December 12, 2018
A woman carries firewood in a village on the Mekong River.
A situation in which all people can use the health services they need, while the use of these services does not expose the user to financial hardship is called Universal Health Coverage (UHC). Dec. 12 is International Universal Health Coverage Day (UHC Day). UHC is one of the targets of the SDGs.
Because about 70 percent of Laos' land is mountainous, its different regions are divided and the country's population is small, just 6 million people, the landlocked country, which is situated in the center of the Indochinese Peninsula, is one of the least developed countries in ASEAN. In this article, we will talk about initiatives to achieve UHC underway in Laos and JICA's cooperation toward that effort.
An initiative to cultivate human resources for maternal and child health in a hospital in Vientiane
JICA provides cooperation in Laos mainly in maternal and child health. Since 2016, the Laotian government has proclaimed health sector reform to be a priority issue, and it has set as national goals "improving access to basic health care services" and "improving financial protection while receiving health care" by 2020 and "achieving UHC" by 2025. While continuing the cooperation it has provided so far, JICA is supporting initiatives to achieve UHC in Laos.
To achieve UHC, the introduction of licensing systems for doctors, dentists and nurses/midwives is being considered. Laos is what the World Health Organization (WHO) defines as a "country with a critical shortage of health care human resources," and it has no system of qualifications or licenses for health-care professionals. JICA anticipates that its support will result in the creation of a national exam and other systems for nurses and accelerate improvement in the quality of health-care human resources.
Hospital staff discuss how to improve medical records.
To improve the quality of health care services, JICA has been carrying out the "Project for Improving Quality of Health Care Services" in four provinces in southern Laos since 2016. In fields such as maternal and child health, kaizen methods are being used to get results at provincial and district hospitals and health centers, and those improvements are expected to be rolled out nationwide. Taking into account the ideas of the staff at each hospital or worksite, the project is creating checklists of points for which quality will be emphasized and implementing them. The lists have been introduced in provincial hospitals in four provinces, and in seven district hospitals as of the end of October.
JICA is also improving core hospitals to enhance medical facilities and equipment.
JICA Expert Dr. Hiromi Obara, who works as a health policy adviser to the Laotian Ministry of Health. At a ceremony of the International Federation of Gynecology and Obstetrics' (FIGO) "Award in Recognition of Women Obstetricians/Gynecologists"
To connect these initiatives and so Laos can move in a coherent direction as a country, in 2016 JICA sent JICA Expert Dr. Hiromi Obara to the Laotian Ministry of Health as a health policy adviser. She is giving advice on policies, strategies and plans, providing technical support, and coordinating among and sharing information with various development partners, for the health sector, with the goal of achieving UHC.
"In Laos and other countries, in many cases, pregnant women live in poverty, so they hesitate to see a doctor, and when they finally do, they sometimes have developed a major illness and cannot be saved, or their medical costs are extremely high, and they fall into further poverty. My starting point is my strong belief that it is not right for people to be unable to receive medical care because they are poor," said Dr. Obara.
According to Dr. Obara, Laos has the lowest population density among the 10 countries of ASEAN, and it is difficult to access health facilities in mountainous and remote areas. "The first thing I thought was that it might be difficult in Laos to use some success stories which have been implemented in countries like Cambodia and Vietnam, for example, the approach of training health volunteers in villages, then having them go around their village and linking to medical treatment.
Dr. Obara leveraged the expertise and network of Japan Overseas Cooperation Volunteers (JOCVs) who work as midwives and nurses in provincial and district hospitals with an emphasis on the field of maternal and child health, in which JICA has provided continuous cooperation. The revision of the Maternal and Child Health Handbook was done incorporating JOCVs’ suggestions, which she compiled.
Coordinating with the Ministry of Health and development partners, she also assisted in developing the "National Health Insurance Strategy 2017-2020,” contributing to the development of strategy and planning documents for achieving UHC.
Dr. Obara has cooperated on improving and developing maternal and child health in several countries including Laos and Cambodia for nearly 20 years and has also been involved in developing WHO guidelines. In recognition of those achievements, she received the International Federation of Gynecology and Obstetrics’ (FIGO) "Award in Recognition of Women Obstetricians/Gynecologists" in October 2018.
A local doctor gives a presentation at a committee investigating a case of maternal death. There are high expectations for the realization of UHC for this problem.
Dr. Obara has this to say about Laos: "The doctors in this country who are leaders train the next generation and are involved in the development of medical systems, besides seeing patients. They shoulder obligations that would be unthinkable in Japan, and that sense of responsibility is impressive."
JICA will continue providing cooperation toward the achievement of UHC in Laos through assistance from various angles, including policy, systems, services and facilities.