Lao People's Democratic Republic

Do you have an interna-tional long-distance call to the Lao People's Democratic Republic? Only confirm the actual hour?

Support for corporate reforms in the Lao People's Democratic Republic, Media Information, 06 August 2016, Australian Minister for Trade, Tourism and Investment, The Hon Steven Ciobo MP

cWe are pleased to announce a further $4.1 million in resources for the Lao People's Democratic Republic. One of the key objectives of the Australian assistance programme in the Lao People's Democratic Republic is to facilitate a strengthened trading system and a more comparable retail industry. Australia has been working with the Lao Ministry of Industry and Commerce, the World Bank and others since 2008 to support the integration of the Lao People's Democratic Republic into the local and world economy.

This funding will help the Lao People's Democratic Republic to work with the World Bank to improve the working environment. This will make it easy for Australia's top-tier businesses to diversify, act and expand in Laos.

The challenge of empowering healthcare workers in the Lao People's Democratic Republic: Prospects for the main actors | Human Resources for Healthcare

Qian1, 2, 3, Fei Yan1, 2Email auteurVoir profil ORCID ID, Wei Wang1, Shayna Clancy4, Kongsap Akkhavong5, Manithong Vonglokham5, La République démocratique populaire lao est confrontée à une pénurie critique et à une mauvaise répartition du personnel de santé. Reinforcing healthcare personnel has been adopted as one of the five priority areas of the National Strategy for the Public Sector ("National Strategy for Health" 2013-2025).

The aim of this survey is to help people in Laos to better recognise, research and understanding the main issues for them. Thirty-three important stakeholder groups with special insight into the present position of healthcare personnel were specifically enlisted for in-depth interview. There is a serious lack of healthcare professionals (doctors, nursing staff and midwives) and laboratory assistants, especially in public utilities and countryside areas.

The main whistleblowers also identify five problems: inadequate output of healthcare personnel in terms of numbers and qualities, a restricted domestic envelope to hire enough healthcare personnel and to offer adequate and fair wages and benefits, restricted managerial capacities, a bad attitude towards working in the countryside and a shortage of well-designed training programmes for work.

In order to increase the allocation of healthcare personnel in the countryside, policies to increase productivity and strengthen staff loyalty should be well incorporated to increase efficiency. In addition, the authorities should recognise the insufficient capacities for managing public healthcare and should devote resources to improving personnel resources at all tiers. Lastly, an evaluation of measures to strengthen healthcare personnel should be undertaken as soon as possible in order to draw on the experience and teachings of the Lao People's Democratic Republic.

Optimum healthcare cannot be attained without healthcare workers, as healthcare workers are the link between healthcare education and healthcare policies[1-3]. It is at the core of all healthcare system and is playing a pivotal part in the improvement of healthcare and the achievement of healthcare goals[1-3]. Nonetheless, the worldwide healthcare staff is in a serious crises.

The overall shortfall of qualified healthcare workforces (doctors, nurses/women) has been esti-mated from 2. 4 million in 2006 to 7. 2 million in 2012 and is anticipated to reach up to 12. Those with a higher incidence of illness and the need for more healthcare personnel generally have a greater shortfall in healthcare personnel.

There is also an unequal division of healthcare personnel between town and country areas within each country. There is also some indication that the world's healthcare personnel are getting older[3]. That is why it is important to review the training, redeployment and pay schemes for healthcare personnel and to launch a new overall healthcare resource policy to strengthen healthcare personnel on the basis of better knowledge and practice.

Lao PDR is one of 57 Lao PDRs facing a serious lack of healthcare staff. There were only 14 healthcare professionals in the state in 2012[1, 4, 5]. Among these employees in the healthcare sector, 59% were women and 16% were minorities[4]. From 2005 to 2012, the healthcare workforce averaged 0.2 doctors and 0.8 nurses and midwives per 1000 inhabitants[5].

The figure was well below the WHO recommendation of 2.28 professionals per 1000 inhabitants[1]. Medium- and high-educated physicians, nursing personnel and midwives represented less than 30% of the overall healthcare workforce[4]. Therefore, there is a serious lack of well-trained healthcare professionals, especially highly educated healthcare professionals.

In the Lao People's Democratic Republic, healthcare staff is unequally spread across various regions. From 2009 to 2010, the city had the highest number of healthcare staff per 1000 inhabitants, 4.2 for all kinds of healthcare staff, twice as many as at nationally in the same period[4].

