WHO75 Highlighting health milestones in Lao PDR

1950

Laos joins the World Health Organization (WHO). Around this time, the country was comprised of 11 provinces, with a population of less than 2 million.

1953

The last transmission of smallpox is recorded in the country. However, eradication necessitated continuing surveillance and efforts to inoculate. Smallpox was the first disease in history to be eradicated. The complete global eradication of smallpox was achieved in 1979 and remains one of WHO’s greatest achievements.

1956

National Malaria Service (NMS) established. Initially based in Savannakhet, the NMS moved to Vientiane in 1958, with additional stations in Luang Prabang and Champasack. Malaria control was an important area of activity for WHO in the country from the earliest days. All accounts of the health situation from this time mention the gravity of the problem. By 1960, the increasingly insecure situation made it impossible to continue the malaria programme. Spraying ceased in 1961. In 1975, there were malaria outbreaks in Vang Vieng, Vientiane and Xieng Khouang provinces. In the 1990s, cases were in the hundreds of thousands. Now, dedicated efforts mean there were just 2305 cases in 2022.

1958

The School of Medicine for Assistant Medical Doctors is founded. In 1970, it became a full medical school, training doctors. Dr Roger Leclercq was transferred from the WHO Rural Health Development Programme to oversee its contribution to medical education. The School of Medicine, which later formed the University of Health Sciences in 2008, was a key achievement – for the first time it was possible for Lao doctors to receive full medical training at home. WHO invested heavily in promoting medical education in the region, and the number of doctors in the country increased from 49 in 1962 to 945 in 1990. With support from WHO, the Educational Development Centre for Health Professionals was established in 2011 within the University of Health Sciences to strengthen medical education and build faculty capacity.

1976

The Institute of Traditional Medicine is established. Imported medications were (and often still are) expensive. Traditional medicine offered an accessible route for much of the population. Scientific research projects on traditional medicine, funded by WHO, included a survey on medicinal plants, while training was also provided to traditional healers to use them as public health educators and primary healthcare providers. Now, WHO supports the Ministry of Health with the development of a Traditional Medicine Strategy and relevant legislation.

1978

The mortality rate for children under the age of 5 sits at a tragic 218 per 1000 live births. However, by 2020, following massive investments in maternal and child health programmes and prioritization by the government, this fell to 44 per 1000 live births. Prior to 1959, there were virtually no maternal and child health services in the country. An ambitious 10-year plan was developed with support from WHO, UNICEF, and other health partners. Once the principal maternal and child health needs were determined, training programmes were established and improvements began to increase. Now, a strong national strategy and well-coordinated national Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) Committee, supported by WHO, ensures all related efforts are well integrated and progress continues to be made.

1982

The National Immunization Programme is established. This includes Bacille Calmette-Guérin (BCG), which is an effective vaccine against tuberculosis, diphtheria-tetanus-pertussis (DTP), which is a three-in-one vaccine against these diseases, oral polio vaccine (OPV)and measles vaccine. Measles vaccination rates for children aged 12–23 months grew from 7% in 1983 to 86% in 2018. Unfortunately, COVID-19 and its associated disruptions caused interruption to routine vaccination, particularly measles and polio.

1995

Lao PDR ratifies the United Nations Framework Convention on Climate Change (UNFCCC), joining a near-universal agreement aiming to stabilize greenhouse gas concentrations at a level that would prevent dangerous human-induced interference with the climate system. This moment came amid periods of extreme weather variation, with drought and flooding occurring between 1996 and 1998. As climate change worsens, Lao PDR is projected to experience more extreme weather, a 10–30% increase in rainy season rainfall, and temperature increases of 2–3 °C by 2050. Significant work is required to ensure the health system is prepared.

2000

An estimated 1042 women die during pregnancy or while giving birth. In 2020, the number dropped to 207 – an 80% drop, one of the fastest dropping rates in the world. Similarly, in 2000, the percentage of births attended by skilled health staff sat at just 17%. As of 2017, this had increased to 64%. Essential to this progress has been improvements in quality of health care including pregnancy care and during childbirth by skilled midwives and nurses, women increasingly giving birth in health centres and hospitals, and a strong national strategy and well-coordinated national RMNCAH Committee. WHO has supported this process and related activities for decades – most recently training 2200 health care workers on pregnancy care in every district and provincial hospital in Lao PDR.

