WHO/Soudaphone Viravongsa
Nurse greeting patients at a clinic in Lao PDR.
© Credits

Improving health systems to ensure health for all

In the face of a myriad of challenges, including COVID-19 and other disease outbreaks, Lao PDR has been able to achieve and maintain significantly improved health indices. However, the country faces future risks that could impede progress, including increased cross-border exchanges, climate change and noncommunicable diseases (NCDs) related to changing lifestyles. NCDs are estimated to account for 60% of total deaths in Lao PDR and have become the major disease burden for those over 40.

The greatest challenge emerging during COVID-19 recovery is health financing. Lao PDR has sustained robust economic growth since 2010 and aims to graduate from Least Developed Country status by 2026. Consequently, many institutional donors have planned to gradually phase out support as national contributions increase.

However, a high debt burden and inflation have left government fiscal space extremely limited – with reductions in budget across all sectors including health since 2020. GDP growth slowed from 5.5% in 2019 to 0.5% in 2020 and 3.8% in 2022. Inflation rose from less than 2% in February 2021 to 38.46% in November 2022.

With demographic, epidemiological and economic transitions underway, strengthening health system resilience to meet current and future health needs requires smart and strategic investments.

 

 

Our support

WHO supports the Ministry of Health to strengthen the national health system towards universal health coverage (UHC) - ensuring every person can access quality services without financial hardship.

We support governance in the health sector and beyond to attain health-for-all UHC targets. This includes assistance for the development and implementation of key health strategies, legislation, policies and plans.

We foster coordination and partnerships for the health sector and partners via a formal Sector-Wide Coordination Mechanism and informal health development partners meetings. Additionally, we lead technical support to the Ministry of Health via a range of technical working groups, and support cross sectional coordination on antimicrobial stewardship and consumption under the One Health Working Group.

We aid integrated, people-centred service delivery through support for health service delivery reforms, including improving accessibility and the referral system, with a strong focus on primary health care (PHC). Via geographic information systems and analysis, our efforts improve efficiency, ensure hard to-reach populations are served and allow for better strategic planning and investment.

We advance the quality and safety of health services by:

  • strengthening regulatory systems for medicines and medical products via registration, quality control and pharmacovigilance to ensure the availability of good quality and safe medicines and medical products;
  • strengthening human resources for health (HRH) to ensure a competent health workforce, by increasing implementation of relevant policies and regulations (such as licensing) and improving distribution of human resources; and
  • strengthening capacity to implement infection prevention and control and tackle antimicrobial resistance through capacity building support, in alignment with the national quality improvement policy.  

We facilitate sustainable health financing and a path to UHC by supporting the Ministry of Health and partners to develop strategic priorities and actions to improve efficiency and sustainability. Supplementing this, we support the Ministry of Health to produce reliable health expenditure data using the National Health Accounts tool and improve the National Health Insurance (NHI) scheme via the development of strategies, guidelines and laws.

We support improved evidence-informed policy decisions through improved health management information systems. We work to ensure adequate evidence for public health policy, strengthen mortality statistics through improved death notification and medical certification, and foster better data use through products and well planned and coordinated systems.

We work to mitigate the impacts of NCDs by improving services at the PHC-level, and support broader efforts to tackle risk factors including tobacco and alcohol control, through legislation, advocacy and engagement with stakeholders.

  

   

Results

  • Key health strategies, policies and plans have been developed and updated, including the Health Sector Reform Strategy, the Health Financing Strategy, the NHI Strategy, the Digital Health Strategy and the in-progress HRH Development Strategy.
  • Sector-wide coordination mechanisms have been established and remain active.
  • A substantial evidence base for health financing and access to health services has been developed, via annual National Health Accounts Report since 2011, and analyses of financial protection and catastrophic health expenditure. These allow rational analysis and determination of costs, budget allocations, and adjustment of provider payment rates under NHI.
  • An integrated health management system has been established, integrating the information systems of almost all public health programmes.  
  • Regulatory systems for medicines and medical products, and HRH, have been strengthened, including enhancing registration for medicines and implementing a health workforce licensing and registration system.
  • Tobacco control legislation has been developed and implemented, in alignment with the WHO Framework Convention on Tobacco Control, including Lao PDR becoming one of the few countries to ban electronic smoking devices.

 

 

The work ahead

Significant challenges exist in addressing equity issues and essential health service utilization remains low – particularly among the poor and those in rural areas. WHO will continue to generate evidence, develop strategies and advocate to address those left behind.

Quality and safety of health care remain key challenges, impacting health system trust and health-seeking behaviour. WHO is committed to supporting the Government’s efforts for strategic allocation of limited resources to improve the quality and safety of health services - aligned with Health Sector Reform Strategy priorities and effective coordination with partners.

Addressing limited quantity, quality and misdistribution of HRH is core to achieving health for all, as is strengthening regulatory systems for medicines. WHO will continue to support both, with a focus on implementing key policies.

Isolated resource-intensive, unsustainable digital health systems continue to be developed with limited central planning or oversight. WHO is supporting implementation of the Digital Health Strategy to ensure strong governance, management and appropriate standards for interoperability.

The economic situation poses a significant threat to sustaining essential health services, particularly via the NHI scheme. Strong government commitment to increasing the health budget with continued support from partners and strengthening public financial management is critical. WHO supports advocacy, research and analysis.

Addressing NCDs and cross-sectoral efforts to prevent NCDs and promote health, such as tobacco control, require substantial investment. WHO is committed to work closely with the Government and partners to improve multisectoral collaboration in these life-preserving areas.

To address and prevent the emerging threat of antimicrobial resistance, we advocate for continued cross-sectoral efforts on One Health with partners FAO, OIE and UNEP.

 

  

Our partners

The Government of the Republic of Korea through the Ministry of Health and Welfare and the Korea Foundation for International Healthcare (KOFIH) 

The Government of Luxembourg through Luxembourg Aid and Development 

The Government of the United States of America through USAID

The European Union  

Gavi, the Vaccine Alliance

The Global Fund to Fight AIDS, Tuberculosis and Malaria  

UHC2030