Retaining doctors in rural Timor-Leste: a critical appraisal of the opportunities and challenges

Health policies and human resource developmentThe government of Timor-Leste recognizes the influence of various social determinants -e.g.education, housing, water and sanitation -on health and therefore seeks to integrate the health sector with several other sectors.The national health sector strategic plan for 2011-2030 embodied the government's goal of providing comprehensive, free primary care and hospital services to all Timorese until 2030. 9Investment in human capital is one of the four priority areas identified in the plan as critical for the efficient delivery of health services.9 Improvement of Timor-Leste's human resources for health has been high on the national government's policy agenda.Soon after the country achieved independence in 2002, the Ministry of Health prepared a Human resources master plan for 2002-2011 to guide future development of the health workforce.10 A year later, a major bilateral agreement between the governments of Timor-Leste and Cuba resulted in the Cuban government offering scholarships to study medicine in Cuba to nearly 700 Timorese students.11 Simultaneously, the Cuban government sent around 230 doctors to work in Timor-Leste.Abstract Timor-Leste is in the process of addressing a key issue for the country's health sector: a medical workforce that is too small to provide adequate care.In theory, a bilateral programme of medical cooperation with Cuba created in 2003 could solve this problem.By the end of 2013, nearly 700 new doctors trained in Cuba had been added to Timor-Leste's medical workforce and by 2017 a further 328 doctors should have been trained in the country by Cuban and local health professionals.A few more doctors who have been trained in Indonesia and elsewhere will also soon enter the workforce.It is expected that the number of physicians in Timor-Leste in 2017 will be more than three times the number present in the country in 2003.Most of the new physicians are expected to work in rural communities and support the national government's goal of improving health outcomes for the rural majority.Although the massive growth in the medical workforce could change the way health care is delivered and substantially improve health outcomes throughout the country, there are challenges that must be overcome if Timor-Leste is to derive the maximum benefit from such growth.It appears crucial that most of the new doctors be deployed in rural communities and managed carefully to optimize their rural retention.