National Action Plan for Health Security

Objectives

Timor-Leste’s National Action Plan for Health Security 2020-2024 seeks to realise the vision of healthy Timorese people in a healthy Timor-Leste by strengthening implementation of the International Health Regulations (2005). Its mission is to prevent, protect against, control and respond to the international spread of disease while avoiding unnecessary interference with international traffic and trade.[1]The plan translates the 2018 Joint External Evaluation findings into coordinated national actions to prevent, detect and respond to public health emergencies.[2]

• Strengthen public-health emergency preparedness and health-security capacities across the 19 Joint External Evaluation technical areas.[3]
• Close gaps in infrastructure, human resources, laboratory testing, food-borne outbreak investigation, surveillance, preparedness planning and emergency response.[3][1]
• Prioritise prevention through biosafety and biosecurity, immunisation, zoonotic-disease control, food safety and sustainable One Health action spanning human, animal and agriculture sectors.[4][5][6]
• Improve detection through national laboratory systems, specimen referral and transport, diagnostic networks, laboratory quality, electronic surveillance tools, data analysis and workforce development.[6][7]
• Enhance response through multi-hazard preparedness, emergency operations, public health and security coordination, medical countermeasures, health-personnel deployment, risk communication, points-of-entry capacities, and chemical and radiological emergency management.[8][9][10]
• Protect communities, property and natural resources through disaster prevention and risk management, while improving food and nutrition security, rural livelihoods, animal-disease surveillance and prevention of exotic diseases.[11]

Implementation

The plan uses a multisectoral, whole-of-government delivery model led by the Ministry of Health, with implementation structured around 62 Joint External Evaluation priority actions and a planning matrix that assigns activities, responsible bodies, budget sources, unit costs and total costs.[1][12]The Ministry provides strategic direction, standards, regulation and oversight of financial and human resources for preparedness and response.[2]

• Coordinate Ministry of Health departments responsible for surveillance, communicable disease control, health promotion, medical emergency and hospital services, alongside the National Health Laboratory, National Hospital, referral hospitals and National Medical Stores of Timor-Leste.[1]
• Engage the Ministry of Agriculture and Fisheries, Ministry of Finance, Ministry of Interior, Inspection and Supervision Authority of Economic, Health and Food Activities, World Health Organization, Food and Agriculture Organization of the United Nations, United Nations Children’s Fund, Timor-Leste Red Cross, donors, civil society, communities, media and industry.[13][14]
• Use the National International Health Regulations Focal Point for high-level advocacy and a multisectoral National Action Plan for Health Security Working Group for situation analysis, review of Joint External Evaluation recommendations, plan drafting and annual implementation review.[14][15]
• Link national planning with the Pandemic Influenza Preparedness Plan, following the June 2019 national consultative workshop in Dili.[12]
• Strengthen One Health coordination by mapping zoonotic diseases, setting joint human and animal health priorities, implementing surveillance and risk mapping, establishing incident command arrangements, testing contingency plans and securing vaccine-supply provisions.[4][5]
• Develop food-safety governance through national bodies, a Food Act, trained inspectors, vendor and community education, and multisectoral arrangements for food-borne disease surveillance, investigation and response.[5]
• Operate public health emergency preparedness and response through an emergency operations centre, while coordinating wider disaster management through the Ministry of Interior, the Secretary of State of Civil Protection and disaster-management committees at district, sub-district and suco levels.[16]
• Build operational capacity through standard operating procedures, training, simulation exercises, risk assessments, procurement of protective equipment, emergency plans and coordination between public health, security, customs, border-control and law-enforcement authorities.[17][8]
• Monitor progress annually through indicators managed by each responsible ministry or agency, with the Working Group convening annually to exchange implementation information.[15]The International Health Regulations Monitoring and Evaluation Framework provides for annual reporting, after-action reviews, simulation exercises and voluntary external evaluation.[2]
• Finance implementation through an estimated five-year requirement of 17,857,468 United States Dollars, of which the Government is to provide 38%, committed donors 35%, and 27% remains to be mobilised.[12][15]Higher early-year spending is intended for infrastructure, software and human resources, while a separate national budget line for International Health Regulations core capacities is proposed.[12][15]

