This case study was published on 8 December 2022 as part of the WHO delivering results and making an impact: stories from the ground report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2020-2021.
The Lao People’s Democratic Republic has an ambitious agenda for achieving Sustainable Development Goal 3 – it seeks to ensure healthy lives and promote well-being across the life course, while undergoing economic, demographic and epidemiological transitions. The country is preparing to graduate from least developed country status by 2026, and with this it will experience a decline in development assistance in the coming years. While the Lao People’s Democratic Republic has worked hard to protect lives throughout the coronavirus disease (COVID-19) pandemic, the economic impact of the pandemic has been significant. The country’s gross domestic product is declining (it dropped from 4.7% in 2019 to −0.4% in 2020), debt burden is increasing and budgetary space for essential expenditures is constrained. Against this backdrop and the Government’s goal of achieving universal health coverage (UHC) by 2025, strengthening the resilience and sustainability of the health system is a priority.
A mother with her child from a remote village in Xiangkhouang Province. ©WHO Country Office in the Lao People’s Democratic Republic/ Yoshi Shimizu
How did the Lao People’s Democratic Republic, with the support of the WHO Secretariat, achieve this?
Over the biennium, WHO supported the review and update of the Health Sector Reform Strategy to guide the country (and partners’ support) on its UHC journey over the next decade. Using “backcasting”, one of the operational ways of working from the WHO Western Pacific Region’s For the future vision,1 WHO facilitated a process of identifying future health needs and strengthening systems approaches. This process showed the need of strengthening the primary health care (PHC) system to future-proof the national health system for meeting the needs of an ageing population carrying a higher burden of noncommunicable diseases (NCDs). With the Government’s commitment to strengthening PHC in alignment with the decentralization policy (the Sam Sang directive), the Health Sector Reform Strategy provides strategic direction for strengthening PHC as a core foundation to reach hardto-reach populations. Moreover, the Reform Strategy aims to improve the efficiency, resilience and sustainability of the health system in the context of donor transition and the pandemic in the country’s journey to achieve UHC. Through multisectoral action, the Reform Strategy also aims to empower subnational governments to strengthen health governance capacity and develop integrated health services with primary care and essential public health functions.
Recognizing the critical role that partnerships will play in facilitating implementation of the Reform Strategy, WHO supported the Ministry of Health to engage partners through a sectorwide coordination mechanism by cochairing the Health Sector Working Group and supporting the alignment of development partners’ support with the Government’s priorities. WHO, the Gavi Alliance, the Global Fund, the United Nations Children’s Fund (UNICEF), the World Bank and other agencies that are signatories to the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP), as well as members of the GAP sustainable financing for health (GAP SFH) accelerator working group, are providing coordinated support to the country in the area of health financing.
WHO supported the Ministry of Health in developing the Health Financing Strategy 2021–2025 for the transition from donor funding to domestic financing, which was adopted in October 2021 in close coordination with key partners, such as the Swiss Red Cross and the World Bank. The Health Financing Strategy aims to increase sustainability, accountability, efficiency and equity in the health system, explore innovative solutions to address health financing challenges and align development assistance more closely with the priorities of the Government. It provides a framework for support from signatory agencies to SDG3 GAP and other partners. In line with the priorities identified in the Health Financing Strategy, WHO worked with GAP SFH and other partners to explore how efficiency gains could be achieved across programmes, specifically at the PHC level, and how partners’ various efforts to introduce innovative financing mechanisms would help to address health financing challenges in the country’s context. The new Health and Nutrition Services Access Project – jointly developed with the World Bank, the Global Fund, the Department of Foreign Affairs and Trade (DFAT) and other members of the GAP SFH accelerator working group – was an example of joint partnership to strengthen PHC through an innovative financing mechanism. WHO collaborated with GAP SFH partners and others to support the Ministry of Health in preparing the country for a smooth transition from external financing to domestic financing by enhancing investment in PHC in alignment with the Health Sector Reform Strategy and the Health Financing Strategy.
In addition, WHO provided technical support for the implementation of the National Health Insurance (NHI) scheme, which was rolled out nationwide in 2016 with the exception of Vientiane Capital. WHO played a significant role in facilitating the National
Health Insurance Bureau in coordinating support from various partners for the NHI scheme. In 2019–2020, WHO conducted an assessment of the implementation of the NHI scheme, which identified key achievements, challenges and future priorities
for improving the efficiency, equity and sustainability of the scheme. Further, WHO and multiple partners – including the International Labour Organization, the Swiss Red Cross and the World Bank – supported the National Health Insurance
Bureau in conducting a costing exercise of the essential health services package and the NHI benefit package to provide critical data for the sustainability reforms of the NHI scheme. In line with the strategic direction of the Health Financing Strategy,
WHO supported the Ministry of Health in updating the NHI Strategy 2021–2025, which was endorsed in September 2022, as well as is working to “reach the unreached” (a thematic priority of the For the future vision). WHO support
aims to enhance governance and financing mechanisms and improve implementation of the NHI scheme, specifically in ensuring financial protection for vulnerable populations.
References
- For the future: towards the healthiest and safest region. Geneva: World Health Organization; 2020 (accessed 9 July 2022).