Digital health is not a technology project. It is a governance choice — a decision to use the tools of the connected age to give every Timorese citizen the same access to information, services, and care that geography and income currently deny to millions. This essay makes the case for why, and maps the architecture of how.
This is Essay V of the Health Policy Essay Series. Essays I–IV addressed healthcare market failure, private investment, pharmaceutical procurement, and Universal Health Coverage equity. This essay examines how digital health technologies — electronic health records, patient portals, telemedicine, national pharmacy databases, and laboratory information systems — can transform access and quality for all Timorese citizens, and what government action is required to drive that transformation.
Imagine arriving at the emergency department of the Hospital Nacional Guido Valadares — the country's only tertiary referral hospital — as a patient transferred from Oecusse or Ermera. The referring doctor wrote notes on paper. The notes may not have travelled with the patient. The patient's medical history, current medications, known allergies, and previous test results are not available to the receiving team. The clinical encounter begins in darkness, and precious minutes are lost reconstructing a past that could have been transmitted in seconds.
Imagine a patient in Maubara who needs a specific antibiotic. The nearest pharmacy does not carry it. He travels to the next town, which also lacks stock. By the third pharmacy, he has spent most of the day, significant money, and physical energy — all in pursuit of a medicine whose availability could have been confirmed on a mobile phone before he left home, had the pharmacies been required to maintain and publish their stock in real time.
Imagine a mother whose child has been diagnosed with Type 1 diabetes. She is given instructions at the clinic, in a rushed consultation, in language she partially understands. She goes home with a pamphlet. She has no way to access further information, monitor her child's progress against clinical norms, communicate questions to the doctor between appointments, or connect with other families managing the same condition. Her child's disease management depends entirely on what she could absorb in a fifteen-minute consultation and retain without any digital support.
These are not hypothetical scenarios. They are the daily texture of healthcare in Timor-Leste today. And they are, in significant part, not inevitable — they are the result of a health system that has not yet made the transition from paper, fragmentation, and physical presence as the primary mode of care delivery, to digital, integrated, and remotely accessible health services. This essay argues that making that transition is not a luxury for when Timor-Leste becomes richer. It is a tool for becoming richer — in human capital, health outcomes, and effective universal coverage — faster.
Digital health will be valued and adopted if it is accessible and supports equitable and universal access to quality health services; enhances the efficiency and sustainability of health systems in delivering quality, affordable and equitable care; and strengthens health promotion, disease prevention, diagnosis, management, rehabilitation and palliative care — in a system that respects the privacy and security of patient health information.
— WHO Global Strategy on Digital Health 2020–2025 (extended to 2027 by World Health Assembly Resolution WHA78(22), May 2025)
The World Health Organization's Global Strategy on Digital Health, first adopted by the World Health Assembly in 2020 and most recently extended to 2027, provides the most authoritative global framework for how countries should approach digital transformation in health. As of 2024, over 129 countries have established national digital health strategies aligned with it, more than 1,600 government officials across 100+ countries have received digital health training, and 130 member states have conducted digital health maturity assessments. Timor-Leste has not yet formally adopted a national digital health strategy, representing both a gap and an opportunity — the opportunity to design a strategy that learns from the extensive experience now accumulated elsewhere.
The WHO strategy identifies four strategic objectives: promoting global collaboration; advancing implementation of the digital health strategy framework; strengthening governance, privacy, and security; and accelerating development and sharing of digital health solutions. For a small country like Timor-Leste, the most immediately actionable of these is the third — governance — because the decisions the government makes now about whether to mandate, incentivize, or merely permit digital health tools will determine whether the country achieves coherent digital integration or a fragmented landscape of incompatible systems.
Digital health is not a single technology. It is a layered architecture of interconnected systems, each of which serves a specific function and depends on the others to deliver its full value. Understanding this architecture is essential before designing a national strategy, because investing in one layer without the others produces incomplete and often wasted results.