Monitoring & Evaluation

Monitoring and evaluation are anchored in the International Health Regulations (IHR) Monitoring and Evaluation Framework and the 2018 Joint External Evaluation (JEE), which assessed Timor-Leste’s capacities across 19 technical areas and informed the National Action Plan for Health Security (NAPHS).[3][2][1]The framework combines mandatory annual IHR reporting with voluntary after-action reviews, simulation exercises and external evaluation.[2]

• Monitor technical-area indicators annually through the responsible ministry or agency, with the multisectoral NAPHS Working Group meeting annually to exchange implementation progress.[15]
• Track implementation through the planning matrix, which records baseline capacity, JEE recommendations, proposed actions and specific activities across the 19 technical areas.[12]
• Strengthen surveillance, laboratory testing, specimen referral, diagnostic networks, laboratory quality systems, electronic surveillance tools and analysis of surveillance data.[6][7]
• Assess zoonotic disease preparedness through indicator P.4.1 on coordinated surveillance and joint human-animal disease priorities, and indicator P.4.2 on functioning multisectoral response mechanisms, including incident command arrangements and tested contingency plans.[4][5]
• Maintain public health and animal health surveillance, including sentinel-herd early warning for foot-and-mouth disease, screw-worm fly and bluetongue disease, and operational reporting to the World Health Organization and World Organisation for Animal Health.[18][16]
• Use the public health emergency operations centre to improve emergency plans and procedures and to support training and simulation exercises.[16]
• Monitor radiation-exposed operational staff through annual medical checks as part of routine checks.[17]

The available material identifies indicator areas for laboratory systems, surveillance, workforce, emergency preparedness and coordination, medical countermeasures, personnel deployment and risk communication.[6][7][8]It does not specify a consolidated set of NAPHS performance targets, detailed reporting timetable beyond annual monitoring and IHR reporting, evaluation methodology, or dedicated evaluation budget.[2][1][15]Food safety monitoring, reporting and accountability arrangements are also not specified beyond proposed surveillance, outbreak investigation and response activities.[5]

Costing & Financing

The five-year NAPHS resource requirement for 2020-2024 is estimated at United States Dollar 17,857,468.[12]Prevention receives the largest allocation, followed by detection, response and other IHR hazard capacities, with higher early-year spending intended to establish infrastructure, software and human resources.[12]

• Finance 38% of the total budget, or United States Dollar 6,856,376, through the Timor-Leste Government.[12]
• Use committed donor financing of 35%, or United States Dollar 6,272,382, of the total budget.[12]
• Mobilise the remaining 27%, or United States Dollar 4,728,710, required to fully fund the plan.[12]
• Establish a separate national budget line to strengthen IHR core capacities.[15]
• Access an existing emergency contingency fund during public health emergencies, noting that it is not included in the NAPHS budget.[12]
• Allocate 8,407,071 to Prevent technical areas and 6,087,762 to Detect technical areas; the currency is not specified in the supplied tables.[6][7]
• Allocate 1,864,425 to Respond activities, including risk communication, points of entry, chemical events and radiological and nuclear emergency capacities; the currency is not specified in the supplied tables.[9][10]
• Fund zoonotic-disease activities with a stated subtotal of 535,275 for 2020-2024, although the currency is not specified.[5]

Budgeted investments include biosafety and biosecurity, immunisation, laboratories, surveillance, human resources, emergency preparedness and operations, risk communication, medical countermeasures, points of entry, chemical-event management and radiation emergency preparedness.[6][7][8][9][10]Several activities identify government financing, while other funding-source entries are recorded as “N” or are not specified.[4][5][17]Australian Government support finances the sentinel-herd early warning system within wider biosecurity surveillance and analysis efforts.[18][11]The material does not specify economic assumptions, a monetary food-safety budget, or resource-mobilisation arrangements for all individual activities.[5][17][8]