Dr Anonh Xeuatvongsa, the manager for the National Expanded Programme on Immunization (EPI) in the Lao People's Democratic Republic. Photo credit: Gavi/2017/Matt Walker
QUESTION: Lao PDR hopes to transition from Gavi support by 2020. What are the key aspects of the country’s transition plan?
ANSWER: Gavi has been supporting Laos since 2002.
We have added six new vaccines into the Expanded Programme on Immunization (EPI) and, with the help of Gavi and partners, our immunisation programme has become quite strong in terms of service delivery.
We know it’s one of the main and most cost-effective public health interventions that can help the country reach its Strategic Development Goals (SDGs), especially in reducing the deaths of mothers and children.
But there are four areas in which we have to improve, which we will emphasise during transition.
QUESTION: What are the four areas you will focus on?
ANSWER: The first is communication with ethnic minorities. In our country we have four main language groups, 49 ethnic groups and 169 dialects.
So it’s difficult to communicate with both local authorities and communities to help them understand the benefits of vaccination.
The second is to improve the management of the cold chain for vaccines.
The third is building the capacity of healthcare workers to deliver vaccines. That means we must continue to provide training in the technical, planning and management aspects of immunisation.
The last area, on which we place a lot of emphasis, is the increased or enhanced political commitment to support the EPI programme in the future.
QUESTION: What problems are caused by having some many languages in Lao PDR, and how do you overcome them?
ANSWER: In the past 10 years the coverage of the EPI has increased, but only among some of these ethnic groups. That’s because there are many barriers to communicating with ethnic minorities in Laos.
Most of the healthcare workers are not from an ethnic minority, and don’t speak their local dialects. Mostly, they only speak Laos.
Communicating about the benefits of vaccinations is still mainly done in the central Laos languages, which local people don’t understand.
Also, the different ethnic communities live in different parts of our country, and in remote areas. Usually these people are not at home. They are usually in the mountains, at their rice fields, where we cannot meet them in big groups.
Five families may be in one place with another 10 elsewhere in the mountains, for example.
So it’s quite difficult to send healthcare staff who can speak to them.
In the future, the EPI programme will focus on communication. The Government and the Ministry of Health is trying to recruit students from different ethnic communities to join its public health, medical and nursing schools.
Once they have graduated from these schools, we hope to send them back to the local communities. In the long-term, they can help improve our communication with ethnic minorities.
In the short term, we will develop public information tools in different languages. We have produced materials including flip-charts, posters and animated cartoons. We are developing the cartoons in five ethnic group languages that will be ready in the next few months.
We will send these out to the community where they will be used to communicate with local ethnic minorities.
QUESTION: Are some parents in Lao PDR still hesitant about their children receiving vaccines?
ANSWER: Some families are hesitant about receiving vaccines. They can produce a mild fever in some children, and they don’t feel well after vaccinations. That can cause families some trouble, as they need to look after their children and sometimes can’t go to work as normal.
Because some families feel that vaccines cause their children to become sick, they feel reluctant to take their children back for another vaccination.
Some have also heard about adverse events following immunisation. Not very often, but it happens and that can lead to a hard time for the programme. We know all adverse events are coincidental, but people perceive that the illnesses result from the vaccinations.
So it’s important to communicate the truth about vaccines to improve coverage in the future.
QUESTION: How do you hope to improve the cold-chain management of vaccines?
ANSWER: There are now more than 1,000 health centres in the country. Thanks to the government’s social development plan, around 90% of them are already equipped with electricity.
The government is trying its best to expand the electricity cables to the local communities. We hope that in the next two years, the government will extend more cables to remote health centres, so that every health centre in the country will have the right cold chain equipment to store vaccines safely.
However, the knowledge and skills of health care workers in district and primary health care centres, particularly around vaccine and cold chain management, is still limited in some areas.
We have to strengthen these to ensure we can preserve the quality of the vaccines.
QUESTION: Can you tell us more about how you plan to build the capacity of health care workers to deliver vaccines?
ANSWER: To some extent, our health workforce is still limited. In the future, the Ministry of Health will try to readjust the number of health care workers.
For example, in the past we have allocated more health workers to curative care. In future, we will try to reallocate more to promoting health. That includes mother and child health programmes, the EPI and nutrition.
Currently when people get sick in the community, they visit the provincial hospitals, not district hospitals. This means that some healthcare workers in district hospitals only see a few patients each day.
We are asking more of these underused healthcare professionals to start visiting mothers and children in the community and promoting the benefits of immunisation and nutrition.
QUESTION: Can you explain more about the political commitment to immunisation in Lao PDR?
ANSWER: We will be working hand-in-hand with the Government, local authorities, provincial and district governors and village chiefs, to get them to support immunisation programmes.
Part of this is about funding. While support from Gavi and other partners is reduced, the Laos Government will do its very best to ensure that support for the EPI programme is increased.
The Government's new Immunisation Law will be approved in the first quarter of next year. This will ensure the Government's future commitment to the EPI programme, including vaccine and operational costs as well as other costs relating to government buildings, communication with ethnic minorities and strengthening the cold chain management system.
We know that the EPI programme is the most cost-effective public health intervention, and saves thousands and thousands of lives. It also saves the national economy the costs of children getting sick.
QUESTION: What role will partners play in helping Lao PDR’s transition?
ANSWER: Laos is still among the least developed countries, and in the future, we may have a hard time with national revenue collections.
Partners, such as WHO, UNICEF, World Bank, Gavi, the Asian Development Bank and other NGOs, will be important in case we’re not able to fulfil every need of the EPI programme in the future.