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Development and implementation of Timor-Leste health policy framework 2002 : a governance analysis

Soares, Ana Isabel de Fátima Sousa (2013). Development and implementation of Timor-Leste health policy framework 2002 : a governance analysis. PhD Thesis, Charles Darwin University.

Document type: Thesis
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Author Soares, Ana Isabel de Fátima Sousa
Title Development and implementation of Timor-Leste health policy framework 2002 : a governance analysis
Institution Charles Darwin University
Publication Date 2013-03
Thesis Type PhD
Supervisor Thynne, Ian Seaton
Belton, Suzanne
Rickard, Greg
Subjects 1117 - Public Health and Health Services
Abstract This thesis examines the role of the central and local administration (the Ministry of Health and District Health Service) and their development partners who are tasked with the implementation of health services with the attendant relevant health policies within the bounds of the Timor-Leste’s Health Policy Framework 2002. This study explores and analyzes how health policy actors, decision makers and implementers engage with policy processes and elements of governance. The elements include: structure, power, equity, ethics, cooperation, responsiveness, transparency, accountability, effectiveness and efficiency, and participation.

The research explores structures and processes that are in place, the way they operate, and their legitimacy. It compares these arrangements in two districts, where one district has good performance and one district has poor performance in terms of achieving Ministry of Health identified health indicators and objectives. The study identifies that these elements of governance are essential to strengthen local health governance and to improve the health status and well-being of the Timorese people.

The overall design of this study followed mixed-methods, qualitative and quantitative approaches with case studies. NVIVO 8 computer software program was used to facilitate data analysis and assist with interpretation. It was identified that the two districts have similarities and differences in history and experience of governance, as well as geography, demography, socio economic and human capital background. These have contributed to differences in performance and differences in the achievement of health indicators and objectives. It was found that the development of health policies and procedures was dominated by those with power,
including donors and leaders of the political parties, which disempowered the local administration and communities. Lack of responsiveness on the part of the central and local administration and partners is the foremost concern of both districts. This lack of responsiveness jeopardizes the implementation of health programs.
Keyword health policy process
system and governance


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