The World Health Organization (WHO) Country Cooperation Strategy (CCS) for Lao PDR is the
strategic framework within which WHO will collaborate with the Government and people of Lao PDR
over the period of 2009-2011. The CCS is based on an assessment of the country’s health needs and
priorities, the United Nations (UN) and WHO’s strategic policies, and the broader health partnership to
improve health in Lao PDR.
The Lao PDR is classified as a low income country with a per capita gross domestic product
(GDP) of US$ 630 (2008). From 2003-07 the average economic growth rate was 7.1%. The country
is landlocked, bordered by China, Vietnam, Cambodia, Myanmar and Thailand, with an estimated
population of 5,868,800 people (2007). Population density is 24 people per square kilometer. Almost
35% of the population lives below the poverty line (2005). As of 2006, 73% of the population resided
in rural areas. The average monthly per capita expenditure is US$ 13.4 and the average household
size is 5.9 people (2005). Administratively, the country is divided into 17 provinces and 140 districts of
which 47 are considered poor. The majority of the poor are ethnic minorities, the majority of whom
traditionally live in remote mountainous areas.
In the recent past, Lao PDR has made some significant progress in socio-economic development.
Life expectancy is on average 60 years compared to 51 in 1985, infant mortality 70 and under-five
mortality 98 per 1,000 live births whilst maternal mortality stands at 405 per 100,000 live births (2005)
compared to the figures of 82, 106 and 530 in 2000. The health status however remains one of the
lowest in the WHO Western Pacific Region. Communicable diseases and maternal and child health
related morbidity and mortality remain areas requiring urgent attention. At the same time, Lao PDR is
undergoing an epidemiologic transition with an increasing incidence of non-communicable diseases
(NCD) and injuries. This poses a major challenge to the health system which is already resource limited.
A major challenge to improving health in Lao PDR is related to perceptions of illness and health in the
rural population and the associated health-seeking behavior.
Despite the market-oriented growth that takes place in the country the Ministry of Health
remains virtually the only provider of health and is strongly administrative. A few semi-government
mass organizations and a range of international non-governmental organizations (INGOs), play an
increasingly important role in the health sector.. Only 2.8% of government expenditure in 2007 was
spent on health care. It is estimated that households account for approximately 52% of total health
expenditure, donors 30%, the Government 15% and the remainder by various social health protection
schemes (Lao National Health Account 2006-7). The relatively poor health infrastructure and difficult
terrain in the poorest parts of the country pose challenges to effective health services delivery.
Utilization of many rural health facilities remains low. The shortage and unequal distribution as well
as the poor qualifications and motivation of many staff in the health sector remain critical issues; the
shortage of qualified health workers in rural areas is of particular concern in this respect.
The health sector is governed by several policies and four laws including the Law on Health Care
of 2005. In 1995, with the Prime Ministerial Decree No. 52, the Government authorized the collection
of official user fees at health facilities. Although the Decree provided exemption of fees for the poor,
the law enforcement and the implementation of the exemption policy have not been uniform across
the settings.