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Statement by Honorable, H.E. Minister of Health, Ministry of Health, RDTL

67th World Health Assembly

Geneva 21 May, 2014: 011.45 am.

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Honorable Chair, Excellences, Madame Director-General of the World Health Organization, Distinguished Delegates, Ladies and Gentlemen

Let me start by congratulating the elected President and Vice Presidents of the 67^th World Health Assembly. I would also like to thank Madame Director-General for your inspirational speech that is a reminder of the health challenges that need to be addressed.

Timor-Leste is a member state of the South East Asia Region. It is committed to the goal of nation building by establishing peace and stability. It faces numerous challenges that affect health and well-being of its people.

In Timor-Leste 70% of the population lives in rural areas in small, dispersed villages isolated by mountainous terrain and poor road conditions. The country has made steady progress in the health sector in the last decade by: reconstruction of health facilities; expansion of community based health services like the SISCa programme. Our efforts are directed at strengthening human resources for health by training considerable number of medical students. Some notable achievements of the health sector include reduction in child mortality from 84/1000 to 64/1000 live births, Elimination of Maternal and Neonatal Tetanus, increase in exclusive breastfeeding rate for 0-6 month old children from 31% in 2003 to 52% in 2010 and improvement in vaccination coverage. The use of modern contraceptives has increased from 7% to 21%.

Despite these achievements we face considerable challenges. These include:

Completing the unfinished agenda of MDGs: addressing high levels of maternal mortality ratio ( 556 per 100,000 live births), infant mortality rate( 64 per 1000 live births) and malnutrition (Stunting 58%, Wasting 18.6% Maternal Malnutrition Rate 27%), child morbidity and mortality. Preliminary results of the recent (2013) National Nutrition Survey show reduction in stunting rates to 50.2% in children but still remain very high.

In addition, the country is highly vulnerable to impacts of climate change which if unchecked could jeopardize the current health gains. The Intergovernmental Panel on Climate Change (IPCC) recently issued a report which says that the effects of climate change are already occurring on all continents and across the oceans. It also says that climate change is affecting health directly due to extreme heat events, floods and indirectly it is affecting vector borne and water borne diseases, under nutrition and mental illness. Many countries are ill-prepared for risks from a changing climate, particularly developing countries where health systems are weak, primary health facilities are ill-prepared and ill-equipped to respond to extreme weather and climatic events, and diseases and meteorological surveillance systems are weak and communities have inadequate coping capacity. To sustain health gains, it would be very important for the Ministries of Health to build the climate resilience of their current actions by incorporating climate risks in their climate sensitive disease programs, by building capacity of health workers and communities, and by strengthening resilience of health facilities to extreme climate and weather events. It is also essential to collaborate with other agencies such as agriculture, water, sanitation, energy, transport, infrastructure to identify risks and develop long term sustainable health adaptation measures to climate change.

The Government has prioritized nutrition in its development agenda and declared its commitment through the 2010 Comoro Declaration, to put an end to hunger and malnutrition. Recently on January 9, 2014 Timor-Leste became the first country in Asia-Pacific to launch a national campaign under the United Nations Zero Hunger Challenge, which seeks to ensure universal access to food in the face of looming threats such as climate change. 

There is a need for renewed focus on communicable and neglected diseases that pose a public health challenges .Currently the prevalence of malaria is being declined  to <0,9/1000 population, some districts is going to pre eliminate,  HIV still low prevalence and the International Health Regulation has been established.

Simultaneously focus is required to address non- communicable diseases such as cardiovascular, chronic obstructive pulmonary diseases that are among the ten leading causes of death. Health services for persons with disabilities, in particular those with mental disabilities, need to be strengthened. SEAR member States wish to emphasize that NCDs are not just a health issue but also a social and development issue. Since the Political Declaration of the UN HLM of the NCDs in 2011, NCDs have been prioritized as a major public health agenda by SEAR Member States.  The Sixty-sixth Session of the Regional Committee unanimously approved the NCD action plan for SEAR for the period 2013–2020. Subsequently national targets and action plans are being developed at the country level.  In addition to the nine global voluntary targets, SEAR countries have taken up an additional target on reducing household air pollution due to the use of solid fuels for cooking. This is a major issue affecting the health of women and children and linked to poverty.Efforts to reduce NCD risk factors, such as tobacco use are being intensified through legislative and fiscal policies. Integrated risk factor surveys are being carried out to measure and monitor trends in underlying determinants of NCDs.  The importance of strengthening vital registration system is increasingly being recognized by Member countries. Early detection and management of NCDs by strengthening primary health care system is now recognized as a key initiative within the health sector. However most of these initiatives are at a pilot stage.

To respond to the issues of Post-2015 Development Agenda, Timor-Leste hosted a Conference on the Post-2015 development agenda in February 2013. It was attended by governments and civil society from the g7+ group of fragile states, Pacific island countries and the group of Portuguese-speaking African Countries (PALOP). The theme of the conference was “Development for all: Stop Conflict, build states and eradicate poverty”. It concluded with the “ Dili Consensus ” that underlined the fact that MDGs cannot be achieved in small, landlocked or conflict affected states in the absence of peace, stability and the rule of law.

There is a need to strive for improving universal health care, promoting health equity and delivering quality health services, improving health sector capacity addressing communicable and non communicable diseases. This necessitiates adoption of a multisectoral approach to health that focuses on social, environmental and economic determinants of health.

Timor-Lesteneed to strive for improving universal health care, promoting health equity and delivering quality health services, improving health sector capacity addressing communicable and non communicable diseases. This necesse and, as far as possible, decentralized and participatory.

Timor-Leste eed to strive for improving universal health care, promoting health equity and delivering quality health services, improving health sector capacity addressing communicable and non comm  provision of free universal health coverage. The National Health Sector Strategic Plan 2011 – 2030 lays a vision towards a “Healthy East Timorese People in a Healthy Timor-Leste”.

The Ministry is committed to improve situation by:

•       Increasing access and coverage by deploying doctors down to the level of sucos, reaching a 1:1500-2000 ration of doctor per population

•       Introduction of domiciliary visits as one of the strategies  to closely monitor health risk, health status and introduce life style modifications

•       Underlining the need for a multi-sectoral approach to health that focuses on social, environmental and economic determinants of health and Ministry of Health is involving other sectors in the process of  health development and involving the health sector in the development agenda of other sectors.

Timor-Leste is now focusing on health systems strengthening to ensure universal access to promotive, preventive, curative and rehabilitative health services. This requires development and implementation of robust national health policies, strategies and plans. Ministry of Health through the support of “EU-WHO Universal Health Coverage Partnership” will ensure that international and national stakeholders are increasingly aligned around National Health Sector Strategic Plan and adhere to other aid effectiveness principles. It will also focus on  improvement of technical and institutional capacities for policy, planning and health financing.

I take take this opportunity to thank all development partners annd especialy WHO  for all support that has been provided and we strongly request continued support from WHO to ensure universal health coverage to the population of Timor-Leste.

Thank for all your kind attention.

Geneva, 21  May, 2014.

Dr.Sergio G.C. Lobo, SpB

Minister of Health, RDTL