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)

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