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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





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


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