Alonso Alvaro, Brugha Ruairí
Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.
Health Policy Plan. 2006 May;21(3):206-16. doi: 10.1093/heapol/czl006. Epub 2006 Mar 24.
Efforts to rehabilitate health systems after periods of prolonged conflict have often been characterized by poor coordination of external actors - multilateral agencies, donors and non-governmental organizations (NGOs). This paper describes the process and analyses the roles of the different stakeholders in the establishment of a government-led district health system in East Timor, between 1999 and 2002, after decades of chronic conflict and Indonesian occupation. Future East Timorese policy-makers and health professionals began to mobilize in May 1999, in preparation for independence. During the emergency phase, from September 1999, when violence erupted, to March 2000, NGOs played a major role in the provision of relief to the population, coordinated by United Nations agencies. An Interim Health Authority, led by local Timorese, was established in March and the major donors began to shift funding from NGOs to the newly established Ministry of Health. A rapid phasing-out of NGOs, accompanied by a sequence of steps to build the capacity of Timorese to manage the new district health system, was implemented. Early evidence shows that health service utilization continued to grow during and after implementation.
在经历长期冲突后恢复卫生系统的努力，往往存在外部行为体——多边机构、捐助方和非政府组织（NGO）之间协调不力的问题。本文描述了1999年至2002年期间，在经历数十年长期冲突和印度尼西亚占领后，东帝汶建立政府主导的地区卫生系统的过程，并分析了不同利益相关者所发挥的作用。未来的东帝汶政策制定者和卫生专业人员于1999年5月开始动员起来，为独立做准备。在1999年9月暴力事件爆发至2000年3月的紧急阶段，非政府组织在联合国机构的协调下，在向民众提供救济方面发挥了主要作用。3月成立了由东帝汶当地人领导的临时卫生当局，主要捐助方开始将资金从非政府组织转向新成立的卫生部。非政府组织迅速逐步退出，同时实施了一系列措施，以增强东帝汶人管理新地区卫生系统的能力。早期证据表明，在实施过程中及实施后，卫生服务利用率持续上升。
