SUMMARY OF COUNTRY REPORTS
Laos
I. Background
Officially, the state of Laos still provides free medical care. Lack of resources is the chronic problem of the health sector. The drug budget within the public sector is only about US$.25 per person per year, representing 20% of the total government health budget. The government would like to introduce cost recovery, but is also quite aware of the burdens it may place on the population. The official view is to encourage the introduction of cost recovery, but exactly how is yet to be determined.
In recent years, a number of international NGOs and agencies (i.e. WHO, Swiss Red Cross, UNICEF, The Nippon Foundation), have supported the establishment of revolving drug funds (RDFs) at the hospital and community level.
A comprehensive national drug policy (NDP) was developed with the assistance of the Swedish International Development Authority (SIDA) in 1991-1993, and approved by the Prime Minister in March of 1993. The list of essential drugs under NDP consists of 300 items (currently under revision).
II. General Objective
The ministry of Public Health (MoPH) would like to see the successful implementation of revolving drug funds nationwide.
III. Achievements
□The Revolving Drug Fund Committee was appointed in December of 1994.
□In collaboration with NGOs and other parties involved in RDF schemes, the MoPH organized a National Consultative Workshop on in April of 1995 in order to assess the various revolving drug fund models currently being implemented in different parts of the country.
□In June, 1995, the RDF Committee, with UNICEF, conducted monitoring and evaluation of RDF activities in 60 district hospitals located in fourteen provinces.
IV. Problems and Constraints
□There are several kinds of RDF systems in operation in Laos, with different pricing and exemption schemes, complicating efforts to monitor and evaluate.
□After adjusting the international price of imported drugs to local prices, these is a significant loss in value.
□The distribution system often breaks down before drugs reach the dispensary level.
□There is insufficient management capacity, and the concept of cost recovery is new and not well understood.
□Health workers receive insufficient preparation/training, and manuals and guidelines do not exist. There is no reporting system.
□There is generally low attendance at health facilities.
□Pharmacies and RDF facilities at the provincial and district levels are poorly equipped.
V. Future National Plans for Community-Based Essential Drug Program and Community Health System
□Develop community-based RDF system in tandem with RDF system in referral institutions
□Produce national guidelines (policies) for RDFs
□Produce manuals on system management for both hospital-based and community-based RDFs
□Develop standard diagnostic and treatment guidelines for common diseases with the use of essential drugs
□Produce manuals on the rational use of essential drugs
□Conduct training programs on RDF system management
□Conduct field monitoring and supervision (central to province, province to district, district to dispensaries or communities)
□Hold national meetings on RDFs every year
VI. Recommendations
□The drug supply should be well planned at the national level.
□Drugs should be procured from local manufacturers to support local production.
□Health personnel involved with drug management at all levels should receive on-the-job training.
□Pharmacies and revolving drug fund facilities should be improved.
□The distribution and logistics management are extremely weak, complicated by poor transportation and communication infrastructure.
These systems must be upgraded, or the provision of drugs will be ineffective.
□Long-term assistance as well as drug supplies are needed to provide time for new systems to prove themselves.
