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/km2

• Poverty rate of 30%• Government spending $10 pcpa• Bias towards curative care ≈50% budget• Reliance revolving drug fund financing primary

level facilities• On-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*

All Worst-off 40%

Best-off 40%

Antenatal care (ANC) 63% 41% 81%

ANC & blood pressure & folate 55% 39% 67%

Delivery public health facility 27% 10% 46%

* Cross-sectional survey in 9 districts of 3 central provinces. 1010 women with child ≤ 18 months

Prior Situation –total costs

• Total direct costs:– Children: US$12.7– Adults: US$30.7

• 19% of HH outstanding prior debt for health– US$98 worst-off– US$126 best-off

Prior 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 cash– 2 providers: paid US$36.4; 36% sufficient cash

Barrier to services for women and children

• Previously, vertically fragmentation and some duplication

• Poor have poor access to services• Need to reduce cost of drugs in public sector• Quality of care requires improvement• Need for targeted interventions while

strengthening public health system

Integrated package of Maternal Neonatal and Child Health services

• Strengthening leadership and governance, • Improvement of service delivery and • Promoting community participation• Promote equitable access of MNCH of the

poor and most vulnerable groups through strengthening community midwifery services

• Plans to increase up to 1,500 midwives (both community and registered midwives) by 2015

Remove Financial Barriers• Health financial protection: main instrument ensuring financial

access to health services• Expansion of Social Health Protections (reach universal coverage

by 2020)– Civil Scheme– Social Security Scheme– Community-based Health Insurance– Health Equity Fund (HEF)

• Voucher scheme• Revenue from NT2 hydropower (Government) spent on HEF and

free MCH• Universal Free MNCH Services for all women and children under 5

Health Equity Fund

• Covered one third of the country• Reimburses for services (fee for services) delivered to the poor

or use a combination of capitation and fix-fee reimbursement• Benefit packages similar to those of the social health insurance

schemes. • Reimburse the cost of food and travel • Some HEFs are managed by non-state partners• Utilisation of health services increased from 0.2 to 0.8

outpatient visits per person per year• Yearly 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 Barriers

• Supply-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