Skip to main content

Table 2 Key constraints and operational solutions within the health care system

From: Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People’s democratic republic: a qualitative study

Level Constraint Cause Solution
1. Health service delivery level (demand-side) Shortage of appropriately qualified staff Inadequate training Strengthen pre-service and in-service training, develop standardized training plans, use cascade training and increase supervision
Provide sufficient per diem for supervision
On-the-job training and mentoring
Limited number of ethnic group healthcare staff Human-resource plans including specific affirmative action policies and strategies to attract men and women from different ethnic groups
Limited number of staff with appropriate language skills Provide additional education to identified men and women from ethnic groups to facilitate entry into formal training programs
Poor understanding of some policies and standards Simple, standardized policies, training and supervision and feedback loops for staff
Reliance on VHVs Creation of more paid positions, provide remuneration, per diem for outreach, training and supervision, on-the-job training and mentoring
VHVs struggle to balance health duties and livelihood needs
Insufficient basic supplies, drugs and equipment Weak supply system an poor financial planning Strengthen management and supply and provide supervision
Pre-service and in-service training, supervision and mentoring
Standardized procurement and disbursement mechanisms
Distant location of facilities Deploy trained staff to peripheral health units
Establish and maintain waiting homes
Insufficient budget Insufficient budget allocation Advocate for increased government budget allocation to health
2. Community and household level (supply side) Low demand, delayed use of services and poor compliance with treatment Inadequate affordable transport Develop community transport schemes
Household resources and willingness/ability to pay Develop and promote appropriate finance schemes
Limited cash flow/livelihood demands – associated with seasonality Strengthen social health insurance (SHI) and social health protection (SHP) schemes which are inclusive of the poor
Delayed decision making Promote birth and emergency preparedness plans
Language Strengthen education for ethnic groups
  Recruit from ethnic populations
Cultural norms Integrate cultural appropriateness into MNCH program planning and design
3. Policy and strategic management Weak management, administration and coordination Few managers Strengthen district level management capacity
Limited management training Clear guidelines and manuals
High administrative burden relative to skills Streamline reporting
4. Cross-sectoral, Limited infrastructure (e.g. electricity, roads, communication networks) Insufficient cross-sectoral action Promote cross-sectoral collaboration and strengthen coordination with different technical working groups
Limited access to education for ethnic groups and women