Lao People's Democratic Republic : Health Sector Governance Program

Sovereign Project | 47137-003

The program will (i) support the government to increase the number of HEF and free MNCH beneficiaries, and to implement health-related human resource and financial management reforms; and (ii) support chronologically sequenced reforms in line with the HSRS implementation plan. The proposed modality combines a programmatic approach designed to support government reforms with a TA loan to build national and subnational capacity to implement reforms. The programmatic approach is designed to provide more effective and flexible ways to translate complex structural reform objectives into implementable policy actions.

Project Details

  • Project Officer
    Xu, Ye
    Southeast Asia Department
    Request for information
  • Country/Economy
    Lao People's Democratic Republic
  • Modality
  • Sector
    • Health
Project Name
Health Sector Governance Program
Project Number
47137-003
Country / Economy
  • Lao People's Democratic Republic
Project Status
Closed
Project Type / Modality of Assistance
  • Grant
  • Loan
Source of Funding / Amount
Grant: Health Sector Governance Program
Source Amount
World Bank US$ 13.20 million
Loan 3279-LAO: Health Sector Governance Program
Source Amount
Asian Development Fund US$ 17.00 million
Loan 3280-LAO: Health Sector Governance Program
Source Amount
Asian Development Fund US$ 6.00 million
Loan: Health Sector Governance Program
Source Amount
World Bank US$ 13.20 million
Strategic Agendas
  • Inclusive economic growth
Drivers of Change
  • Gender Equity and Mainstreaming
  • Governance and capacity development
  • Knowledge solutions
  • Partnerships
Sector / Subsector
  • Health / Health insurance and subsidized health programs - Health sector development and reform - Mother and child health care

Gender
Gender equity theme
Description

The program will (i) support the government to increase the number of HEF and free MNCH beneficiaries, and to implement health-related human resource and financial management reforms; and (ii) support chronologically sequenced reforms in line with the HSRS implementation plan. The proposed modality combines a programmatic approach designed to support government reforms with a TA loan to build national and subnational capacity to implement reforms. The programmatic approach is designed to provide more effective and flexible ways to translate complex structural reform objectives into implementable policy actions.

The programmatic approach comprises two subprograms that facilitate a concerted policy dialogue on the basis of an agreed policy matrix related to key health governance reforms and sector priorities. The program policy matrix includes reforms completed prior to consideration of subprogram 1 by the ADB Board of Directors, and indicative triggers for subprogram 2 to facilitate continuous dialogue with the government (Appendix 4). Subprogram 1 supports policy reforms to achieve the program's four outputs. Further reforms in these key policy areas are foreseen to be supported under subprogram 2. The MOH and the government began undertaking the key subprogram 1 reforms in August 2013, and all 15 policy measures required for subprogram 1 have been completed. Subprogram 2 specifies 11 triggers (prior actions that are to be completed before submission to the Board) that need to be completed by July 2018. These triggers will advance the accomplishments achieved under subprogram 1.

Project Rationale and Linkage to Country/Regional Strategy

To make health services accessible to the poor, the government has introduced Health Equity Fund (HEF) schemes across the country. HEF is a social protection scheme, targeting the poor as identified by village and district authorities. In 2014, the HEF schemes covered about 109,000 poor families, or about 45% of all poor households. The government uses the revenues generated by major hydroelectric investments to finance the social protection schemes, in conjunction with development partners. The government has also implemented a free maternal, neonatal, and child health care (MNCH) scheme, financed by a combination of government revenues and external assistance. However, the implementation, financial management, and monitoring mechanisms for these schemes differ, depending on the funding source. The government has established common rules, procedures, and management systems for the schemes to harmonize their implementation under the National Health Insurance Bureau, and increase the number of beneficiaries. This will be the first step in moving towards providing health insurance to 80% of the population, which is a targets of the HSRS.

The midterm review of the Asian Development Bank (ADB) Strategy 2020 recommends expanding operations in the health sector to 3%5% of ADB's annual approvals. ADB's country partnership strategy, 20122016, for the Lao PDR includes support to public financial management in the health sector. The program is included in ADB's country operations business plan, 20152017 for the Lao PDR, and is aligned with the operational plan for health, 20152020. ADB has supported health system development through several TA projects and programs focusing on governance and public financial management. Previous ADB health projects and programs focused on infrastructure and staff capacity development in selected provinces, and helped to improve the health facility network and access to health services in these areas. Those interventions contributed to (i) establishing health service standards, (ii) provincial planning and budgeting, (iii) increasing the recurrent budget, (iv) human resource development, (v) MNCH policies, and (vi) financial management; ADB also has supported the HSRS through policy advisory TA that helped MOH develop a draft plan to implement health sector reforms.

Impact

Universal health coverage achieved by 2025 (Health Sector Reform Strategy)

Project Outcome

Description of Outcome

Health services delivery, particularly for the poor, women, and children, improved

Progress Toward Outcome
Outcome indicators have been achieved.

