Access to Quality Health and Nutrition Services – Tackling One of Laos’ Enduring Challenges

Phase 2 of the Health and Nutrition Services Access Project (HANSA2), approved by the World Bank in February 2024, and by the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria (the Global Fund) in December 2023, will help the Lao government scale-up the delivery of quality essential health services to those most in need and play an important role in improving nutrition in rural areas. 

Building on the first Health and Nutrition Services Access Project, which began in 2020 and ends this year, HANSA2 makes up to $62 million of financing available to address longstanding problems in bringing health services to rural communities, particularly to women and children from ethnic groups. Funding comes from the World Bank, the Government of Australia, the Global Fund, and Gavi,-the Global Vaccine Alliance. 

As one of the pillars of the World Bank’s nutrition convergence approach in Laos, HANSA2 will help staff in district health services and health centers work with villagers to address poor diets and feeding practices among mothers, high birth rates among adolescents, and low take-up of services, including for ante-natal care, assisted child delivery, and vaccination. It will also expand services such as family planning, and water supply and sanitation.

Megan Jones, Australian Ambassador to the Lao PDR said, “Improving health service access in remote areas is essential for long-term development. Despite improvements in national averages, there are persistent and high disparities in health outcomes and service coverage by ethnicity and location, and not all population groups are benefiting equally from improvements. For example, we know the infant mortality rate is almost five times higher in Khammuan than in the capital, while in Phongsaly, only around 37% of women get assistance from skilled personnel when giving birth. HANSA2 will make concerted efforts not only to ensure midwives are easier to find, but also work with rural villagers to help them understand where and how to access health services, and why they are so important”.

To provide nationwide coverage, phase 2 scales up many HANSA activities from the four northern provinces targeted in phase 1. The first phase improved primary health care services using performance-linked payments, and has enhanced the District Health Information System, which provides data on sex, age, ethnicity, and location for better planning, monitoring, and decision making in the allocation of resources.

Tuberculosis and HIV services were hampered by the COVID-19 pandemic, with drops recorded in TB case notifications and in the number of people reached by HIV prevention services. Despite the disruption, Since HANSA 1 started, TB treatment coverage has bounced back, rising from 58% in 2021 to 82% in 2022, close to the 90% global target. While the percentage of people living with HIV that are receiving antiretroviral treatment reached 58% in 2022, more needs to be done to get to the 95% UNAIDS 2025 goal.

HANSA2 will continue to support increased TB prevention and treatment coverage, and increased HIV services among key populations and people living with HIV/AIDS. The project will also continue integrating TB and HIV services into Laos, primary healthcare system and strengthening health systems to withstand the effects of climate change.

"The HANSA partnership of government, development agencies and civil society organizations provides a solid platform to jointly support more efficient, effective, and sustainable financing for health programs. This second phase of the project is designed to increase access to quality health care and strengthen health systems for better health outcomes and climate change resilience, contributing to the fight against AIDS, TB, and malaria,” said Mark Edington, the Global Fund’s Head of Grant Management.

Nadia Lasri, Senior Country Manager and Coordinator of Gavi support in the Lao PDR, said “Addressing malnutrition helps boost immunity and vaccination effectiveness, especially for the most vulnerable. HANSA2 will enhance access to quality health and nutrition services, and provide an integrated coordinated approach to strengthening health systems and addressing gender and climate change concerns in the Lao PDR.”

HANSA2 will begin scaling up Health and Nutrition Services Access activities immediately, working in tandem with the five other World Bank nutrition convergence projects to counter of one Laos’ most persistent challenges. The Ministry of Health will implement the four project components through its Department of Planning and Finance, technical departments, centers, and provincial and district health offices.

Project components:     

1. Financing for Primary Health Care Services using the National Health Indicators system
2. Integrated Primary Health Care Service Delivery
3. Adaptive Learning and Project Management
4. Contingency Emergency Response