Professor Peter McMinn from the Sydney Southeast Asia Centre leads a program to help Timor-Leste's health ministry implement the Lymphatic Filariasis, Hookworm and Yaws Elimination Program.

The relationship between Timor-Leste and Indonesia has improved steadily since the independence referendum in 1999. Indonesia is now one of Timor-Leste's key trade partners and has strongly supported its application for membership of ASEAN. The two countries are also working toward settling border disputes that have been unresolved for many years.

This mood of cooperation is also working in the health sector.

Since Timor-Leste regained its independence, public health officials in Dili and Indonesian West Timor have faced substantial challenges in regard to the control of tropical infections which have an enormous impact on the health of already marginalised populations. Diseases such as lymphatic filariasis (elephantiasis), intestinal worm infections (especially hookworm) and yaws are highly prevalent across the island of Timor and cause chronic disfigurement, disability and death.

Elimination of these diseases can be achieved by mass drug administration (MDA) to affected populations (target 75-80%) annually for a period of 5-7 years. Such a program requires high levels of coordination and cooperation by health officials and the engagement of affected communities.

Efforts to free the developing world from these and other tropical infections received a boost in 1998, when the World Health Assembly resolved to eliminate them globally by 2020. The chances of doing so were greatly enhanced when a consortium of pharmaceutical companies pledged to donate the drugs required to treat these infections free of charge to all countries participating in the World Health Organization (WHO) Global Elimination Program.

Many countries have now commenced this program with support from the WHO, pharmaceutical companies, the Gates Foundation and other donors. However, it has not begun in Timor-Leste and has been interrupted in Indonesian Timor due to low capacity in the health workforce and a lack of donor support. The situation has been complicated by the recurrence of conflict in Timor-Leste and the logistical challenges involved in bringing together teams to work across national borders.

In December 2011 the Timor-Leste Minister of Health signed Memoranda of Understanding (MOU) on cross-border cooperation for public health with the Indonesian Minister of Health in Jakarta and with the Governor of Nusa Tengara Timur (NTT) Province in Kupang, West Timor, both vital steps in implementing the program. Under the latter MOU it was agreed that the Government of Timor-Leste and the Indonesian Provincial Government of NTT would cooperate to monitor and implement shared public health challenges. This cross-border cooperation is particularly important for the East Timorese enclave of Oecusse, which is completely surrounded by Indonesian territory.

The program is scheduled to commence in 2014. A senior public health expert from the Ministry of Health in Jakarta has recently assisted the Timor-Leste Ministry of Health to develop a detailed program implementation plan that includes cross-border cooperation on disease surveillance and information sharing on the progress of program implementation. Furthermore, a public health official from NTT will be invited to join the Task Force and vice versa.

Cross-border cooperation will be critically important during the post-MDA enhanced surveillance program to verify disease elimination and to ensure that Timor Island can be certified free of these diseases by the WHO in the shortest possible time. Such collaboration represents a practical example of cross-border cooperation that is of mutual public health benefit for Indonesia and Timor-Leste.

Photo by the author.