National Reporting Instrument 2024

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Background

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Adopted in 2010 at the 63rd World Health Assembly (WHA Res 63.16), the WHO Global Code of Practice on the International Recruitment of Health Personnel (“the Code”) seeks to strengthen the understanding and ethical management of international health personnel recruitment through improved data, information, and international cooperation.

Article 7 of the Code encourages WHO Member States to exchange information on the international recruitment and migration of health personnel. The WHO Director General is mandated to report to the World Health Assembly every 3 years.

WHO Member States completed the 4th round of national reporting in May 2022. The WHO Director General reported progress on implementation to the 75th World Health Assembly in May 2022 (A75/14). The report on the fourth round highlighted the need to assess implications of health personnel emigration in the context of additional vulnerabilities brought about by the COVID-19 pandemic. For this purpose, the Expert Advisory Group on the relevance and effectiveness of the Code (A 73/9) was reconvened. Following the recommendations of the Expert Advisory Group, the Secretariat has published the WHO health workforce support and safeguards list 2023.

The National Reporting Instrument (NRI) is a country-based, self-assessment tool for information exchange and Code monitoring. The NRI enables WHO to collect and share current evidence and information on the international recruitment and migration of health personnel. The findings from the 5th round of national reporting will be presented to the Executive Board (EB156) in January 2025 in preparation for the 78th World Health Assembly.

The deadline for submitting reports is 31 August 2024.

Article 9 of the Code mandates the WHO Director General to periodically report to the World Health Assembly on the review of the Code’s effectiveness in achieving its stated objectives and suggestions for its improvement. In 2024 a Member-State led expert advisory group will be convened for the third review of the Code’s relevance and effectiveness. The final report of the review will be presented to the 78th World Health Assembly.

For any queries or clarifications on filling in the online questionnaire please contact us at WHOGlobalCode@who.int.

What is the WHO Global Code of Practice?

Disclaimer: The data and information collected through the National Reporting Instrument will be made publicly available via the NRI database (https://www.who.int/teams/health-workforce/migration/practice/reports-database) following the proceedings of the 78th World Health Assembly. The quantitative data will be used to inform the National Health Workforce Accounts data portal (http://www.apps.who.int/nhwaportal/).

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Disclaimer

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[1] Note: Case-based facility data collection as that in the WHO Global Bum Registry does not require WHO Member State approval.
[2] The world health report 2013: research for universal coverage. Geneva: World Health Organization; 2013 (http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf)
[3] WHO statement on public disclosure of clinical trial results: Geneva: World Health Organization; 2015 (http://www.who.int/ictrp/results/en/, accessed 21 February 2018).
For more information on WHO Data Policy kindly refer to http://www.who.int/publishing/datapolicy/en/

I have read and understood the WHO policy on the use and sharing of data collected by WHO in Member States outside the context of public health emergencies

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Contact Details

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Name of Member State:

Timor-Leste

Name of designated national authority:

Agostinho da Cunha

Title of designated national authority:

National Director of Human Resources Health

Institution of the designated national authority:

: MOH Directorate Human Resources Health

Email:

agostinhodacunha4@gmail.com,WHOGlobalCode@who.int,dhilloni@who.int

Telephone number :

+670 77487451

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Contemporary issues

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Hide [NRIxI] The questions marked * are mandatory. The system will not allow submission until all mandatory questions are answered.

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Contemporary issues on health personnel migration and mobility

Hide [Q1x1] 1.1 In the past 3 years, has the issue of international recruitment of health personnel been a concern for your country?

No, this is not a problem in my country

Health workers in Timor-Leste have recorded substantial increase in the domestic workforce over the past 15 years, particularly in terms of availability and production capacity of doctors. The total number of health workers recorded by 2023 is more than 7,000.

Hide [Q1x2] 1.2 In the past 3 years, has the issue of international reliance on health personnel (international recruitment of health personnel to meet domestic needs) been a concern for your country?

No, this is not a problem in my country

Until 2016, there were 1000 doctors from Cuba working in Timor Leste. And in 2018, with the addition of Timorese health workers, be it general practitioners, specialist doctors, nurses, there was a change in policy. Yes, international health workers are only prioritized as specialist or subspecialist doctors. Currently, there are 74 specialist Timorese doctors working in 6 hospitals in Timor Leste. And specialist doctors from abroad; Cuba, China, as many as 31.

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Health Personnel Education

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Health personnel education, employment and health system sustainability

Hide [Q2] 2. Is your country taking measures to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country, including areas of greatest need?

Yes

Hide [Q2x1] Please check all items that apply from the list below:

2.1 Measures taken to ensure the sustainability of the health and care workforce

2.2 Measures taken to address the geographical mal-distribution and retention of health and care workers^*

2.3 Other relevant measures taken to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country

Hide [Q2x1x1] 2.1.1 Measures taken to ensure the sustainability of the health and care workforce

Forecasting future health and care workforce requirements to inform planning

To predict the need for health and care workers in the future, the analysis usually used is; the ratio of health workers to the population in Timor Leste, the National Strategic Plan for the Health Sector 2011-2030, and the National Strategic Plan for HRH. In addition, support has been obtained from WHO-TL experts to help forecast the needed per year, for the next 30 years.

Aligning domestic health and care workforce education with health system needs

Efforts that need to be made and have been outlined in the National Strategic Plan for Human Resources for Health (NSPHRH) are: Strengthen and update content and modalities for pre-service education, including: Curriculum review, Supervision of curricula in accordance with competencies defined for health personnel, and also Increase practice locations for students and new graduates (interns).

