Timor-Leste’s next big health test: true Universal health care for all

Op-ed by Dr Arvind Mathur, WHO Representative  

In Timor-Leste, health care is officially free.

Walk into a public facility and you won’t be handed a bill for the consultation or the hospital bed. Data shows that families here also spend a smaller share of health costs out of pocket than in many similar countries. And yet, getting care could carry a burden that doesn’t show up on paper.

Many families in remote sucos still bear the cost of getting to that “free” hospital. When ambulance waits are long or rough roads make access difficult, they may have little choice but to arrange their own transport. A hired car borrowed fuel money, days away from work and extra expenses at the bedside can quickly add up. As these indirect costs mount, some patients may opt for early discharge, delay care or stop treatment altogether. Health care without a fee, therefore, can still carry a heavy financial burden.

That is exactly what Universal Health Coverage (UHC) is meant to fix. UHC is the promise that people can reach services, find competent health workers, get essential medicines, and rely on a primary health system that is properly funded. In simple terms: care where and when people need it, without being pushed into hardship.

UHC Day, marked every year on December 12, is the moment the world stops to check how far we are from that promise. This year’s theme says it bluntly: “Unaffordable health costs? We’re sick of it!” It’s a reminder that when people must choose between buying medicines and meals, health systems are not doing their job.

Timor-Leste knows what determined action in health can achieve. In July 2025, Timor-Leste was certified malaria-free by WHO – only the third country in the South-East Asia Region to achieve this, and its second disease eliminated in two years, after lymphatic filariasis. This remarkable public health achievement took years of political will, community mobilization and a primary health care (PHC) network able to find every case, treat promptly and prevent the next infection.

The task now is to bring that same focus to the broader UHC goal.

Timor-Leste starts from a strong position, with free public health services. But as I stated above, UHC goes beyond removing user fees. It is about whether people can reach services, and whether medicines and skilled providers are available not just in Dili but across the country. These remain key challenges Timor-Leste is still working to address.

Much of WHO’s work with Ministry of Health over the past few years has been to close those gaps in ways that move the country closer to UHC.

One key focus has been bringing care closer to people. Recognizing that PHC is the key that unlocks UHC, the government is driving its flagship Programa-Integrado-Saúde (PIS) – an integrated package of services delivered closer to where people live.

This year, under PIS, specialist care has moved closer to communities through outreach focused on noncommunicable diseases such as diabetes and hypertension. Specialist doctors visited CHCs in Dili and Aileu and consulted more than 1,000 patients, sparing many an expensive and time-consuming trip to see a consultant in the capital.

Another vital link – community health volunteers, Voluntáriu Saúde Komunitária – is being revitalized with clearer roles, training and a modest but assured incentive for specific tasks, so they can again act as a trusted bridge between families and the formal system.

As far as UHC is concerned, the most visible gains have come in emergency and critical care, where capacity has grown from just six intensive care beds at HNGV to 75 high-dependency and ICU beds across the country. More than 1,300 health workers have been trained in emergency and critical care, supported by new simulation skill centres that let teams practise managing real-life emergencies.

Prevention has not been forgotten. Timor-Leste has introduced sharp increases in “pro-health” taxes, including a steep rise in tobacco excise, to curb some of the highest smoking rates in the region and slow the rise of heart disease, cancer and stroke. It may not be a popular move, but it is one of the most cost-effective ways to protect lives.

None of these reforms may seem dramatic on its own. But together, they start to answer the central question UHC Day asks: when people in Timor-Leste need care, will the system show up for them, without leaving them poorer?

The honest answer is: not yet. But the direction is clear. If Timor-Leste keeps investing in primary care, protecting families from hidden costs and working closely with partners, affordable “health for all” can become a lived reality.