The impact of out-of-pocket expenditures on families and barriers to use of maternal and child health services in Timor-Leste

As a young nation, Timor-Leste has made considerable advances in rebuilding its health system, but overall utilisation of health services remains low by regional standards. This paper underlines that the Timor-Leste population continues to face a heavy burden regarding maternal and child health, though the government is committed to improving the access of its people to adequate healthcare services.

The paper highlights that public sector facilities in Timor-Leste are free to most patients, and informal payments are rare, unlike in other countries. However, it notes that:

• large disparities exist in use of critical maternal and child health services between rich and poor, and across districts, and these correlate with maternal and child health outcomes
• the limited financial impact of out-of-pocket spending is evident, but it does not mean that the there is good healthcare coverage
• indeed, the low level of spending is largely because most families lack access to any medical facilities
• in addition, a frequent shortage of medicines is an area where families do experience some financial burdens in obtaining care

Conclusions are that:

• expanding the use of facility-based maternal and child health services is critical to improving maternal and child health outcomes in Timor-Leste
• expanding access to inpatient services is also critical to improve rates of skilled birth attendance
• as a matter of fact, the government must focus on expanding the service delivery network in rural areas to bring healthcare facilities closer to most families
• the Timorese healthcare system must be strengthened by improving the supply and availability of medicines in government facilities