Real-time information guides better care in the Lao People’s Democratic Republic

June 2018

WHO/D. Hodgson

Noi* cradles her newborn daughter as she crosses the bamboo bridge in her village of Vieng Phouka, tucked among the sugar cane and rubber plantations in the mountainous north of the Lao People’s Democratic Republic.

“This is my first baby. She was born just three days ago in the district hospital. They gave me this little book with all the information I need, like her weight and the vaccines she was given before we were discharged.”

Along with Noi, other mothers with their babies are gathered outside the home of Vieng Phoukha’s health worker. That day, a group of experts from the Ministry of Health, the World Health Organization (WHO) and the World Bank are visiting as part of a field mission.

Village outreach is just one element of the health sector reform launched in 2014 by the Lao Government as part of its commitment to universal health coverage. The field visit to Noi’s village focused on monitoring nutrition and growth, checking immunizations, promoting healthy behaviours and gathering the latest health data.

“This helps us learn more about the nutrition situation in the mountainous part of the country,” Dr Chansaly Phommavong, Director of the Health Information Division at the Ministry of Health, says about the village outreach. “We also were able to monitor the growth of the children and record the data. Training has been provided to village health workers on how to record and report information.”

The Lao People’s Democratic Republic, a lower-middle-income country of nearly 7 million people, lags behind most other Member States in the WHO Western Pacific Region in a range of critical health indicators: the country’s maternal mortality ratio is among the highest in the Region, about half of births take place in health facilities, malnutrition and stunting are endemic, and immunization rates are low. Most are attributable to the country’s weak health system performance which needs concerted efforts and investment from the Government and its partners for better health outcomes of the Lao people.

In addition, resources are limited. The number of health workers per capita is among the lowest in the Region, as is the national health budget at less than 3% of gross domestic product. In addition, nearly a third of the population spend more than 25% of their household income on health. As a result, the Lao People’s Democratic Republic ranks below other Member States in the Region in terms of access to, and coverage of essential health services.

The Government, however, is now fully committed to improving health. It has increased domestic expenditures for health over the past five years. In addition, the Ministry of Health, with the support of WHO and The World Bank, is implementing the National Health Sector Reform Strategy and Framework to 2025 to ensure improved health outcomes. The Framework represents the Government’s commitment to universal health coverage, with its aim to expand essential health services to 80% of the population by 2020.

“The Government’s Health Sector Reform Strategy will help improve community service delivery,” says Dr Juliet Fleischl, WHO Representative in the Lao People’s Democratic Republic. “This will mean better access to, and coverage of, health services for vulnerable and hard-to-reach population groups.”

Strengthened health information systems is one of five priorities driving the reforms with a web-based data reporting system launched in 2014.

Staff in the country’s more than 1000 health centres and 153 hospitals are now required to enter information on patients on a monthly basis. The collated data enable programme staff at provincial and district levels to view real-time information online concerning: maternal, newborn and child health; nutrition; malaria; HIV and tuberculosis services; vaccine storage; basic equipment and commodities; and integrated outreach services. This is all part of an effort to improve the planning and delivery of community-based services.

The data collection and data analytics system is part of a joint effort between the Ministry of Health and partners such as WHO, the World Bank and the University of Oslo to support reform of the health sector in the Lao People’s Democratic Republic. “Reliable data will help improve service organization and planning and highlight areas that policy-makers need to pay more attention to” says Dr Hong Anh Chu, Technical Officer in the WHO country office in Vientiane.

For example, data can be used to support health service planning by ensuring that health workers are adequately equipped and supported to respond to anticipated health needs, such as an expectant mother living in a remote village who is faced with a high-risk pregnancy.

“Better data allow health authorities to capture a snapshot of the situation that is closer to reality,” Dr Chu says. “That means better mobilization of limited resources and stronger integrated community-based services for maternal and child health services, including immunization and nutrition.”

Better data also give the Ministry of Health a solid evidence base to support requests for an increase in the national health budget. The end result will be a stronger health system and better health outcomes for the Lao people.

*Name has been changed