Timor-Leste reviews AMR progress and shapes next National Action Plan

At Vera Cruz Community Health Centre (CHC) in Timor-Leste’s capital, antimicrobial resistance (AMR) is already affecting daily care.

“We are watching resistance grow right in front of us,” said Dr Marília Piedade, head of the centre. “Antibiotics we have relied on for years are failing. We reach for stronger alternatives and sometimes those medicines fail too.”

Dr Marília Piedade, Head of Vera Cruz Health Centre, presenting the current situation on antimicrobial resistance (AMR). ©WHO Timor-Leste

AMR is already affecting care on the ground

AMR occurs when bacteria, viruses, fungi and parasites stop responding to the drugs designed to subdue them. The World Health Organization counts AMR among the defining public health challenges of this generation. Bacterial AMR was directly responsible for an estimated 1.14 million global deaths in 2021 and indirectly contributed a total of 4.71 million lives lost.

Timor-Leste is moving to address that threat. Supported by WHO Timor-Leste, WHO SEARO and WHO Headquarters, the review is helping the country identify priorities for its next National Action Plan on AMR through 2030.

From 27 to 30 April, the Ministry of Health, with technical support from WHO Timor-Leste, convened a four-day multisectoral workshop to review the country’s response to AMR and prepare for the next National Action Plan (NAP).

The workshop marked a key milestone in a review process launched in 2024 to assess implementation of the country’s 2022–2026 National Action Plan on AMR. Over four days, participants reviewed findings from documents, interviews and stakeholder consultations, conducted facility visits, and examined how AMR-related practices are being applied in health facilities.

A timely review as Timor-Leste looks to 2030

“For Timor-Leste, the review is both timely and forward-looking,” said Dr Arvind Mathur, the WHO Representative to Timor-Leste. "The country's current National Action Plan on AMR runs till 2026, and the workshop provided an opportunity to reflect on what has been achieved, what has changed, and what needs to be prioritised in the next plan that will guide actions through 2030."

WHO Representative Dr Arvind Mathur during a debriefing with technical experts from WHO Timor-Leste, WHO South-East Asia Regional Office (SEARO), and WHO Headquarters. ©WHO Timor-Leste

Dr Mathur underlined that AMR is not merely a health sector concern. It touches hospitals, communities, farms, food systems and the environment, demanding a One Health approach that convenes multiple sectors around a shared agenda.

The review brought together national stakeholders and technical experts from WHO Timor-Leste, the WHO South-East Asia Regional Office (SEARO) and WHO Headquarters, alongside a range of stakeholders and partners. They included: the WHO Collaborating Centre for AMR (One Health Trust), the Menzies School of Health Research, the FAO Country Office and others. National representation included the Ministry of Health, National Hospital Guido Valadares (HNGV), the National Health Laboratory (NHL), the Ministry of Agriculture, Livestock, Fisheries and Forestry (MALFF), and the Ministry of Tourism and Environment. The review was supported by the Fleming Fund of the United Kingdom Department of Health and Social Care, using UK Aid, and the UHC Partnership.

The visiting team comprised Dr Sarah Paulin-Deschenaux, technical officer for AMR at WHO Headquarters; Dr Bassem Zayed, Unit Head and Regional Advisor for AMR at WHO SEARO; and Mr Rishiraj Bhagawati, an AMR expert with the One Health Trust.

Testing practices on ground: what health facilities revealed

Working groups focused on five strategic areas: governance, coordination, monitoring and financing; public awareness, education and training; AMR and antimicrobial use surveillance; infection prevention and control, WASH and immunisation; and safe, appropriate use of antimicrobials across human, animal and environmental health.

To connect the discussions to conditions on the ground, the expert team visited Vera Cruz CHC, HNGV and the NHL.

At HNGV, teams described systems already in place: an antimicrobial stewardship team, antibiotic treatment guidelines, IPC focal points across wards, and a microbiology laboratory supporting appropriate prescribing.

"If we prescribe antibiotics blindly, we will feed the resistance further," said Armenia da Costa Pereira, head of Quality Control at the hospital.

The team meeting with staff at the National Laboratory. ©WHO Timor-Leste

At NHL, partners stressed the importance of stronger laboratory capacity and surveillance to map resistance patterns. “Health workers at every level are engaged and making the most of the resources available,” said Tessa Oakley, Senior Technical Advisor at Menzies Timor-Leste. The next step is to expand AMR surveillance to referral hospitals.

The review also highlighted persistent gaps. Blood culture results can take three to five days, and patients often leave before they are available. Even when the right antibiotic is identified, it may not be in stock. “What do we do then?” asked Dr Piedade of Vera Cruz CHC.

Embedding AMR in stronger health systems

That ground-level feedback was one of the review’s key strengths.

"Since the previous NAP was developed, more data has become available, global and regional guidance has evolved, and Timor-Leste now has an opportunity to make its next plan more practical and aligned with national needs," said Dr Paulin-Deschenaux. She noted that Timor-Leste has great commitment and capacity, but domestic financing will remain critical for sustained implementation.

Timor-Leste has demonstrated strong commitment to addressing AMR. “The next step is to translate that into sustained action—through infection prevention and control, stewardship, surveillance and access to quality-assured medicines,” said Dr Zayed.

Group work session during the AMR National Review Meeting. ©WHO Timor-Leste

The workshop’s final day focused on mainstreaming AMR interventions across the health system. Directors from municipal health services, referral hospitals, the national hospital, universities and partners, including the Menzies School of Health Research and St John of God, joined the discussion.

A local response to a global threat

A key message from the review was that AMR action cannot stand as its own programme but be woven into the everyday work of the health system. From prescribing practices and infection prevention to laboratory services, supply chains and workforce capacity, it must be integrated into all spheres.

As Timor-Leste prepares its AMR roadmap through 2030, the workshop delivered a clear message: AMR is a global threat, but the response must be built locally.