If the COVID-19 pandemic taught us anything, it is that without health we have nothing. We cannot take health for granted.
As WHO Representative to Laos for the last two years, I know well how the health challenges we face can seem impossible to overcome.
Yet, if there is one thing I have learnt from my time in this beautiful country, it is that success in the face of adversity is very much possible – with commitment, collaboration, and investment.
These vital components are essential to addressing the evolving health burdens that Lao PDR faces as a lower middle- income country – triple burdens due to communicable diseases like malaria, low vaccination rates, maternal and child health challenges, as well as emerging health challenges like climate change, and those linked to socioeconomic development, like diabetes and heart disease.
Looking back, it is easy to forget how complex COVID-19 was. In Laos, as in other countries, the pandemic exposed gaps in the health system’s capacity and investment in health.
While these we r e significant problems, the pandemic also provided an opportunity to focus and invest – achieving massive gains in the process.
I am particularly proud about the opening of three medical oxygen production facilities in provincial hospitals, and the introduction of the digital vaccine registration, with more than 74 percent of Lao people registered – just two examples of the longer-term benefits of the COVID-19 response.
But while an effective COVID-19 response has been the focus of late, there are many other successes that have been achieved.
The grave threat of malaria has been almost eliminated from the country. Cases have fallen from an estimated 460 000 in 1997 to less than 750 last year.
In October 2023, the Lao PDR el iminated lymphatic filariasis – also known as elephantiasis – a painful and disabling neglected tropical disease. From 2000 to 2020, the number of pregnant women who died per 100 000 live births dropped from 579 to 126 – a reduction of 78.7 percent – one of the fastest falling rates in the world.
Post-COVID-19, a joint Ministry of Health, Ministry of Home Affairs, and WHO community engagement programme – CONNECT – is transforming how hundreds of the Lao PDR’s most remote, diverse communities and different agencies collaborate for better health outcomes.
These are just a few tasks that might have seemed impossible in the past, yet now serve as a reminder that – with commitment, collaboration, and investment – what may seem impossible is within our reach.
They are achievements that reflect commitment and leadership by the Ministry of Health and other ministries, and provincial and district officials.
They are milestones that prove the power of effective collaboration between the Government, par tner s , communities and, crucially, healthcare workers, to deliver public health results.
They are successes that demonstrate the generosity of our partners – the governments and development agencies of Australia, Canada, China, the European Union, France, Germany, Japan, Luxembourg, Norway, the Republic of Korea, Switzerland, the United Kingdom, and the United States of America, as well as a range of international organisations.
They are wins that reflect the hard work of WHO Laos personnel.
And most importantly, they prove success is possible. We can overcome even daunting health challenges. This is crucial to recognise given the work that remains ahead of us in a changing context.
Front and centre is sustainable health financing to help us overcome accumulated debt in health facilities for medicines and services, expected reductions in donor funding, and the dire need for an appropriately resourced health workforce that can provide quality healthcare services.
Further, as Laos develops, the health landscape is developing with it. Communicable diseases like malaria are declining, while high blood pressure, heart disease, stroke, diabetes, and cancer are on the rise. These will increase as the country becomes more regionally linked, and we see easier access to imported, low-cost processed foods.
Climate change will continue to grow as an extreme health threat, with Laos particularly vulnerable. Projections are for more extreme weather, a 2–3 °C rise in temperature by 2050, and a 10–30 percent increase in rainfall. The direct impacts are clear – increased natural disasters, injuries, and destruction – and the health system is at significant risk. Most healthcare facilities have limited sanitation facilities, and just 1% have maintenance plans in case of extreme weather.
The health system is not currently ready to tackle the rapidly increasing burden of noncommunicable diseases and changing climate conditions.
But, are these challenges insurmountable? Impossible? No – they are not.
We have seen time and again, success is possible. It will simply require more. More commitment, more collaboration, and more investment.
So, to the Government and development partners, I ask: continue your inspiring and committed efforts, ensure we reach the unreached no matter where or who they are, and seek every opportunity to safeguard and increase investment in health.
The Ministry of Health, National Assembly and the Prime Minister have shown strong leadership on health-protecting legislation, with a world-leading ban on e-cigarettes as just one example. At present, Laos has the lowest tobacco tax rate in the region – pro-health taxes would be an easy pathway to increased revenue and improved health outcomes.
Similarly, increasing health budgets will produce results. Now is the time for Laos to ensure health for all by increasing the health budget to its committed 9 percent allocation. By investing in health, we invest in the future of the country.
We only need to look back to the progress made in malaria and lymphatic filariasis elimination, maternal mortality rates, and more, to know that investment in health is money well spent. Countless lives have been and can be saved with these investments and efforts – and, again, increasing funding from pro-health taxes is an easy win here.
These challenges are not beyond us. Success is possible. It will simply require more.
So, in short: commitment, collaboration and investment – these are the key ingredients which have led us to the extraordinary achievements made to tackle seemingly insurmountable health obstacles in the past. They will be even more important to addressing the emerging challenges of the future.
Happily, I know WHO will be there every step of the way to support the people of Laos, as we have been since opening the first UN office in Lao PDR more than 60 years ago and will remain far into the future.
About the author: Dr Ying-Ru Lo is the departing WHO Representative to Laos. An infectious disease physician from Germany, she has more than 30 years of experience as a clinician and public health expert.