Sustainable financing for Primary Health Care and Universal Health Coverage in Lao People’s Democratic Republic
The Lao People’s Democratic Republic (Lao PDR) has an ambitious agenda for achieving Sustainable Development Goal 3. The country seeks to ensure healthy lives and promote wellbeing across the life course, while undergoing economic, demographic, and epidemiological transitions. Lao PDR is preparing to graduate from Least Developed Country status by 2026 and with this will experience a decline in development assistance in the coming years. While Lao PDR has worked hard to protect lives throughout the COVID-19 pandemic, the economic impact of the pandemic has been significant. Gross domestic product growth is declining (it dropped from 4.7% in 2019 to -0.4% in 2020), debt burden is increasing, and budgetary space for essential expenditures is constrained. Against this backdrop and the Government’s goal of achieving universal health coverage (UHC) by 2025, strengthening the resilience and sustainability of the health system is a priority.
Over the biennium, WHO supported the review and update of the Health Sector Reform Strategy to guide Lao PDR (and partners’ support) on the country’s UHC journey over the next decade. Specifically, utilizing “backcasting”, one of the operational ways of working from the WHO Western Pacific Region’s “For the Future” vision, WHO facilitated a process of identifying future health needs and strengthening systems approaches. This process showed the need of strengthening the primary health care system (PHC) to future-proof the national health system to meet the needs of an ageing population with a higher burden of noncommunicable diseases (NCDs). With the Government’s commitment to strengthen PHC in alignment with the decentralization policy, Sam Sang, the Health Sector Reform Strategy provides strategic direction for strengthening PHC as a core foundation to reach hard-to-reach populations. It also aims to improve the efficiency, resilience and sustainability of the health system in the context of donor transition and the pandemic in the country’s journey to achieve UHC. Through multisectoral action, the strategy also aims to empower subnational governments to strengthen health governance capacity and develop integrated health services with primary care and essential public health functions.
Recognizing the critical role that partnerships will play in facilitating implementation of the strategy, WHO supported the Ministry of Health to engage partners through a Sector-Wide Coordination mechanism by co-chairing the Health Sector Working Group and supporting alignment of development partners’ support with the Government’s priorities. WHO, the World Bank, the Vaccine Alliance (Gavi), the Global Fund, the United Nations Children's Fund (UNICEF) and other agencies who are signatories to the Global Action Plan for Healthy Lives and Well-being for All (GAP), as well as members of the GAP’s sustainable financing for health accelerator working group (GAP SFH) are providing coordinated support to Lao PDR in the area of health financing.
Photo Credit: © WHO Country Office in Lao PDR/Yoshi Shimizu
Photo Caption: Breastfeeding mothers at Mahosot Hospital, Vientiane capital, Lao People's Democratic Republic.
WHO supported the Ministry of Health in developing the Health Financing Strategy for the transition from donor funding to domestic financing in the period 2021-2025, which was adopted in October 2021 in close coordination with key partners such as the World Bank and the Swiss Red Cross. The strategy aims to increase sustainability, accountability, efficiency, and equity in the health system, explore innovative solutions to address health financing challenges and align development assistance more closely with the Government priorities. It provides a framework for support from GAP signatory agencies and other partners. Based on priorities identified in the Health Financing Strategy, WHO has worked with GAP SFH and other partners to explore how efficiency gains can be achieved across programmes, specifically at the PHC level, and how partners’ various efforts to introduce innovative financing mechanisms would help address health financing challenges in the Lao PDR context. The new Health and Nutrition Services Access Project, jointly developed by the World Bank, the Global Fund and other members of the GAP SFH accelerator working group, is one example of partners’ joint support to strengthen PHC through an innovative financing mechanism. WHO collaborated with GAP SFH partners and others to support the Ministry of Health in preparing the country for a smooth transition from external financing to domestic financing by enhancing investment in PHC in alignment with the Health Sector Reform Strategy and the Health Financing Strategy.
In addition, WHO provided technical support for the implementation of the National Health Insurance (NHI) scheme, which was rolled out nationwide since 2016 with the exception of Vientiane Capital, and played a significant role in supporting the National Health Insurance Bureau (NHIB) in coordinating support from various partners for the NHI scheme. In 2019-2020, WHO conducted an assessment of the NHI scheme’s implementation, which identified key achievements, challenges and future priorities towards improved efficiency, equity and sustainability of the scheme. Further, WHO and multiple partners, including the World Bank, the International Labour Organization (ILO) and the Swiss Red Cross, supported the NHIB to conduct a costing exercise of the Essential Health Services Package and the NHI benefit package to provide critical data for the NHI scheme’s sustainability reforms. In line with the strategic direction of the Health Financing Strategy, WHO is currently supporting the Ministry of Health in updating the NHI Strategy, as well as working to “reach the unreached”, a thematic priority of WHO’s regional “For the Future” vision; WHO’s support aims to enhance governance and financing mechanisms and improve implementation of the NHI scheme specifically in ensuring financial protection of vulnerable populations.