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*population in 2020，GNI and life expectancy in 2019 are updated based on UN's data. *Medical information is based on WHO’s report of 2017Mental Health Atlas-country profile |
I. Overview |
Laos, officially the Lao People’s Democratic Republic (Lao PDR), is a socialist state and the only landlocked country in Southeast Asia Indochinese Peninsula. Laos shares a border with Vietnam, Cambodia, Thailand, Myanmar, and China. There are 68 ethnic groups in Laos, and each ethnic group has its own unique language, religious beliefs and cultural customs. In 2020, it has an estimated population of 7.27 million, with 66.8% dispersed and living in rural areas. Many places are difficult to access due to the mountainous landscape and up to 21% of the population still live in the areas without roads. (https://en.wikipedia.org/wiki/Laos) & (United Nations, 2020)
With an area of 236,800 square kilometers, the official language spoken in Laos is Lao. Vientiane is the capital and largest city in which they speak a little English, French, Chinese, and Vietnamese, while minority dialects are mostly used in mountainous areas. In 2015, the male to female ratio by the United nation in Laos was 104:100 with 37.3% under 15 years of age and 3.7% above 65 (2016ASEAN report, p58). The life expectancy at birth is 65 years for men, and 67 years for women. In 2019, Laos' GNI per capita is 2,570 US Dollars. The government spends 4.6% (as % of total medical health expenditure) of its budget on mental health and health expenditure per capita is US$15. The World Health Organization (hereinafter called WHO) estimated that the neuropsychiatric conditions accounted for 11.3 percent in Laos of the total disease burden in the world.
Laos is divided into 17 provinces (khoueng) and one municipality (kampheng nakhon) which is the capital city Vientiane. Provinces are further divided into townships (muang) and villages (ban). The Ministry of Health (MOH) in Laos is the main provider of health services for the country, which are the main services provider, including the developing policies, guidelines, monitoring health executions. managing and allocation of manpower and resources, evaluations, etc. In addition, the training and cultivation are also the main tasks of MOH; the health professionals in the University of Health Sciences in Laos (hereinafter called UHS) and the other seven Provincial level health colleges are now under the jurisdiction of MOH.
II. Mental health policy and system |
The Law on Health Care (2005) provided the lawful backup for the health sector, national and social health insurance administrative organizations. It also gave the authority to provincial and district health unit to collect fees for the services, and also the fee-exemption for the poor. Due to lack of health care related to maternal and child health, the government set up the National Commission to advise, monitor, and promote for communities services for mothers and children. Mental health policy became available in 2007, and the strategy on Mental Health started since 2013, but there were not implemented widely because of limitations in human and finance resources. There is still no policy and/or regulation which integrate the mental health with the medical insurance care system. (2016 ASEAN Report, p58~59)
The health-care system has three administrative levels, which is a central government-MOH, 17 provincial health offices (PHO) and district level health offices
(DHO). With respect to the health services, there are organization in terms of providers in each level. District-level providers are managed by the DHOs, while community-level providers (health centers) also operated by the DHOs. It is the four-level organization as we may understand. At the village level, there are a large number of village health volunteers (VHVs) and members of community health committees as well as the traditional birth attendants.
Laos has implemented recently the Health Insurance Reform to access the healthcare for the first time to the 70 year old elderly. The government significantly increased its subsidies to the National Health Insurance (NHI) in 2016 in line with the country’s ambitious goal to achieve universal health coverage by 2025.
III. Human Resources |
There are about 19,000 public sector health workers. Based on WHO report, there are 0.03 psychiatrists, and 0.26 nurses per 100,000 population in Laos, while there is no information about social workers, psychologists, and occupational therapists. (2016ASEAN Report, p59)
As of 2013, Laos has a limited number of mental health professionals, including two psychiatrists, two Neurologists, one mental health nurse practitioner, 11 general physicians who were practically trained at the mental health organizations in the country and Thailand. Additionally, there are 16 nurses and therapists in total, and no psychologist or social workers in service for public sector. (2016ASEAN Report, p60)
The UHS-Laos is the unique university in which the undergraduate and postgraduate are for the health professional training in the country, and composed of seven faculties, such as Faculty of Basic Sciences、Medicine、Pharmacy、Dentistry、Nursing Sciences、Medical Technology and Postgraduate Studies. The vision of the UHS-Laos is to be recognized in the region as an institute of higher education learning that is contributing to the production of knowledge of high quality health personnel who are motivated to serve for the Laos and committed to a lifetime contribution. Most of teachers in UHS have completed medical training domestically, due to the inadequate ability of language, they have difficulty in obtaining the latest foreign research resources.