2006

The Government of Lao PDR ratifies the WHO Framework Convention on Tobacco Control (FCTC) – a global treaty global treaty under which nations pledge to abide by a set of universal standards regarding tobacco production, sale, distribution, advertisement and taxation. This was followed by the first National Tobacco Control Law in 2009, and a 2010 Prime Minister’s decree banning all forms of tobacco advertisement, promotion and sponsorship. In 2021 the National Assembly approved the amended National Tobacco Control Law which includes banning novel and emerging nicotine and tobacco products, including e-cigarettes – one of just 30 countries to do so. Unfortunately, tobacco use remains an immense burden in Lao PDR, killing approximately 7000 children, women and men each year, and costing 3.6 trillion Lao Kip. Contributing heavily to this are the lowest tobacco tax rates in the Association of Southeast Asian Nations (ASEAN).

2007

Lao PDR reports its first two human infections of avian influenza A (H5N1). In the same year, the first National Workplan for Emerging Infectious Diseases was drafted, outlining national priorities for strengthening health security. This was mandated under the International Health Regulations (IHR 2005), which requires Member States to prepare and respond to public health threats such as avian influenza. Since then, with WHO support, Lao PDR has made significant advancements in building its core public health capacities. Improved surveillance and laboratory systems in all provinces enable rapid detection and response to outbreaks. Rapid response teams and more than 100 Lao Field Epidemiology Training (Lao FET) alumni conduct disease surveillance and response across all provinces. Use of District Health Information Software-2 (DHIS-2) for digital surveillance data management has been expanded to all districts in all 18 provinces. Efforts are still required to ensure health system resilience to current and future health security threats.

2011

Life expectancy in Lao PDR exceeds 65 years for the first time.

2013

Lao PDR becomes the first South-East Asian country to introduce a pneumococcal vaccine and begins a demonstration project for human papillomavirus (HPV) vaccine, tackling two major killers. Since 2013 Lao PDR has made significant progress in expanding routine immunization nationwide, adding the above-mentioned and other vaccines to the existing routine immunization schedule. Vaccinations are delivered primarily via community health centres and schools, with significant outreach efforts and a robust infrastructure network. In 2019, the HPV vaccine was introduced nationwide, protecting girls against one of the country’s most deadly diseases, cervical cancer. The first vaccine was delivered at Sompanya School, Xaythany District, Vientiane Capital.

2016

The tax-based National Health Insurance (NHI) scheme, ensuring access to care without financial hardship, particularly for the poor, is introduced in four provinces. The NHI scheme was rolled out nationwide to cover all provinces except Vientiane Capital by the end of 2017. As of 2017, about 94% of the total population were covered by social health protection schemes. In 2019, all existing social health protection schemes, including the National Social Security Fund for the formal sector, were integrated into the NHI scheme in 17 provinces. Unfortunately, funding shortfalls are one of the major challenges in implementing the NHI scheme. Since 2019, the annual NHI budget has been only 180 billion Lao Kip – the budget needed is at least two to three times higher.

2021

Lao PDR successfully responds to the COVID-19 pandemic, with 217 000 cases reported from the start of the pandemic to early 2023 and fewer than 800 fatalities. The highly effective response demonstrated that using a whole-of-government and whole-of-society approach in Lao PDR minimized the pandemic’s impacts and supported national socioeconomic recovery efforts. While the pandemic was an unprecedented challenge, it also acted as a stimulator for strengthening preparedness and response capacity, and infrastructure. The challenge now is sustaining investments made to support to longer term health systems strengthening.

2022

Lao PDR submits dossier to WHO for verification and certification of the elimination of lymphatic filariasis (elephantiasis) – a neglected tropical disease (NTD) caused by microscopic, thread-like worms. Extensive and targeted mass drug administration activities were conducted from 2012 to 2017, with no cases identified since then despite ongoing assessments. WHO supports elimination efforts of NTDs, combining building staff capacity, medicine donation, mass drug administration and disease surveillance in endemic areas. The prevalence of schistosomiasis infections fell to less than 1% in 2021 compared to 7% in 2003 and is targeted for elimination by the end of 2030. Due to successful mass drug administrations, and integrated water, sanitation and hygiene (WASH) and awareness-raising efforts in schools and communities, the national prevalence of soil-transmitted helminthiasis has fallen from 61.8% in 2000-2002 to 17.7% in 2020. While significant gains have been made, re-infection and spread remain a significant risk.

2023

The Ministry of Health launches its first ever digital health strategy. The previous three years of the COVID-19 pandemic have shown us first-hand the power of digital technologies in health. Their successful adoption meant better disease surveillance, improved information sharing to policy makers, health care workers and other key stakeholders including the public, and better care for those in need with enhanced electronic medical records.

WHO75: Highlighting health milestones in Lao PDR