This case study analyses the challengesof establishing a pharmaceutical and medical supplies systemin a Timor-Leste post-conflict context. In the aftermath ofits separation from Indonesia, the Timor-Leste healthinfrastructure was in total disarray, with more than a thirdof health facilities destroyed, and those remaining severelydamaged. The crisis in human resources was severe, as morethan 80 percent of qualified public-sector staff hadreturned to Indonesia. The resultant heavy dependence onexpatriates was complicated by language incompatibility, andnationals were not well integrated into planning andimplementation processes, as an entire public sectorinfrastructure was being established de nouveau. Despite thefledgling status of the public sector, a sophisticatedorganizational framework was envisioned for theestablishment of the health sector supply system: anautonomous agency that would be a non-profit wholesaler orrevolving drug fund and a public sector monopoly. The casestudy reviews the development of the policy and legalframework for the pharmaceutical sector, and the key phasesof the commodity supply system, including: product selectionthrough an essential drugs list; procurement hampered by useof procedures that were not appropriate for purchasing drugsfor an entire country; the establishment of a centralizedwarehousing and distribution system; projected financing ofthe supply system through development of a business plan forthe autonomous agency. In its exploration of the transitionfrom post-conflict situation to health system development,the case study identifies lessons that are broadlyapplicable to foreign aid and external assistance in othercontexts, including the tendency to'poly-prescribe' overly ambitious and overlysophisticated solutions not pragmatically grounded in thecurrent realities of public sector institutional and humanresource constraints and capabilities.
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