Health Sector Financing in Lao PDR - World...
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Health Sector Financing in Lao PDR
Transcript of Health Sector Financing in Lao PDR - World...
Health Sector Financing in Lao PDR
Contents
1. Health Financing Situation in Lao PDR
2. Key Achievements and Challenges in Health Sector
3. Policy Recommendations
All photos are copyright World Bank Group Laos.
Health Financing Situation in Lao PDR
Government spending increased yet from a very low level
Government spending on health has increased significantly in recent years, albeit
from a very low level and erratic base
Spending on health has more than doubled to about US$182 million in FY13/14
from US$70 million in FY09/10
Budget plans indicate further increase with the commitment of meeting spending
target of 9% (or about $290 million)
Health Financing Situation in Lao PDR
Per capita spending and public share on health are low regionally
Per capita health spending in
2014 was $33 for total health
spending; $16 for public
health spending, lower than
the regional peers
Health share of the
government budget was one
of the lowest in the region
FY15/16 budget, health share
of the government budget
increased to 7.4% or
$237million
Sri LankaChina
Nepal
Vietnam
Thailand
Myanmar
MalaysiaCambodia
PhilippinesBhutan
Timor-Leste
PakistanIndonesia
Lao PDR
India
05
10
15
20
25
30
Pe
rcen
tage
(%
)
Source: WHO
Health share of government budget in developing countries, 2012-2014Health’s share of the government budget, 2014
Government Budgetary Spending on Health
Government budgetary spending on health has been mostly
allocated to capital expenditures and wages
Recently there is a welcomed trend of increasing planned allocation in
FY15/16 for operational expenditures to about 35% of total government
health spending.
Government health spending has
been mostly allocated towards
capital expenditures and wages,
leaving little room for operational
expenditures.
The low level of operational
expenditures has serious
implications for service delivery.
0%3%5%
61%
30%
2%
17%
10%
39%
32%
External
SHI
Other
Tax
OOP
2000 2014
Source: WHO
Total health expenditures by agent, 2000 - 2014
Composition of Health Spending in Lao PDR
OOP and high reliance on external financing is a challenge
In Lao PDR the dominant source
for financing health is out-of-
pocket (OOP) payments from
households which can be as high
as 39%
External assistance for health is
another dominant source for
health in Lao PDR.
In 2014, 32% of the total health
expenditures financed from
external sources.
Health Financing Transition
Managing donor transition while reducing OOP is a key
Lao PDR is undergoing health
financing transition:
a consistent increase in health
expenditure
a decrease in OOP spending and
external financing as a share of
total health expenditure
While external financing will continue
to play an important role, the level of
donor funds is expected to decline in
coming years
Under-five mortality (left axis)
Infant mortality (left axis)
Life expectancy (right axis)
45
50
55
60
65
70
75
Ye
ars
25
50
100
150
250
Mo
rta
lity r
ate
pe
r 1
,00
0 liv
e b
irth
s
1980 1985 1990 1995 2000 2005 2010 2014Year
Source: World Development Indicators databaseNote: y-scales logged
Sector Outcomes and Key Challenges Ahead
Lao PDR has made steady and significant progress on key health
outcomes but challenges still remain
Increase in life expectancy
from 49 in 1980 to 66 years
in 2014
The under-five mortality rate
has declined from 200 to 67
per 1,000 live births
Infant mortality has declined
from 135 down to 51 per
1,000 live births
Yet, progress is uneven,
geographic and socio-
economic disparities remain
very high
Key Challenges in Lao Health Sector
Double Disease Burden - new NCD challenges while addressing
unfinished MDGs agenda
Lao PDR faces the epidemiological
transition from types of health issues
being dominated by communicable
disease to non-communicable disease
(NCD).
The country faces double disease
burden: increasing NCDs, unmet MDG
targets and challenges of malnutrition
and stunting.
Policy Recommendations
In making further progress towards UHC
Lao PDR will need to decrease reliance on OOP spending,
continued increase in government health spending from
domestic sources through strengthened health systems and social
health protection schemes.
Need to ensure not just an increase in the levels of spending, but
also an increase in the efficiency and effectiveness of spending
to achieve desirable population health outputs and outcomes while
ensuing sustainability of financing for health.
Policy Recommendations
In making further progress towards UHC
Integrating/streamlining multiple mechanisms for financing and
delivery of health programs and services.
The policy of expanding national health insurance is a positive step,
however challenges remain to ensure effective implementation and
sustainable financing of national health insurance.
Continued commitments to expand coverage and financial protection
for the poor and beyond with an overall policy aim of attaining UHC
by 2025.
Thank you!Keomanivone Phimmahasay
Emiko Masaki
