Lowering the Barriers to health services for women and children in Lao PDR

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Lowering the Barriers to health services for women and children in Lao PDR. Soulivanh Pholsena BSc (Med), MBBS, MPH, CMIP-1 Secretary to Minister & Director of Foreign Relations Ministry of Health. Background. Country size of UK Only 6.3 million population 24 people/km 2 - PowerPoint PPT Presentation


Primary care financing in Laos: a view from beneath

Lowering the Barriers to health services for women and children in Lao PDRSoulivanh Pholsena BSc (Med), MBBS, MPH, CMIP-1Secretary to Minister & Director of Foreign RelationsMinistry of HealthBackgroundCountry size of UK Only 6.3 million population24 people/km2Poverty rate of 30%Government spending $10 pcpaBias towards curative care 50% budgetReliance revolving drug fund financing primary level facilitiesOn-track in achieving most of MDG targets Comparison Government health expenditure and private health spending as percent of GDP among countries in Asia during 2007

National Health Accounts 2009-10

Prior Situation*AllWorst-off 40%Best-off 40%Antenatal care (ANC)63%41%81%ANC & blood pressure & folate55%39%67%Delivery public health facility27%10%46%* Cross-sectional survey in 9 districts of 3 central provinces. 1010 women with child 18 months

Prior Situation total costsTotal direct costs:Children: US$12.7Adults: US$30.7

19% of HH outstanding prior debt for healthUS$98 worst-offUS$126 best-offPrior Situation total costs (2) 30% insufficient money to cover direct costs episode Children: 24%Adults : 39%

17% consulted 2nd provider 1 provider only: paid US$13.8%; 76% sufficient cash2 providers: paid US$36.4; 36% sufficient cashBarrier to services for women and childrenPreviously, vertically fragmentation and some duplicationPoor have poor access to servicesNeed to reduce cost of drugs in public sectorQuality of care requires improvementNeed for targeted interventions while strengthening public health systemIntegrated package of Maternal Neonatal and Child Health servicesStrengthening leadership and governance, Improvement of service delivery and Promoting community participationPromote equitable access of MNCH of the poor and most vulnerable groups through strengthening community midwifery servicesPlans to increase up to 1,500 midwives (both community and registered midwives) by 2015Remove Financial BarriersHealth financial protection: main instrument ensuring financial access to health servicesExpansion of Social Health Protections (reach universal coverage by 2020)Civil SchemeSocial Security SchemeCommunity-based Health InsuranceHealth Equity Fund (HEF)Voucher schemeRevenue from NT2 hydropower (Government) spent on HEF and free MCHUniversal Free MNCH Services for all women and children under 5Health Equity FundCovered one third of the countryReimburses for services (fee for services) delivered to the poor or use a combination of capitation and fix-fee reimbursementBenefit packages similar to those of the social health insurance schemes. Reimburse the cost of food and travel Some HEFs are managed by non-state partnersUtilisation of health services increased from 0.2 to 0.8 outpatient visits per person per yearYearly average cost per beneficiary: US$ 5-6 (US$ 4 in direct benefits to the poor)Relationship between third party, provider and beneficiaries

Remove Non-financial BarriersSupply-side: health system reform, improve availability and quality of service (train and distribute SBA; Community Midwife; improved referral system; Emergency Management, IMCI)Demand-side: advocacy, motivate to visit the health facilities. Cultural barriers: health education, public health awareness, cultural sensitive Thank you