Lao People's Democratic Republic: Health Sector Governance Program

Health / Health insurance and subsidized health programs - Health sector development and reform - Mother and child health care

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.

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, 2012 2016, 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, 2015 2017 for the Lao PDR, and is aligned with the operational plan for health, 2015 2020. 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.

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

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.