Timor-Leste's situation — a small, mountainous nation with dispersed population, limited infrastructure, and significant reliance on mobile communication — closely parallels many Pacific Island countries and territories (PICTs), which have a decade of experience with digital health implementation ahead of Timor-Leste. Research published in 2025 mapping electronic health record (EHR) coverage across fourteen PICTs in the WHO Western Pacific Region found that EHRs are only available in about 47 percent of countries worldwide, and that PICTs face specific challenges including geographically dispersed service delivery points, workforce shortages, and infrastructure constraints.
The same research identifies important lessons: that EHR adoption requires not just software, but change management, staff training, and sustained technical support; that the total cost of ownership (acquisition, maintenance, and training) is often the primary barrier in low-income settings; and that open-source solutions designed for resource-limited environments have significantly reduced the financial barrier to adoption. Critically, Fiji's PATISPlus electronic medical record system has demonstrated that a Pacific Island context-specific EHR can be implemented, sustained, and actually used by clinical staff — providing a regional proof-of-concept that is directly relevant to Timor-Leste's ambitions.
Three conditions that must coexist for digital health implementation to succeed are simultaneously present in Timor-Leste at this moment: a compelling need that existing analogue systems cannot adequately serve; a sufficient technical readiness in terms of connectivity and device penetration; and a window of institutional opportunity to establish the governance framework before the private sector and individual providers create a fragmented landscape of incompatible systems that becomes expensive and difficult to integrate.
The need has been documented throughout this essay series. Fragmented, paper-based records that prevent continuity of care. Medicine stockouts that send patients on wasted journeys because availability information does not exist in accessible form. Geographic barriers to specialist consultation that cause avoidable referral travel. Chronic disease patients managing complex conditions with no digital support between appointments. A regulatory system (AIFAESA) that has limited visibility into the actual practices of private pharmacies and clinics because there is no digital reporting infrastructure connecting them.
The readiness is real and growing. Mobile phone penetration in Timor-Leste has increased dramatically, with high smartphone ownership even in lower-income households. The 2023 Maluk Timor Annual Report noted specifically that despite poor internet coverage in rural areas, mobile phone use is high and community interest in e-learning and digital health tools is significant. The infrastructure gap is real but narrowing, and several initiatives — including solar-powered health post installations and expanding mobile network coverage — are addressing it directly.
The single most important design principle for Timor-Leste's digital health strategy is: mobile first. The country's population will not access health services digitally through desktop computers or even through broadband internet connections in most cases. They will use smartphones — often low-cost Android devices — over 4G or 3G mobile networks. Any digital health system that is not designed to function optimally on these devices and networks will fail to reach the majority of the population it is meant to serve.
Mobile-first design means more than responsive web design. It means offline functionality for areas with intermittent connectivity, so that a health worker or patient can input data locally that synchronizes when connection is restored. It means lightweight applications that do not consume excessive data. It means interfaces that function in local languages — Tetum at minimum, with Portuguese and Indonesian as supplements. And it means user experience designed for people who may have limited digital literacy, including visual navigation, audio support, and simple workflows.
The patient portal is the most transformative of all digital health tools from the citizen's perspective — and the most important to understand correctly. A patient portal is not merely a website where a patient can book an appointment. In its full conception, it is the digital interface between a patient and the entire health system: a single, secure, personalised space through which the patient can access their complete health record, communicate with providers, receive education and alerts, track their own health data, search for services, and navigate the health system — regardless of which facility they use or which provider they see.
Book, reschedule, or cancel appointments at any registered public or private facility. Receive SMS/app reminders. Reduce no-shows and wasted clinic time.
View own medical history, diagnoses, procedures, and clinical notes across all facilities. Continuity of care regardless of where the patient presents.
Full medication list from all prescribing providers. Allergy flags. Drug interaction warnings. Refill reminders. Reduces medication errors and adverse events.
Access test results from any registered laboratory. Trend charts for chronic disease markers (blood sugar, HbA1c, blood pressure). Download or share with another provider.
Asynchronous communication with the care team between visits. Ask non-urgent clinical questions. Receive responses. Reduces unnecessary appointments for simple queries.
Condition-specific education modules in Tetum, Portuguese, and Indonesian. Videos, illustrated guides, and care plans. The antidote to the fifteen-minute consultation's information deficit.
Log blood pressure, blood glucose, weight, symptoms. Visual trend displays. Share automatically with care team. The foundation of supported chronic disease self-management.