Implementation Progress

Description of Project Outputs

Health sector reform process improved

Implementation of the HEF and free MNCH schemes improved

Health human resources management capacity strengthened

Health sector financial management system strengthened

Status of Implementation Progress (Outputs, Activities, and Issues)

Achieved.

Following the publication of the new Accounting Law in 2014 and the finance manual on the management of public funds issued by the Ministry of Finance in 2015, the MOH adopted and implemented a unitary bookkeeping and reporting system for use in central, provincial and district budget units and health offices and facilities (referred to as the MoF system)

Achieved.

Following the publication of the new Accounting Law in 2014 and the finance manual on the management of public funds issued by the Ministry of Finance in 2015, the MOH adopted and implemented a unitary bookkeeping and reporting system for use in central, provincial and district budget units and health offices and facilities (referred to as the MoF system).

The bookkeeping and reporting system adopted by MOH is implemented countrywide.

Achieved.

NHA 2013-2016 report was finalized, and approved by the Minister of Health in December 2017.

Single NHA reports for the years 2013-2014-2015-2016 have been finalized and approved by DG, DOF.

NHA 2017 has been completed, approved and printed.

Achieved.

The National Annual Health Congress presided by a Vice Prime Minister endorsed the report on achievement of HSR Phase 1, HSR Phase 2, and the HSR plan integrated in the 2017 health sector annual operational plan.

The National Commission on HSR meeting was held on 19 December 2017. The meeting adopted the report on HSR Phase 1 (2013-2015), the plan for the period 2016-2020 and the plan 2018 for HSR integrated with the health sector plan 2018.

Achieved.

The roadmap on HRH was adopted by the Minister of Health under decree No. 2684/MOH on 13 November 2017.

The financial management roadmap was adopted by the Minister of Health under letter No. 0149/MOH.DoF on 2 February 2018.

Achieved.

HEF are merged progressively with free care for the poor under NHI.

NHI has been rapidly rolled-out across the country in the last 3 years and has received 22B Kip in 2014/2015, 66.5B Kip in 2015-2016, and increased to 183B Kip in 2017, and covered 17 provinces (except Vientiane Capital).

The implementation started in 2016 in 4 provinces of Attapeu, Saysomboun, Luang Namtha, and Sekong (19 districts). In 2017, it was extended to 13 more provinces: Bolikhamsai, Saravan, Phongsaly, Houaphanh, Oudomxay, Xiengkhouang, Savannakhet, Vientiane, Bokeo, Sayaboury, Khamouane, Champassak, and Luang Prabang. This brings the total number of districts covered with NHI to 139.

The DHIS2 was upgraded and confirmed provision of free MNCH to women in all districts (148), 143 districts for under 5, and 141 districts for the poor by the end of October 2017.

Achieved.

In August 2017, NHIB conducted the NHI financial management rapid assessment. Report was finalized in November 2017 and MOH endorsed it on December 2017.

In 2018, an assessment on the NHI scheme was conducted. ADB funded the household survey while the Lao Tropical and Public Health Institute conducted the assessment at the health facility level.

Data collection for the household survey has been completed and tables of indicators have been submitted to NHIB and SRC.

Achieved.

All provinces are submitting annual reports on distribution of health staff using HPMIS. It includes data on gender and ethnicity.

Annual Report on Health Personnel Distribution for 2015 and 2016 have been finalized and printed. The report for 2017 is was endorsed by Health Minister on 20 July 2018 and printed.

Achieved.

PHOs of Vientiane, Bolikhamsay and Khammouane formulated their workforce plans in 2015. DHP developed the workplans for Luang Namtha, Bokeo, Attapeu, Sekong, Oudomxay, Saravanh, Xiongkhuang, Huaphan and Phongsaly provinces which were endorsed by PHO authorities and MOH. Development of HRH for Saysomboun, Savannakhet, Champassak, Luangprabang, Sayaboury, and Vientiane Capital were completed in June 2018.

DHP organized a national meeting in December 2018 to confirm endorsement and implementation of the plans.

Achieved.

Decree No. 3172/MOH dated 3 December 2015 endorsed the Strategy of Health Care Professional Licensing and Registration System in Lao PDR 2016-2025.

A regulatory framework for the registration and licensing of healthcare professionals has been developed (DHC/HPC Office, 2016).

The Decree No. 1307 dated 30 June 2017 for licensing and registration of healthcare professionals has been finalized and signed by the Minister of Health.

Geographical Location
Nation-wide

Safeguard Categories

Environment
C
Involuntary Resettlement
C
Indigenous Peoples
B

Summary of Environmental and Social Aspects

Environmental Aspects
Involuntary Resettlement
Indigenous Peoples

Stakeholder Communication, Participation, and Consultation

During Project Design
During Project Implementation

Business Opportunities

Consulting Services
All consulting services packages have been contracted. The project engaged an accounting firm to provide financial management and accounting services for the TA Loan. Individual consultants were also engaged to provide technical advise, program management, and due diligence (gender and social safeguards) support. All consultants were recruited using ADB's Guidelines on the Use of Consultants (March 2013, as amended from time to time).
Procurement
All goods packages have been procured. Shopping procedures were used for contracts for procurement of goods worth up to $100,000 and National Competitive Bidding for packages above $100,000. Procurement agent was used to procure the vehicle package. Procurement was undertaken in conformity with ADB's Procurement Guidelines (April 2015, as amended from time to time).

