Australia’s Partnership for Human Development in Timor Leste: A conversation with Armandina Gusmao Amaral

Australian Ambassador for Regional Health Security, Stephanie Williams, is back on the road to meet with Australia’s partners in the region and learn about how they have fared during the pandemic. 

On today’s episode, Ambassador Williams speaks to Armandina Gusmao Amaral, the Program Director at the Partnership for Human Development. Mana Dina is a stalwart of public health and development in Timor Leste, having worked with AusAID, then the Department of Foreign Affairs and Trade since 2004. She developed her passion for healthcare and serving her community watching her late father work as a nurse when she was a child, and she has dedicated her career to helping develop Timor Leste’s health sector.

Mana Dina and Stephanie talk about building resilient health systems in Timor Leste and how the pandemic has challenged the work of the Partnership for Human Development. Mana Dina talks about how her passion for working with people and communities has helped her work in coordination, engagement and management of health systems. We also discuss Mana Dina’s work mentoring the next generation of health workers in Timor Leste and what more needs to be done to not only strengthen the healthcare system in our region, but also develop the pipeline of talented healthcare workers from doctors and nurses, to public health professionals.

We hope you enjoy the conversation and learn more about the Partnership for Human Development’s work at http://phd.tl/ 

Transcript

Dr Stephanie Williams  00:01

Hello, and welcome to Contain This. I'm Stephanie Williams and on today's episode, I'm pleased to bring you an interview I recorded with Armandina Gusmao Amaral, the Program Director at the Partnership for Human Development while I was visiting Timor Leste last week.

Mana Dina has worked for over two decades in public health in Timor Leste. We talked about building resilient health systems in Timor Leste, how the work of the pandemic challenged how Partnership for Human Development operated in Dili and around the country. Mana Dina talks about how her passion for working with people and communities has helped her in her roll today coordinating and engaging with so many partners in health in Timor. We also discuss how she started out in health in Timor, she really has a terrific story. I hope you enjoy the episode. 

Dina, thanks for joining us today on Contain This. I wonder if we can start with you telling us about your current role in health, here in Timor, and your journey to get to this role.

Armandina Gusmao Amaral 1:06

Thank you very much, Dr Steph, for allowing me this very important opportunity. So currently I serve as Programme Director at the Partnership for Human Development. It's an Australian government funded social sector focussed development aid programme in Timor Leste and it reflects Australia's commitment to work in partnership with the government in particularly improving the life of the Timorese people.  

The PHD is focusing on three main programmes. So primary health care services system strengthening, basic education, as well as in social protection. Abt Associates is the company that I'm working at managing this programme. Two main roles that I currently hold, is to work with the team at PHD maximising the resources from the Australian government to support the government of Timor Leste's health sector priorities, particularly in primary health care, including in nutrition, so basically focusing on getting behind what the Ministry of Health would like to see as the vision for health sector improvement in Timor Leste. The second thing, which I'm still learning is becoming an integral part of PHDs executive team, basically bringing my localised knowledge and experiences, both technical and and in managerial, and in working with others to shape PHDs programming and, and engagement with relevant key stakeholders in this country.  

Talking about my journey, how have I come to where I am right now. I've actually come a long way from starting at a very low base in my professional career, but I consider them all equally important in shaping me and who I am now. I started by helping people talking to each other, or communicating with each other as as an interpreter for the Medicines Sans Frontiers Holland at the very early days of our independence. Basically I travelled with doctors and midwives, from Dili to health facilities in two of the municipalities in Timor - Liquiçá and Bobonaro, basically facilitating healthcare provisions by these international doctors, working with the local midwives and doctors, as well as some training to these people at the health facilities.  

