The 12 th ASEAN & Japan High Level Officials Meeting (HLOM) on Caring Societies Country Reports Lao PDR Vientiane Oct, 2014
Lao PDR 236 800 km 2 Population: 6.6 Mio. - Rural/Urban: 85%/15% Distinct ethnic groups: 49 - Lao Loum 55% - Lao Teung 27% - Lao Sung 15% Provincial entities: 18 Districts: 142 Life expectancy at birth: 66 years Maternal mortality ratio: 357-405 / 100 000 U5 mortality ratio: 48-79 / 1000 Human Development Index: 122 / 172 Gender Index: 51 / 140 GDP per capita USD: US$ 980 (US$1,130 in 2012) - 35% of GDP from agriculture 71% of population on less than US$ 2 / day Population below poverty line: 26% Literacy rate: 73% 76% of workforce in agriculture activities Main economic perspectives: - Hydro-power, mining, timber Access to sanitation: - Rural/Urban: 38%/86% Access to safe water: - Rural/Urban: 51%/72% 1. Background. Lao People's Democratic Republic (Lao PDR) is a landlocked country in the Mekong sub-region, flanked by Vietnam, China, Myanmar, Thailand, and Cambodia. The World Bank classifies Laos as one of the least developed countries. Lao PDR economy is largely subsistence based with however a increasing weight on exports related to natural resources (hydro-power, mining, wood). War, disease, crop substitution, and shift from swidden agriculture have all contributed to an increase in poverty and inequality. Unexploded ordnances continue to cause death and injury and deny the use of land for cultivation or grazing. Occasional flooding and drought are the main identified natural risks and expose many communities to seasonal food insecurity. Laos is going through a period of rapid change, largely driven by a boom in Foreign Direct Investment (FDI) and globalization.
Economic growth stands at an impressive 8%, and the Government aims to sustaining this rate for the coming years, as indicated in their 7th National Socio-Economic Development Plan (NSEDP) 2011-2015. Economic growth poses serious challenges linked to environmental, social and cultural changes and increasing inequities. Political development The development and implementation of economic reforms since 1986 contributed to slow but steady reductions in poverty. Since the early 1990's, Laos has also been increasingly engaged regionally and internationally. Laos joined ASEAN in 1997 and is committed under the ASEAN Free Trade Area. Laos gained advances in social development in recent years, and significant progress has been made towards achieving the Millennium Development Goals (MDGs). Laos Human Development Index (HDI) climbed from the 141st to the 122th rank from 1993 to 2010 but remains the lowest ranking country in South East Asia. In 2011, Lao Government confirmed its commitment for the 2015 MDGsand for accessing the list of Low Developed Countries by 2020. 2. Population size, Age and Sex Composition In 2012, Lao PDR had a total population of 6.6 million of which 3.259 million were females and 3.254 million were males. Since the last census taken in March 1995 the population has grown by 2.1 percent per year. The age and sex-distributions of the population are shown in table 1. Table 1. Age and-sex Distributions Age group Femal Male Total 0-14 39% 40% 39% 15-64 57% 56% 57% 65+ 4% 4% 4% Total 100% 100% 100% Laos population is a young population with 55% under 20 years old, total fertility rate is at 3.5. The population growth rate is at 1.8% (2010), There is only 4% has more than 65 year. 3. Lao Lifestyle. Lao people typically socialize as families, and most live in extended families with three or sometimes more generations sharing one house or compound. The family cooks and eats together sitting on the floor with sticky rice and dishes shared by all. Sometimes when someone pays a visit unexpectedly at meal time we automatically invite them to join us without any hesitation.
