Evaluation of Rural Incentive Schemes for Health Workers in Timor-Leste

The project works with partner countries and local stakeholders to reduce financial barriers to care and treatment, ensure equitable access to essential health services for all people, and improve the quality of health services. Led by Abt Associates, the five-year, $209 million project will build local capacity to sustain strong health system performance, supporting countries on their journey to self-reliance and prosperity. The Ministry of Health (MoH) in Timor-Leste has made significant progress in increasing the number of health workers in the country. By 2001, the MoH had recruited 724 health workers, but high vacancy rates persisted in Dili and the National Hospital due to the lack of higher-level trained specialists. However, a diplomatic agreement between Timor-Leste and Cuban leadership in 2003 resulted in a game-changing increase in the number of medical doctors. By the end of 2004, the Cuban Medical Brigade had agreed to train 1,000 local doctors in Cuba and deploy 300 Cuban doctors to do the training. This effectively increased the ratio of doctors to population from 0.03 to 0.71 doctors per 1,000 people, making the ratio the highest in Southeast Asia. The number of health workers has increased substantially over the past 15 years, doubling in the past five years alone. By August 2017, there were 4,911 public servants on the MoH payroll, compared with just 900 in 2002. The growing number of new medical graduates joining the workforce has given the government a sufficient pool of health workers to meet the government's human resources (HR) targets. The Strategic Plan 2011–2030 aims to staff each of the 498 villages in the country with one generalist doctor, two nurses, two midwives, and a laboratory technician. However, this opportunity comes with great challenges. The increase in the country's financial burden from a growing health workforce is unavoidable. As of 2016, about 80 percent of the health budget went to health workers' salaries. The relative size of this investment in human resources for health (HRH) indicates the need to ensure that those funds are effectively and efficiently spent. In addition, there is a need to retain those professionals who will soon be freed from their six-year contract that requires them to work in the public sector. The MoH can build on existing incentives, such as training scholarships, and devise and effectively implement additional ones to retain these health professionals. The MoH also needs to respond to the lack of motivation of health workers in rural areas, where absenteeism has been reported. Evidence suggests that many health workers prefer to work in urban areas because the rural areas lack infrastructure and basic services. In response, the government has made a great effort to retain health workers in the remote areas by developing incentive mechanisms, such as recruiting students from rural areas, providing scholarships for health professionals, and implementing rural incentive schemes. The evaluation of these schemes is crucial to determine their effectiveness in retaining health workers in rural areas and improving the quality of health services in these areas. The evaluation of rural incentive schemes for health workers in Timor-Leste is a critical component of the LHSS project. The evaluation aims to assess the effectiveness of these schemes in retaining health workers in rural areas and improving the quality of health services in these areas. The evaluation will provide recommendations to the MoH on how to improve the rural incentive schemes and ensure that they are effective in achieving their objectives. The evaluation will also provide insights into the challenges faced by health workers in rural areas and the factors that influence their motivation and retention.