This, coupled with my childhood time of hanging around at health post where my late father served as a nurse and going house to house helping and actually witnessing him delivering babies and doing the dressing for lepra cases have actually served my desire to find out more and work in health sector development since then. I've worked for a different organisation since 1999. I was once jr journalist for a weekly magazine called [INSERT], I worked with UNHCR for emergency relief as a programme officer, I then moved to work with UNICEF as an executive secretary - that's where I got my taking notes skills from - for the representative, and lastly, I think, my longest career in initiating development sector support working for AUSAID and then DFAT from 2004. I would like to acknowledge that my time with AUSAID it and back then and DFAT have actually provided me a great opportunity to learn more about development, understanding the key roles of what's bilateral development partners, what's multilateral development partners, who are the technical implementers, how are you engaging with the government. I always share with my colleagues that my first year in AUSAID is actually just sitting and listening to people, being quiet and really learning how people are navigating through the challenges and risk and also grabbing the opportunity to do development. I really built myself and maximise that time around 11 years with AUSAID and DFAT back then. And, again, those has actually been what shaped me as who I am today. And since 2016, I joined the Partnership for Human Development and have been holding on to this and still passionate about this until today.

Dr Stephanie Williams  06:07

I know they you're such a part of the Australian story in Timor in health, through AUSAID and DFAT. And I didn't appreciate until just now how many different perspectives you have had in different organisations, but really being shaped by the community health work early on.  In the Partnership for Human Development, you know, you talked about delivering health and education and nutrition services, how did the pandemic change your ability to support the government here deliver those critical services?

Armandina Gusmao Amaral 06:45

I'd like to start by saying that sometimes when you just work, you didn't actually realise that things has actually changed, you've actually redirected a little bit. PHD as a programme is actually quite well placed in a very positively unique situation, to support advancing DFAT's resources as well as supporting the Government of Timor Leste's priorities in responding to this, the pandemic. 

As a programme, I'd like to say that because of that unique position, we did not change so much, but perhaps more on maximising our existing strengths, the already existing strengths and redirecting approaches and efforts. The reason I'm saying this is because of two things. One is the strength of our already existed, PHDs technical implementing partners, both in mostly in health, but also in education as well as less on social protection because we're just sort of starting with the reform programme. The second thing is PHDs own technical and operational strength as a development development facility, as I mentioned earlier to advance DFAT's support to Government of Timor Leste is emergency response to the pandemic, particularly in health, in education and social protections. 

There are many hurdles along the way, similar to other countries in the world. Timor Leste did not expect, the health system does not expect to sort of absorb the heat of the of this pandemic. The health system is basically not ready for the big waves and and the people themselves we are not ready.  As a member of the organisation, PHD, I'm very proud to see our small contributions in health, in getting behind the Ministry of Health's leadership and the some of the autonomous institutes, particularly the one that's dealing with the autonomous public institute that is dealing with drugs and consumables. 

We are basically working very closely with them together with DFAT to ensure that the immediate readiness to respond to the pandemic is actually there. So that's ranging from working with them to make sure that the isolation facilities and the quarantine facilities, the infrastructure is ready with our contribution. The essential drugs, consumables and equipment are basically procured as much as possible or maximising what's already here. The logistical readiness, the availability of relevant protocols, both at the central as well as at the municipal health facility level. 

I mentioned earlier about our technical existing technical implementing partners. One of the good combination is that it's not just about working to respond to the pandemic. But also equally important is working to make sure that the essential routine services are basically continued to be maintained. And that's not easy during the pandemic because you're basically asking the same health providers, the same health managers to cope with all of these situations. And this is where extending the arm of the Government of Timor Leste through our technical implementing partners has been something that's that I am proud to be part of and the government's also appreciating. 

I want to mention all of them, because they are doing such a great job. They are working really hard with the government's own frontliners to make sure that services are there. And our two cents in terms of having these partners already in our book, with the DFAT funding is actually a really good thing in it that you can mobilise them quickly. They have already people on the ground, who knows the system who worked with the system, so has the relationship and like really extending the arm of the government and, and the openness of the government for this.  

In summary, I'm actually proud to be getting behind the frontliners, you don't get your hands dirty and doing the work. But when you sit  in the table and mobilising yourself around and seeing that actually the people who you want to see working with the government are actually working your government people are actually there are a lot of challenges, but they're still working is is actually something that making you proud that you can help people who are on the ground, you can help people who are actually working hard. 

