A young nation, a bold promise
For Timor-Leste, the constitutional right to health is both a promise and a blueprint. As the young nation shapes its health system, diabetes and hypertension care is being used a pathway to bring health services closer to communities, turning political commitment for equitable primary health care into action.
05 November 2026 Minaho Sugimori
The intersection of political commitment and care
In Timor-Leste, non-communicable diseases (NCDs) are now among the leading causes of illness and premature death. Hypertension affects more than one in three adults, while diabetes prevalence continues to rise — likely an underestimate in a population where screening has historically been low and diagnosis often comes late.
In 2024, 21,600 adults were living with diabetes, a number projected to climb to 39,100 by 2050. For people living with diabetes, these numbers are not abstractions. They translate into long journeys to understaffed facilities, interrupted access to treatment, and diagnoses that arrive only once complications have already taken hold. Access to care that is timely, continuous, and close to home can mean the difference between stability and crisis.
Recognising this growing challenge, the Government of Timor‑Leste has made access to health care a constitutional right, placing Universal Health Coverage (UHC) at the centre of its national development agenda. Within this context, diabetes and hypertension have emerged not only as public health priorities but as tracer conditions — lenses through which to strengthen the foundations of primary health care itself.
This is where the World Diabetes Foundation (WDF) comes in. Through its first-ever engagement in Timor-Leste, WDF has partnered with the World Health Organization Regional Office for South-East Asia (WHO SEARO) and WHO Timor-Leste country office, under the guidance of the Ministry of Health of Timor-Leste, to help translate ambitious political commitments into practical, system-level change. This powerful collaboration is aimed at ensuring that care does not stop at policy, but reaches everyone, including communities living in remote areas who lack access to care.
Building the health system from the ground up
Timor-Leste is Southeast Asia’s youngest nation, having gained independence in May 2002. Today, it is home to approximately 1.4 million people, nearly 74% of whom are under the age of 35. This demographic profile presents both a challenge and an opportunity: a rapidly changing disease burden against the backdrop of a health system still consolidating after independence, but also a rare chance to build sustainable services early, learning from neighbouring countries.
But its geography complicates delivery. As a small island nation heavily reliant on costly international imports, Timor-Leste faces additional barriers to ensuring consistent access to essential diabetes care. Coupled with Timor-Leste’s mountainous terrain, limited transport infrastructure and dispersed rural communities make frequent facility-based care extremely challenging. Historically, diabetes care was largely restricted to referral hospitals, with limited capacity at primary health care level. Many patients were required to travel weekly for short medication refills, often at the expense of livelihoods and household responsibilities. Upon arrival to the hospital, it was a chance whether or not medicines were available.
The costs of inaction
Even with a young population, approximately 7% of adults aged 18 and above in Timor-Leste are living with diabetes. Most are diagnosed late. National data from 2023 indicate that 89% of people have never been screened, only 12.3% of people with diabetes receive any form of treatment, and just 20% of those on treatment are aware of their diagnosis.
The consequences can be debilitating. People who present with advanced complications often require referrals abroad for care, generating high costs. These costs carry a double toll. For families, they cause an enormous financial burden. For the state, the government subsidises a portion through the national insurance scheme, creating severe expenditures that could instead be used towards the government’s commitment to universal health coverage. Slowly but surely, diabetes and hypertension accelerate cycles of illness and poverty, placing increasing strain on the health system.
More than ever, the urgency for early detection, decentralised care, systematic follow-up, and increased workforce capacity rings clear for the small island nation. Simultaneously, Timor‑Leste is working to shed an identity defined by conflict and fragility, replacing it with one grounded in dignity, equity, and cooperation. Nowhere is this more visible than their health system priorities.
Set into motion: the 50x20 pathway
In 2023, Timor‑Leste made a bold political commitment: to place 50,000 people with hypertension and/or diabetes on protocol‑based management by 2025. Known as 50×25, the initiative aligns with the WHO South‑East Asia Region’s SEAHEARTS resolution, which aims to place 100 million people across the region on standardised treatment pathways.
50×25 was not conceived as an individual NCD initiative. Rather, it served as part of broader health system strengthening, using diabetes and hypertension to improve availability of essential medicines, service readiness, health information systems, and workforce capacity.
WDF’s support has been catalytic in operationalising this ambition. Through the first phase of the project, WDF has worked alongside the Ministry of Health, WHO Timor‑Leste, and WHO SEARO to embed diabetes and hypertension care within the government’s flagship reform programme: Programa Integrado Saúde (PIS), or the Integrated Health Programme.
PIS aims to decentralise care, integrate promotive, preventive, curative, and rehabilitative services, and bring essential health services closer to communities. They achieve this by deploying mobile health outreach teams at the village level, providing integrated health services and specialist care. PIS also positions doctors at the health post level to bring essential services as close to communities as possible.
Like dominos, implementation cascades
Initially, the project was set to be implemented in the Aileu municipality, where the first phase focused on strengthening care across the entire diabetes and hypertension cascade. However, the project sparked renewed government commitment.
