A fever, headache or other common symptom does not always point to an obvious diagnosis.
For frontline healthcare workers in Timor-Leste, the challenge is often working out what else could be happening, what questions need to be asked and whether a patient needs further testing, referral or follow-up.
As part of its broader healthcare professional development work, Maluk Timor has developed an Infectious Disease Training Package to help healthcare workers strengthen these practical clinical skills when caring for people with infectious diseases, including HIV and tuberculosis (TB).
Rather than focusing only on recognising individual conditions, the training looks at the thinking behind a clinical decision: how to assess a patient, consider different possibilities and decide what needs to happen next.
Why clinical reasoning matters
Primary healthcare workers are often the first people patients see when they become unwell.
That first consultation can shape what happens next. Some patients can be treated at the health facility, while others may need further investigation, referral or advice about symptoms that should prompt them to return.
The difficulty is that many illnesses can present in similar ways, particularly in their early stages. Through this training, we’re helping healthcare workers build confidence in assessing what a patient is experiencing, considering other possible causes and deciding whether further investigation, testing, referral or follow-up may be needed.
Making healthcare training practical
The Infectious Disease Training Package was developed through Maluk Timor’s Dijitaliza Pakote Formasaun Integradu – Kuidadu Saude Primaria (DPFI-KSP) program, meaning Digitise Integrated Training Packages for Primary Health Care. Through the program, Maluk Timor is helping frontline healthcare workers strengthen practical skills while supporting ongoing professional development.
The training was co-developed by the National Institute of Public Health Timor-Leste (INSP-TL) and Maluk Timor, with input from Hospital Nacional Guido Valadares, the National Ambulance and Medical Emergency Service, national health programs and specialist doctors.
Bringing together experience from across Timor-Leste’s health system has helped keep the training grounded in the situations frontline healthcare workers face every day.
Rather than relying on lectures alone, sessions use case studies, role plays, games, group discussions and practical exercises. Participants can work through a clinical situation, consider what might be happening, discuss different approaches and practise how they would communicate with the patient.
This also gives healthcare workers an opportunity to apply new knowledge before taking it back into their everyday work.
What happened when the training was piloted?
The first pilot of the Infectious Disease Training Package was held in July 2025 with 27 healthcare workers from Dili, including doctors, nurses, pharmacists, midwives and laboratory staff. Further sessions involved healthcare workers from community health centres in Dili and Manufahi.
Participants worked through clinical scenarios, practising patient assessment, diagnosis and decision-making.
Maluk Timor’s 2025 Annual Impact Report recorded improved post-training knowledge scores across the Dili and Manufahi pilots, while participants particularly valued the practical format and its relevance to their work.
Participants also asked for additional case studies, longer training sessions and further opportunities for digital learning.
Building a ‘safety mindset’
A strong focus of the training is what Maluk Timor calls a “safety mindset”. This means helping healthcare workers think beyond the immediate symptoms, while also making sure patients understand any warning signs and when they should return for care if their condition does not improve.
One participant described how the training had changed the way they approached patient care:
“This training changed the way I think. Now I don’t just treat the symptoms, I think about what else could be happening and how to explain it clearly to my patients.”
Other participants reported improvements in their diagnostic skills, including when assessing patients with common symptoms such as headaches. They also said the training helped them think more creatively in resource-limited settings.
Where HIV and TB fit into the training
The Infectious Disease Training Package covers the recognition and management of infectious diseases, including HIV and TB, two important areas of Maluk Timor’s work.
For HIV care specifically, the training focuses on skills including the early identification of symptoms, communication around treatment adherence and supporting better long-term care for people living with HIV.
These conversations matter because good HIV care extends beyond diagnosing the condition or prescribing treatment. Healthcare workers also need to be able to explain treatment clearly, respond to patients’ concerns and support people to remain connected with care.
For frontline healthcare workers, recognising when HIV, TB or another infectious disease could be part of the picture can also help guide decisions about testing, treatment or referral.
By combining clinical and communication skills, the training helps healthcare workers decide what may need to happen next while making sure patients understand their care.
Building local training skills
The training has also given Maluk Timor’s HIV and primary healthcare teams the chance to strengthen their own facilitation skills.
As the modules were tested, facilitators built experience in co-facilitation, clinical assessment and competency-based training. They also learned to adapt sessions during delivery and use participant feedback to refine the training.
Maluk Timor’s 2025 Annual Impact Report notes that working together helped facilitators build greater teamwork, adaptability and confidence in delivering practical training that reflects the realities of healthcare facilities in Timor-Leste.
Practical training that can be used every day
The early pilots show what can happen when professional development is built around the decisions healthcare workers actually need to make.
Participants improved their knowledge, reported greater confidence in their diagnostic skills and valued being able to practise with realistic clinical scenarios.
Those skills can then be used in everyday consultations, whether that means asking another question, considering a different diagnosis, explaining treatment more clearly or recognising that a patient needs further testing or referral.
For Maluk Timor, practical training like this is one way to support healthcare workers to make stronger clinical decisions and provide better care for people affected by HIV, TB and other infectious diseases across Timor-Leste.
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