Improving quality of education and health personnel in alignment with service delivery needs

Develop the capacity of training and education institutions for the production of a qualified health workforce. Strengthen training/education institutions, Accreditation, Common Examination, Establishment of a Timorese Examinations Board, Regulation of private sector education

Creating employment opportunities aligned with population health needs

• Strategic interventions are needed such as; a standard staffing needs analysis aligned to the 2019 Essential Services Package, with complementary updates to costs and service requirements by level, which would also include pharmaceuticals and medical equipment needs, allowing for a comprehensive review of the medium-term needs of the entire health system. There may also be consideration of existing financial capacity and a realistic estimate of fiscal space for the next five years• Create a mechanism to deploy new graduates from remote areas to primary health care facilities in their places of origin. • Implement the $100 per month housing allowance for health workers in remote areas as stated by law • Implement the rural supplemental payments as required by law.

Managing international recruitment of health personnel

Timor-Leste is involved in bilateral consultations on international recruitment of health personnel. In 2003-2018, the Ministry of Health through the Ministry of Foreign Affairs of the TL carried out MOUs of cooperation with several countries such as the Republic of Cuba, Cabo Verde, Indonesia, Australia, China and others for health workers, especially general practitioners and specialist doctors, Legal Advisors to meet the demand in the Health sector at that time. Recruitment is usually based on expertise through CV analysis and interviews. In addition, bilateral discussions for visa exemptions for diplomatic and official passports took place with Cabo Verde, the Republic of Cuba, the Republic of China, and Indonesia.

Improving management of health personnel

Establish and roll out a human resources management manual to guide managers at the municipal and sub district levels in implementing policies and procedures as it applies to health workers under their purview. MOH to facilitate development and acquisition of management and leadership capacity for health professionals at all levels of the health system. Strengthen/build the capacity of Municipal Managers in the areas of management and decentralization.

Specific provisions on health personnel regulation and recruitment during emergencies

Until now, MOH TL has not had any arrangements or recruitment of health workers during emergency response

Others

Hide [Q2x2x1] Check all that apply for Measures taken to address the geographical mal-distribution and retention of health and care workers

2.2.1 Education

2.2.2 Regulation

2.2.3 Incentives

2.2.4 Support

Hide [Q2x2x1x1] 2.2.1.1 Education Measure

Education institutions based in rural/underserved areas

As a new country that is still in the development process, there are many problems such as inadequate educational buildings and facilities, lack of teaching staff, low salaries and not attracting people to work in remote areas

Student intake from rural/underserved areas and communities

It is true that through academic selection sometimes their academic grades do not meet the requirements

Scholarships and subsidies for education

Scholarships and educational subsidies are available from the Government, managed by the Ministry of Education ( Human Capital Development Funding)

Relevant topics/curricula in education and/or professional development programmes

Six nationally accredited institutions provide health training courses for pre-service candidates in the country. Most health staff are educated with the ultimate goal – and implicit assumption – of being absorbed into the public sector. All Faculties have curriculum topics available

(Re)orientation of education programmes towards primary health care

Ministry of Health Directorate of Public Health needs to have a technical meeting to see this program in depth

Others

Hide [Q2x2x2x1] 2.2.2.1 Regulation Measure

Scholarships and education subsidies with return of service agreements

Scholarships and education subsidies with service return agreements are regulated by ministerial regulations. Scholarships are given based on the length of education. For example, general practitioners have a 6-year education period. So, when they finish their education, they must work or serve for 6 years before they can move to another place, for example to a private health sector or others.

Mandatory service agreements with health personnel that are not related to scholarships or education subsidies

None, usually working as a civil servant who is willing to be placed anywhere.

Enhanced scope of practice of existing health personnel

All health facilities starting from Health Post, CHC, Referral and National Hospital are filled with all health workers who provide primary, secondary and tertiary health services to the people of Timor Leste

Task sharing between different professions

The HRH Directorate assisted by WHO Partner, USAID, developed a Job Description Manual for all health professions working in PHC, Secondary Health Care and Tertiary Health Care. So that health professionals work based on the existing job description

Provisions for pathways to enter new or specialised practice after rural service

This aspect is still under discussion, namely that a doctor who works in remote and very remote areas for 2-3 years will be given priority to take a specialist. However, there are no written ministerial regulations

Others

Hide [Q2x2x3x1] 2.2.3.1 Incentives Measure

Additional financial reimbursement

Additional financial reimbursement, subject to proof of expenditure

Education opportunities

Educational opportunities, many with various MOH partners, in addition to scholarships from the Government’s Human Capital Development Fund (HCDF/FDCH)

Opportunities for career advancement or professional growth

Not prioritized for opportunities for career advancement or professional growth

Professional recognition

Professional recognition, this is done when someone retires or dies.

Social recognition

Opportunity for pathways to permanent residency and/or citizenship for international health personnel

Others

Hide [Q2x2x4x1] 2.2.4.1 Support Measure

Decent and safe working conditions

Decent and safe working conditions exist, but only in a few places, not yet available in all places

Decent and safe living conditions

Decent and safe living conditions, this is very subjective

Distance learning/e-learning opportunities

Distance learning/e-learning opportunities, this opportunity is always available, depending on the person concerned to manage it. Only for internet access the connection is very low

Others

Hide [Q2x3x1] 2.3.1 Please describe - Other relevant measures taken to educate, employ and retain a health and care workforce that is appropriate for the specific conditions of your country.

Several measures can be implemented: 1) Training/Education: align health workforce production by the education sector to health sector needs; rationalize the scholarship scheme; invest in improving training institution faculties and infrastructure; complete a review of pre-service training curricula,2) Motivation, performance and retention: implement standard operating procedures for staff recruitment, deployment and transfers; providing regular, integrated in-service training with supportive supervision for all public health sector workers; offer opportunities for merit based career advancement; implement a rural retention incentive scheme comprised of financial and non-financial incentives.

