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Lao People’s Democratic Republic

Strengthening the health system in Lao People’s Democratic Republic

UNICEF Image
© UNICEF Lao People's Democratic Republic/2007/Jim Holmes
Nang Thoum receives a neonatal tetanus vaccination during a visit of the District Mother and Child Health outreach team in Nongkham village.

Context and challenge: Inadequate provision of health services to large rural population

The Lao People’s Democratic Republic is a mountainous, largely rural country in South-East Asia with an average gross national income per capita of less than US$600 in 2007. Nearly 40 per cent of the population in this nation – which comprises some 50 ethnic groups – lives below the poverty line. Although the country is on track to meet Millennium Development Goal 4, having managed to reduce its under-five mortality rate by 57 per cent between 1990 and 2007, significant health challenges remain for mothers and newborns. Undernutrition, improved feeding and hygiene practices, immunization, environmental health, and ensuring adequate skilled health personnel to deliver quality health services are the most pressing of these challenges.

More than 1 in 7 newborns suffer from low birth weight, a condition related to poor maternal nutrition. Exclusive breastfeeding is far below the regional average of 43 per cent for East Asia and the Pacific. Only 60 per cent of the population has access to improved drinking water supplies, and just 48 per cent has access to adequate sanitation facilities. Rural and urban regions are sharply divided in access to both of these critical services. Low immunization rates are also of concern here: In 2007, only 40 per cent of infants under age one were immunized against measles, and just 47 per cent of pregnant women were immunized against neonatal tetanus. The lifetime risk of maternal death in the country stood at 1 in 33 in 2005, the highest in the region.

UNICEF Image
© UNICEF Lao People's Democratic Republic/2007/Jim Holmes
A doctor examines a child during a visit of the District Mother and Child Health outreach team in Namsoi village.

Action: Expanding rural primary health care services in phases in Sayaboury province

Notwithstanding these challenges, advances are being made steadily to expand health services to the country’s large rural population. One such programme in Sayaboury province, situated between the Mekong river and the Thai border in the northwestern part of the country, is a partnership among the Provincial Health Office, Save the Children Australia and others to enhance primary health-care infrastructure there. The programme has been carried out in four phases, each phase spanning three years and building on its predecessor’s successes. 

Phase I focuses on strengthening the provincial management team responsible for training district health teams, village health volunteers and traditional birth attendants, developing fixed and mobile maternal and child health clinics, and providing essential equipment; Phase II integrates primary health care at all levels – provincial, district and village; Phase III expands the programmes into four remote districts; and Phase IV strengthens the skills of health workers by adopting the Integrated Management of Childhood Illness framework.

Planning in all four phases also emphasizes women’s education in improved nutrition practices and the dissemination of information on clinical care and immunization.

 

UNICEF Image
© © UNICEF Lao People's Democratic Republic/2007/Jim Holmes
A woman receives birth spacing services during a visit of the District Mother and Child Health outreach team in Nongkham village.

Impact and opportunities: Programme districts see a decline in maternal mortality ratio

The Sayaboury programme has shown significant successes, at the very affordable rate of only US$1 per person each year or US$4 million over a 12-year period. The district’s maternal mortality ratio fell from 218 per 100,000 live births to 110 per 100,000 live births between 1998 and 2003. The median age at which infants received complementary foods increased from 2.8 months in 1999 to 3.7 months in 2001, while the rate of exclusive breastfeeding for the first four months rose from 28 per cent in 1999 to 66.2 per cent in 2004. Vaccination coverage remained inadequate, however, with only 50 per cent of children under age one receiving three or more doses of the vaccine for diphtheria, pertussis and tetanus in 2007.

Health infrastructure building, as in the Sayaboury programme, expanded immunization and supplementation campaigns, and community health initiatives are steadily beginning to help reduce the still-high burden of maternal and newborn deaths in Lao PDR..


 

 

To learn more

UNFPA, Maternal and Neonatal Health in East and Southeast Asia, 2008.| PDF English

UNICEF, The State of the World’s Children 2009: Maternal and newborn health. | PDF English | Spanish | French

UNICEF, The State of Asia-Pacific’s Children 2008: Child Survival. | access report

UNICEF Lao PDR | website

WHO, Neonatal and Perinatal Mortality: Country, regional and global estimates 2004. | access report

Perks, C. et al., ‘District Health Programmes and Health-sector Reform: Case study in the Lao People’s Democratic Republic’, Bulletin of the WHO, vol. 84, no. 2, February 2006. | PDF English

 

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