Social Transfers in the Fight against Hunger: Experiences of Health Sector in the Lao P.D.R

Sector Working Group for Health Policy Level:Sector Working Group for Health Policy Level:

21 November 2008 21 November 2008

Donechan PalaceDonechan Palace

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Social Transfer to the Fightagainst Hunger- Experiences ofHealth Sector in the Lao P.D.RSocial Transfer to the Fightagainst Hunger- Experiences ofHealth Sector in the Lao P.D.R

21-23 Feb 2013, in Phanom Phenh

Dr. Chandavone PHOXAY

Deputy Director General

Hygiene-Health Promotion Depart,

MoH Lao P.D.R

Socio-demographic indicatorsSocio-demographic indicators

•Population 6,2 million inhabitant

•Population in rural areas 72.8 % (2005)

•16 Provinces and 1 capital city

•IMR 68/ 1,000 live births

•U5MR 73 /1,000 live births

•MMR 357 /100,000 live births

Source: NSC, 2005; UNICEF 2006; The Government report2009, Global Finance Estimation 2010

LAOLAO

Flood in 2007Flood in 2007

PovertyPoverty

Nutritional Status in Lao P.D.RNutritional Status in Lao P.D.R

Source: the 7th National Health Congress report 2012

OpportunitiesOpportunities

•The 7th five year National Socio-economicdevelopment plan and poverty eradicationstrategy

• Nutrition is one of the top national agendaand priority

•Social protection including health financialscheme is one of key driven priority in healthsector reformed in Dec 2012

Key Policy and CommitmentKey Policy and Commitment

•National nutrition policy (2008), strategy, operational plan2010-2015, but no single common strategic plan on foodand nutrition security

•Health care services with fee exemption for:

–the poor

–pregnant women, delivery

–children < 5 year of age

•National Assembly endorsed on increasing governmentbudget for health sector to 9% of total governmentexpenditure on December 2012.

Coordination MechanismCoordination Mechanism

•Sector wide coordination for health at national to subnational levels

•Round table - platform for governmental multi-sectoral and development partners coordination onresources mobilization and aid effectiveness

•Country member of SUN movement – globalcoordination

•On going for strengthening Multi-sectoral coordinationin particular on nutrition and food security wouldengage line ministries & DPs

Multi-sectoral coordination onnutrition and food securityMulti-sectoral coordination onnutrition and food security

•Objective:

–To have common plan on nutrition & food security

–Common result framework

–Fund raising

–Effective fulfilling gap for nutrition priorityinterventions

To achieve MDG1 and graduate from the leastdeveloped country by 2020

Experiences on Social Transfers inother sector in Lao P.D.RExperiences on Social Transfers inother sector in Lao P.D.R

1.Voucher transfer

2.Target: the poor

3.Service delivery:

Health care services

4.Outcome: utilization ofhealth facility

5.Challenges:

–Identification the poor

–Huge paper work for PHCstaff

–Limited governmentbudget

Cash and Kind

Target: the poor livingsparsely in mountain couldnot access to key services

Services: Land, Housing/shelter, facilities, healthcenters, schools, seed,agricultural equipments,livestock

Comprehensive ruraldevelopment

Challenge: limitedgovernment resources

Social protection byGovern/donorsSocial protection byGovern/donors

Experiences on Social Transfers inHealth Sector in Lao P.D.RExperiences on Social Transfers inHealth Sector in Lao P.D.R

Health Equity fund & HC feeexemption for the poorby Govern/DonorsHealth Equity fund & HC feeexemption for the poorby Govern/Donors

1.Voucher transfer

2.Target: the poor

3.Service delivery:

Health care services

4.Outcome: utilization ofhealth facility

5.Challenges:

–Identification the poor

–Huge paper work for PHCstaff

–Limited governmentbudget

Cash and Kind

Target: the poor livingsparsely in mountaincould not access to keyservices

Services: Land, Housing/shelter, facilities, healthcenters, schools, seed,agricultural equipments,livestock

Challenge: limitedgovernment resources

Cash incentive: CommunityNutrition project supportedby WB - EU trusted fundfrom 2011-2013Cash incentive: CommunityNutrition project supportedby WB - EU trusted fundfrom 2011-2013

•Objectives: improvecoverage of MCH servicesand improve health outcomeof mother and children

•Target:

–Pregnant and lactatingwomen and children 2 YR old

•Service delivery

–Conditional Cash Transfers(CCT)

–Community-based Nutrition

•Objectives: scaling upcoverage of MCH servicesand improve healthoutcome of mother andchildren

•Target:

–Pregnant and lactatingwomen and children 5YR old

•Service delivery

–MCH

–Community-basedNutrition

Free exemptionFree exemption

Fee exemption :Fee exemption :

Nutrition and MCHNutrition and MCH

supported byGovernment & otherssupported byGovernment & others

CCTCCT

•Support for fee exemption forAntenatal care (ANC), delivery,postnatal care (PNC) & children< 2 Yrs

–Cash incentive for demand sidewith condition:

•Enrollment

•Utilization health services

•Package: transportation +opportunity costs

–Cash incentive for providingside:

•Subsidize fee for health facilitiesbased services

•Outcomes: increasing utilizationuptake of women (ANC, PNC,medical professional assisteddelivery) and children in healthfacilities - MDG 4-5

Fee exemption MCHsupported byGovernment & othersFee exemption MCHsupported byGovernment & others

< 5 Yrs childrenFull package and scaling up Supportfor fee exemption for Antenatal care(ANC), delivery, postnatal care (PNC)and children < 5 Yrs children

–Cash incentive for demand side withcondition:

•Utilization health services

•Package: transportation + opportunitycosts

–Cash incentive for providing side:

•Pay for fees for health facilities basedservices

Outcomes: increasing utilization uptakeof women (ANC, PNC, medicalprofessional assisted delivery) andchildren in health facilities - MDG 4-5

•Objectives: to improve nutritional status of motherand children to achieve MDG1 by 2015

•Target:

–Pregnant and lactating women and children 2 YRs old

•Direct nutrition service delivery with free of charge

–Facility & community based screening for mal-nurishedchildren < 5 yrs - synergy with MCH services & child wellbeing check-up

–Community-based care for malnourished children

–Preventive supplementary feeding - the 1st 1000 daysintervention: providing nutrient food for pregnant womenin ANC, delivery, PNC, & children < 2 Yrs

Free exemptionFree exemption

Nutrition programsNutrition programs

supported by Government & otherssupported by Government & others