Complete vaccination history including childhood immunization and adult vaccines. Reminders for due vaccinations. Critical for Timor-Leste's expanded immunization programme.
Search nearby facilities, check services offered and opening hours, see which specialists are available and when, access pharmacy stock search — all in one interface.
Video or voice consultation with a healthcare provider, accessible directly from the portal. The bridge between geographic distance and clinical expertise.
Personalized notifications: overdue appointments, abnormal results needing follow-up, disease outbreak alerts in the patient's area, medicine recall notices.
Parent or guardian access to child records. Carer access for elderly or disabled family members. Critical for the family-centred care model common in Timorese culture.
One of the most underappreciated dimensions of the patient portal is its role as an ongoing health education platform. The fifteen-minute clinical consultation is the dominant mode of health education delivery in Timor-Leste's current system. In those fifteen minutes, a clinician must conduct an examination, form a diagnosis, prescribe treatment, and explain what the patient needs to know to manage their condition. The information compression required is extreme, and the evidence base on how much patients retain from verbal consultations is not encouraging — studies consistently show that patients forget up to 80 percent of what they are told in clinical settings within twenty-four hours.
The patient portal fundamentally changes this dynamic. When a patient is diagnosed with diabetes, hypertension, or tuberculosis, the portal becomes the medium through which they access condition-specific education at their own pace, in their own language, when they have the cognitive and emotional bandwidth to absorb it. Research published in 2025 confirms that digital health technology — including mobile health apps and patient portals — has demonstrable potential to improve health literacy and self-management in patients with chronic diseases including diabetes, hypertension, and cardiovascular disease. Studies specifically note that digital health literacy is modifiable — meaning that patients who initially lack digital health skills can acquire them, particularly when the system is designed for their context.
For Timor-Leste's particular burden of non-communicable diseases — where WHO notes that nearly 4 percent of adults have raised fasting blood glucose, with a diabetes death rate among women four times that of men — the patient portal's capacity to extend education and monitoring beyond the clinic walls is not peripheral. It is essential to any serious chronic disease management strategy. A diabetic patient in Timor-Leste who can access a portal in Tetum to understand their HbA1c results, receive reminders about foot care, and message their doctor with questions between appointments is receiving categorically better care than one who is not — regardless of whether they live in Dili or Maubara.
The foundational technology enabling the patient portal — and connecting all health providers into a coherent system — is the electronic health record (EHR): a digital, longitudinal, patient-specific record that follows the patient across all facilities, providers, and episodes of care. The EHR is the antithesis of Timor-Leste's current reality of paper notes that stay at one facility, referral letters that may not accompany the patient, and receiving clinicians who begin each consultation in information darkness.
In a functioning EHR system, when a patient referred from Suai Referral Hospital arrives at HNGV in Dili, the receiving surgeon can review the referring doctor's clinical notes, the patient's complete medication list, their last blood tests, their known allergies, and the documentation of the procedure that was attempted before transfer — all before the patient enters the room. Clinical decisions become faster, safer, and better informed. Diagnostic duplication is reduced. Drug interactions are flagged automatically. The patient does not have to reconstruct their medical history from memory under stress.
The experience of the Pacific region confirms that EHR implementation in small island developing states is feasible and beneficial. Fiji's PATISPlus system has demonstrated that a Pacific context-adapted EHR can improve care quality and continuity. A 2022 study from Tuvalu — arguably the most resource-constrained environment imaginable — documented that even basic digital communication between outer island health posts and the central hospital, enabled by satellite connectivity, reduced unnecessary patient transfers and improved the quality of handover when transfer was genuinely needed. If Tuvalu can implement digital health communication infrastructure, Timor-Leste — larger, more resourced, and with existing mobile infrastructure — has no credible reason not to.
António has been prescribed amoxicillin-clavulanate for his child's ear infection. He leaves the health centre and walks to the nearest pharmacy, 20 minutes away. It is out of stock. He takes a motorcycle taxi to the next pharmacy. Also unavailable. A neighbour suggests trying the pharmacy on the other side of Dili. By the time he finds the medicine — on his fourth attempt, two hours later, $8 in transport spent — the clinic is closed and he cannot get the prescription revalidated. His child has missed a dose.
