WHO staff and local health officials map out high-risk locations in a village for dedicated health outreach and support.
COVID-19 demonstrated the crucial importance of governments taking responsibility for health beyond the health sector and building solutions from the “grounds up”.
In Lao PDR, long-standing challenges in community health were highlighted and exacerbated by the pandemic, particularly for some of the country’s 50 ethnic groups. In certain areas, weak relationships between villagers and the health system result in limited health care access or demand, vaccine hesitancy, poor maternal and child health outcomes, and low levels of trust – in both health systems and health-care providers.
Similarly, limited local ownership or governance regarding health decision-making hinders the ability of communities and local authorities to identify and implement changes to improve services. This is crucial as local health financing decisions largely sit outside the health sector with provincial and district authorities.
Results
- In directly-supported communities: increase in births at health-care facilities and use of antenatal care, higher vaccination rates (reflecting increases in trust and engagement of local authorities), improved communication and coordination between village authorities and health centres, and better psycho-social support and decreased stigmatization for families isolated during COVID-19.
- Increase from 41% to 80% in pregnant women attending antenatal care clinics in a number of villages.
- In one focused campaign in Xieng Khouang Province, provincial booster coverage increasing from 24 to 32% within two weeks, and in 29 “high-risk” villages – communities where previous COVID-19 vaccination efforts had limited success in the province – improved community engagement resulted in a 246% increase in the number of people newly vaccinated compared to previous traditional outreach.
- The Ministry of Health and Ministry of Home Affairs are formally expanding the initiative (via a Memorandum of Understanding) to use existing and new CONNECT networks to: support a range of outreach and services, such as birth registry; address gaps in other health areas; and introduce other human and social development priorities.
- Sustainable funding mechanisms are being implemented. For example, many district governors have committed to implementing CONNECT using local government funds, and/or are mobilizing private sector support.
The work ahead
While the CONNECT initiative has leveraged improved multisectoral collaboration between the Ministry of Health and Home Affairs to improve primary health care beyond COVID-19, further support is necessary to:
- expand efforts nationwide to priority communities requiring longer-term assistance – WHO is supporting integrating the approach into government public administration practices, policy and planning, but significant gaps will remain due to limited resources;
- transition to a longer-term strategy and action plan to strengthen health governance and community engagement beyond COVID-19 responses; and
- ensure sustainable financial support for multisectoral collaboration–WHO is coaching local authorities in ways to identify sustainable funding and other resources for scale-up and continuous support.
Our partners
The Governments of the United States of America, through USAID
The Government of Australia, through the Department of Foreign Affairs and Trade (DFAT) and Australian Aid
The Government of the Republic of Korea, through the Korea Foundation for International Healthcare (KOFIH)
The Government of Luxembourg, through Luxembourg Aid and Development