Hide [Q3x1] 3.1 Are there specific policies and/or laws that guide international recruitment, migration and integration of foreign-trained health personnel in your country?

Yes

Hide [Q3x1x1] 3.1.1 Please provide further information in the box below:

Law/policy 1

WHO Global Code of Practice: Timor-Leste adheres to the WHO Global Code of Practice on the International Recruitment of Health Personnel. This code provides ethical guidelines and practices for the recruitment of health workers and aims to strengthen health systems globally

Law/policy 2

National Health Policies: Timor-Leste has developed national health policies that include strategies for human resources for health (HRH). These policies focus on rebuilding and strengthening the health workforce, especially in post-conflict settings.

Law/policy 3

International Organization for Migration (IOM): The IOM works with the Government of Timor-Leste to ensure safe, orderly, and regular migration. This includes supporting the integration of foreign-trained health personnel and protecting the rights of migrant workers

Hide [Q3x2] 3.2 Are there any policies and/or provision for international telehealth services in your country through health personnel based abroad?

Yes

Hide [Q3x2x1] Please describe

Timor-Leste has been working on implementing telehealth services, including collaborations with international health personnel. For example, the East Timor Hearts Fund (ETHF) has been providing cardiac services through telehealth since 2010, especially during the COVID-19 pandemic when international travel was restricted 1-2. These services have been crucial in addressing the significant burden of cardiac diseases in the country. Additionally, the World Health Organization (WHO) and other partners have been supporting Timor-Leste in improving healthcare access, including through telehealth initiatives. These efforts are part of broader strategies to enhance healthcare infrastructure and training for health workers in remote areas.

Hide [Q3x3] 3.3 Has your country established a database or compilation of laws and regulations related to international health personnel recruitment and migration and, as appropriate, information related to their implementation?

Yes

Hide [Q3x3x1] Please provide a web-link

Web-sitehttps://www.iom.int/sites/g/files/tmzbdl486/files/documents/2023-07/iom-tl-factsheet-v3.pdf. Timor-Leste has made efforts to address the recruitment and migration of health personnel through various policies and frameworks. However, there doesn’t appear to be a single, centralized database specifically compiling all laws and regulations related to international health personnel recruitment and migration. The country has developed strategies and policies to manage human resources for health, including recruitment strategies. Additionally, the International Organization for Migration (IOM) works with the Government of Timor-Leste to support migration governance, which includes aspects related to health personnel.

Hide [Q3x3x2] Please upload any format of documentation that provides such information (e.g. pdf, excel, word)
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Hide [Q4] 4. Recognizing the role of other government entities, does the Ministry of Health have mechanisms (e.g. policies, processes, unit) to monitor and coordinate across sectors on issues related to the international recruitment and migration of health personnel?

Yes

Hide [Q4x1] Please describe

The Ministry of Health (MOH) in Timor-Leste has mechanisms in place to monitor and coordinate across sectors on issues related to the international recruitment and migration of health personnel. These mechanisms include: Policies and Frameworks: The MOH has developed policies and frameworks to manage human resources for health (HRH). These policies are designed to address recruitment, retention, and deployment of health workers. Coordination Department: There are specific units within the MOH that focus on HRH administration. These units work in collaboration with other government entities, such as the Civil Service Commission, to ensure a coordinated approach to health workforce management. International Collaboration: The MOH collaborates with international organizations, such as the WHO, International Organization for Migration (IOM), to address issues related to the migration of health personnel. This collaboration helps in aligning national policies with international standards and practices. Integrated Health Programs: The MOH has implemented integrated health programs that aim to strengthen the healthcare system. These programs include capacity-building initiatives and the establishment of health simulation-based skills centers to improve the quality of medical care

Hide [Q5] 5. Please describe the steps taken by your country to implement the following Code recommendations.
Check all items that apply from the list below:

5.1 Measures have been taken or are being considered to introduce changes to laws or policies on health personnel consistent with the recommendations of the Code.

Timor-Leste has been actively working on improving its health personnel legislation and policies. Here are some key steps and considerations: Human Resources for Health Retention Strategy: Timor-Leste, with support from WHO-TL, USAID, has developed a strategy to retain health personnel. This includes initiatives for rural recruitment, continuing professional development, financial incentives, and management support . Law No. 11/2023 on Safety, Health, and Hygiene at Work: This law establishes general principles and rules to promote safety, health, and hygiene in workplaces across Timor-Leste. It applies to all workers, including health personnel, and includes special protections for vulnerable groups. National Medicines Policy and Pharmaceutical Legislation: Revisions to these policies aim to improve access to quality medicines and strengthen regulatory systems, which indirectly supports health personnel by ensuring they have the necessary resources to provide care. These steps reflect Timor-Leste’s commitment to enhancing its health workforce and aligning with international recommendations

5.2 Actions have been taken to communicate and share information across
sectors on the international recruitment and migration of health personnel, as well as to publicize the Code, among relevant ministries, departments and agencies,
nationally and/or sub-nationally.

The country has been working on strengthening its health workforce through various initiatives and collaborations. For instance: International Collaboration: Timor-Leste collaborates with international organizations like the International Organization for Migration (IOM) to support the government in strengthening institutional capacities and sharing information across sectors. Publicizing the Code: Efforts have been made to publicize the WHO Global Code of Practice on the International Recruitment of Health Personnel among relevant Ministries, Departments, and Agencies to ensure ethical recruitment practices.

5.3 Measures have been taken to consult stakeholders in decision-making
processes and/or involve them in activities related to the international recruitment of health personnel.