After — The Digital Pharmacy PortalAntónio receives his prescription. He opens the national pharmacy portal on his phone, types the medicine name, and sees in real time which licensed pharmacies within 5 km have it in stock, their current price, and their opening hours. He goes directly to the right pharmacy, obtains the medicine in 20 minutes, and his child receives the first dose on schedule.
This scenario — multiplied across thousands of prescriptions and patients each day, across all thirteen municipalities of Timor-Leste — represents an enormous accumulated cost of wasted time, wasted money, delayed treatment, and patient frustration that is entirely preventable with appropriate digital infrastructure. The analogue pharmacy search is not just inefficient. In cases involving acute infections, time-sensitive medications, cold-chain products like insulin, or critical prescription items, delayed access has direct clinical consequences.
The government has a straightforward regulatory instrument available: make digital inventory disclosure a condition of pharmacy licensing. Every licensed pharmacy in Timor-Leste — public or private — would be required, as a condition of maintaining its operating license, to maintain a real-time or near-real-time digital inventory of its available medicines and their current stock status. This information would be transmitted to and published through a national pharmacy portal operated by INFPM (Instituto Nacional da Farmácia e do Medicamento) and supervised by AIFAESA.
Every licensed pharmacy — public health facility dispensary, private pharmacy, hospital pharmacy — connected to a central national portal operated by the government (INFPM/AIFAESA). The portal is publicly accessible via web and mobile app, in Tetum and Portuguese.
The national pharmacy portal does not only serve patients. It gives AIFAESA and INFPM a real-time view of the national medicine landscape that is currently simply impossible with paper-based or fragmented reporting. Inspectors can identify pharmacies that consistently report implausible stock profiles — potential indicators of unlicensed dispensing or falsified inventory. Cross-referencing pharmacy stock reports with INFPM's procurement and distribution data creates a chain-of-custody audit trail from manufacturer through distributor to dispensing point. Stock patterns across municipalities can signal supply chain failures before they become crises. The portal is simultaneously a consumer service and a regulatory intelligence tool.
Given Timor-Leste's small size — approximately 1.3 million people and fewer than 100 licensed private pharmacies — the most efficient model is not to require each pharmacy to build its own portal independently (as larger countries with developed digital infrastructure might do) but for the government to operate a single unified national portal to which all pharmacies connect. This eliminates the cost and technical barrier to individual pharmacies creating compliant portals, ensures data standardisation, guarantees public accessibility, and places the regulatory intelligence function directly with AIFAESA and INFPM.
Portugal's INFARMED (Autoridade Nacional do Medicamento e Produtos de Saúde) operates a national medicines database and pharmacy registry that serves as a useful reference model for Timor-Leste, bearing in mind that the Timorese system would be far simpler by necessity and should be built on open-source or regional technology platforms rather than bespoke software. The Philippine Food and Drug Administration has implemented a similar national medicine availability database for a much larger country, demonstrating that regulatory-led pharmacy digitalization is technically and administratively feasible in the Southeast Asian context.
The identical logic applies to diagnostic laboratories. A patient requiring a fasting blood glucose test, a complete blood count, a tuberculosis culture, or an imaging study is currently unable to know, without physically visiting the facility, whether the specific test they need is available, whether the reagents are in stock, what the cost will be, and how long results will take. In a country where the national reference laboratory is in Dili and private diagnostic facilities are concentrated in the capital, a patient from Ainaro or Viqueque faces enormous uncertainty before committing to a journey for a test that may not be performable on the day of their visit.
Every licensed laboratory publishes which tests are currently performable, current reagent availability, and estimated turnaround time. Updated daily at minimum.
Published fee schedule for each test at each facility. Price comparison enables patients and referring clinicians to make informed choices without surprise billing.
Patients can book laboratory slots in advance, eliminating waiting hours and enabling facilities to manage workflow. Integration with patient portal allows automatic result delivery.
Test results delivered directly to the patient portal and the referring clinician simultaneously. Eliminates result loss, delays, and the need for a physical return visit to collect results.
