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

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
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
National Health Accounts 2009-10 spending as percent of GDP among countries in Asia during 2007


Prior situation
Prior Situation* spending as percent of GDP among countries in Asia during 2007

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


Prior situation total costs
Prior Situation – spending as percent of GDP among countries in Asia during 2007total 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
Prior Situation – spending as percent of GDP among countries in Asia during 2007total 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
Barrier to services for women and children spending as percent of GDP among countries in Asia during 2007

  • 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


I ntegrated package of maternal neonatal and child health services
I spending as percent of GDP among countries in Asia during 2007ntegrated 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
Remove Financial Barriers spending as percent of GDP among countries in Asia during 2007

  • 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
Health Equity Fund spending as percent of GDP among countries in Asia during 2007

  • 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)


R elationship between third party provider and beneficiaries
R spending as percent of GDP among countries in Asia during 2007elationship between third party, provider and beneficiaries


Remove non financial barriers
Remove Non-financial Barriers spending as percent of GDP among countries in Asia during 2007

  • 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
Thank you spending as percent of GDP among countries in Asia during 2007


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