The Government of Lao has made progress in efforts to achieve the universal coverage aims to achieve
it by 2020. Together with the free MNCH policy (maternal and children under 5 services) approved in
2011, a Prime Minister’s Decree has been approved and guidelines have been drafted for the
implementation. More specific emphasis is made on the Government’s funding for free MNCH services in
10 of the 56 prioritised districts, plus other development partners have covered the service in number of
other districts.
The health network claims to cover 93% of the population at an average walk of 90 minutes to a health
facility. There are, however, major differences in access to services across geographical, social, political,
economic, and ethnic and gender factors. User fees and high out-of-pocket payments have also led
patients to delay care until illness is severe. High costs coupled with poor services lead to low utilization
of services. A recent study commissioned by WHO titledthe burden of out of pocket expenditure and
health service utilisation in Lao PDR (2011) found that those who mentioned financial barriers as a
reason for not seeking care were mostly among the poor and the poorest households. The poor
households are more vulnerable to catastrophic status, especially among family with children under 5
years old and elderly with long-term illness. Inequities in access to services are greatest in rural areas,
where households in the highest income quintile have an in-patient admission rate of 42.4 per 1,000
populations, nearly 3 times the rate of 15.9 for households in the lowest income quintile. Similarly,
Health Service Delivery Profile Lao PDR, 2012 8
households located further from services than those in urban areas have less access to health services;
only one quarter of the poor live in villages with a medical practitioner compared to one half of the nonpoor
who have closer access to doctors.
The Government has committed to support reform to strengthen efforts to increase social protection
coverage through progressive legislation, restructure and funding for health insurance, in order to reach
out to more vulnerable and excluded groups, of which will contribute to reducing inequities.