Not involving all stakeholders. Done per institution only as needed

5.4 Records are maintained on all private recruitment agencies for health
personnel authorized by competent authorities to operate within their jurisdiction.

So far it is done per Institution only

5.5 Good practices, as called for by the Code, are encouraged and promoted among private recruitment agencies.

There is no comprehensive information available

5.5a Promotion of the Code among private recruitment agencies.

Done per Institutions

5.5b Domestic legislation or policy requiring ethical practice of private recruitment agencies, as consistent with the principles and articles of the Code.

The country has implemented various policies and legislation aimed at ensuring ethical recruitment practices. These measures are designed to align with international standards and principles, such as those outlined in the International Labor Organization (ILO) Code of Practice on Ethical Recruitment. For instance, Timor-Leste’s Labor Code includes provisions that regulate the activities of private employment agencies, ensuring they operate transparently and ethically. The Labor Code mandates that these agencies must be licensed and comply with specific standards to protect workers from exploitation and abuse. Additionally, SEFOPE (Secretary state for Labour) Timor-Leste has been working on improving its legal framework to better protect workers’ rights and promote fair recruitment practices. This includes efforts to enhance the enforcement of existing laws and to raise awareness among employers and workers about ethical recruitment standards.

5.5c Public or private certification of ethical practice for private recruitment agencies.

Certification of public or private ethical practices for private recruitment agencies is conducted by SFOPE (Secretary State of Labor)

5.5d Others

5.6 None of the above

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Government Agreements

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Government-to-Government agreements on migration or mobility of health personnel

Hide [Q6] 6. Has your country or sub-national governments entered into any bilateral, multilateral, or regional agreements and/or arrangements with respect to the international recruitment and/or mobility of health personnel?

Yes

Hide [Q6x1xA] 6.1 A Please use the table below to describe each of the active bilateral, regional or multilateral agreements or arrangements:

	a. Title of Agreement	b. Type of Agreement
Agreement 1	MOU	1
Agreement 2	MOU	2
Agreement 3
Agreement 4
Agreement 5
Agreement 6
Agreement 7
Agreement 8
Agreement 9
Agreement 10
Agreement 11
Agreement 12
Agreement 13
Agreement 14
Agreement 15

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Government Agreements - 6.1 A

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Hide [Q6x1xAx1] c. Countries involved

MOU

CUB

MOU

AUS

Hide [Q6x1xAx2] d. Coverage

MOU

National

MOU

National

Hide [Q6x1xAx3] e. Main focus of agreement (check all that apply)

	Education and training	Health cooperation	Promotion of circular migration	Philanthropy or technical support	Qualification recognition	Recruitment of health personnel
MOU	1	1	1	1	1	1
MOU	1	1	1	1	1	1

Hide [Q6x1xAx4] f. Categories of Health Personnel (check all that apply)

	Doctors	Nurses	Midwives	Dentists	Pharmacists
MOU	1	1	1	1	1
MOU	1	1	1	1	1

Hide [Q6x1xAx5] g. Validity period

	Start Year	End Year
MOU	2018	2022
MOU	2024	2029

Hide [Q6x1xAx6] h. Signatory of the agreement from your country

MOU

Ministry of Foreign Affairs

MOU

Ministry of Foreign Affairs

Hide [Q6x1xAx6x1] If Ministry of Health is not a signatory, did the Ministry of Health participate in the development of the agreement?

MOU

Yes

MOU

Yes

Hide [Q6x1xAx7] i. Signatory of the agreement from the partner country (ies)

MOU

Ministry of Foreign Affairs

MOU

Ministry of Foreign Affairs

Hide [Q6x1xAx7x1] If Ministry of Health is not a signatory, did the Ministry of Health participate in the development of the agreement?

MOU

Yes

MOU

Yes

Hide [Q6x1xAx8] j. Content of agreement

Hide [Q6x1xAx8x1] j.i. Does the agreement include elements to benefit the health system of your country and the partner country(ies)?

MOU

Yes, has elements to
benefit the health system of my country and partner country(ies)

MOU

Yes, has elements to
benefit the health system of my country and partner country(ies)

Hide [Q6x1xAx8x1x] Please explain:

MOU

https://www.plenglish.com/news/2022/09/14/cuba-and-timor-leste-to-strengthen-medical-cooperation/ https://timor-leste.gov.tl/?p=36628&lang=en&n=1 https://www.otago.ac.nz/news/newsroom/otago-signs-mou-with-timor-lestes-national-university https://www.unsw.edu.au/news/2024/09/unsws-long-history-with-timor-leste-celebrated-at-the-signing-of-an-mou-with-the-universidade-nacional-timor-lorosae

MOU

Hide [Q6x1xAx8x2] j.ii. Does the agreement include elements on health worker rights and welfare?

MOU

Yes

MOU

Yes

Hide [Q6x1xAx8x2x] Please explain:

MOU

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Government Agreements - 6.1 B

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Hide [Q6x1xB] 6.1 B Please use the table below to describe the implementation of each of the active bilateral, regional or multilateral agreements or arrangements

Hide [Q6x1xBx1] Has the agreement been implemented?

MOU

Yes

MOU

Partially implemented

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	Start year of implementation:
MOU	2018
MOU	2024

Hide [Q6x1xBx2a] How many health personnel have left or entered your country through this agreement since its implementation?
Agreement: MOU

	Number of personnel
Doctors	Specialist medical doctors 74
Nurses	600
Midwives	400
Dentists	52
Pharmacists	68

Hide [Q6x1xBx2b] How many health personnel have left or entered your country through this agreement since its implementation?
Agreement: MOU

	Number of personnel
Doctors	26 candidates for specialist medical Docters
Nurses	Most of the midwives and nurses are all graduates from UNTL in the country
Midwives	Most of the midwives and nurses are all graduates from UNTL in the country
Dentists	52
Pharmacists	68

Hide [Q6x1xBx3] Please explain if and how has the health system of your country benefitted from the agreement.

