Leaving no one behind by improving access for mothers and children

This year, WHO celebrated its 70th anniversary with the theme of #HealthForAll and Universal Health Coverage, everyone, everywhere, can access essential health services without facing financial hardships.

Using immunisation and mother and child service delivery as entry points, a monitoring and evaluation exercise was conducted in seven provinces in Lao PDR, namely Vientiane Capital and Province, Bolikhamxay, Luang Prabang, Oudomxay, Savannakhet and Xieng Khuang.

The review covered seven key areas which includes health system, financing and programme management, human resources, vaccine supply, quality and logistics, service delivery, immunisation coverage and adverse event following immunisation (AEFI) monitoring, disease surveillance and outbreaks, and advocacy, communication and demand generation. Provincial and district health office and hospitals, and village health facilities were reviewed.

Women accessing health services for ante-and post-natal care, immunisation and therapeutic treatment were also interviewed. A team comprising members from Ministry of Health, US Center for Disease Control, UNICEF and WHO was in Oudomxay Province, La and Beng districts and documented these activities.

Oudomxay Province, La District, Samakhixay Health Centre

Madam Bouaphanh is a 22 years old Khmu housewife who brought her firstborn boy who is about four months old to follow up on his routine vaccination. She had delivered at the health facility and the boy had received the hepatitis B vaccine at birth and bacillus Calmette–Guérin (BCG) vaccine, and the vaccination book revealed her son is up-to-date with vaccination schedule with diphtheria, tetanus, and pertussis (DTP) and Pneumococcal conjugate (PCV), while the next appointment will be in October.

She has walked about 3 kilometres to reach the health centre, and most mothers interviewed were comfortable with multiple injections, although some preferred two injections at a time.

Madam Bouaphanh with her four month old son

The health workers informed us about Madam Sinmone, a 22 years old Khmu housewife who have delivered her baby on 3rd May at the health centre. The baby boy weighs three kilograms, and he had the Hepatitis B vaccine at birth. The next appointment for the baby’s vaccination is due on 21 June and mothers issued with the child’s health vaccination card clearly stated when the next immunizations are due.

Postpartum cord care ensure clean, dry cord while health worker remind mother of the next vaccination date

We met Madam Soukvannaly, a 20 year old Khmu housewife with her first child, a 3 weeks old baby girl born in April 2018. The baby was delivered at the health centre and received hepatitis B vaccine at birth. She was visiting the health centre as the child had eye discharge, and we see that the community has good health seeking behaviours as most of the mothers have good experiences with the health workers.

Madam Soukvannaly brought the child’s health immunization card, and the next vaccination date is due on 22 June

Oudomxay Province, Beng District, Nahome Health Centre

In the mountainous area of Beng District, Nahome Health Centre covers 7 villages, within a radius of 26 kilometres. However, five of the villages are hard-to-reach areas which require overnight outreach services.

The villagers who live close to the health centre often come by the health centre to collect water. This address some social determinants of health and health inequalities in term of access to clean water, sanitation, education and health services.

The water collection point at the Nahome Health Centre
Young girls are leaving after collecting their pail of water
A Hmong mother seeking treatment for her backache accompanied by her children

Children coming along for consultation as they often have to act as translator for their parents in communicating in Lao language with the health worker. Now, they have a Hmong nurse who is able to speak in their ethnic language.

Outreach services for tetanus-diphtheria (Td) vaccination for girls of child bearing age
School girls arrive at the fixed post for their TD vaccine

Oudomxay Provincial Hospital

On an average day, the Oudomxay Provincial Hospital sees about 40 women for antenatal checks and 35 children for routine vaccination. The patients come from the eight villages within their catchment areas, although they are also seeing more people coming from the districts.

One of the patients we interviewed is Madam Vanpheng, 24 years old who came from La District, she is six months’ pregnant and is attending her sixth antenatal checks. This is her second pregnancy and her eldest boy is four years old. Her son was also delivered at this hospital so she plans to deliver her second child here. She was covered by health insurance for her first pregnancy and she would like to use the free maternal delivery services when she delivers in August.

Madam Vanpheng is getting her regular antenatal check

Madam Mokkham is 30 years old and she is here with her third child, a ten months old boy receiving his Japanese encephalitis (JE) vaccine. Many of the mothers interviewed received information on the free services from village health volunteers or health centre staff.

Madam Mokkham with her ten months old boy

Achieving universal health coverage by extending social health insurance

By removing the financial barriers, we see more mothers accessing health services for both delivery and child vaccination. This addressed the health inequalities in the country, and reduce maternal and child mortality and morbidity and therefore contributes to the Sustainable Development Goals.

There are health facilities like Nahome Health Centre that is under-utilised but they provide regular outreach services, arranging with village heads to provide evening session for the farming community. These health facilities addressed equity issues, providing services to the under-served vulnerable population living in remote areas, meeting the goals of leaving no one behind.