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Political Economy of Healthcare in Post-conflict Timor-Leste: Contestation and Ownership in Policy-Making
Paksi, Arie K.
Paksi, Arie K.
Publication Date
2018
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The University of Bradford theses are licenced under a Creative Commons Licence.
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Accepted for publication
Institution
University of Bradford
Department
Faculty of Social Sciences
Awarded
2018
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Abstract
This thesis examines the political economy of national ownership in situations of aid-dependent and oil-dependent, with particular reference to the case of the
reconstruction of the healthcare system in Timor-Leste. The study demonstrates
that, in a range of areas, the FRETILIN government (2002-2007) was able to
exercise some autonomous decision-making even though it was heavily aid
dependent. Conversely, under CNRT government (2007-2017), elites were
empowered by oil resources and consequently they had greater control over
development. The study identifies three main approaches used in development
policy-making: patronage-based, populist and rationalist, and argues that, from
2002 onwards, the Timorese government generally used patronage-based
strategies that benefitted elite political networks, increasing corruption.
However, the creation of a ‘modern’ healthcare system that would benefit future
Timorese generations was central to elites’ political ideology and consequently
healthcare became subject to populist rather than patronage-based politics.
Analysis of four key health programmes, funded separately by the World
Bank, the Cuban government, WHO, and USAID, shows that ownership in the
field of healthcare has become concentrated among powerful groups (donors,
elites, MoH, and the Church). Meanwhile, health professionals, who advocate a
liberal approach, lack a political voice. These case studies indicate that the
Paris Declaration’s focus on country ownership to ensure better aid delivery
was unrealistic because, in reality, ‘ownership’ becomes subject to contestation
among powerful actors with different power resources. Findings on the analysis
of the four programmes also suggest that Timorese elites did not worry much about healthcare, rather than it being ‘central’ to their ideology.
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Qualification name
PhD