A community-led accountability initiative that helped health teams in Timor-Leste strengthen feedback loops, coordinate local responses, and make service delivery more inclusive.
Timor-Leste
When community feedback is not visible or traceable, health systems have fewer ways to identify problems, include excluded groups, and respond before service gaps widen
Timor-Leste’s Ministry of Health has a mandate to deliver equitable, community-responsive health services across geographically dispersed and low-connectivity settings. But in practice, frontline teams and government partners often work with limited feedback from the communities they serve.
When reporting systems are fragmented, community feedback is difficult to trace, and local issues are not visible across the system, service delivery becomes harder to coordinate. Problems can take longer to identify, harder-to-reach groups can be left out of decisions, and local health teams have fewer opportunities to respond quickly with the information they need.
This is especially important for people who are often excluded from formal decision-making, including women, young people, and people with disabilities. Without structured ways for these groups to raise priorities and participate in local health discussions, accountability mechanisms risk reinforcing the same gaps they are meant to solve.
The challenge was not simply to collect more information. It was to strengthen the processes, relationships, and tools that help communities and government work together — so that feedback becomes visible, traceable, and useful for action.
Community-based accountability depends on practical systems that people can use in real service delivery settings.
Catalpa worked with the Ministry of Health Timor-Leste, the Global Partnership for Social Accountability through the World Bank, local civil society organisations, municipal and national health officials, community leaders, and Village Health Assemblies to strengthen social accountability in community health systems.
Rather than creating a parallel process, the work was designed to align with the Ministry of Health’s existing Community-Based Monitoring framework. Government partners retained ownership of priorities and implementation, while Catalpa supported the design and delivery of practical workflows, governance arrangements, and digital tools that could help communities and officials identify, track, and respond to service delivery issues.
At the centre of the work was the Suku Social Accountability and Inclusion Toolkit: a co-designed toolkit developed to reflect local operating realities and support structured engagement between communities and government. The toolkit helped Village Health Assemblies and health officials use shared processes to identify issues, review evidence, coordinate responses, and monitor progress.
The approach combined community engagement, capability strengthening, and simple digital infrastructure. Local civil society organisations provided ongoing mentoring, while 245 Village Health Assembly members were trained in accountability and inclusion. Low-cost tools — including issue trackers, calendars, and feedback systems — supported more consistent reporting, clearer traceability, and better coordination across community and government actors.
These tools were designed for low-connectivity environments and offline-first workflows, recognising the realities of service delivery in remote settings. The pilot was implemented across four Suku in Ermera and Manufahi municipalities.
The real innovation wasn't better maps — it was a better planning process. Instead of scattered information across paper forms, spreadsheets, and manual calculations, health teams could use one workflow that brought together maps, population data, service information, and local validation.
Governance was anchored in national immunisation structures. The process engaged stakeholders across different levels of the system — ensuring the approach was not just technically sound, but institutionally relevant and locally supported.
Accountability works when communities and government have shared ways to identify problems, track progress, and act together.
Stronger feedback loops, more inclusive decisions, more responsive services
The pilot made community feedback easier to track, improved coordination between communities and government, and helped local health data inform planning and service delivery.
The pilot strengthened local accountability processes and improved coordination between communities and government. Communities and health officials increasingly worked together to identify, prioritise, and address local health issues, supported by more structured information flows and shared visibility of progress.
The work showed that social accountability is not only about raising concerns. It is about creating the conditions for those concerns to move through a system — from community discussion, to evidence review, to government planning, to follow-up action.
More than 1,300 messages, photos, and files were shared through the system, giving stakeholders a clearer and more transparent way to coordinate around local health issues. This reduced information gaps and helped communities, civil society organisations, and government actors respond more quickly together.
Across the pilot sites, communities identified 27 health-related issues, with 15 resolved during the pilot period. This strengthened local problem-solving capacity and reduced delays in addressing service gaps.
Women, young people, and people with disabilities were consistently involved in discussions. Some communities also included LGBTQI+ participants. Broader participation helped improve the relevance and equity of decisions, ensuring local health priorities reflected a wider range of community experiences.
Communities were able to use digital tools despite constraints such as limited connectivity and device access. This demonstrated the feasibility of digitally enabled accountability systems in remote and low-resource contexts, especially when tools are simple, low-cost, and designed around offline-first workflows.
Municipal and national health officials used community-generated data in planning and monitoring processes. This helped strengthen evidence-informed decision-making and improve alignment between community needs and government action.
Stewardship, ownership, and capability inside existing systems
Sustainability was approached through stewardship: strengthening ownership, capability, governance, and resourcing within existing systems rather than relying on external structures.
The work aligned with Ministry of Health Community-Based Monitoring guidelines, supporting institutional integration rather than a parallel accountability system. Training and mentoring helped build local capacity to continue facilitation, monitoring, and coordination. The toolkit reinforced practical workflows that can be sustained within existing community and government structures.
Digital tools played an enabling role, not a standalone one. They were designed to be low-cost, adaptable, and usable in low-connectivity environments, reducing dependency on external support while strengthening the behaviours that make accountability systems work: consistent reporting, shared visibility, coordination, and follow-up.
As a young girl and member of GSI who joined the ASS structure, I feel very happy that this program exists. The Telegram app helps us share information and respond to issues quickly. The simple suggestion form also makes it easy for the community to share their ideas confidentially.
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