Clinicians can order tests electronically through the EHR, automatically transmitting the request to the laboratory with patient history attached. Reduces transcription errors and missing clinical context.
Published accreditation status, external quality assurance participation, and last inspection date for each laboratory — allowing patients and clinicians to choose quality-verified facilities.
Telemedicine is the delivery of healthcare services using information and communication technologies across a distance. It is not the future of medicine — it is a proven, widely deployed modality that has been in routine clinical use in multiple countries for decades. It is not a replacement for physical examination and in-person care — it is a complement that enables clinical expertise to be delivered where and when physical presence is not available or necessary. And it is not a single technology — it encompasses a range of modalities, from real-time video consultation to asynchronous image transmission to store-and-forward referral systems.
The APEC 2022 Telemedicine Development in the Asia-Pacific report documents that mobile network expansion is making telemedicine viable as a primary care tool across the region — including in developing economies where broadband infrastructure is limited but 4G mobile coverage is growing. It notes that a mobile network is often the main route to telehealth services in rural areas, and that government policies issued to expand telemedicine use have been critical drivers of adoption in multiple Asia-Pacific economies.
A nurse at a remote health post consults a physician at the district referral hospital via video before deciding whether to transfer a patient. Reduces unnecessary transfers, improves triage quality, and ensures better handover when transfer is needed.
A doctor at a community health centre in Maliana conducts a teleconsultation with a cardiologist at HNGV in Dili, sharing ECG images and clinical notes. The patient gets specialist guidance without a four-hour journey.
A diabetic patient in Manufahi sends self-monitored blood glucose readings through the patient portal. The care team reviews them remotely and adjusts medication without an in-person visit — unless values are abnormal and physical review is warranted.
A community midwife in a remote suco consults an obstetrician in Dili via video about a high-risk pregnancy, enabling early identification of complications and planned referral before an emergency develops.
Mental health services are almost entirely concentrated in Dili. Teleconsultation enables psychiatrists and psychologists to serve patients in all municipalities, addressing a critical gap in non-communicable disease care.
Teleconsultation with specialists in Australia, Indonesia, or Portugal for complex cases currently requiring expensive international referral. Reduces medical tourism costs and keeps care within the Timorese system where possible.
Low-acuity consultations (follow-up reviews, prescription refills for stable chronic conditions, test result discussions) conducted via patient portal video call, freeing clinic capacity for patients requiring physical examination.
X-rays, ultrasound images, and pathology slides captured at district facilities and transmitted digitally for expert interpretation in Dili or internationally. Brings specialist diagnostic capability to every hospital with imaging equipment.
In 2020, Tuvalu — a Pacific Island nation of approximately 11,000 people, more geographically remote than any municipality in Timor-Leste, and with a fraction of Timor-Leste's economic resources — began installing Very Small Aperture Terminals (VSAT) at health facilities on remote outer islands to enable digital data exchange with the central hospital. A peer-reviewed study published in 2022 in PLOS Digital Health documented the results: digital communication between outer island health posts and the main hospital improved the quality of clinical handover before patient transfers, reduced unnecessary transfers, and enabled a level of remote clinical support that was previously impossible.
The study's authors note that Tuvalu lacked many of the administrative instruments and regulatory frameworks needed to fully realize telemedicine's potential — a finding that contains an important lesson for Timor-Leste: the technology is the easy part. The governance framework — legislation authorizing teleconsultation, professional liability frameworks for remote prescribing, privacy protections for digitally transmitted clinical data, and reimbursement mechanisms that pay providers for teleconsultation services — is what determines whether telemedicine becomes embedded in clinical practice or remains a pilot project.
Digital health transformation does not happen by itself. Without government action, digital health in Timor-Leste will remain what it is today: a collection of unconnected initiatives, incompatible systems, and digital deserts where the public sector has not invested and the private sector has no incentive to go. The government must play two roles simultaneously: enabling the digital health ecosystem through standards, infrastructure investment, and technical assistance; and mandating participation through licensing conditions, reporting requirements, and enforcement. The first without the second creates a voluntary landscape that excludes the populations most in need. The second without the first creates compliance burdens that providers cannot meet.
