Maternal and Child Health Out-of-Pocket Expenditure and Service Readiness in Lao PDR
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World Bank, Washington, DC
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Lao PDR has made notable progress in
improving maternal health, with mater¬nal mortality
decreasing from 1,600 per 100,000 births in 1990 to 220 in
2013.1 However, in order for further gains to be realized,
at least two barriers need to be addressed – the low
utilization of maternal health (MH) services and weak
financial protection, especially among the lower wealth
quintiles, in order to improve the level and equity of
maternal health. In order to address these financial
barriers, the Government of Lao PDR introduced a national
free maternal and child health (MCH) policy. Although there
were geographic variations in the operationalization of this
policy,4 the essence is that user fees paid OOP by pregnant
women or for children under-five were replaced with
case-based payments paid by or through the government or
donors, for essential MCH services. In addition, small cash
payments were provided to patients to cover opportunity and
transport costs. This report summarizes key findings from
two household, village, and health center surveys in
southern and rural Lao PDR conducted in 2010 and 2013,
providing for the first time in Lao PDR, large-scale
household-level data on OOP expenditure for MCH-specific services.
Palabras clave
prenatal care, maternal health, health expenditure, health centers, health systems reform