Guido Valadares National Hospital (, ) (HNGV), formerly Dili National Hospital, is the Public hospital of Timor-Leste. It is located in , on the eastern edge of the capital city of Dili.
History The hospital was founded in 1982 by the then Indonesian administration of East Timor, and was built the following year. Initially, its name, in Indonesian, was (RSUP) (); it was also known, in English, as the Dili National Hospital.
As a consequence of the 1999 crisis that led ultimately to East Timorese independence from Indonesia, the hospital was taken over by the International Committee of the Red Cross (ICRC), which managed it until 2003, a period that included a year-long preparation for hand over. During that period, the IRC and the government of East Timor cooperated in upgrading the hospital, including by expanding the number of wards and units, recruiting more staff, and improving medical and non-medical equipment.
From 2000, the United Nations Population Fund (UNFPA) assisted the hospital, by providing it with medical equipment, and in building the capacity of health staff to practice obstetrics and gynaecology, to help address the problem of high maternal mortality and other reproductive health issues.
At the same time, the Ministry of Health took steps to recruit health workers to displace those who had fled East Timor during the 1999 crisis; of the 126 doctors who had been working there in 1999, only 26 had remained in the entire country. By 2001, the Ministry had recruited 724 health workers, but as they included few higher-level trained specialists, the national hospital still had a 96% vacancy rate.
The ICRC officially handed the hospital over to the government of Timor-Leste on 29 June 2003. During the handover ceremony, Mari Alkatiri, Prime Minister of the country's first constitutional government, inaugurated several new buildings, and announced that government had officially renamed the hospital after Guido Valadares, a former member of the Fretilin National Committee and the Vice-Minister of Labor and Social Welfare in the Council of Ministers formed by Fretilin in 1975.
On 15 November 2005, Alkatiri launched a project for the improvement of the hospital. The project, co-financed by the government and the European Union, and scheduled for completion in October 2007, included thorough rehabilitation of the hospital complex and construction of a new operating theatre. During the launching ceremony, Alkatiri also underlined the important role that was being played by Cuba and China in staffing the hospital.
As of 2011, HNGV had 260 beds, with secondary and tertiary healthcare services. By 2014, the number of beds had increased to 340, extending over 14 wards and units; the hospital also had 581 staff, both international and local.
Also in 2014, an external accreditation assessment was carried out at the hospital using the International Finance Corporation (IFC) Hospital Readiness Accreditation survey tool. The score that year was only 5.7%; the assessment has been carried out annually ever since, to monitor improvement.
The same year, a functional analysis of HNGV carried out for the Ministry of Health concluded that management capacities were very low at all levels, with upper and middle managers having no formal educational background in management. Consequently, work organisation was very poor, as was the quality of control and supervision. Middle management and staff were generally demotivated.
According to the report of the functional analysis, poor leadership at the hospital was affecting its entire management structure. The vast majority of the people interviewed by the report's authors had said that the global situation at the hospital had been deteriorating for years, and that the deterioration had accelerated since 2011. Upper management had not been sympathetic to that view, and, in turn, had made complaints of their own about the oversight of the hospital by the Ministry.
The upper management structure at HNGV was the same as a 50 bed hospital, and the report's authors considered a revised structure HNGV was proposing to the Ministry would be worse. Additionally, there were daily major breaches of most elementary hygiene and infection prevention rules, and nobody at the hospital seemed to care. The report's recommendations included a drastic change in leadership of the hospital, an improvement in management capacities, alterations to staffing practices, work organisation, supervision and control, and increased systematisation.
After considering the report, the Ministry developed a four day training program to promote good governance of hospitals. The program was held at a number of venues, including four of Timor-Leste's regional reference hospitals, and then, in mid-October 2016, was carried out at HNGV.
The following year, 2017, the government of Japan agreed to provide HNGV with a variety of medical equipment worth 200 million yen (approximately million). The aim of the grant aid was to improve HNGV's healthcare service, especially for patients needing emergency or obstetrics and gynaecology care. That year's IFC Hospital Readiness Accreditation survey score was 26%; additionally, a group of researchers carried out an analysis of drug management in the hospital's department of pharmacy. The result of that analysis, which was not published until 2020, indicated that most of the management systems did not yet comply with the applicable standards.
Meanwhile, on 16 April 2019, the Deputy Minister of Primary Health Care, Élia dos Reis Amaral, swore in 17 new HNGV Heads of Department.