MOU

Timor-Leste has not been prominently featured in recent discussions or publications regarding specific bilateral, multilateral, or regional agreements focused on the international recruitment and mobility of health personnel. However, the World Health Organization (WHO) and other international bodies have emphasized the importance of such agreements to ensure ethical recruitment practices, and mutual benefits for both source and destination countries. These agreements are designed to manage health worker migration effectively, preventing workforce shortages in countries with critical health needs while promoting fair employment conditions for migrant health workers

MOU

This agreement is very beneficial for health workers who receive scholarships from local governments and other countries to help improve the quality of reliable health workers to contribute to improving the health system in the country

Hide [Q6x1xBx4] Please describe if and how the health system of other country(ies) has benefitted from the agreement.

MOU

Hide [Q6x1xBx5] Please explain if and how the provisions on health workers rights and welfare were implemented.

MOU

These agreements are designed to manage health worker migration effectively, preventing workforce shortages in countries with critical health needs while promoting fair employment conditions for migrant health workers

MOU

Hide [Q6x1xBx6] Please provide any other relevant information on the agreement (e.g., context, positive elements, gaps and lessons learnt).

MOU

Hide [Q6x1xBx7] Full text of the agreement and associated documents (implementation plan, progress report, implementation report, evaluation report, etc.)

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MOU
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Responsibilities, rights and recruitment practices

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Responsibilities, rights and recruitment practices

Hide [Q7] 7. If your country employs/hosts international health personnel to work in the health and care sectors, which legal safeguards and/or other mechanisms are in place for migrant health personnel and to ensure that enjoy the same legal rights and responsibilities as the domestically trained health workforce?
Please check all items that apply from the list below:

Migrant health personnel are recruited using mechanisms that allow them to assess the benefits and risk associated with employment positions and to make timely and informed decisions on the employment.

In Timor-Leste, there are ongoing efforts to improve the recruitment and retention of health personnel, including migrant health workers. The specific mechanisms that allow migrant health personnel to assess the benefits and risks associated with employment positions and make timely and informed decisions are not explicitly detailed in the available resources. The broader goal is to strengthen the healthcare system and ensure that all health workers, including migrants, are well-supported

Migrant health personnel are hired, promoted and remunerated based on objective criteria such as levels of qualification, years of experience and degrees of professional responsibility on the same basis as the domestically trained health workforce.

In Timor-Leste, the recruitment and management of health personnel, including migrant workers, aim to follow objective criteria such as qualifications, experience, and professional responsibilities. However, there are challenges in consistently applying these standards due to factors like the availability of qualified personnel and the need to fill positions in remote areas. Efforts are being made to improve the recruitment process and ensure equitable treatment for all health workers, whether domestically trained or migrants. This includes initiatives to enhance training, provide financial incentives, and support professional development.

Migrant health personnel enjoy the same opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression.

In Timor-Leste, migrant health personnel face some challenges in accessing the same opportunities as domestically trained health workers. While there are efforts to integrate and support all health professionals, disparities still exist in terms of professional education, qualifications, and career progression.

Institutional arrangements are in place to ensure safe migration/ mobility and integration of migrant health personnel.

Timor-Leste has institutional arrangements in place to ensure the safe migration, mobility, and integration of migrant health personnel. The government, with support from the International Organization for Migration (IOM), has developed policies and frameworks to manage migration effectively. These include: Migration Governance: Timor-Leste has established comprehensive migration governance structures to address various aspects of migration, including health. Health Integration: Specific projects, such as community-based tuberculosis screening, have been implemented to ensure the health needs of migrants are met. Labour Mobility Schemes: Timor-Leste participates in international labour mobility schemes, such as the Employment Permit System with South Korea and the Pacific Labour Scheme with Australia, which include provisions for the welfare and integration of migrant workers. These efforts are part of a broader strategy to facilitate safe, orderly, and regular migration, ensuring that migrant health personnel are well-integrated and supported.

Measures have been taken to promote circular migration of international health personnel

Some key efforts include: Labour Mobility Schemes: Timor-Leste participates in labour mobility schemes such as the Employment Permit System (EPS) with South Korea and the Pacific Labour Scheme (PLS) with Australia. These programs facilitate the temporary migration of workers, including health professionals, allowing them to gain experience abroad and return with enhanced skills

Other measures (including legal and administrative) for fair recruitment and employment practices of foreign-trained and/or immigrant health personnel (please provide details)

In Timor-Leste, fair recruitment and employment practices for foreign-trained and immigrant health personnel are guided by several legal and administrative measures. Here are some key aspects: 1. Adherence to International Standards: Timor-Leste aligns with the WHO Global Code of Practice on the International Recruitment of Health Personnel. This code emphasizes ethical recruitment practices, ensuring that the rights of health workers are protected and that recruitment does not negatively impact the health systems of source countries 2. National Legislation: Timor-Leste has national laws that govern the employment of foreign workers, including health personnel. These laws ensure that foreign workers are treated fairly and have the same rights and protections as local workers. This includes compliance with labor laws, non-discrimination policies, and fair wage practices 3. Administrative Procedures: The government has established administrative procedures to facilitate the fair recruitment of foreign health workers. This includes transparent recruitment processes, proper documentation, and support services to help foreign workers integrate into the local health system 4. Timor-Leste collaborates with international organizations such as the International Labour Organization (ILO) and the International Organization for Migration (IOM) to implement best practices in the recruitment and employment of foreign health personnel. These collaborations help ensure that recruitment practices are ethical and that foreign workers are supported throughout their employment

