LAO PEOPLE’S DEMOCRATIC REPUBLIC

NATIONAL ROUND TABLE PROCESS

Health

CBD Savanaket MPTaylor

The Government has helped boost family planning across the country, including in remote areas through training community based distributors of reproductive health care kit.

The Ministry of Health chairs the Health Sector Working Group. The Embassy of Japan and the World Health Organisation are Co-Chairs.

Key health outcomes and output indicators show progress, in particular in the area of maternal & child health and nutrition; (1) Maternal and Child Health: The 2015 Lao Census Report shows the Maternal Mortality Ratio at 206 per 100,000 live births; mortality rate amongst children under 5 years of age was 86 per 1,000 live births; and 57 per 1,000 live births amongst children less than 1 year old.  These figures show a declining trend, compared to data from previous reports. The national average of DPT-HepB coverage is at 67%, (2) Nutrition: The latest Nutrition Survey showed that the ratio of child malnutrition (stunting- low height for age) was reduced to 36 % in 2015 from 44% year 2011/12.

The National Nutrition Strategy to 2025 and Plan of Action 2016-2020 (NNSPA) has been implemented at the central and sub-national levels, then progress and outcomes were confirmed in the 2nd Nutrition Forum on 17th Nov 2016 as pre-consultation for the RTIM. The Forum also emphasized the importance of multi-sectoral coordination which is required for an effective convergent approach and for scaling up nutrition interventions, for joint implementation of actions, for funds allocation, monitoring, evaluation and reporting.

Vision and priorities

The sector’s strategy by 2020 defined in the 8th Five-Year Health Sector Development Plan (2016-2020) is “To ensure good health with thorough and equitable access to good health services for all citizens who understand their own health care and the comprehensive health sector reform”, towards reaching Universal Health Coverage by 2025 and health SDG by 2030.

The sector’s goal by 2020 is to improve access to basic health services and financial protection by implementing Health Sector Reform Phase II (2016-2020).

The five priority areas to achieve the sector’s goal and vision are: Improve (i) Human Resources for Health; (ii) Health Financing; (iii) Governance, organization and management; (iv) service delivery and hospital management; and (v) health information system (HIS).

Expected key outcomes of each priority area are: (i) Health Centres will have at least mid-level health workers including at least one midwife; (ii) increased coverage of the health insurance to 80%; (iii) reorganize health SWG and sector coordination mechanisms in line with the priority areas of Health Sector Reform;   strengthen Public-Private-Partnership (PPP) implementation; (iv) define , deliver and expand health service package nationwide, and (v) further strengthen HIS by introducing ICT system.

Lessons and challenges

To implement the Health Sector Reform Phase II effectively, coordinated strategic & budget plans, and improved monitoring & reporting across programmes are necessary. To ensure these, Technical Working Groups (TWGs) as the sector-wide coordination mechanism should be further strengthened.

The limited numbers of human resources and financial resources to the health sector continue to be major bottlenecks in the sector (1) to scale up quality health service delivery targeting all ages, and (2) to ensure equitable access to health services without financial hardship.   In particular, the health sector is entering the health finance transition where some major external funds, such as GAVI, are reducing/leaving. If other financial sources (e.g. domestic sources) do not cover the gaps, out-of-pocket payment could be increased consequently.

Other sectors’ support is necessary to (1) further reduce maternal & child mortalities and malnutrition of children (e.g. improvement of road, maternity leave in labour ensuring breastfeeding), and (2) improve fiscal spaces for social health protection (e.g. sin tax for tobacco and alcohol), and (3) implement effective PPP.

Local authorities’ support in community mobilization and sub-national levels’ (provinces and districts) contribution in implementing priority programmes are important.

Support needed

From the government:

  • Ensure stronger support and collaboration from other sectors in implementing health sector reform Phase II (2016-2020) by holding the National Commission to implement Health Sector Reform set by PM Decree 029 regularly.
  • Allocate at least 9% of the national budget to the health sector; and,
  • Continue to allocate quotas and more qualified staff to the health sector every year, and continue to monitor percentages of health center without any midwife.

From development partners:

  • Jointly and effectively support the sector planning, implementation and monitoring by the sector-wide coordination mechanism to be agreed by the Ministry of Health and Development Partners for effective coordination.

Sub Sector Working Groups

The Health Sector Working Group includes six Technical Working Groups. They include:

  1. Planning and Finance (Chair – Department of Planning and International Cooperation & Department of Finance, Ministry of Health)
  2. Human Resources (Chair – Deputy Director General of Department of Training and Education for Health, Ministry of Health)
  3. Mother and Child Health and Nutrition Chair – Deputy Director General of Department of Hygiene and Health Promotion Prevention, Ministry of Health)
  4. Health Care (Chair – Deputy Director General of Department of Health Care, Ministry of Health)
  5. Food and Drugs (Chair – Director General of Department of Food and Drugs, Ministry of Health)
  6. Hygiene and Health Promotion (Chair – Director General of Department of Hygiene and Health Promotion)

SWG secretariat contacts

  • Ms. Toumlakhone Rattanavong, Chief of International Cooperation Division, Department of Planning and International Cooperation, MOH, Tel: 020-5541 9255
  • Dr. Hiromi OBARA, Health Policy Advisor, JICA, Tel: 021-241100