Lao PDR

The note analyzes overall trends in government health financing and expenditure patterns and discusses some of the efficiency and equity issues pertaining to current... Show More + government health spending patterns. The policy note is one of a series of health financing analyses, complementing earlier policy notes focusing on out-of-pocket spending as well as community-based and social health insurance schemes in the country. This reliance on out-of-pocket payments represents a considerable financial barrier to utilization of health services. The prominence of out-of-pocket spending in the form of user fees and revolving drug funds (RDFs) also raises concerns over management of funds at health facility level and regarding the potential for over prescription. In contrast, social health insurance expenditures are very low in Lao PDR: social insurance schemes cover about 11.4 percent of the population but account for only about 2.8 percent of total health spending. The Lao government has committed to increasing government spending to 9 percent of the budget, implying roughly a three-fold rise compared to plan spending for fiscal year 2011/12. If the policy goal is to raise government health spending equitably across the provinces, achieving it will be challenging. The overall economic outlook for Lao PDR is positive. Economic growth is projected to be 8.3 percent in 2012, and is expected to be in the range of 7-8 percent over the period 2013-2015. This note is one of a series of complementary health financing analyses on out-of-pocket spending and community-based and social health insurance schemes in the country. Additional analytical work in progress will review and assess demand-side pilot interventions currently being initiated by the government, such as the national free maternal and child health policy and the conditional cash transfer pilot. Show Less -

Social Health Insurance (SHI), which is part of a broader social security system, is one of the main risk-protection schemes operating in Lao People's Democratic Republic... Show More + (PDR) and is expected to play an important role in moving the country toward universal coverage in the health sector. Although the scheme is mandatory, enrollment among the target population is low due a variety of reasons that are only partially understood. This study was conducted to better understand the factors affecting enrollment in SHI, to document employers' experiences with and perceptions of the scheme, and to identify opportunities and challenges of expanding coverage in the future. A survey was administered to 130 employers (including 65 member firms and 65 non-member firms) in Vientiane Capital. The study reveals opportunities for strengthening SHI and expanding enrollment, but also highlights the challenges of achieving high coverage rates. Expansion will require increased formalization of the labour market, effective enforcement mechanisms and effective and efficient tax collection systems. Stronger enforcement also increases incentives for evasion and informality of the labour market, while voluntary enrollment within firms makes the scheme prone to adverse selection. As the government finalizes the new health financing strategy, the costs and benefits of various approaches should be considered. However, regardless of the financing arrangement taken, increased public spending in the health sector and improved coordination The study reveals opportunities for strengthening SHI and expanding enrollment, but also highlights the challenges of achieving high coverage rates. Expansion will require increased formalization of the labour market, effective enforcement mechanisms and effective and efficient tax collection systems. Stronger enforcement also increases incentives for evasion and informality of the labor market, while voluntary enrollment within firms makes the scheme prone to adverse selection. As the government finalizes the new health financing strategy, the costs and benefits of various approaches should be considered. However, regardless of the financing arrangement taken, increased public spending in the health sector and improved coordination across schemes can help to strengthen the health system and build up the foundation on which universal coverage can be achieved. Show Less -

Community-Based Health Insurance (CBHI) has become one of the key risk-protection schemes and is expected to play an important role in helping the country move toward... Show More + universal coverage in the health sector. Introduced in 2001 as a pilot project by the Ministry of Health (MOH), the scheme has received technical assistance from World Health Organization (WHO) and financial support from the United Nations Human Security Fund. Currently, Agence Francaise de Developpement (AFD) supports the MOH with scheme expansion in two provinces. The office responsible for managing the scheme is the Health Insurance Program, within the Department of Planning and Finance, MOH. The MOH contracts hospitals to provide services for CBHI members and a gate keeping system requires CBHI members to first seek services at the contracting facility in their district. The benefit package for CBHI members is similar to the health care benefits in the two formal schemes: it covers outpatient and inpatient services including primary health care, specialist services, diagnostic tests, and prescribed drugs that are available at the hospitals. Show Less -

Educational attainment and literacy rates in Lao PDR have improved significantly. Years of education research have established that, after family background, teachers... Show More + are one of the most important determinants of student outcomes. A good teacher can have a long lasting impact on what and how much a student learns. The importance of teachers is even more significant in developing countries where, on average, parental socioeconomic status tends to be low and notable resource constraints abound. In these circumstances, good teaching becomes all the more critical as parents might not be able to provide academic help at home or school resources may not be readily available to enrich the classroom environment To begin to understand how these challenges manifest themselves in Lao PDR, this study examines the current status of teachers in primary and lower secondary schooling as well as government policies that strive to improve teaching in particular and education quality more generally. It explores teacher supply, and demand to identify potential bottlenecks in the availability of trained personnel. It describes teachers demographic characteristics and their skills. It looks at teacher salaries, their level and how this compares to other countries. It examines classroom conditions, pupil-teacher ratios, educational expenditures, and other factors that influence the context of teaching and opportunities to engage in high quality instructional practice. Lastly, this report explores teacher performance, as measured by teacher attendance, teaching practices, and student assessment outcomes. In addition, the report draws on a recent body of research that has explored various aspects of teachers and teaching in Lao PDR. The discussion focuses on primary and lower secondary school teachers, who together represent 87 percent of the teacher population in Lao PDR. Throughout the paper, effort is made to investigate how teachers and their teaching situation vary by region of the country (uplands, mountain, and lowlands) and type of school (urban, rural, and remote). It also explores variations by gender and ethnicity. Show Less -