There is no formal postgraduate training for doctors in psychiatry. Medical undergraduates receive 2 weeks' curriculum in psychiatry, however, the course is not popular among students. The academic department is located in Mahosot Hospital, but there is a paucity of textbooks which are especially ones written in the Thai and Lao languages. Most medical students respond that English textbooks are an obstacle to their advanced learning due to limited practice. The physical conditions of the in-patient unit do not enhance the appeal of working with patients who are mentally ill. Thus, doctors are interested in psychiatry, must seek for further learning outside Laos. Currently, community doctors, who manage most mental health problems in primary care, do not receive training in assessment and treatment. Most of time, they resort to using psychotropic medication.
IV. Mental health system and promotion |
Almost all hospital beds in Laos are designed for acute care. There are no designated psychiatric hospitals and neither have the long-term care institutions in the country.
The number of facilities of public sector services under the Ministry of Health in 2013 is as follows:
Central level: There are four central Hospitals and three special treatment centers providing tertiary curative care as well as dermatology, ophthalmology, and rehabilitation.
(1)Provincial and district level: Health centers: 16 with 1,589 beds
(2)District Hospital: 130 with 1,944 beds
(3)Health centers: 892 with 2,113beds
(4)In the capital city, there are 35 mental health beds in 2 general hospitals (0.06 beds
(5)per 10,000 population) providing inpatient and outpatient services.
The admission diagnosis for these inpatient are as follows:
(1)Thymopathy (feeling affection disorders), 38%.
(2)Schizophrenia and related disorders, 18%.
(3)Substance use disorder, 16%. (2016 ASEAN Report, p59)
As for Outpatient services, the primary diagnoses are mostly the neurotic, stress related, somatoform, schizophrenia. (2016 ASEAN Report, p61)
In order to help promoting of mental health in the Laos, the WHO set a Short-term National On-site Consultancy for Mental Health and Psychological Support (MHPS), The national consultant will report to and be guided by the WHO Country Office Acting Coordinator, Health System Development, in collaboration with the Ministry of Health experts on mental health and psychological support team. The consultant needs to provide technical support to the Department of Health Care and Rehabilitation (DHCR) and the Department of Hygiene and Health Promotion (DHHP), Ministry of Health (MOH) to conduct training of trainers (TOT) on core mental health at central and provincial levels, which is aimed to improve the shortage of mental health workforce in Laos.
V. Major issues, challenge, and opportunities |
Use of tobacco and alcohol has also been recognized as a serious substance abuse problem, and lead to an increase of related diseases and criminals.
In addition to the lack of mental health care, there is limited government budget to allocate for mental health care services. As budgets for the mental health care services are incorporated within the overall hospital budgets, and only have a limited range of routine treatments for certain common mental illnesses and epilepsy. It adopted a "community mental health" model in rural areas, including training village workers and providing outreach clinic. The model was commenced in May 2007, and expanded in 2010. With regard to the Mental Health Care service, only 1% of the medical doctors and nurses were trained and to devote themselves to mental health.
(1)No national mental health treatment protocol is in primary care.
(2)No standard mental health referral system is in the system
(3)Only medical doctors and physician assistants are allowed to prescribe psychotropic medicines
(4)Physician assistants and nurses are allowed to prescribe medicines in remote areas where a medical doctor is not available.
(5)Inadequate supervision by central government's team to ensure qualified and appropriate care. (2016ASEAN Report,p60)
No nationwide mental health data is available. There is a limited mental health care facilities at community level except those provided by Basic Need Program (BNP). Community awareness on mental health is inadequate. There is no anti-stigma program for the community and health professionals either. Strong cultural belief is still superstitions and stigmatized associated with mental illness, and it is misunderstood that mental disorders are untreatable. Traditional healers so far play important role for mentally ill people, and to believe the traditional therapies can treat them. (2016ASEAN Report,p60~61)
The government spends 4.6% (as % of total health expenditures) of its budget on mental health. Health personnel are concentrated in the bigger towns. Access to the rural areas is difficult because of poor traffic infrastructure. Consultations with doctors and nursing cares in primary and secondary care are free, however, patients need to pay for physical examinations and medications, as well as the cost of hospitalization. Most medications can be bought without prescription at pharmacies, but the drug misuse is an important issue recently. The economic and social changes of the past decade are affecting the mental health of the people gradually, and the explosion of substance misuse among teenagers and young adults will be a worry in the psychiatric community services .
VI. Potential exchange issues |
In recent years, the MOH has made significant progress in terms of health policy, development and decentralization of health services to provincial, district and health center levels medical facilities. However, investment in health is still low and out-of-pocket spending is above 62.6% and National Health Insurance (social health protection) coverage is 12.5% of the total population. Health service provision is strained by a lack of qualified, adequately distributed staff, adequate infrastructure construction and affordable drug supply. As a result, personnel training, remote teaching experience, community mental rehabilitation model, medical management of the procurement of essential drugs, substance and alcohol addiction prevention and treatment, children and adolescent mental illness diagnosis and treatment are all the potential issues for future exchanges.