Health policy evolution in Lao People’s Democratic Republic: context, processes and agency

Abstract

During the last 20 years Lao People’s Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally.

Politics and Agricultural Policy Implementation in Tanzania

“…Implementation techniques and styles may also vary across government regimes within the states. Jonsson et al, (2015) are in congruence with other scholars on the role of context in policy implementation; nevertheless, they also underscore the importance of timing and historical legacies. In low-income countries, the bureaucratic and political contexts vary considerably; hence, the conditions that allow for effective implementation in one country may hinder implementation in another (Grindle, 1980).…”

Developing a national health research agenda for Lao PDR: prioritising the research needs of stakeholders

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Different kettles of fish: Varying patterns of antibiotic use on pig, chicken and fish farms in Lao PDR and implications for antimicrobial resistance strategies

“…However, regulations may not be sufficient to decrease AMR risks. In Lao PDR, despite this successful formulation of policy regulating access to antibiotics in the human health sector, laws are not strictly followed or implemented (Paphassarang et al., 2002 ; Jönsson et al., 2015 ). To be effective, health strategies must understand and rely on quality data covering the knowledge, skills, priorities and practices of actors and should recognize the various constraints on human behaviour (Panter‐Brick et al., 2006 ).…”