I would like to say that this is obviously not just a PHD thing to be proud of.  I would like to really acknowledge the persistent and trusted strategic leadership from the DFAT team in Timor Leste. Especially during the time when we are hit by Delta Omicron and then flood and every other things comes together in one year, particularly in 2021. Everyone was so supportive of of each other and maximising each of our strengths, in programming and technical and in strategic engagement with with the Government of Timor Leste, particularly with the Ministry of Health during that time.  This is actually one of the thing also that got me up every morning and got motivated that I am being supported, DFAT is looking at us, maximising our efforts, DFAT wants to really be serious in helping the Government of Timor Leste, so why should I be sitting back and laying back and then relax. So it's really some of the interesting time.

At the end of the day, I'm very proud that the Government of Timor Leste the people who are working really hard, they hardly have a rest. It's like, seven days a week thing for them. They can with their efforts to take the lead on everything. They can feel it actually our development partners, our technical implementing partners are getting behind us. Yes, there is not much of systematic coordination. Yes, there are so many inefficient spending. Yes, there is continued issues with basic logistical support. Yes, there are human resource management issues. Yes, we need to be more inclusive in gender, disability, other vulnerable groups such as LGBTQI. But the fact that the country or the Ministry of Health in this case, because I work very closely with them jumps through many complexities, in addressing the pandemic and bringing the arms of many partners together in a time of need, is something that I would really like us to, it's my hat's off. Situations, every time I think about, they're not just responsible for pandemic, they're also responsible for other things, they still need to respond to the central institutions, what's your budget spending is like, what's your actual planning is like, so they're really working hard from ministers down to all the health care providers at different facilities. 

Dr Stephanie Williams  13:45

So we're recording this in Timor now, this podcast, and I have had the great benefit of travelling around Timor last couple of days and to see the achievements, as you say, of the Government of Timor Leste, not just with their vaccine coverage, but in their partner coordination and the delivery of services, which even if interrupted, the frontline workforce, and the municipal health authorities are the ones having to show up every day.

Armandina Gusmao Amaral 14:24

Indeed. 

Dr Stephanie Williams  14:25

So when you describe that sort of dizzying array of partners, just then all the partners of PHD and then all the multilateral partners, did you as PHD just bring everyone together regularly? How did you how did you coordinate with your implementing partners during the pandemic?

Armandina Gusmao Amaral 14:45

It's not just PHD coordinating. But it's us maximising the comparative advantage of each of these different partners, systematically. In the non pandemic time, we have our regular monthly catchups, we have our quarterly catchups, we have our discussion with other development partners, but it's not as systematic as we would have liked to.  So we basically utilise different mechanisms. We use WhatsApp, we coordinate through emails, sometimes we are all going together to one Ministry of Health organised coordination meeting, and we're just maximising our time there. Some officials from DFAT are still trying to make it as organised as possible. And that's what I got behind. So the regular weekly during the high times coordination with the development partners is actually me working with someone from DFAT to is actually very persistent and got the good relationship. Creating a WhatsApp group for both the technical team as well as with development partners, making sure that okay, let's call everybody to come together. I guess it's a collective efforts because people just have the willingness and people realise that there is a need. We're trying to make sure that because we're all trying to help the Ministry of Health it's not just me, PHD, I go along and walk around with the Ministry people. 

I don't always the realisation that I don't always have all the skill set and and the technical resources in particular, to respond to the Ministry of Health. So, if one person is getting in there, we call the other partners to come along. So for example, if I see these as this is actually the comparative advantage of UNFPA, then I call like, it's an individual kind of thing I call UNFPA. Or actually, I may or may need to call Maluk Timor as well because they have the specialisation to be able to respond to some infrastructure issues in the isolation facilities. Or the maternity room in the isolation facility is not working well and we need to equip it. It's not necessarily PHD, but it's it's UNFPA.  So while, we need to appreciate the Government of Timor Leste as well, because as much as possible, they are establishing the National Commission, the technical Commission's and as much as possible while they need to work going out there and respond, they're still calling everybody together. Now what we maximise, is that, okay, we're all in these big meetings, we know that these are the gaps, these are the priorities, and then we gather ourselves. It just gets the willingness of everybody to collaborate. 

