Lowering the barriers to health services for women and children in lao pdr
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Lowering the Barriers to health services for women and children in Lao PDR. Soulivanh Pholsena BSc (Med), MBBS, MPH, CMIP-1 Secretary to Minister & Director of Foreign Relations Ministry of Health. Background. Country size of UK Only 6.3 million population 24 people/km 2

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Lowering the Barriers to health services for women and children in Lao PDR

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Lowering the Barriers to health services for women and children in Lao PDR

Soulivanh Pholsena

BSc (Med), MBBS, MPH, CMIP-1

Secretary to Minister & Director of Foreign Relations

Ministry of Health


Background

  • Country size of UK

  • Only 6.3 million population

  • 24 people/km2

  • Poverty rate of 30%

  • Government spending $10 pcpa

  • Bias towards curative care ≈50% budget

  • Reliance revolving drug fund financing primary level facilities

  • On-track in achieving most of MDG targets


Comparison Government health expenditure and private health spending as percent of GDP among countries in Asia during 2007


National Health Accounts 2009-10


Prior Situation*

* Cross-sectional survey in 9 districts of 3 central provinces. 1010 women with child ≤ 18 months


Prior Situation –total costs

  • Total direct costs:

    • Children: US$12.7

    • Adults: US$30.7

  • 19% of HH outstanding prior debt for health

    • US$98 worst-off

    • US$126 best-off


Prior Situation –total costs (2)

  • 30% insufficient money to cover direct costs episode

  • Children: 24%

  • Adults : 39%

  • 17% consulted 2nd provider

  • 1 provider only: paid US$13.8%; 76% sufficient cash

  • 2 providers: paid US$36.4; 36% sufficient cash


Barrier to services for women and children

  • Previously, vertically  fragmentation and some duplication

  • Poor have poor access to services

  • Need to reduce cost of drugs in public sector

  • Quality of care requires improvement

  • Need for targeted interventions while strengthening public health system


Integrated package of Maternal Neonatal and Child Health services

  • Strengthening leadership and governance,

  • Improvement of service delivery and

  • Promoting community participation

  • Promote equitable access of MNCH of the poor and most vulnerable groups through strengthening community midwifery services

  • Plans to increase up to 1,500 midwives (both community and registered midwives) by 2015


Remove Financial Barriers

  • Health financial protection: main instrument ensuring financial access to health services

  • Expansion of Social Health Protections (reach universal coverage by 2020)

    • Civil Scheme

    • Social Security Scheme

    • Community-based Health Insurance

    • Health Equity Fund (HEF)

  • Voucher scheme

  • Revenue from NT2 hydropower (Government) spent on HEF and free MCH

  • Universal Free MNCH Services for all women and children under 5


Health Equity Fund

  • Covered one third of the country

  • Reimburses for services (fee for services) delivered to the poor or use a combination of capitation and fix-fee reimbursement

  • Benefit packages similar to those of the social health insurance schemes.

  • Reimburse the cost of food and travel

  • Some HEFs are managed by non-state partners

  • Utilisation of health services increased from 0.2 to 0.8 outpatient visits per person per year

  • Yearly average cost per beneficiary: US$ 5-6 (US$ 4 in direct benefits to the poor)


Relationship between third party, provider and beneficiaries


Remove Non-financial Barriers

  • Supply-side: health system reform, improve availability and quality of service (train and distribute SBA; Community Midwife; improved referral system; Emergency Management, IMCI…)

  • Demand-side: advocacy, motivate to visit the health facilities.

  • Cultural barriers: health education, public health awareness, cultural sensitive…


Thank you


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