National Policy on Health Impact Assessment, Lao PDR

byDr Tayphasavanh Fengthong

Dr Soutsakhone ChanthaphoneDr Bountang Duangtaphak

Mr Sisavath Kongmy

1st HIA for ASEAN Workshop“Understanding Health Impact Assessment (HIA):

A Foundation for the Well-being of the ASEAN Community”13-14 February 2012, Thailand

Contents

• Country description• Environmental health status• What we have done so far in the

context of HIA• The way forward

Country descriptionLao PDR is a land-linked country,

and shares border with China, Vietnam, Cambodia, Thailand and Myanmar.

Total area : 236,800 km2

Population: 5.62 mill Density : 24 p/sqkm

17 provinces

Climate: Rainy and Dry seasons

Religion: Buddhism

Capital: Vientiane

Population in rural areas: 72.8%

Adult literacy rate: (F: 50%; M:74%)

Population growth rate: 2.5% per year

Life expectancy: 61 years (F: 63; M: 59)

47 ethnic groups, covering120 ethnic sub-groups and languages

11,000+ small villages and mostly with poor road access

Agriculture = 80% of jobs, mostly subsistence farming in remote areas

Country description

Economic Growth

Conservation of natural resources

Social/cultural development

Harmonious “triangular” approach to

development of Government

Lao Government Policy

4 main sectors in NationalGrowth and

Poverty EradicationStrategy (NGPES)

Agriculture and Forestry

Health

Infrastructure (Rural Road)

Education

The Sixth National Socio-Economic Development Plan (NSEDP 2006-2010) identifies health as one of the four

priority sectors for development.

Health situations

Considerable progress has been achieved over the past ten years in improving the health system in the Lao PDR which are Maternal, infant and under five infant mortality rates (MMR, IMR and U5MR, respectively) have dropped

significantly

MMR

IMR

U5MR

1995 2000 2005

656

104

170

530 405

82 70

106 98

Total fertility rate: 4.04% Crude birth rates: 29.9% (LRHS 2005)

Crude death rates: 5.4% (LRHS 2005)

Source: Census 2005

2005 (LRHS 2005)

56

68

Child and maternal malnutrition

The malnutrition rate in children under five in Lao PDR is very high compared to other countries in South

East Asia and Asia in general.

Almost two in every five children under age five in Lao PDR are moderately and severely underweight (37.9%)

Stunting: 41.2% Wasting: 7.4%

Northern part34%

Middle part33%

Southern part50%

Source: MICs3 2006

Development

Environment Health

Road construction Road construction

Mining MiningDam projectDam project

Water supplyWater supply

Industrial production

Tourism

Industrial production

Tourism

Irrigation, Fisheries Livestock

Irrigation, Fisheries Livestock

Source: Lao PDR Development Report 2010, Natural Resource Management for Sustainable Development

Source: Lao PDR Development Report 2010, Natural Resource Management for Sustainable Development

Implementation progress on HIA

Developed HIA policy and approved by Prime Minister on March 2006

Established HIA Team and focal point

Developed a Practical Guideline for HIA

Appraised IEE or EIA of many

development projects

Shared experiences and learning with other countries about HIA

Implementation progress on HIA

Increased HIA capacity for MoH staffs and different sectors

Good HIA model of Namtheun2

Harmonization of HIA with the existing

EIA

Field monitoring with others

sectors

Carried out case studies:-Health impacts of traditional artisanal mining activities-Health impacts of indoor air pollution-Health Vulnerable Assessment of climate change

Degree of Prime Minister, No: 54/MP, 23/03/2006 on the Declaration of use and Implementation of National

Policy on HIA

97 IEE and EIA reports

41 dam projects

31 mining projects

3 agricultural projects

9 road projects

1 sustainable Tourism

Development project

1 Bank Erosion Protection projects

4 industry projects

7 power line

extension

Ministry of Health

Department of Hygiene and Prevention

Environmental & Occupational Health and Safety Division

Health Impact Assessment Unit

Technical back up team withinMinistry of Health

Focal points in other ministries

Organization Structure on HIA

Constraints

Awareness of HIA still limited

Lack capacity to do HIA of many development projects

Limited HIA funding support

Life expectancy (y): 61 CDR/1000: 9.8 MMR/100 000: 405 IMR/1000: 56 U5MR/1000: 68 Stunting (%): 40.7 Wasting (%): 6.4 Underweight (%): 37.1

Life expectancy (y): 72 CDR/1000: 5.3 MMR/100 000: 200 IMR/1000: 32 U5MR/1000: 40 Stunting (%): 28 Wasting (%): 2 Underweight (%): 15

2005 2020Commu Dis

Non Comm Dis

Injury/acc

Malnutrition

Mental dis

Environment Social Economy

Poverty

HIA

Policy/Program/project

Screening

Scoping

Assessment

Reporting/ DisseminationM/E

IndividualInstitutional

The Way Forward

• Short term:– Review the community health impacts from the existing

development projects in terms of public health action plan including M/E

– Strengthening HIA capacity for HIA Team and provincial staffs– Conduct HIA advocacy meeting with high levels from different

ministries– Sharing knowledge and experiences on HIA with other

countries– Considering HIA of small projects (SME, Land fill sites etc,.)

• Long term: – Develop a HIA long term action plan to get funding support

We need a cross-sectoral responsibility for health

Human health is not only the responsibility

of the health sector !

Conclusion