Dr Stephanie Williams  17:34

Yeah and we've, we've seen that partnership on display well in the last few days, which is the time I've been here. And I guess the challenge is emergencies and crises, make us work differently and better together. And how do we continue...We can't continue running in crisis mode, correct to coordinate but but each time there is this moment, the relationships get a bit stronger and a bit easier and I think we have to normalise that a bit.  Can I ask, in terms of you describe such a great journey in health to where you are now, what your advice is to young Timorese who are interested in working in health. 

Armandina Gusmao Amaral 18:18

I fully agree with you that at some stage, we need to move away from this vertical approach COVID-19 respond, response and COVID-19 vaccinations have been well resourced how we actually work to learn from this vertical approach and apply it in the routine services. And the Ministry of Health will continue to count on each of us both development and technical implementing partners. And I see some good moves both from the central Ministry of Health, in already taking the discussions with us development partners in terms of integrating the current efforts of COVID-19 into the routine services, we need to intensively work with the government not to work outside but work with the government to make that happen.  

In my young Timorous colleagues who are interested to work in health, I would like to say that every profession is important and are needed in different ways in this country. We're still developing, we still need a lot more good human resources, to support all of the all of the different efforts. There are a lot of opportunities for young Timorese. I guess me personally, what I have learned is that maybe not necessarily the case for developing countries, for example, we get to experience the reality. We get to see the day to day struggle of our family, our immediate families, our neighbours, our surrounding within the communities. So it's just a matter of taking that to systematisation, I guess. I don't know whether that's the correct word. But how you are going up to a bit of academic kind of experience to make sure that okay, what I've seen in my community, in my family, in my neighbourhood, is actually this is how they describe it systematically and how I can help. But I guess you can be a health manager, or you can be a clinical person and providing essential health care services. Both are equally important, but be responsible and be accountable as much as you can, as you will be dealing with the helping and saving lives. It's a very onerous opportunity. I have personally witnessed to my own like I mentioned earlier, late father how a health provider is assisting a woman in giving life to others. Through my professional careers, I have witnessed how a health provider in rural health post is making a big effort trying to be creative, working extra miles to try and provide health care services to people.  When you are aware of this reality, as a manager, at the municipal or national, with the government or with external partners, you'd be motivated to do your best and contribute to support those who are at the frontlines. Whether you are a manager, whether you're an official entering data, whether you're a logistician, a pharmacist, an ambulance driver, or a clinician, you will be contributing to making that change to one person's life at the end of the day. Thank you.

Dr Stephanie Williams  21:37

Yeah, what makes you most hopeful about the future here?

Armandina Gusmao Amaral 21:42

My I think that's a very tough question. Sometimes you do just doing it, and then you forgot that, I guess, witnessing how...Timor is quite complex. Our political settings can be quite complex. But witnessing the collective efforts during this pandemic, I felt like everybody cares about everybody else.  Culturally, we're very collective. We're helping each other. So and then I also saw out there in the community through my own teenage children, as well as the communities, I'm surrounding that there are young people who are eager to learn, and who are eager to see and do good things for this country. And before it's too late, I hope that while there are always different views about development in this country, we can maximise the existing development assistance to this country before we run out of it, because I think developed countries cannot just be focusing on Timor. There are also other countries that would be increasingly needing their support as well. So how are we as a country actually maximising that. Me through my own small contributions in working with the people in the health sector, but also other people around this country.

Dr Stephanie Williams  23:12

So Dina, thank you for sharing your story and your passion and your hope for the future.

Armandina Gusmao Amaral 23:18

Thank you very much, Dr Steph.

Dr Stephanie Williams  23:22

Thank you for joining us for this episode of Contain This. I'm Stephanie Williams, Australia's Ambassador for Regional Health Security. I've been talking to man Mana Dina, the Program Director at the Partnership for Human Development in Timor Leste. This is a 10 year programme funded by the Australian government to support the Government of Timor Leste to deliver services in health, education, gender, disability, nutrition, social solidarity and inclusion. Since its inception in 2016, the Partnership for human development has supported improved access to health services across Timor Leste says 14 municipalities and collaborated with the Ministry of Health to produce a new bilateral programme health design. 

We hope you enjoy this episode. Subscribe to Contain This for our next episode in two weeks’ time.