All of elderly in Lao PDR live with their family, Parents or grandparents usually help raise their grandchildren before they reach school age. Grown-up children usually also live in until they get married and sometimes even until after they have their own children so that the grandparents can help raise them or sometimes until they save enough money to build their own house. However, one of the children (usually the youngest daughter in big families) lives with the parents, inherits the main house, and takes the responsibility of taking care of aging parents. The moved-out children support their parents by sending money back if they live far away, otherwise they come to visit and eat together as a family very often. In Laos there is no social security or other welfare yet, such as homes for the elderly provided by the government. However, as our family bonds are strong and everyone in the family helps everyone out it is an important part of our culture to take care of our aging parents and grandparents. This might change in the future because the Lao simple life is slowly being replaced by modern lifestyles and the extended families are gradually being replaced by nuclear ones as people have fewer children these days. 4. Health care coverage The Government is committed to making public health services an integral part of national socio-economic development.. To this end, the health care system has developed during the last Two five-year plans (5th and 6th, spanning 2001-2010) under the government s guidance, with participation from communities and international agencies. A number of health-related Legislations have been adopted, namely the Law on Drugs and Medical Equipment (2000), the Public Health Law (2003), the Law on Hygiene Disease Prevention, Health Promotion and the Health Insurance degree. The system has improved and has gradually expanded to form a complete network, from the central level to the districts and villages, albeit not to the full satisfaction in terms of the quality. In the area of prevention, emphasis is being placed to primary health care with Emphasis on high risk groups, child immunization, recommendations on the use of safe and Sanitised water, management and control of transmittable diseases such as diarrhoea, malaria, dengue fever, tuberculosis, leprosy and HIV/AIDS. Diseases caused by drug addiction are also being closely monitored. Under the government, there are more than 870 health centres, 124 district hospitals, 12 provincial hospitals, four regional hospitals, and four central hospitals. This system has contributed to the diversification of health care services in the country. Village drug kits were provided in 5,934 villages, covering about 98% of the total target villages (on average, one in two villages). They have especially been distributed in the 72 poor districts, where about 94% villages have been provided with these health packs. 70% of the hospital service expenditure was supported by Government
(Capital, Labor and one part of Material cost), 30% is the patient contribution (Drug and some medical consumable). This is one of the Government policies to help population access the Hospital service including the elderly. Table 2. Number of Health facilities Item Unit 2010 2011** 2012 Central hospitals Places 4 4 4 Curative centers Places 3 3 3 Regional hospitals Places 4 4 4 Provincial hospitals Places 12 12 12 District hospitals Places 131 130 131 Health center Places 862 872 892 Village drug kits Places 5 764 5 239 5 561 Private clinic Places 222 964 1 133 5. Health Insurance coverage. The Government of the Lao PDR (GoL) is committed to pursue reforms aiming to achieve universal coverage of social health protection by the year 2020. According to the strategy outlined in the health sector reform process initiated in 2012, GoL aims to both increases funding to the national health care system through increased supply-side subsidies, and to strengthen and expand the coverage under existing social health protection mechanisms. These measures are targeted at reducing the burden of out-of-pocket payments estimated at over 60 per cent of total health expenditures. The high share of out-of-pocket expenditures, together with growing income inequalities are obstacles preventing access to health care for all, and reasons for exposure to catastrophic risk, in particular for the poorer income quintiles of the population. At the present, Lao PDR has 4 mains Health insurance schemes: State Authority social security schemes for civil servants (SASS), Social security Organization for formal-sector employees (SSO), Community Based Health insurance (CBHI) schemes, and Health equity funds (HEFs) providing free access to care for the poor;
Schema 1. Health Insurance coverage 70% 60% 50% 40% 30% 20% 10% 0% 11% 11% 9% 65% 15% 12% 2% 2.50% SASS SSO CBHI HEF Targ. Cov. CBHI and HEF scheme cover all of family member including Ageing aand also SSO and SASS schemes cover also their retired member; If Health protection cove all of the population (As UHC), All of Ageing also will be covered. Table 3: Ageing Health Insurance coverage HI scheme Member SASS 15,765 SSO 6,104 CBHI 6,096 HEF 28,809 Total 56,774 0.87% The management Health Insurance schemes divide as three levels: Central Level: (CMC) Minister to the Ministry of Health, Chairman; Deputy Minister to the Ministry of Labour and social Welfare, Vice Chairman; Deputy Minister to the Ministry of Finance, Vice Chairman; Socio-Cultural Affairs committee, National Assembly, Member; Director General, Department of Curative, Ministry of Health, Member; Director General, Department of Policy, Ministry of Finance, Member; Director General, Department of social Security, Ministry of Labour and social Welfare; Chief of Cabinet, Lao Trade Union, Member; Executive Directors, National Chamber of Commerce and Industry, Member; Director General, Department of Finance, Ministry of Health, Member;
Director General of NHIB. Provincial Level : (PMC) Provincial Deputy Government, Chairman; Director General Provincial Department of Health, Vice Chairman; Deputy General Provincial Department of Finance, Vice Chairman; Deputy General Provincial Department of Labour and social Welfare, Vice Chairman; Deputy Head Office of Regional People s Assembly, Member; Director of Provincial Hospital, Member; Deputy Director of Provincial Trade Union, Member; Member Executive of Provincial Chamber of Commerce and Industry, Member; Director Provincial of NHIB, Member. District Level : (DMC) District Vice Governor, Chairman, Member; Health of the District Health Office, Vice Chairman; Health of Labour and Social Welfare Office, Vice Chairman; Health of the District Finance Office, Member; Director of the District Hospital, Member; Health of the District Office of Lao Front for National Construction, Member; Health of District Trade Union, Member; Health of Village Cluster, Member. 6. Future cooperation with and among ASEAN countries for the ageing population. - Study more in the ageing population target among ASEAN countries to clarify their real situation in each area (Economic, Society, Environment, Health ) - Ageing social protection should be one of the priority policies that ASEAN country Government should discuss and have a agreement to implement. - Health protection or Universal Health coverage, to Ensure all people, including ageing, can use the promotion, prevention, curative, rehabilitative and palliative health services that they need, is one of the social protection policies that ASEAN countries should fully cooperate. (Information,
experience, Technical, Fund ) - Set up the Ageing social protection committee network among ASEAN countries to share Ageing information, the Ageing implement project experience - Exchange the tour of the Ageing among ASEAN country (Government or private supporting), tour is one of their most favorite and happiest activity.