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WEEKLY NEWSLETTER
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Laos
Index
Despite government promises that the urban-oriented
health
system inherited from the RLG would be expanded to support
rural
primary health care and preventative programs, little
money had
been allocated to the health sector as of 1993. According
to
figures from 1988, less than 5 percent of the total
government
budget was targeted for health, with the result that the
Ministry
of Public Health was unable to establish a management and
planning
system to facilitate the changes envisioned. UNICEF
considered the
effort to construct a primary health care system to have
failed
entirely.
Official statistics identified hospitals in fifteen of
the
sixteen provinces, plus several in Vientiane, and clinics
in 110
districts and more than 1,000
tasseng
(subdistricts--see Glossary).
In reality, most subdistrict clinics are
unstaffed,
unequipped, and unsupplied, and in 1989 only twenty of the
district
clinics actually provided services. The physical condition
of the
facilities is poor, with clean water and latrines
unavailable at
most health posts, and electricity unavailable at 85
percent of
district clinics, rendering vaccine storage impossible.
Drugs and
equipment stored in the central warehouses are seldom
distributed
to outlying provinces, and in most situations, patients
had to
purchase Western pharmaceuticals from private pharmacies
that
imported stock from Thailand or Vietnam.
The number of health care personnel has been increasing
since
1975, and in 1990 the ministry reported 1,095 physicians,
3,313
medical assistants, and 8,143 nurses. Most personnel are
concentrated in the Vientiane area, where the population
per
physician ratio (1,400 to one) is more than ten times
higher than
in the provinces. In 1989 the national ratio was 2.6
physicians per
10,000 persons.
Training medical personnel at all levels emphasizes
theory at
the expense of practical skills and relies on curricula
similar to
those used prior to 1975. International foreign aid donors
supported plans for a school of public health, and texts
were
written and published in Lao. As of 1990, however, the
school did
not exist, because of delays in approval of its structure
and
difficulties in finding trainers with the appropriate
background.
Rural and provincial health personnel work under
conditions
similar to their counterparts in education: salaries are
low and
seldom paid on time, necessary equipment and supplies are
unavailable, and superiors offer little supervision or
encouragement. In these circumstances, morale is low, job
attendance sporadic, and most health care ineffectual. In
general,
the population has little confidence in the health care
sector,
although some village medics and a few district or
provincial
hospitals are respected by their communities.
Use of traditional medical practitioners remains
important in
urban as well as rural locations. Healers who know how to
use
medicinal plants are often consulted for common illnesses.
The
Institute of Traditional Medicine of the Ministry of
Public Health
formulated and marketed a number of preparations from
medicinal
plants. Spirit healers are also important for many groups,
in some
cases using medicinal plants but often relying on rituals
to
identify a disease and effect a cure. Many Laotians found
no
contradiction in consulting both spirit curers and
Western-trained
medical personnel.
In the absence of a widespread system of health
workers, local
shops selling drugs became an important source of
medicines and
offered advice on prescriptions. However, these pharmacies
are
unregulated and their owners unlicensed. As a consequence,
misprescription is common, both of inappropriate drugs and
incorrect
dosages. In rural areas, vendors commonly make up small
packets of
drugs--typically including an antibiotic, several
vitamins, and a
fever suppressant--and sell them as single-dose cures for
a variety
of ailments.
Data as of July 1994
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