Institutional design and organizational practice for universal coverage in lesser-developed countries: Challenges facing the Lao PDR

Ahmed, Shakil; Annear, Peter Leslie; Phonvisay, Bouaphat; Phommavong, Chansaly; Cruz, Valeria de Oliveira; Hammerich, Asmus; Jacobs, Bart

doi:10.1016/j.socscimed.2013.01.019

Cited by 17 publications

(18 citation statements)

References 14 publications

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“…Integration of health services, decentralization, and restructuring should not translate to a diminishing quantity and quality of the workforce required to achieve malaria elimination targets. Raising government employment quotas, redistribution of tasks and health services, capacity-development activities and cross-training of the healthcare workforce [14], recruiting national staff with international experience, and recruiting professionals from the private sector [32] are proposed options to ensure a health workforce dedicated to the implementation and reporting of malaria activities [4]. Whilst acknowledging the challenges of maintaining this cadre of volunteers and workers over time, support from civil society organizations can create an enabling environment for training, supportive supervision, and service delivery.…”

Section: Discussionmentioning

confidence: 99%

Malaria elimination in Lao PDR: the challenges associated with population mobility

Kounnavong

Gopinath²,

Hongvanthong³

et al. 2017

Infect Dis Poverty

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Although the Lao People’s Democratic Republic (Lao PDR) is comparatively small landlocked country with patterns of both in- and out-migration, its human migration situation has been poorly studied. This is despite all of the country’s 18 provinces sharing both official and unofficial border checkpoints with neighboring countries. Economic reforms in the last decade have seen a gradual increase in the promotion of foreign investment, and main towns and transportation networks have been expanding thus offering new opportunities for livelihoods and economic activities.In the last decade, there has also been a significant reduction of reported malaria cases in Lao PDR and while this is an important prerequisite for eliminating malaria in the country, malaria outbreaks reported in the last four years suggest that population mobility, particularly in the south, is an important factor challenging current control efforts.Bolder investment in social sector spending should be geared towards improving health service provision and utilization, ensuring equitable access to primary health care (including malaria) through efforts to achieve universal health coverage targets. This should be extended to populations that are mobile and migrants. The local government plays a critical role in supporting policy and enforcement issues related to private sector project development in the provinces. Cross-border initiatives with neighboring countries, especially in terms of data sharing, surveillance, and response, is essential. Mechanisms to engage the private sector, especially the informal private sector, needs to be explored within the context of existing regulations and laws. Existing and new interventions for outdoor transmission of malaria, especially in forest settings, for high-risk groups including short- and long-term forest workers and their families, mobile and migrant populations, as well as the military must be combined into integrated packages with innovative delivery mechanisms through social marketing approaches. This should happen at multiple points in the mobility pathway and involve the private sector rather than being fully reliant on the national malaria vertical programThis article based on the review of existing literature from abstracts and full texts, includes published, peer-reviewed English language literature sourced through PubMed and grey literature sources through Google and Google Scholar. The review included also case reports, sector reports, conference proceedings, research reports, epidemiology studies, qualitative studies, and census reports in both Lao and English languages. The authors used the search terms: malaria and mobile populations, malaria control program and elimination, health system performance, malaria outbreak, Lao PDR; and included articles published until June 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0283-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Malaria elimination in Lao PDR: the challenges associated with population mobility

Kounnavong

Gopinath²,

Hongvanthong³

et al. 2017

Infect Dis Poverty

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“…Although quite a few articles have been published about health in Lao PDR in general, only a limited number has a policy focus. For instance, Jönsson (2002) analysed the development of the Lao NDP, Paphassarang et al (2002b) assessed the implementation of the NDP, Tomson et al (2005) studied the usefulness of research evidence in the implementation of the NDP, Boupha et al (2005) wrote a report on exemption policy covering the time from 1975 to 2005, Annear et al (2008) studied equity in health, Patcharanarumpol et al (2009) analysed health care financing for the poor, and Ahmed et al (2013) discussed organizational and institutional challenges of universal health coverage. Other articles have focused on the functioning of health insurance ( Annear et al 2011 ; Syhakhang et al 2011 ; Alkenbrack et al 2013 ) or the health system and infectious diseases ( Mounier-Jack et al 2010 ).…”

Section: Methodsmentioning

confidence: 99%

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

Jönsson

Phoummalaysith

Wahlström

et al. 2014

Health Policy and Planning

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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.

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“…The choice of instruments and their settings should be feasible to be effective . The governance arrangement in the health sector includes the prevailing system of health financing and delivering care, organizational arrangements, the extent of regulations and compliance in the health sector, consumer protection, and participation . Furthermore, large formal‐sector employment, high wages and salaries, low poverty, small family size, well‐functioning providers' networks, and solidarity in society are considered as prerequisites of PHI .…”

Section: Effective Policy Design: What It Takes For a Policy To Be Efmentioning

confidence: 99%

Understanding public health insurance in India: A design perspective

Maurya

2019

Health Planning & Management

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Summary It is broadly accepted that health policy is crucially affected by contextual conditions. Yet, little is known about how the context limits the effectiveness of public health insurance (PHI) programs and the extent to which these limitations could be overcome. The objective of the paper is to address these issues on the basis of the examination of 17 PHI schemes introduced by federal and state governments in India since independence. Faced with the challenge of simultaneously expanding insurance coverage while containing costs, governments have overwhelmingly favored the latter. At the same time, governments have lacked the capacity to monitor performance, which has led providers to compromise quality in return for low payment rates. While there have been modest improvements in recent years, reform efforts have been hindered by contextual conditions that constrain the use of measures to control profiteering by for‐profit agencies. The paper argues that system‐wide data on the quality of providers (system‐level operational capacity) and the ability of public agencies to monitor quality and link it with payment (organizational‐level operational capacity) critically determined the program effectiveness. We demonstrate the interaction between contextual variables, program design elements, and policy capacity linking to performance, arguing for a broader approach to understand PHI performance. We extend the present frameworks on PHI effectiveness that have narrowly focused on the design of health financing functions without factoring unfavorable context and limited policy capacity in developing countries. The paper contributes to improving PHI performance operating in unfavorable contextual conditions in India and elsewhere.

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Institutional design and organizational practice for universal coverage in lesser-developed countries: Challenges facing the Lao PDR

Cited by 17 publications

References 14 publications

Malaria elimination in Lao PDR: the challenges associated with population mobility

Malaria elimination in Lao PDR: the challenges associated with population mobility

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

Understanding public health insurance in India: A design perspective

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