With the project’s close alignment to Timor-Leste’s national Universal Health Coverage ambitions, the Ministry of Health mobilised additional support and pooled shared resources, enabling accelerated expansion to the capital municipality of Dili. What started as supported implementation bloomed into a government-driven expansion, embedded within national systems and budgets. By early 2026, the two pilot municipalities alone have already contributed nearly 50% of the country’s 50×25 target. This included 2,573 people with diabetes and over 21,429 people with hypertension placed on protocol‑based, a true testament to how quickly local success can drive national progress.
The results at the systems-level speak for themselves. With the nation in the driver’s seat, supported by WDF, and technical support from the WHO, this initiative has:
-
Introduced simplified, standardised management protocols at primary health care level
-
Strengthened referral linkages between community health centres and health posts
-
Rationalised medicine procurement by prioritising the Essential Medicines List within existing budgets
-
Extended medicine dispensing from 7 days to 30 days, reducing travel burden and improving adherence
-
Lowered the recommended screening age from 40 to 30, enabling earlier diagnosis
-
Developed an NCD drug quantification and forecasting tool to support national medicine and diagnostic supply planning
-
Implemented a revised NCD recording and reporting system, including a pilot digital e‑tracker, with NCD patient data now integrated into the national DHIS2 health information system
-
Increased public awareness of diabetes and hypertension through multi-channel campaigns and outreach, reaching over 62,400 views
-
Developed national guidelines for the care of women with diabetes during pregnancy
-
Established a bidirectional Tuberculosis (TB)-diabetes screening and referral framework
-
Produced an implementation guide for diabetic retinopathy screening at PHC level to enable systematic early detection, designed for use in Timor-Leste and other Southeast Asia countries
For healthcare workers, the model of care has transformed from ad-hoc, one-off practices, to procotol- and team-based delivery.
This transformation can be directly credited to the over 300 frontline providers across all health facilities in the two municipalities who were trained through a cascade model. The focus of their training was to standardise diabetes and hypertension care, so that the availability of treatment is no longer a question; rather, a given.
At the same time, community health clinics, health posts, and treatment posts have been equipped and strengthened to support consistent, high-quality service delivery.
And for people, access to care began to change.
“I felt happy with my diagnosis, because I now know what to do about my headaches and dizziness,” shared Erminda Garcia.
Erminda, 32, is a mother of three living with diabetes in Aileu. She was screened at the Dona de Casa Health Centre as part of routine outpatient care. Erminda also received her NCD passport, a simple tool designed to support continuity of care across services. For months, she had been experiencing persistent headaches and dizziness, symptoms she had learned to live with instead of seeking caring for.
For Erminda, receiving a diagnosis did not frighten her. In fact, it relieved her. For the first time, she knew what was happening in her body. And just as importantly, what to do next.
Under previous guidelines, Erminda would not have been screened. The WHO typically recommends universal screening starting at age 40, but the project deliberately lowered the screening age to 30. In a setting where every resource must be carefully weighed, this was an intentional and consequential choice. Lowering the screening age required the calibrated approach of balancing limited supplies, workforce capacity, and outreach ambitions against the risk of missing people at earlier stages of disease. As early findings are released, they suggest that enabling diagnosis before complications set in can re-emphasise the case for earlier intervention in Timor-Leste’s young population.
Within just two years, over 30,000 people have been screened for diabetes, and ~224,700 screened for hypertension, far exceeding initial targets. In all, 2,049 of those screened were newly diagnosed with diabetes and started on treatment. The same decentralised model also led to the identification and management of over 21,000 people with hypertension, accelerating progress towards Timor‑Leste’s 50×25 target. Erminda’s case shows how those big numbers translate into individual lives transformed by early care.
Widening the map of care
Building on these achievements, the second phase of the project is scaling the model to three additional municipalities, with the aim to reach 46% of the nationwide population. While maintaining support to the original areas, the project deepens integration with maternal health services (including screening for hyperglycaemia in pregnancy) and TB services, advancing bi‑directional TB‑diabetes screening.
Moreover, until now, Timor-Leste has had virtually no data on type 1 diabetes (T1D). It is unknown how many people are affected, where they are, and whether they are receiving care. This critical data and service gap will be addressed by introducing T1D surveillance and care at selected referral sites.
Predictability: the key unlocking foundations for the future
For people living with diabetes, access to care is the key that unlocks the door to treatment. It also unlocks the door to predictability; to knowing that medicines will be available; that diagnoses will lead the action; that care will not require impossible trade-offs.
In Timor‑Leste, diabetes has become a vehicle for strengthening primary health care, advancing equity, and giving practical meaning to the constitutional right to health. Unraveling now is a clear trajectory for political commitment and integrated prevention and care that reaches every corner of the island nation.
For a young nation still shaping its health system, that journey matters. Timor-Leste is showing what is possible when ambition, partnership, and people remain at the centre.