Laos’ 22 cases might suggest relatively little cause for concern to those used to reports of soaring case numbers in the Philippines and Indonesia. However, behind these low case numbers lies a struggling healthcare system which cannot afford a surge in cases, especially in poor, rural communities. Here’s what the Promotion of Family Health Association (PFHA) is doing to help.
PFHA staff delivering healthcare advice to rural Laotians (Picture taken from PFHA Facebook)
PFHA was established in 2012 in response to a challenging Laotian context characterised by a large youth population, high incidence of STIs, ongoing gender inequality, and numerous ethnic groups with varying socio-cultural norms. Against this backdrop, PFHA aims to support access to comprehensive sexual and reproductive health and rights education, focusing particular attention on empowering youth, women, and ethnic minorities. In 2018, they provided 131,098 essential sexual/reproductive health services in both rural and urban settings.
During the pandemic, PFHA has been working to integrate COVID-19 aid into their existing programmes. They are particularly well-positioned to extend COVID-19 aid because they’ve forged links with rural communities, who comprise 65% of the Lao population and who will potentially be hit hardest by the pandemic. PFHA has a network of local community members which has allowed them to hold health education sessions in more than 250 remote communities. Such outreach efforts are crucial because the challenges faced by the Lao healthcare system affect the rural and poor population disproportionately.
Here are some of the key factors that make the rural poor population in Laos especially vulnerable to a potential surge in COVID-19 cases:
Low public spending on healthcare: Despite increases in recent years, the country’s government healthcare expenditure continually ranks among the lowest in the SEA region. This chronic under-funding of the healthcare sector means high out-of-pocket expenditure which many simply cannot afford to pay. 18.3% of the population lived in poverty in 2018-19; this year, the World Bank estimates that, as a result of border closures making it nearly impossible for migrant workers to find employment, a further 1.4-3.1% of the Lao population (or between 96,000 and 214,000 people) could be newly classified as living in poverty.
Physical distance to medical facilities: There’s a clear urban-rural and lowland-highland divide in terms of access to healthcare. It takes significantly longer for rural and highland patients to reach a health facility.
Urban concentration of healthcare workers: Because of the unequal distribution of qualified health workers, medical equipment, and government subsidies in favour of affluent urban areas, the rural/poor population can largely only access a smaller range of lower-quality health services.
Inadequate sanitation and handwashing: In 2017, a total of 23% of the population still used either unimproved facilities (where excreta is not separated from human contact) or practiced open defecation. Meanwhile, a total of 50% of the population had no access to handwashing facilities with soap and/or water. These percentages are concentrated in the rural areas, suggesting that the rural population may have less capacity to carry out widely-recognised COVID-19 prevention measures such as handwashing with soap.
How can PFHA help?
Leveraging on their ability to reach remote areas, PFHA plans to purchase COVID-19 prevention equipment for health facilities and communities, including thermometers, PPE, rubbing alcohol, masks, and hand gel. This equipment is projected to reach around 25 health facilities, 100-125 health service providers, 125 villages, and 3,125 families covered by health centres. Alongside this, they will continue the important work they’ve done to provide essential sexual and reproductive health services and education.
Because of their limited access to healthcare, the rural poor population are likely to bear the worst of COVID-19 in Laos. By integrating COVID-19-specific aid into their existing health outreach programmes, PFHA can provide preventive aid to the communities who need it most.
If you're interested in donating to PFHA, please check out this fundraiser.