The international experience — including the German e-Health Law (E-Health-Gesetz), which created a legal roadmap for digitalization with specific mandates and timelines, and the WHO's documented analysis of Tanzania's Digital Health Strategy, which identified gaps in governance and capacity building as the primary barriers to implementation — consistently shows that voluntary digital health adoption in healthcare sectors produces fragmented results. Clinicians and healthcare facilities will not invest in EHR systems that other facilities do not use, because the interoperability benefit only materializes when the network is comprehensive. This is the classic network effect problem: each additional participant increases the value for all other participants, but no individual participant has sufficient incentive to join first. Government mandate breaks the deadlock.
All licensed pharmacies must register with the national portal and update medicine availability at minimum daily. Condition of operating license renewal. Enforcement through AIFAESA annual inspection checklist.
All licensed laboratories must publish test availability, current prices, and turnaround times on the national health portal. Integration with AIFAESA laboratory accreditation register.
All healthcare facilities (public and private) must submit statutory disease notifications electronically. Replaces paper-based notification which results in systematic under-reporting and delayed outbreak response.
All public health facilities must adopt the national EHR system. Private clinics and hospitals must use an AIFAESA-approved EHR with minimum interoperability standards. New facility licenses only granted with EHR compliance.
All patient referrals between licensed facilities must be transmitted digitally through the national health platform. Paper referral letters to be replaced, eliminating lost referrals and information gaps.
Legislation establishing the legal status of teleconsultation, professional liability framework, prescribing rules for telemedicine, and reimbursement conditions. Without legal framework, clinicians will not practise telemedicine regardless of technical availability.
A unique patient identifier assigned to every Timorese citizen — linked to the national civil registry — enabling patient matching across facilities and the creation of a longitudinal health record that follows the patient for life.
All public facilities must offer patient portal access to registered patients, with minimum functionality: record access, appointment booking, and secure messaging. Patient opt-in with informed consent. Multi-language (Tetum, Portuguese, Indonesian).
All prescriptions issued by licensed prescribers to be electronically generated and transmitted, replacing paper prescriptions. Links prescribing to dispensing, enables medicine safety checks, and provides the data foundation for rational medicines use monitoring.
A digital health strategy that fails to protect patient privacy will fail — not only because it creates genuine harm through data breaches or misuse, but because it erodes the trust that patients must have in the system for them to use it and share their information honestly with healthcare providers. Timor-Leste does not yet have comprehensive data protection legislation aligned with international standards such as the GDPR or the WHO's guidance on health data governance. Enacting such legislation — specific to health data, with strong penalties for unauthorized access or disclosure — must accompany, not follow, the rollout of digital health systems.
The minimum requirements include: patient consent for data collection and specified uses; prohibition on sharing patient data with commercial third parties; government-operated secure data infrastructure; end-to-end encryption for all data in transit; strong access controls ensuring that only authorized clinicians can access specific patient records; and an independent oversight body (potentially within AIFAESA or a dedicated data protection authority) with powers to investigate complaints and impose sanctions. Health data is among the most sensitive data a government holds about its citizens. It must be treated accordingly.
Before building, map what exists. Commission (with WHO/UNDP technical support) a comprehensive assessment of existing digital health tools across all health facilities, current connectivity levels by municipality, staff digital literacy, and the state of health information systems. Use the WHO digital health maturity model as the framework. This assessment is the evidence base for all subsequent investment decisions.
Months 0–6Draft and pass: a Digital Health Act establishing the legal basis for EHRs, patient rights to their data, and telemedicine; a Health Data Protection Regulation; and regulations amending pharmacy and laboratory licensing requirements to include digital disclosure obligations. Engage civil society and patient groups in the drafting process to build public trust.
Months 3–12This is the highest-impact, lowest-cost, and most immediately visible digital health intervention available. Using open-source platform technology, build and launch the national pharmacy stock portal and laboratory service catalogue. Train all licensed pharmacies and laboratories on the system, with AIFAESA inspection compliance from Year 2. Consider building on existing mSupply infrastructure for the pharmacy component.
