Lessons from the Cuba-Timor Leste

Health Co-operation
Tim Anderson, University of Sydney
Health Care Personnel Training Session
Transforming Timor Leste Conference
Dili, 6 July, 2009
• Largest and most effective health aid
program in the region – yet very little
studied
• I want to outline how it happened, before
moving to these two questions:
– What makes this program profound?
– What are the lessons from it?
 How did it happen?

• Agreement on program early 2003 at Non

Aligned Movement summit in Malaysia
• Program grew rapidly 2004-2006
– 2003, first students leave for Cuba, September
– 2004, 15 doctors arrive in TL, April
– 2005, scholarship offer raised to 300, April (JRH)
– 2005, scholarship offer raised to 1,000, Dec (MA)
– 2006, almost 300 Cuban health workers in TL
Why 1,000 scholarships?
• A number of African countries had several dozen Cuban
scholarships, and Cuban doctors, but
• the only other Cuban program outside LatAm of this
scale was for Western Sahara (UN decol list)
• Cuba (a NOAL leader) clearly identified with TL’s newly
independent status, and its liberation struggle
• Fidel Castro commented that Cuba perhaps did not help
TL as much as it could have, in the past (RA)
• The program 2003-2005 had proceeded very well
 What makes this program profound?

• Question of technical excellence? – c.f. USGO

behaviour and accreditation
• Developing country oriented training, with
preventive and primary focus
• Ethos of training – public sector, solidarity
oriented, against ‘entrepreneurial medicine’
• Systematic nature – large scale, long term,
coordinated and with an exit strategy
Benefits of the approach:
• Rural health care system initiated and serviced
by Cuban doctors, at minimal cost
• Training aims to address needs of entire national
system, with indigenous personnel
• Rural, preventive, primary focus meets needs
• Ethos and scale should mitigate the ‘brain drain’
• Cuban technical and further training back up
 What lessons and challenges?

For Timor Leste:

• Need to continue investing in infrastructure and
human resources
• Flexible incorporation of incoming graduates
• Commitment to support and develop TL Faculty
of Medicine
• Coordination of the various international health
programs and projects
For global cooperation:
• Note Cuba’s preparatory training in language
and science (c.f. required language standards)
• Note benefits of systematic programs, with full
transmission of skills (c.f. projects, dependency)
• Look for articulation of health cooperation
programs (through TL Health) making use of
new human capacity (c.f. projects)