Laos

In collaboration with the Ministry of Health, PSI Laos launched the Women’s Health Project in 2011 to increase access to IUDs and other contraceptive methods. In 2012, one in four women in Laos had never heard of IUDs and more than half had never heard of the contraceptive implant. To change this reality, PSI Laos now works closely with the Ministry of Health, the Maternal and Child Health Center, the United Nations Population Fund and provincial health departments in 10 provinces to strengthen the capacity providers in the public and private sectors have to offer high-quality sexual and reproductive health services. PSI Laos supports the government to carry out training on sexual and reproductive healthcare in the public and private sectors, including clinical training on the insertion of IUDs and contraceptive implants, while advocating for increased access to comprehensive sexual and reproductive healthcare for women served in the private sector. These activities are all part of efforts by PSI Laos to gradually transition financial responsibility and activity ownership to the Ministry of Health.

PSI Laos improves knowledge of contraceptive methods so that women can make informed decisions about their reproductive health. This includes through Huk Mi Plan, an integrated digital ecosystem of sexual and reproductive health and rights resources that PSI Laos launched in 2019 in partnership with the Ministry of Health. The broad range of resources, including youth-friendly and engaging information via Facebook, the first Lao language sexual and reproductive health website and a series of 21 educational videos in four local ethnic languages, Lao Loum and English create a safe space for women and offers reproductive health counseling via an online messenger, a hotline and by linking them with trained, quality-assured providers. Thus far, the Huk Mi Plan Facebook page has established a community of over 20,000 followers. PSI Laos is also training government health educators on effective reproductive health interpersonal communication to ensure long-term sustainability and integration of sexual and reproductive health into national frameworks. From December 2018 to October 2019, 116,924 women were reached by a combination of PSI Laos and PSI Laos-trained government health educators in the public sector, with 50,308 referral cards distributed and 29,851 returned. Health educators also use these sessions to raise awareness about the new national health insurance scheme.

With the adoption of the 2016 National Safe Abortion Clinical Guidelines, the abortion landscape in Laos has liberalized considerably, though progress has been slow and access to information and affordable, quality-assured abortion services remains low. Of the estimated 100,000 abortions that take place each year in Laos, nearly 40,000 are considered unsafe, and the vast majority occur via unregulated and potentially low-quality channels.

Over the past eight years, PSI Laos has emerged as the Ministry of Health’s key technical partner on abortion, having elevated safe abortion as a major public health issue and garnered support for the development of clinical guidelines, provider trainings and registration of medical abortion products. PSI Laos will continue its work to ensure that all safe abortion sites have trained staff, are fully stocked with necessary commodities and equipment and effectively collect and use data.

In partnership with the Laos government’s Centre for Malaria, Parasitology and Entomology, PSI Laos is working to engage the private sector to support malaria elimination in Laos, as well as other countries in the Greater Mekong Subregion. PSI Laos recruits private sector outlets such as pharmacies and clinics to join the Public-Private Mix program and provides malaria case management training. As a result of PSI Laos advocacy, improved national malaria case management guidelines were implemented in 2019, helping contribute to a 50% increase in the number of malaria cases tested that year. PS Laos I is also working to ensure the availability of anti-malarial medications and malaria detection tests by strengthening the existing supply chain for these products at the district and village levels. And in an effort to expand access to high-risk populations in hard-to-reach areas, PSI Laos has piloted a number of innovative new intervention approaches, including its Shop-based Village Malaria Worker network and its work training providers on military bases.

PSI Laos has developed comprehensive mobile technology solutions for providers and implemented the use of an encrypted Facebook Messenger chatbot application to increase reporting for suspected and confirmed malaria cases into national information systems. These tools are improving data management and enable results to be more easily shared with government partners to inform future malaria elimination strategies.

In collaboration with the Ministry of Health and the National TB Center, PSI Laos supports the government’s goal to detect more cases of TB. By engaging the private sector, patients with TB are now offered directly observed short-course treatment in private sector clinics. PSI Laos also mobilizes pharmacists to refer clients with key symptoms of TB to Sun Quality Health clinics (a PSI social franchise) for screening. PSI Laos uses mobile video units to provide information on TB, conduct interactive group discussions and offer on-site prescreening and referrals by a private health provider to communities in high-risk locations.

PSI Laos is working to reduce the transmission of HIV and sexually transmitted infections by increasing access to high-quality, affordable or free prevention products and services, including condoms and HIV testing. In support of the National HIV/AIDS Program, PSI Laos provides a comprehensive package of products and services to female sex workers. This includes behavior change communication activities focused on HIV/sexually transmitted infection awareness, instructions on correct and consistent condom use, and group and one-on-one outreach sessions. PSI Laos has also implemented a new risk-tracing snowball approach in all two provinces to target previously unknown networks of female sex workers for HIV testing, diagnosis and referral for treatment.

Through strategic partnerships with both the public and private sector, PSI Laos is working to increase condom use equitably and sustainably in Laos. As part of this strategy, in 2019 PSI Laos relaunched its Number One brand condoms in order to diversify its condom lineup, ensure long-term product sustainability and enable a competitive, quality-assured condom market across all income levels.

With funding from the World Diabetes Foundation, PSI Laos works to strengthen Laos’ ability to respond to the growing threat that diabetes poses to the health and development of the country by establishing national policies on the treatment of type 2 diabetes, hypertension and gestational diabetes in Laos. Currently, no such policies exist at the national level, and most healthcare providers lack the necessary training and skills to provide proper treatment to individuals suffering from these afflictions.

PSI Laos and the Ministry of Health have developed a three-year plan for the creation and implementation of an initial national response to diabetes and its common comorbidities. PSI Laos will work with multiple stakeholders, including the Ministry of Health and WHO, to develop national guidelines for each target health area and create training modules for healthcare providers based upon the guidelines. In addition, PSI Laos and the Department of Health Care will educate healthcare providers at hospitals on the proper diagnosis and treatment of type 2 diabetes, hypertension and gestational diabetes. These hospitals will become centers of excellence on diabetes, hypertension and/or gestational diabetes management, with the ultimate aim of establishing a sustainable framework for diabetes care by providing both national guidelines and training modules that will last long beyond the project’s completion.

Under the leadership of the Laos Department for Communicable Disease Control and with consortium partners, WHO and the Clinton Health Access Initiative (CHAI), PSI Laos is helping to strengthen a public health emergency operations center (PHEOC) in the Ministry of Health to enable effective, timely response to any public health threat. The PHEOC will be leveraged to accelerate the country’s achievement of malaria elimination by further transforming surveillance into a core intervention, improving accountability for key malaria metrics through higher scrutiny within the Ministry of Health and capacitating an incident management system for rapid response.

During the implementation phase, the consortium will conduct PHEOC-related trainings for all core staff and provincial/district level staff, build out emergency response plans by health area and collaborate with international partners (WHO Geneva and WHO Western Pacific Region, Thailand Ministry of Public Health Emergency Operations Center and US Centers for Disease Control and Prevention) to receive training and develop a network of partners that can be leveraged in the future.