No measures in place

Not applicable – does not host/employ foreign health personnel

Hide [Q8] 8. If health personnel from your country are working abroad in the health and care sectors, please provide information on measures that have been taken or are planned in your country to ensure their fair recruitment and employment; safe migration; return; and diaspora utilization in your country, as well as difficulties encountered.
Please check all items that apply from the list below:

Arrangements for fair recruitment

Arrangements for decent employment contracts and working conditions in destination countries

Arrangements for safe mobility

Arrangements for return and reintegration to the health labour market in your country

Arrangements for diaspora engagement to support your country health system

Other

No measures in place

Specifically, for health workers from Timor Leste who work abroad, there is no special recruitment yet. All workers, including health workers from Timor Leste working abroad, currently have all recruitment processes handled by SEFOPE (Secretary State for Labor) Timor Leste

Not applicable – health personnel from my country are not working abroad

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International migration

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International migration and mobility pathways for health personnel

Hide [Q9x1] 9.1 If your country hosts international health personnel to work in the health and care sector, how do they come to your country? (check all that apply)

	Direct (individual) application for education, employment, trade, immigration or entry in country	Government to government agreements that allow health personnel mobility	Private recruitment agencies or employer facilitated recruitment	Private education/ immigration consultancies facilitated mobility
Doctors	1	1	1	1
Nurses	1	1	1	1
Midwives	1	1	1	1
Dentists	1	1	1	1
Pharmacists	1	1	1	1
Other occupations	1	1	1	1
Other occupations	0	0	0	0
Other occupations	0	0	0	0
Other occupations	0	0	0	0
Other occupations	0	0	0	0

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Hide [Q9x2] 9.2 If health personnel from your country work/study abroad, how do they leave your country? (check all that apply)

	Direct (individual) application for education, employment, trade, immigration, or entry in the destination country	Government to government agreements that allow health personnel mobility	Private recruitment agencies or employer facilitated recruitment	Private education/ immigration consultancies facilitated mobility
Doctors	1	1	1	1
Nurses	1	1	1	1
Midwives	1	1	1	1
Dentists	1	1	1	1
Pharmacists	1	1	1	1
Other occupations	1	1	1	1
Other occupations	0	0	0	0
Other occupations	0	0	0	0
Other occupations	0	0	0	0
Other occupations	0	0	0	0

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Recruitment & migration

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Data on international health personnel recruitment & migration

Improving the availability and international comparability of data is essential to understanding and addressing the global dynamic of health worker migration. Please consult with your NHWA focal point, if available, to ensure that data reported below is consistent with NHWA reporting^*.
(The list of NHWA focal points is available here. Please find the focal point(s) for your country from the list and consult with them.)

For countries reporting through the WHO-Euro/EuroStat/OECD Joint data collection process, please liaise with the JDC focal point.

Hide [Q10] 10. Does your country have any mechanism(s) or entity(ies) to maintain statistical records of foreign-born and foreign-trained health personnel?

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Inflow and outflow of health personnel

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Hide [Q11] 11. Do you have a mechanism to monitor the inflow and outflow of health personnel to/from your country? (check all that apply)

Inflow

Outflow

Hide [Q11x3] 11.3 If you have any document with information on health worker inflows and outflows for your country, please upload

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Stock of health personnel

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Hide [Q12x1] 12.1 Consolidated stock on health personnel, disaggregated by place of training and birth
For the latest year available, consistent with the National Health Workforce Accounts (NHWA) Indicators 1-07 and 1-08, please provide information on the total stock of health personnel in your country (preferably the active workforce), disaggregated by the place of training (foreign-trained) and the place of birth (foreign-born).

Hide [Q12x1a] Please provide data on the stock of active health personnel in your country by one of the following ways:

Fill in the table below

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	Total	Place of training-Domestic Trained	Place of training-Foreign trained-total			Place of birth-National Born	Place of birth-Foreign Born	Data Source*	Year of data	Does the data represent active stock?	Does the data represent active stock?
Medical Doctors (generalist + specialists)	1105	96	967	1063	42	1063	42	NHA MOH	2023	1	Currently HRH-MOH is in the process of updating national level data.
Nurses	1410	200	1210	1410	0	1410	0	NHA MOH	2023	1	Currently HRH-MOH is in the process of updating national level data.
Midwives	690	100	590	690	0	690	0	NHA MOH	2023	1	Currently HRH-MOH is in the process of updating national level data.
Dentists	52	0	52	52	0	52	0	NHA MOH	2023	1	Currently HRH-MOH is in the process of updating national level data.
Pharmacists	277	0	277	277	0	277	0	NHA MOH	2023	1	Currently HRH-MOH is in the process of updating national level data.