Contact

Responsible ADB Officer
Xu, Ye
Responsible ADB Department
Southeast Asia Department
Responsible ADB Division
Human and Social Development Division, SERD
Executing Agencies
Ministry of Health

Timetable

Concept Clearance
16 Jun 2015
Fact Finding
19 May 2015 to 22 May 2015
MRM
07 Jul 2015
Approval
18 Sep 2015
Last Review Mission
-
Last PDS Update
26 Mar 2020

Funding

Loan 3279-LAO

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
18 Sep 2015 01 Oct 2015 21 Oct 2015 31 Mar 2016 - 31 Mar 2016
Financing Plan
  Total (Amount in US$ million)
Project Cost 17.00
ADB 17.00
Counterpart 0.00
Cofinancing 0.00
Loan Utilization
  Date ADB Others Net Percentage
Cumulative Contract Awards 17 Jun 2022 17.00 0.00 100%
Cumulative Disbursements 17 Jun 2022 17.00 0.00 100%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - Satisfactory - Satisfactory - Satisfactory

Loan 3280-LAO

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
18 Sep 2015 01 Oct 2015 21 Oct 2015 31 Mar 2019 31 Mar 2020 13 Jul 2020
Financing Plan
  Total (Amount in US$ million)
Project Cost 6.25
ADB 6.00
Counterpart 0.25
Cofinancing 0.00
Loan Utilization
  Date ADB Others Net Percentage
Cumulative Contract Awards 17 Jun 2022 5.99 0.00 100%
Cumulative Disbursements 17 Jun 2022 5.99 0.00 100%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - Satisfactory - Satisfactory - Satisfactory

Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.

The Access to Information Policy (AIP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.

The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.

In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

Title Document Type Document Date
Health Sector Governance Program: Subprograms 1 and 2 Completion Report Project/Program Completion Reports Aug 2021
Health Sector Governance Program: Audited Project Financial Statements (January-June 2020) Audited Project Financial Statements Dec 2020
Health Sector Governance Program: Procurement Plan Procurement Plans Feb 2020
Health Sector Governance Program: Audited Project Financial Statements (January-December 2018) Audited Project Financial Statements Jun 2019
Health Sector Governance Program: Audited Project Financial Statements (January-December 2017) Audited Project Financial Statements Jun 2018
Health Sector Governance Program: Audited Project Financial Statements (October 2015-December 2016) Audited Project Financial Statements Jun 2017
Loan Agreement (Special Operations) for Health Sector Governance Program - Subprogram 1 Loan Agreement (Special Operations) Oct 2015
Technical Assistance Loan Agreement (Special Operations) for Health Sector Governance Program - Subprogram 1 Loan Agreement (Special Operations) Oct 2015
Health Sector Governance Program: Gender Action Plan Gender Action Plans Sep 2015
ໂຄງການແຜນງານບໍລຫິ ານຄຸມ້ ຄອງສາທາລະນະສຸກແລະໂພສະນາການ Translated PDS Sep 2015
Health Sector Governance Program: Project Administration Manual Project/Program Administration Manual Aug 2015
Health Sector Governance Program: Report and Recommendation of the President Reports and Recommendations of the President Aug 2015
Health Sector Governance Program: Concept Paper Concept Papers Jun 2015

Safeguard Documents See also: Safeguards
Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.

Title Document Type Document Date
Health Sector Governance Program: Resettlement Framework Resettlement Frameworks Jun 2015
Health Sector Governance Program: Environmental Assessment and Review Framework Environmental Assessment and Review Framework Jun 2015
Health Sector Governance Program: Indigenous Peoples Development Plan Indigenous Peoples Plans/Indigenous Peoples Development Plans Jun 2015

Evaluation Documents See also: Independent Evaluation

None currently available.


Related Publications

None currently available.


The Access to Information Policy (AIP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.

Requests for information may also be directed to the InfoUnit.

  • 29 Jun 2021 | Project Result / Case Study

    Empowering women in public service in Lao PDR

    ADB's support for Lao PDR’s Health Sector Governance Program helped the government move toward its goal of universal health care by 2025 and improved delivery of health services, particularly for the poor, women, and children.
  • 01 Oct 2015 | News Release

    ADB, Lao PDR Sign $23 Million Loan to Improve Health Service Delivery

    ADB and the Government of Lao People’s Democratic Republic (Lao PDR) have signed a $23 million loan agreement for subprogram 1 of the Health Sector Governance Program. 

Tenders

Tender Title Type Status Posting Date Deadline
National Public Financial Management Consultant2 Individual - Consulting Closed
Deputy Chief Technical Adviser Individual - Consulting Closed
International Safeguard Specialist Individual - Consulting Closed

Contracts Awarded

No contracts awarded for this project were found

Procurement Plan

Title Document Type Document Date
Health Sector Governance Program: Procurement Plan Procurement Plans Feb 2020