During the COVID-19 pandemic in 2020 and 2021, HNGV reported that it had a number of strengths relating to maintenance of quality, including leadership, an established quality team, a multi-disciplinary Quality and Safety Committee, an appropriate hospital motto ("Excellence in service, commitment, compassion and knowledge"), and motivated staff. Additionally, the HNGV quality team was involved in training at the country's five other referral hospitals, and patient satisfaction with HNGV increased from 77% in 2019 to 89% in 2021. On the other hand, there was a large pandemic-related decrease in visits to the outpatient department and the emergency room, caused mainly by a "lack of trust" in the health system and "increased fear" of the hospital during the pandemic.
A further consequence of the COVID-19 pandemic was the donation in July–August 2021 by the ICRC to Cruz Vermelha de Timor-Leste () (CVTL) and HNGV of more than 115,000 items of personal protective equipment (PPE) and sanitation materials. As the national COVID-19 referral hospital, HNGV not only treated COVID-19 patients, but also supplied equipment, including materials donated by the ICRC, and personnel, to other health care providers that were treating the disease in East Timor.
In early 2022, the Royal Australasian College of Surgeons engaged a consultant to develop a strategic plan to improve the clinical education function at HNGV, and support the positioning of the facility as a national teaching hospital over the longer term.
On 24 June 2022, a mobile intensive care unit (ICU) arrived in Timor-Leste to be located at HNGV. It had been donated by the American people, as part of provided to support Timor-Leste's health security. The first unit of the ICU was a 9-bed supplement to the 25 ICU beds with which the hospital was already equipped. Later that year, on 5 October 2022, the government's Council of Ministers approved a proposal by the Minister of Health, Odete Maria Freitas Belo, for the construction of a five-storey Paediatric and Coronary Intensive Care Unit at HNGV. It was expected that the unit would improve specialised quality care for emergency and urgent paedriatic cases, and also the national response to emerging and sporadic outbreaks of diseases with major public health impacts, including dengue fever and cholera.
The foundation stone for the new ICU building was laid by the Prime Minister, Taur Matan Ruak, on 26 January 2023. During the stone laying ceremony, Belo said that the facility would take two years to construct, and, when completed, would accommodate 327 beds, 81 midwives, and 163 nurses.
Description Overview HNGV is located in Culu Hun, on the eastern edge of the capital city of Dili. It is the largest hospital in Timor-Leste, and the only national referral hospital providing primary and secondary care to patients from all over the country, in what is a challenging resource-limited environment.
Functions At a meeting held on 21 September 2015, the government's Council of Ministers resolved as follows:
In particular, HNGV provides the secondary health services for five of the nation's municipalities; at a further meeting of the Council of Ministers, held on 10 May 2016, it was determined that "... the hospital is to ensure the delivery of healthcare to the municipalities of Dili, Ermera, Liquiça, Manatuto and Aileu until the creation of the respective Municipal Hospitals."
These five municipalities – Timor-Leste's capital city and its four neighbours – account for 46% of the country's population. The Dili Municipality catchment area alone has around 300,000 residents, and the hospital's total catchment population is approximately 500,000.
Management As an autonomous institution, HNGV is accountable directly to the Minister of Health, and is funded directly by the Ministry of Finance. Its management team is led by a hospital director and a clinical director; a quality focal person is in post, but no ward or service level managers.
The hospital also has no formal system for patient, family or community engagement in its management.
A significant and challenging management problem for the hospital is the number of languages used by its healthcare professionals, who may include specialist doctors from Cuba, China, Australia, or the UNFPA, as well as local doctors (who may have been trained in Indonesia). On a daily basis, English (HNGV's working language), Spanish, Portuguese, Indonesian and Tetun are used in conversation and in the hospital's clinical notes.
Services HNGV administers both inpatient health care and a wide range of outpatient health services; it also has emergency care facilities, specialised services and enhanced laboratory facilities. , it had 260–340 inpatient beds. On occasions, such as when there is an outbreak of dengue fever, patients are forced to share beds.
Inpatient services at HNGV cover general medicine, general surgery, paediatrics, obstetrics and gynaecology, and emergency. The hospital also admits patients for elective procedures through outpatient clinics. , the outpatient services provided were:
Additionally, HNGV has comprehensive clinical support services: laboratory and blood transfusion, pharmacy, radiology, physiotherapy and acupuncture. The on site diagnostic laboratory includes haematology, biochemistry, and histopathology; the National Health Laboratory ( (LNS)), which is located nearby, provides diagnostic microbiology services.
Also on the site of the hospital, but separately from the outpatient care buildings, is a major national facility for eye care; it provides daily outpatient treatment of cataracts, and also eye health outreach to the municipalities.
Referrals As the national referral hospital, HNGV is one of East Timor's six referral hospitals, and the country's only tertiary referral hospital., According to Ministry of Health guidelines, patients cannot be transferred from a primary level health facility to a referral hospital, or from another referral hospital to HNGV, without a referral. Consequently, a patient must often visit multiple facilities before reaching HNGV.