Primary Health Care in Bokeo, Laos

Context

Official Statement

The development of the province of Bokeo , on the border with Burma and Thailand , is difficult due to isolation, the dispersion of villages, and the variety of ethnic groups living on its territory. The Mekong River is the main communication artery. The population is extremely poor, and the level of education is very low. Medical staff is insufficiently trained and doesn't always have the necessary equipment to work efficiently. Most of the villages have neither drinkable water nor latrines. Access to healthcare and medicine is very limited. The main causes of death are malaria, acute breathing infections, diarrhoea, and chronic malnutrition.

Objective

Initiated in March 1999, the primary healthcare and health education program's objective is to contribute to the improvement of the population's health, specifically for women and children of ethnic minorities, who are much more disadvantaged.

Therefore, it is essential to support existing health structures and create a healthcare system in the Bokeo province, in Northern Laos , which allows ethnic minorities to learn basic actions to prevent the most common illnesses and benefit from basic medical treatment in an acceptable sanitary environment.

Location:

The project concerns two districts, Ton Pheung and Muang Meung, and a special area (assimilated to a district), Nam Nou, in the Bokeo province.

Bokeo, the smallest of the 17 provinces in Laos , is unique because three quarters of its border is constituted by the Mekong . Thus, the geographic zone of the project is very difficult to reach. During half of the year, climatic conditions make travel by boat on the Mekong or its tributaries very difficult and expensive.

Bordering 4 countries ( Laos , Thailand , Burma , and China ), this area named "The Golden Triangle" has striking socio-economic characteristics as there is a high level of ethnic diversity and trade. Beyond the Mekong plains and banks, populated mainly by the Lao Loum, the rest of population consists almost exclusively of ethnic minorities, mainly Akkha, Lahou, Yao Mien, H'mong. Some live in very precarious conditions because of recent migration from the mountains to the plains (including areas from Padham to Muang Meung and Nam Nhou) or a compulsory return from refugee camps in Thailand .

Beneficiaries:

• Children under 5 years old;
• Children from primary schools benefiting from health education and who, in turn, become messengers for health;
• Mothers, including during their pregnancy;
• Families (2,211);
• A total of more than 12,000 inhabitants (27,480 total in the three targeted districts) of 47 targeted villages;
• Support to district hospitals and health centres allows reaching a greater proportion of the populations;
• Health centre and hospital staff will benefit from trainings, as will primary school teachers and directors of 13 schools taking part in the health education programme.

Local Partners:

• Ministry of Health
• Ministry of Education
• District Department for Health
• Health departments of the targeted districts and provinces
• Education departments of the targeted districts and provinces
• District Hospital personnel
• Health centre staff
• Village leaders
• Village Health Volunteers (VSV)
• Traditional midwives
• Local representatives of collective organisations (Women's Union , Elderly and young people)

The four last institutional groups constitute what we call the Committee for Village Sanitary Development.

Project Duration: 1999-2003

Funding: European Union, Ministry of French Foreign Affairs

Staff: Expatriate staff: 1 person responsible for primary health care and 1 person responsible for health education.

Local staff: 3 Laotian doctors, additional health personnel from provinces and districts, and Village Health Volunteers and traditional midwives from each targeted village.