatory for all fresh graduates to be registered with the MoH. However, the MoH discontinued issuing of professional cards for international health professionals in 2011.. This was because it found itdifficult to validate their qualifications. The MoH only issues identity cards for suchindividuals. As pre-service health personnel education is under the UNTL, therefore the accreditation of health professional schools and programmes is under the jurisdiction of the Ministry of Education. Accreditation criteria is currently being developed with involvement of MoH and professional bodies. 7.4 HRH information A monitoring and evaluation plan for national HRH strategic objectives is yet to be developed. Establishment of Human Resource Information System is proposed. 7.5 HRH research There are no HRH specific research programmes. 45

Annex 1: Classification of health workforce of the WHO South-East Asia Region The health workforce of the WHO South-East Asia Region is grouped into the following 10 categories: 1. practitioners Includes general practitioners, medical specialists and medical assistants. 2. Dental practitioners Includes dentists, dental specialists and dental technicians (e.g. dental assistants, dental hygienists, dental nurses). 3. Pharmacy practitioners Includes pharmacists, pharmaceutical technicians/assistants (e.g. pharmacy assistants, pharmaceutical technicians). 4. Nursing and midwifery practitioners Includes nursing professionals, midwifery professionals, nursing-midwifery professionals, nursing specialists, midwifery specialists, nursing associate professionals (e.g. public health midwives, community midwives, assistant midwives, community-based skilled birth attendants), and nursingmidwifery associate professionals (e.g. auxiliary nurse-midwives). 5. Non-medical public health practitioners Includes public health generalists, public health, specialists, food and nutrition professionals (e.g. nutritionists, food science specialist, dieticians), environmental and occupational health professions (e.g. environmental health officer, sanitarians, occupational health officers), environmental and occupational health inspectors and associates (e.g. public health inspectors, food inspectors), community health workers (e.g. basic health workers, family welfare assistants, family welfare visitors, health assistants, lady health visitors), and community health volunteers. 6. technologists Includes medical imaging technicians (e.g. radiographers, mammographers), medical technicians (e.g. medical laboratory technicians, blood bank technicians), laboratory assistants (e.g. medical laboratory assistants, assistant radiographers, assistant blood bank technician), and biomedical technologists (e.g. medical equipment technicians, medical equipment engineers, biomedical technologist, biomedical engineers). 7. Traditional medicine practitioners Includes traditional medicine practitioners (e.g. Ayurvedic Practitioner, Homeopath, Koryo Medicine, Unani. 8. Veterinarian practitioners (working for human health aspects) Includes veterinary public health specialists, and veterinary technicians. 9. Other health workers Includes a large number of health workers such as optometrists, physiotherapists, physiotherapy assistants, occupational therapists, occupational therapy assistant, and other health professional and health associate professionals not elsewhere classified. 46

10. Health management and support staff Includes a large number of non-health professional workers such as health service managers, medical records technicians, health statisticians, clerical, accounting and other general support staff (e.g. ward clerks, medical secretary, medical store keepers). 47

Human Resources for Health Country Profile Template, WHO/SEARO Annex 2: Health workforce classification mapping of the WHO South-East Asia Region (Note: Code for each sub-category as per International Standard Classification of Occupations code) Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations Practitio ners General Practitioner (2211) Professionals with minimum of 4 years of university education in the field of medicine with minimum of 1 year internship. Preventing, diagnosing, caring for and treating illness, disease and injury in humans and the maintenance of general health. They do not limit their practice to certain disease categories or methods of treatment, and may assume responsibility for the provision of continuing and comprehensive medical care. General, Doctors, Physicians. They may supervise the implementation of care and treatment plans by other health care providers, and conduct medical education and research activities. Specialists (2212) doctors with minimum of 1 year of postgraduate education/ training. They are recognized as specialists by a national regulatory body (such as medical council). Preventing, diagnosing, caring for and treating illness, disease and injury in humans using specialised testing, diagnostic, medical, surgical, physical and psychological techniques. They specialise in certain disease categories, types of patient or methods of treatment, and may conduct medical education and research activities in their chosen areas of specialisation. They may supervise the implementation of care and treatment plans by other health care providers. Anesthesiologists, Cardiologists, Community medicine specialists, Critical care medicine specialists, Dermatologists, Emergency medicine specialists, Endocrinologists, Family medicine physicians/ specialists, Gastroenterologists, Geriatric medicine specialists, Haematologists, Hepatologists, Infectious disease specialists, examiners, oncologists, Neonatologists, Nephrologists, Neurologists, Nuclear medicine specialists, Obstetric- Gynecologists, Occupational medicine specialists, Orthopedic surgeons, Otolaryngologists (ear, nose, and throat specialists),

Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations Pathologist, Pediatrician, Perinatologist, Preventive and social medicine/public health specialists, Psychiatrists, Radiation oncologists, Radiologists, Rheumatologists, Sports medicine specialists, Surgeons, Urologists. Assistants (3256) Assistants to the medical doctors with minimum of 3 years of accredited education/training in medical assistant. Perform basic clinical and administrative tasks to support patient care under the direct supervision of, or as per plan, practices and procedures established by a medical practitioner or other health professional. Assistants. Dental Practitio ners Dentists (2261) Professionals with minimum of 4 years of accredited university education leading to a dentistry degree. Diagnosing, treating and preventing diseases, injuries and abnormalities of the teeth, mouth, jaws and associated tissues to promote and restore oral health. Dentists. Dental Specialists (2261) Dentist with accredited postgraduate degree in dental specialty. They are recognized as specialists by a national regulatory Diagnosing, treating and preventing diseases, injuries and abnormalities of the teeth, mouth, jaws and associated tissues where the complexity of a condition requires specialised diagnostic, surgical and other techniques to promote and restore oral health. They usually practise in their specialized field only. Endodontists, Oral and maxillo-facial surgeons, Orthodontists, Paedodontists, Periodontists, Prosthodontists. body (such as dental council). Dental Technicians (3251) Assistants to dentists with minimum of 1 year of training in dental skills. Provide basic dental care services for the prevention and treatment of diseases and disorders of the teeth and mouth, as per care plans and procedures established by a dentist or other oral health professional. Dental Assistants, Dental Hygienists, Dental Nurses. Pharma cy practitio ners Pharmacists (2262) Professionals with minimum of 4 years university education in pharmacy and internship. Store, preserve, compound, test and dispense medicinal products. They counsel on the proper use and adverse effects of drugs and medicines following prescriptions issued by medical doctors and other health professionals. Pharmacists. 49

Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations They contribute to researching, preparing, prescribing and monitoring medicinal therapies for optimising human health. Pharmaceuti cal technicians/ assistants (3213) Assistants to pharmacists with minimum of 1 year of accredited education in pharmacy assistant or technician. Perform routine tasks associated with preparing and dispensing medicinal products under the supervision of a pharmacist or other health professional. Pharmacy Assistants, Pharmaceutical Technicians Nursing and Midwifer y practitio ners Nursing professional s (2221) Professionals with minimum of 3 years of accredited education in the field of nursing. Plan, manage, provide and evaluate nursing care services for persons in need of such care due to effects of illness, injury, or other physical or mental impairment, or potential risks for health. They work autonomously or in teams with medical doctors and other health workers. Professional Nurses, Staff Nurses, Public Health Nurses, Community Health Nurses. They may supervise the implementation of nursing care plans, and conduct nursing education activities. Midwifery Professional s (2222) Professionals with minimum of 3 years of accredited education in the field of midwifery. Plan, manage, provide and evaluate midwifery care services before, during and after pregnancy and childbirth and newborn care. They provide normal delivery care for reducing health risks to women and newborns, working autonomously or in teams with other health care providers. Professional Midwives. They may supervise the implementation of midwifery care plans, and conduct midwifery education activities. Nursing- Midwifery Professional s (2221 & 2222) Professionals with minimum of 3 years of accredited education in the field of nursing and midwifery or nursing professionals having 6 months - 1 year of accredited post-basic education in the field of midwifery. Plan, manage, provide and evaluate (1) nursing care services for persons in need of such care due to effects of illness, injury, or other physical or mental impairment, or potential risks for health and (2) midwifery care services before, during and after pregnancy and childbirth, including normal delivery, and newborn care. They work autonomously or in teams with medical doctors and other health workers. They may supervise the implementation of nursingmidwifery care plans, and conduct nursingmidwifery education activities. General Nurse- Midwives, Professional Nurse- Midwives. Nursing Specialists (2221) Nursing Professionals with minimum of 1 year of accredited post-basic Plan, manage, provide and evaluate specialized nursing care services for persons in need of such care due to effects of illness, injury, or other physical or mental impairment, or potential risks Clinical Nurse Specialists, Advanced Practice Nurses, Nurse 50

Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations training/education in any specialty in nursing (e.g. pediatric, neonatal, cardiac nursing, etc). They are recognized as specialists by a national regulatory body (such as nursing council). for health. They specialise in certain nursing specialty and may conduct nursing education and research activities in their chosen areas of specialisation. They work autonomously or in teams with medical doctors and other health workers. They may conduct midwifery education activities and provide consultation to other nursing practitioners.. Midwifery Specialists (2222) Midwifery Professionals with minimum of 1 year of accredited post-basic training/education in advanced midwifery. They are recognized as specialists by a national regulatory body (such as midwifery council or nursing and midwifery council). Plan, manage, provide and evaluate midwifery care services before, during and after pregnancy and childbirth and newborn care where complexity of conditions/situations required advanced knowledge and skills in midwifery. They provide normal delivery care as well as perform selected life-saving interventions for reducing health risks to women and newborns, working autonomously or in teams with other health care providers. They may conduct education and research activities in midwifery and provide consultation to other midwifery practitioners. Advanced Practice Midwives, Midwife. Nursing Associate professional s (3221) with minimum of 18 months of accredited education in the field of nursing. Provide basic nursing care for people who are in need of such care due to effects of illness, injury, or other physical or mental impairment. They implement care and referral plans as per plans, practice and procedures established by nursing and other health professionals. Practical Nurses. with 6 months - 1 year of education/training in the field of nursing. Assist in providing routine patient care services as per care plans, practices and procedures established by nursing and other health professionals. Assistant Nurses, Nurse Aids. Midwifery Associate professional s (3222) with 18 months 2 years of accredited education in the field of midwifery. Provide basic midwifery care and advise before, during and after pregnancy and childbirth and newborn care. They implement care and referral plans, including normal delivery, to reduce health risks to women and newborns as per plans, practice and procedures established by midwifery and other health professionals. Public Health Midwives, Community Midwives. with 6 months of accredited midwifery education. Assist in providing basic midwifery care and advise before, during and after pregnancy and childbirth and newborn care. Assistant Midwives, Community-based Skilled Birth 51

Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations They implement care and referral plans, including Attendants. assisting in normal delivery, to reduce health risks to women and newborns as per plans, practice and procedures established by midwifery and other health professionals. Nursing- Midwifery Associate professional s (3221 & 3222) with minimum of 18 months of accredited education in the field of nursing and midwifery. Provide basic nursing care for people who are in need of such care due to effects of illness, injury, or other physical or mental impairment as well as provide basic midwifery care and advise before, during and after pregnancy and childbirth, including normal delivery, and newborn care. They implement care and referral plans as per plans, practice and procedures established by nursing, midwifery and other health professionals. Auxiliary Nurse- Midwives. Non- Public Health Practitio ners Public Health Generalists (2263) Non-medical professionals with university education in public health bachelor s degree. Plan, manage, provide and evaluate basic public health services for disease prevention and promotion of population health. They manage environments to reduce health risks of the community. Public Health Officer, Public Health Technical Officer. Public Health Specialists (2263) Non-medical public health professionals with post-graduate degree in public health specialties (e.g. epidemiology, entomology, health economics, health statistics, health education etc). Plan, manage, provide and evaluate specialized public health interventions in their area of specialization for disease prevention, promotion of population health, and minimize health risks of the community. Epidemiologists, Health Educators, Health Promotion Officer/specialists, Biostatisticians. Food and Nutrition Professional s (2265) Professionals with minimum of 3 years of university education in nutrition/dietetics. Plan, manage, provide and evaluate various dietary interventions, clinical and/or public health nutrition programmes, food safety, food technology or food toxicology programmes. Nutritionists, Food Science specialists, Dieticians. Environmen tal and Occupationa l Health Professional s Professionals with minimum of 3 years of university education in environmental and/or occupational health. Plan, assess and investigate the implementation of programs and regulations to monitor and control environmental factors that can potentially affect human health, to ensure safe and healthy working conditions, and to ensure the safety of processes for the production of goods and services. Environmental Health Officer, Sanitarians, Occupational Health officer. (2263) Environmen t and occupational with minimum of 2 years training in public Plan, assess and investigate the implementation of programmes and regulations to monitor and control environmental factors that can potentially affect Public Health Inspectors, Food inspectors. 52

Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations health inspectors and associates health or related fields. water, sanitation, food hygiene, food safety; and carry out disease investigation and prevention. (3257) Community Health workers (3253), not elsewhere classified, work at the district level and below in the health system with formal education of 6-18 months. Provide health education, referral and follow-up, case management, and basic preventive health care and home visiting services to specific communities. They provide support and assistance to individuals and families in navigating the health and social services system. Family Welfare Assistants, Family Welfare Visitors, Lady Health Visitors, Health Assistants, Basic Health Workers, Community Health Volunteers (3253) People chosen by the community and trained to deal with health problems of individuals and the community. Provide health education and assist individuals, families in the communities accessing health care services. Community health volunteers, Public Health Communicators, Public Health Volunteers, Village Health Volunteers. Technol ogists Imaging Technicians (3211) with minimum of 2 years of education in medical technology, radiology or a related field. Test and operate radiographic, ultrasound and other medical imaging equipment to produce images of body structures for the diagnosis and treatment of injury, disease and other impairments. Radiographers, Mammographers. Technicians (3212) with minimum of 2 years of accredited education/training in medical technology or related field. Perform tests on environmental and human specimens of body fluids and tissues in order to get information about the disease epidemiology and / or health of a patient or cause of disease/death. Laboratory Technicians, Blood Bank Technicians. Laboratory Assistants (3212) Assistants to medical technicians with minimum of 1 year of accredited training in any health technicians course. (e.g. laboratory, radiology, etc.). Assist in non-invasive diagnostic/screening procedures (radiographic, ultrasound, other imaging procedures) or perform/assist in conduct of tests on environmental and human specimens of body fluids and tissues in order to get information about the disease epidemiology and / or health of a patient or cause of disease/death as per plan, practices and procedures established by medical technology and other health professionals. Laboratory Assistants, Assistant Radiographers, Assistant Blood Bank Technician Biomedical technologist s with minimum of 2 years of education in the Service, maintain and repair radiographic, ultrasound, laboratory and other medical equipment. Equipment Technicians, Equipment Engineers, (3211) field of bio-medical engineering or a Biomedical technologist, 53

Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations related field. Biomedical Engineers. Traditio nal Medicin e Practitio ner Traditional Medicine (2230) recognized in indigenous system of medicine (Homeopathic/ Oriental Medicine Apply procedures and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention or treatment of physical and mental illnesses. Ayurvedic, Unani, Homeopath, Koryo medicine practitioners. /Complementary Medicine) with minimum of 4 years education leading to a degree + 1 year internship Veterina ry practitio ners (workin g for human health aspects ) Veterinary Public Health Specialists (2250) Veterinary doctors (professionals with at least 4.5 years of university education in the field of veterinary medicine + internship) with minimum 1 year of post-graduate education on epidemiology/ veterinary public health. Preventing, diagnosing and controlling zoonoses, food borne illnesses and intoxications. Providing expert opinion as a team member in outbreak investigation of emerging diseases/zoonoses at the human animal interface. They may assume responsibility for food safety. Veterinary Public Health Specialists, Veterinary Epidemiologists. Veterinary technicians and assistants (3240) Assistants to veterinarians with minimum 1 year of education in animal science. Assist in performing basic veterinary tasks to support laboratory animal management and zoonoses control under the direct supervision of, or as per plan, practices and procedures established by a veterinary doctor or other health professional. Veterinary Technicians, Veterinary Assistants Other Health Workers Optometrists (2267) with minimum of 2 years education in the field of optometry Provide primary eye health and vision care services. They provide diagnosis management and treatment services for disorders of the eyes and visual system. Dispensing opticians design, fit and dispense optical lenses for the correction of reduced visual acuity. Optometrists, Ophthalmic Technicians. Physiothera pists (2264) with minimum of 2 years of education in physiotherapy. Provide physical therapeutic treatments to patients in circumstances where functional movement is threatened by injury, disease or impairment. They may apply movement, ultrasound, heating, laser and other techniques. Physiotherapists, Physical Therapists. 54

Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations Physiothera py Assistants (3255) Assistants to physiotherapists with minimum of 1 year of education in physiotherapy. Provide basic physical therapeutic treatments to patients as per plan, practices and procedures established by physiotherapy and other health professionals Physiotherapy Assistants. Occupationa l Therapists (2269) with minimum of 2 years of education in occupational therapy. Provide occupational therapeutic treatments to patients to improve their ability to perform tasks in their daily living and working environments. They work with individuals who have conditions that are mentally, physically, developmentally, socially or emotionally disabling. Occupational Therapists. They also help them to develop, recover, or maintain daily living and work skills. Occupationa l Therapy Assistant (2269) Assistants to occupational therapists with minimum of 1 year of education in occupational therapy. Provide basic occupational therapeutic treatments to patients as per plan, practices and procedures established by occupational therapy and other health professionals. Occupational Therapy Assistant. Other health professional s not elsewhere classified To be defined by countries as per country context. To be defined by countries as per country context. To be defined by countries as per country context. (2269) Other health associate professional s not elsewhere classified To be defined by countries as per country context. To be defined by countries as per country context. To be defined by countries as per country context. (3259) Health manage ment and support staff Health Service Manager (1342) Records Technicians (3252) Non-medical professionals with minimum of 2 years education in health service management. with minimum of 1 year of education in health information and/or medical records. Plan, coordinate and supervise the provision of clinical, personal care and community health care services. Assess, manage and implement health records processing, storage and retrieval systems in medical facilities and other health care settings to meet the legal, professional, ethical and administrative records-keeping requirements of health services delivery. District Health Officer. Records Technicians, Health Statisticians. 55

Catego ry Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations Support staff Clerical, accounting, and other support staff. This category may include a wide range of occupations connected with health service provision. Ward Clerks, Secretary, Store Keeper. 56

Annex 3: Health workforce classification mapping of Timor Leste (Note: Code for each sub-category as per International Standard Classification of Occupations code) Category Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations General Practitioner Professionals with minimum of 7 years of university education in the field of medicine with minimum of 1 year internship. (Doctors trained in Indonesia) Professionals with minimum of 6 years of university education in the field of Preventing, diagnosing, caring for and treating illness, disease and injury in humans and the maintenance of general health. They do not limit their practice to certain disease categories or methods of treatment, and may assume responsibility for the provision of continuing and comprehensive medical care. They may supervise the implementation of care and treatment plans by other health care providers, and conduct medical education and research activities. General, Doctors, Physicians. medicine with minimum of 1 year internship. (Doctors trained in Cuba and Timor Leste) Specialists doctors with minimum of 2 year of Preventing, diagnosing, caring for and treating illness, disease and injury in humans using specialised testing, diagnostic, medical, surgical, Anesthesiologists, Cardiologists, Dermatologists, postgraduate education/ training. physical and psychological techniques. They specialise in certain disease categories, types of patient or methods of treatment, and may conduct medical education and research activities in their chosen areas of specialisation. They may supervise the implementation of care and treatment plans by other health care providers. Endocrinologists, Obstetric- Gynecologists, Orthopedic surgeons, Otolaryngologists (ear, nose, and throat specialists), Pathologist, Pediatrician,, Psychiatrists, Radiation oncologists, Surgeons Dental Dentists Professionals with minimum Diagnosing, treating and preventing diseases, injuries and abnormalities of the teeth, mouth, Dentists. 57

