○Reduce mortality and morbidity of children under five years of age from diarrhoeal disease, acute respiratory infections and other common illnesses

○Reduce inappropriate drug use in treatment of children under five

○Strengthen health system through development of vertical and horizontal linkages between local communities and public/private social sector personnel

○Continue to strengthen and expand community drug revolving fund system in five target provinces

○Promote malaria prevention at community level through use of impregnated mosquito nets and mosbar

○Institute school programs in health education, malaria prevention, CDD and ARI

○Improve prescription practices of pharmacists and drug sellers in cases of diarrhea and ARI

○Improve case management practices of pharmacists and drug sellers in cases of diarrhea and ARI

○Promote nationally approved list of essential ARI drugs among pharmacists and drug sellers

○Consolidation of village RDF and community health monitoring and evaluation system

○Mid-term review of village RDF system at central, province, and district levels

○Second workshop for trainers in facilitation techniques and workshop session design

○Second round of training for village RDF volunteers in:

- malaria, diarrhea, and ARI treatment and prevention

- community/household hygiene and sanitation

- nutrition

- safe birth practices

- communication skills (use of health education flip charts)

- dissemination of eleven basic health messages based on Facts for Life manual

○Household and community health data collection; data processing and analysis; identification of priority problems and planning for action; and initiation of self-monitoring and planning by villagers

○Development, pre-testing and printing of new communication materials; revision of RDF manual

○Preparation for expansion to next 132 villages in target provinces and districts

○Five-day workshop being planned to set out strategies, develop implementation plan and discuss curriculum for training of pharmacists and drug sellers on rational drug use for CDD, ARI and malaria

○Essential ARI drugs being purchased for distribution to health facilities with staff trained on correct ARI case management

○Health education materials, such as flip charts and posters, are being reviewed by the CDD/ARI Committee. IEC materials on CDD being reprinted for expansion of program from ten to eighteen provinces in early 1997.

○Improvement in community health
During the mid-term evaluation and assessment of village RDFs in seventeen districts, village leaders and community members reported positive effects from RDFs. Village volunteers' records of disease patterns suggest a declining number of malaria, CDD and ARI cases in many communities.

○Improvement in community hygiene and sanitation
There are observable positive changes in household and community hygiene and sanitation.

○Staff capacity building
Province and local health staff are now capable of working in teams for project planning, management, monitoring and supervision. Most village health workers (VHWs) are now able to use the RDF manual and have sufficient skills in simple diagnosis, drug prescription and correct case management. Based on reports, serious cases needing hospital attention are on the decline, attributable to the expanding availability of early detection and treatment.

○Inadequate understanding of RDF operations
This is being resolved as government staff gains experience.

○Lack of transport equipment
The project has provided motorcycles, tuk tuks, and bicycles to province/district teams and VHWs.

○Shortage of personnel for project management and supervision
This is resolvable only by ensuring that village RDF committees are strong and understand self-monitoring and supervision responsibilities.

○Inadequate government budget for operational costs
The project is providing partial support for monitoring costs to ensure effective project supervision.

○Integration into government policy framework
The concept of community-based RDF operations is relatively new in Laos. The government is studying health cost recovery and developing a policy framework on RDFs within the health system. On completion of the study, community-based RDFs will be officially integrated into the government health system.