Months 6–18Select or adapt an open-source EHR (OpenMRS and OpenEMR have been successfully deployed in comparable resource-limited settings; Fiji's PATISPlus offers regional reference). Pilot in three or four diverse facilities — HNGV, one referral hospital, one community health centre, one remote health post. Use the pilot to refine workflows, training programmes, and connectivity solutions before national rollout.
Months 12–30Deploy a secure video consultation platform connecting all community health centres and health posts to their district referral hospital. Establish teleconsultation protocols — which clinical scenarios require teleconsultation before transfer, how to document and bill, how specialist rosters are managed. Train health workers. This single intervention, if implemented at adequate quality and with sustainable connectivity, could prevent hundreds of unnecessary and expensive patient transfers annually.
Months 18–30Working with the Civil Registry, assign a unique health identifier to every Timorese citizen. Integrate with the EHR as the key that links all clinical data across facilities into a single longitudinal record. Launch the patient portal, initially with appointment booking, record access, and medication history. Add chronic disease self-management tools, health education content in Tetum and Portuguese, and teleconsultation access as the system matures.
Months 24–42Extend EHR adoption to licensed private clinics and hospitals through licensing conditions, with a phased timeline that gives providers adequate preparation time. Provide a government-supported onboarding programme — technical assistance, training, and a subsidized access model for small private providers — to reduce the compliance burden. Enforce compliance through AIFAESA's regular inspection and licensing renewal process.
Months 30–48Create a permanent multi-stakeholder Digital Health Governance Board (Ministry of Health, AIFAESA, Ministry of Justice/data protection, civil society, private sector, patient representatives) to oversee implementation, review standards, resolve interoperability issues, and conduct annual public reporting on digital health progress. This institutionalizes the governance function and ensures the strategy remains responsive to evolving technology and user needs.
Month 12 onwardsDigital health transformation takes longer, costs more, and meets more resistance than predicted in every country that has attempted it. The most common failure modes are: underestimating the training and change management required to get clinical staff using new systems; overestimating connectivity reliability; underestimating the total cost of ownership (particularly ongoing maintenance); and failing to achieve interoperability between separately developed systems. Timor-Leste can avoid many of these failure modes by adopting existing regional solutions (adapted rather than built from scratch), investing heavily in workforce training, establishing strong interoperability standards from the outset, and building maintenance capacity locally rather than depending on external consultants.
The digital health tools described in this essay are not science fiction. They are in routine use across the Asia-Pacific region, in countries no wealthier than Timor-Leste and with health challenges no less severe. A Timorese patient who can use a mobile phone to find which pharmacy has their medicine, access their test results without returning to the clinic, manage their chronic disease with a patient portal that speaks to them in Tetum, and consult a specialist in Dili from a health post in Manufahi via video call — that patient is not being given something exotic. They are being given what patients in Fiji, Tuvalu, Indonesia, and the Philippines already have or are rapidly approaching. The question is not whether Timor-Leste can afford digital health. It is whether Timor-Leste can afford to remain without it.
The government's role in this transformation is not optional. Digital health will not reach the populations who most need it — the rural poor, the geographically isolated, the chronically ill without access to specialist services — unless the government uses its regulatory authority to mandate participation by all providers, public and private, invest in the shared national infrastructure, and enforce the privacy and security standards that make patients willing to trust the system with their most sensitive information. Voluntary adoption produces a digital health system for the urban middle class. Mandatory, well-supported adoption produces a digital health system for all Timorese.
The patient portal, the national pharmacy portal, the national EHR, the telemedicine network, the digital laboratory service catalogue — together, these form a connected ecosystem that fundamentally transforms the patient's position in the health system. No longer a passive recipient who journeys to wherever expertise happens to be concentrated, and hopes that the medicine they need is available when they arrive. Instead, an informed, connected participant in their own care, with a medical history that follows them wherever they go, specialist guidance available without leaving their community, and the information tools to understand and manage their own health. That is the promise of digital health, properly implemented. And it is a promise that Timor-Leste has both the need and the growing capacity to fulfill.
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INFARMED — Autoridade Nacional do Medicamento e Produtos de Saúde. National Medicines Database and Pharmacy Registry, Portugal. Reference model for government-operated pharmaceutical information systems.