Category Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations of 6 years of accredited university education leading to a dentistry degree. (Dentists trained in Indonesia) jaws and associated tissues to promote and restore oral health. Dental Technicians Assistants to dentists with minimum of 3 year of training in dental skills. (Dental Nurses and technicians trained in Indonesia) Provide basic dental care services for the prevention and treatment of diseases and disorders of the teeth and mouth, as per care plans and procedures established by a dentist or other oral health professional. Dental Nurses, Dental Laboratory Technician Pharmacy practitioners Pharmacists Professionals with minimum of 3 years university education in pharmacy (Pharmacist trained in Indonesia) Professionals with minimum of 4 years university education in pharmacy Store, preserve, compound, test and dispense medicinal products. They counsel on the proper use and adverse effects of drugs and medicines following prescriptions issued by medical doctors and other health professionals. They contribute to researching, preparing, prescribing and monitoring medicinal therapies for optimising human health. Pharmacists. (Pharmacist trained in Cuba) Pharmaceuti cal technicians/ assistants ( Assistants to pharmacists with minimum of 3 year of education in pharmacy science (Pharmacy technician trained in Indonesia). Perform routine tasks associated with preparing and dispensing medicinal products under the supervision of a pharmacist or other health professional. Junior Pharmacy Technician 58

Category Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations Nursing and Midwifery practitioners Nursing professionals Professionals with minimum of 3 years of education in the field of nursing. Plan, manage, provide and evaluate nursing care services for persons in need of such care due to effects of illness, injury, or other physical or mental impairment, or potential risks for health. They work autonomously or in teams with medical doctors and other health workers. Professional Nurses They may supervise the implementation of nursing care plans, and conduct nursing education activities. Midwifery Professional s Professionals with minimum of 1 years of education in the field of midwifery. Plan, manage, provide and evaluate midwifery care services before, during and after pregnancy and childbirth and newborn care. They provide normal delivery care for reducing health risks to women and newborns, working autonomously or in teams with other health care providers. Professional Midwives. They may supervise the implementation of midwifery care plans, and conduct midwifery education activities. Midwifery Associate professionals with 18 months 2 years of accredited education in the field of midwifery. Provide basic midwifery care and advise before, during and after pregnancy and childbirth and newborn care. They implement care and referral plans, including normal delivery, to reduce health risks to women and newborns as per plans, practice and procedures established by midwifery and other health professionals. Public Health Midwives, Community Midwives. with 6 months of accredited midwifery education. Assist in providing basic midwifery care and advise before, during and after pregnancy and childbirth and newborn care. They implement care and referral plans, including assisting in normal delivery, to reduce health risks to women and newborns as per plans, practice and procedures established by midwifery and other health professionals. Assistant Midwives, Community-based Skilled Birth Attendants. Nursing- Midwifery Associate professionals with minimum of 18 months of accredited education in the field of nursing and midwifery. Provide basic nursing care for people who are in need of such care due to effects of illness, injury, or other physical or mental impairment as well as provide basic midwifery care and advise before, during and after pregnancy and childbirth, including normal delivery, and newborn care. Auxiliary Nurse- Midwives. They implement care and referral plans as per 59