Hide [Q12x1x1x] If you have any document with information on stock of active health personnel for your country, their distribution by place of training and place of birth, please upload

HRHMOH Data Request

Currently HRH MOH is in the process of updating HRH data nationally

Hide [Q12x2] 12.2 Please provide data on the top 10 countries of training for foreign-trained health personnel in your country.
This information can be provided by one of the following two options:

Fill in the table below

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	Doctors	Nurses	Midwives	Dentists	Pharmacists
Total foreign trained personnel
Country 1: Top country of training	CUB	IDN	IDN	IDN	IDN
Country 1: No. of foreign trained health personnel	976	1210	690	54	277
Country 2: Top country of training	IDN	TLS	TLS	IDN
Country 2: No. of foreign trained health personnel	20	200	100	0
Country 3: Top country of training	PRT
Country 3: No. of foreign trained health personnel	4	0	0	0
Country 4: Top country of training	AUS
Country 4: No. of foreign trained health personnel	4	0	0	0
Country 5: Top country of training	PHL
Country 5: No. of foreign trained health personnel	4	0	0	0
Country 6: Top country of training	FJI
Country 6: No. of foreign trained health personnel	8	0	0	0
Country 7: Top country of training	CHN
Country 7: No. of foreign trained health personnel	4	0	0	0
Country 8: Top country of training	NZL
Country 8: No. of foreign trained health personnel	3	0	0	0
Country 9: Top country of training	TLS
Country 9: No. of foreign trained health personnel	40	0	0	0
Country 10: Top country of training	IND
Country 10: No. of foreign trained health personnel	0	0	0	0
Source (e.g. professional register, census data, national survey, other)	HRH-MOH	HRH-MOH	HRH MOH	HRH MOH	HRH MOH
Year of data (Please provide the data of the latest year available)	2023	2023	2023	2023	2023
Remarks	Cuba has been a significant contributor to the medical training of Timorese health professionals	Many Timorese health workers receive training in neighbouring Indonesia due to its proximity	MOH-HRHSI is updating health worker data	MOH-HRHSI is updating health worker data	MOH-HRHSI is updating health worker data

Hide [Q12x2x1x] If you have any document with information on the distribution of foreign-trained health personnel for your country by their country of training, please upload

No comment

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Technical and financial support

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Technical and financial support

Hide [Q13] 13. Has your country provided technical or financial assistance to any source countries or countries in the WHO health workforce support and safeguards list 2023, or other low- and middle-income countries on health workforce development, health system strengthening, or for implementing other recommendations of the Code (e.g., strengthening data, information and research on health workforce for translation to policies and planning, etc.)

Hide [Q14] 14. Has your country received technical or financial assistance from any WHO Member State or other stakeholders (e.g., development partners, other agencies) for health workforce development, health system strengthening, or for implementing other recommendations of the Code (e.g., strengthening data, information and research on health workforce for translation to policies and planning, etc.)?

Yes

Hide [Q14x] Please provide additional information below (check all that apply):

Support for health workforce development (planning, education, employment, retention)

Support for other elements for health system strengthening (service delivery; health information systems; health financing; medical products and technology; and health leadership and governance)

Other areas of support:

Hide [Q14x1] Please specify support for health workforce development (planning, education, employment, retention)

	Supporting country/entity	Type of support (please specify)
	WHO	The WHO has been actively involved in providing technical assistance to Timor-Leste. This includes developing training programs for emergency and critical care, as well as Basic Life Support and Basic Emergency Care courses. WHO has also supported the development of a health workforce 5-year plan. WHO, in partnership with the European Union, works to build resilient health systems in Timor-Leste.
	Development Partners USAID, World Bank, AusAID	Timor-Leste has collaborated with several development partners to strengthen its health policies and systems. For instance, the UHC Partnership has been instrumental in supporting the country’s health financing strategy and the implementation of the Essentials Primary Health Care service and Family Health Care delivery model. USAID: Through the Local Health System Sustainability Project, USAID works to strengthen health governance and ensure equitable access to essential health services; World Bank: The World Bank supports health access and rapid improvements through projects like the HARI’I Project; AusAID: Collaborates with various NGOs to support the implementation of health activities under the Health Sector Strategic Plan Support Project.
	KOICA Support	The Korea International Cooperation Agency (KOICA) has supported mental health initiatives in Timor-Leste, working with WHO and the Ministry of Health and Education to pilot programs in schools and integrate mental health into national programs.

Hide [Q14x2] Please specify support for other elements of health system strengthening (service delivery; health information systems; health financing; medical products and technology; and health leadership and governance)

	Supporting country/entity:	Type of support (please specify)
	WHO, EU	Service Delivery: The World Health Organization (WHO) and the European Union (EU) have been working together to enhance Timor-Leste’s health service delivery, especially in response to the COVID-19 pandemic. This includes training health professionals and improving critical care management; Medical Products and Technology: Support from international partners like WHO and the EU has helped Timor-Leste enhance its capacity for testing, diagnostics, and the availability of essential medical supplies
	WHO, USAID	The WHO and USAID Health System Sustainability Activity focuses on improving the government’s capacity to produce and use quality data for decision-making, which is crucial for effective health information systems; USAID’s initiatives also aim to strengthen health financing at both national and subnational levels, ensuring that financial barriers to care are reduced and equitable access to health services is promoted
	USAID	The Local Health System Sustainability Project under USAID works to build local capacity for strong health system performance, supporting the Ministry of Health in strategic management and governance

Hide [Q14x3] Please specify other areas of support

Supporting country/entity:	Support Area:	Type of support:
Australia	Scholarships to continue specialist doctors, specializations in other health fields	Australia Award Scholarship
New Zealand	Scholarships to continue specialist doctors, specializations in other health fields	NZ Development Scholarship
KOICA	Scholarships to continue specialist doctors, specializations in other health fields	KOICA Scholarship

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Constraints, Solutions, and Complementary Comments

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Constraints, Solutions, and Complementary Comments

Hide [Q15] 15. Please list in priority order, the three main constraints to the ethical management of international migration in your country and propose possible solutions:

	Main constraints	Possible solutions/recommendations
	Lack of Comprehensive Migration Policies: Timor-Leste lacks well-defined and comprehensive migration policies that address the rights and needs of migrants, both incoming and outgoing	Develop and Implement Comprehensive Policies: The government should work with international organizations like the IOM to develop and implement comprehensive migration policies that protect the rights of migrants and ensure their well-being; Regular Policy Reviews: Establish a mechanism for regular review and updating of migration policies to adapt to changing migration patterns and challenges.
	Limited Institutional Capacity Constraint: There is limited institutional capacity to manage migration effectively, including inadequate infrastructure and human resources	Capacity Building: Invest in training and capacity-building programs for government officials and institutions involved in migration management; Infrastructure Development: Improve infrastructure at key points of entry and within institutions responsible for migration management to handle the flow of migrants more efficiently.
	Border Security and Transnational Crime Constraint: Increased mobility has led to challenges in border security, including the risk of transnational organized crimes	Enhanced Border Security Measures: Implement advanced border security measures, including the use of technology for better monitoring and control; International Cooperation: Strengthen cooperation with neighboring countries and international organizations to combat transnational crimes and ensure secure borders.

Hide [Q16] 16. What support do you require to strengthen implementation of the Code?

Support to strengthen data and information on health personnel

Capacity Building: Focus on building local capacity to analyze and use health data effectively. This includes training health workers and managers to use data for decision-making; Human Resources Information Systems (HRIS): Implementing and improving HRIS helps in managing and utilizing health workforce data. This system supports better planning, recruitment, and retention of health personnel

Support for policy dialogue and development

Support for the development of bilateral/multi-lateral agreements

Others

Professional Development: Enhancing training and professional development opportunities for health workers ensures they have the necessary skills and knowledge. This includes continuous education and specialized training programs; Equitable Workforce Distribution: Efforts are made to ensure that health personnel are distributed equitably across the country, addressing disparities in healthcare access; Financial and Social Incentives: Providing financial incentives and improving working conditions can help retain health workers, especially in rural and underserved areas.

No support required

Hide [Q17] 17. Considering that the Code is a dynamic document that should be updated as required, please provide reflections from your country on the past 14 years since the resolution on the Code.

Hide [Q17x1] Please comment on if/how the Code has been useful to your country.

Reflecting on the past 14 years since the resolution on the Code, Timor-Leste has seen significant developments and challenges. Overall, the Code has been a dynamic and evolving document that has significantly contributed to Timor-Leste’s progress. It has provided a foundation for reconciliation, legal reforms, and the promotion of human rights, while also highlighting areas that require ongoing attention and adaptation.

Hide [Q17x2] Do any articles of the Code need to be updated?

Yes

Legal and Social Context: The legal framework and social context in Timor-Leste have also evolved. Issues such as access to justice, the role of women and children in society, and the use of local languages in media have highlighted the need for the Code to be inclusive and reflective of these changes1. https://law.stanford.edu/wp-content/uploads/2018/04/Legal-History-and-the-Rule-of-Law-in-Timor-Leste.pdf

Hide [Q17x3] Does the process of reporting on Code implementation and the review of the Code relevance and effectiveness need to be updated?

Yes

Review of Code Relevance and Effectiveness: The relevance and effectiveness of the Code should be reviewed periodically to ensure it aligns with current needs and challenges. This includes incorporating feedback from various stakeholders, including local communities, to make the Code more inclusive and responsive.

Hide [Q17x4] Please comment on the WHO health workforce support and safeguards list (e.g. if your country is included in the list, how has that affected you; if your country is reliant on international health personnel, how has the list affected you; if your country is not in the list, how has it affected you)

Impact on Countries Included in the List : For countries included in the list, such as those with significant health workforce shortages, the safeguards can help retain essential health personnel. This can lead to improved healthcare services and better health outcomes for the population. However, it might also limit opportunities for health workers seeking employment abroad, potentially affecting their income and career growth; Impact on Countries Relying on International Health Personnel: Countries that rely heavily on international health personnel might face challenges in recruiting from the countries on the list. This could lead to staffing shortages and increased pressure on existing health workers. These countries may need to invest more in training and retaining their own health workforce to mitigate these effects; Impact on Timor-Leste: Timor-Leste is not included in the WHO health workforce support and safeguards list. This means that Timor-Leste does not face the same restrictions on international recruitment of health personnel. However, it also means that Timor-Leste might not receive the targeted support and safeguards aimed at countries with the most critical health workforce needs. This could impact the country’s ability to attract and retain health workers, potentially affecting the overall quality of healthcare services.

Hide [Q18] 18. Submit any other complementary comments or material you may wish to provide regarding the international recruitment and migration of health personnel, as related to implementation of the Code.

Please describe OR Upload (Maximum file size 10 MB)

The WHO Global Code of Practice on the International Recruitment of Health Personnel is a comprehensive framework designed to guide ethical recruitment practices and strengthen health systems worldwide. Here are some key points and complementary comments regarding its implementation: Ethical Recruitment: The Code emphasizes the importance of ethical recruitment practices, ensuring that the rights of health personnel are respected and that recruitment does not negatively impact the health systems of source countries; Strengthening Health Systems: One of the primary goals of the Code is to support the strengthening of health systems, particularly in developing countries. This includes promoting fair treatment and support for migrant health workers; Voluntary Nature: While the Code is voluntary, it serves as a crucial reference for countries to develop or improve their legal and institutional frameworks for the international recruitment of health personnel; Monitoring and Reporting: The Code includes a robust monitoring framework to track its implementation and impact. Regular reporting helps identify challenges and areas for improvement; Global Cooperation: The Code fosters international cooperation and information sharing, which are essential for addressing the complex issues related to health worker migration; Impact of COVID-19: The pandemic has highlighted the critical need for a well-distributed health workforce. Many countries have faced acute shortages, underscoring the importance of adhering to the principles of the Code to ensure global health security.

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