Category Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations plans, practice and procedures established by nursing, midwifery and other health professionals. Non- Public Health Public Health Generalists Non-medical professionals with university education in public health bachelor s degree. Plan, manage, provide and evaluate basic public health services for disease prevention and promotion of population health. They manage environments to reduce health risks of the community. Public Health Officer Public Health Specialists Non-medical public health professionals with postgraduate degree in public health specialties (e.g. epidemiology, entomology, health Plan, manage, provide and evaluate specialized public health interventions in their area of specialization for disease prevention, promotion of population health, and minimize health risks of the community. Public Health Officer economics, health statistics, health education etc). Nutrition Professional Professionals with minimum of 1 year of university education in nutrition/dietetic s. Plan, manage, provide and evaluate various dietary interventions, clinical and/or public health nutrition programmes Nutritionists Environment al Health Professional s Professionals with minimum of 1 years of university education in environmental health. Plan, assess and investigate the implementation of programs and regulations to monitor and control environmental factors that can potentially affect human health, to ensure safe and healthy working conditions, and to ensure the safety of processes for the production of goods and services. Environmental Health Officer, Community Health Volunteers People chosen by the community and trained to deal with health problems of individuals and the community. Provide health education and assist individuals, families in the communities accessing health care services. Promotores Saude Familia (PSF) 60

Category Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations Technologists Imaging with minimum Test and operate radiographic and imaging equipment to produce images of body structures Radiographers, Technicians of 1 years of for the diagnosis and treatment of injury, disease education in and other impairments. medical radiology or a related field. Laboratory Assistants to Assist in non-invasive diagnostic/screening Laboratory Assistants medical procedures (radiographic, ultrasound, other Assistants, technicians with imaging procedures) or perform/assist in minimum of conduct of tests on environmental and human 6months specimens of body fluids and tissues in order to training in any get information about the disease epidemiology health and / or health of a patient or cause of technicians disease/death as per plan, practices and course. (e.g. procedures established by medical technology laboratory, and other health professionals. radiology, etc.). Other Health Workers Optometrists with minimum Provide primary eye health and vision care services. Optometrists, Op. of 1 years education in the field of optometry Dispensing opticians design, fit and dispense optical lenses for the correction of reduced visual acuity. Physiotherap Provide physical therapeutic treatments to Physiotherapists, ists with minimum patients in circumstances where functional Physiotherapist Nurse of 3 years of movement is threatened by injury, disease or education in impairment. physiotherapy. They may apply movement, ultrasound, heating, laser and other techniques. Health Health Non-medical Plan, coordinate and supervise the provision of District Health Officer. management and support staff Service Manager professionals with some training in clinical, personal care and community health care services. health service management. Assess, manage and implement health records Records Records with minimum processing, storage and retrieval systems in Technicians. Technicians of 2 year of medical facilities and other health care settings education in to meet the legal, professional, ethical and health administrative records-keeping requirements of information health services delivery. and/or medical records. (Trained in 61

Category Subcategory (Code) Definition based on educational qualification Scope of work Examples of designations Indonesia) Support staff Clerical, accounting, and other support staff. This category may include a wide range of occupations connected with health service provision. Ward Clerks, Secretary, Store Keeper. Logistics, Driver, Security, Cleaner, HR, Admin 62

Annex 4: Members of the taskforce Name Position/title Organization Contact address Mr Duarte Ximenes Director,Human Ministry of Health, Timor duartex01@yahoo.com Resources Department, Leste Dr Sergio Lobo National Advisor, Human Resources Ministry of Health sgclobo@yahoo.com Mr Francisco do Rego Mr Ostelino da Silva Mr Basilio Martins Pinto Mr Augusto J Pinto Department Human Resources Department, Human Resources Department Head, Health Policy Department Human Resources Department Ministry of Health Ministry of Health Ministry of Health Ministry of Health joen_63@yahoo.com lenio6204@yahoo.com basiliomp67@yahoo.com lacurubic_78@yahoo.com 63