In addition, there is a misallocation of healthcare personnel to different kinds of healthcare institutions (central clinics, local clinics, rural clinics, rural clinics and rural clinics ), most of which are staffed in rural clinics and rural clinics[6]. Only a few healthcare professionals occupy posts in rural healthcare centres, most of which are situated in isolated, hilly and inaccessible areas[4].

Furthermore, the overall capacities of healthcare personnel in the Lao PDR are constrained due to the low level of education and reduced incentive, which includes low wages and the absence of career advancement possibilities, which also have an impact on healthcare personnel performance[5, 6]. This shortage of personnel in the Lao People's Democratic Republic is similar to many other industrialised and emerging states.

In Australia, more physicians and nursing staff work in conurbations than in isolated areas, which is why the GOA initiated the "More Ph. There is an uneven distribution of healthcare employees in China, not only between countryside and cities, but also between regions[8].

There is also domestic displacement of qualified medical workers from the countryside to the city and from the general to the privately-owned sectors, a new major challenges for the country's medical sector[9]. In the Lao People's Democratic Republic, the country's medical system works at three different administration levels: centrally (Ministry of General Government, MOH), provintially (Provincial Institutes of General Government, PHOs) and at regional government departmental ( "District Institutes of Health", DHOs)[4, 6, 10].

Lao's healthcare system has been decentralised and some responsibilities for programming and budgets have been transferred to the province and districts, but there are indications that capacities for healthcare and governance at the province and districts level are limited[4-6]. Governments' healthcare spending is also moderate, and the healthcare system depends heavily on donor funding[6, 11].

In 2012, the federal budget for Germany was only 2.6% of overall expenditure on health[12]. In the Lao People's Democratic Republic, the majority of care is provided by four organisational tiers of care: centralised hospital administered directly by the MOH, province-based hospital administered by the PHO, local hospital administered by the DHO and municipal provider (health centres and local drugs kits) also administered by the DHO[4, 10, 13].

As a result of the unequal division of staff by institution types, many institutions providing essential medical care are short staffed and incapable of providing essential services[6]. You can see the structures of the medical institutions in Supplementary Record 1. Lao PDR is now under the Seventh National Socioeconomic Plan and has used the Seventh Five-Year National Development Plan for the Public Sector as a road map to meet the health-related Millennium Development Goals (MDGs) and make all Laotians' lives better[14].

In this context, the National Strategy for the Public Sector ( "National Strategy for Health", 2013-2025) was adopted in 2012 and is to be phased in in three stages with the aim of reaching the health-related MGs by 2015 and general healthcare by 2025. Reinforcing healthcare staff is one of the five priority areas of the reform[10]. Therefore, the development of a better knowledge of the present medical staff in the Lao People's Democratic Republic is necessary to reach the goal of "human resource for health".

Earlier studies and reporting mainly contained quantified information on healthcare personnel in the Lao PDR and did not provide a full and integral view of healthcare personnel in the Lao PDR. The aim of this survey is to help people in Laos to better recognise, research and understanding the main issues for them.

In addition, we make recommandations for the further training of medical staff in the framework of the Lao People's Democratic Republic's public Health reforms. The aim of these interventions was to research and better understand the issues and issues facing the Lao People's Democratic Republic's public sector staff. During the staffing phase, the following elements are assessed: monitoring, remuneration, system support, life-long training and work.

After all, the four main issues in the phase-out phase are immigration, occupational choices, healthcare and security and retirement; they are also the influential elements of employee turnover. Important stakeholder groups with special insight into the present position of healthcare personnel were attracted by a targeted random sample strategy[15]. Locations were chosen in municipal and countryside areas with different economical circumstances.

Vientiane, the capitol, is an urbane area and the Vientiane provinces a country area. For the purpose of this survey, three types of information officers were recruited: political decision-makers, administrators and healthcare professionals. Political decision-makers for public healthcare personnel budgeting and administration were chosen from the MOH. There are three recruitment groups for the administration of healthcare management:

1 ) MOH and National Institute of Public Hospitals (NIOPH) administration personnel, 2) province or county administration personnel, 3) administration personnel from various public care institutions (type A and B2 county hospitals and centres). We also hired a number of new members of our team, including those with different experience in this area.

Field work was carried out over 3 week in the Lao People's Democratic Republic. This first 1-week session was used by members of the research teams of the Lao People's Democratic Republic, China and the USA to get ready for the field work and to carry out a one-week face-to-face with them. The four thematic leaders for different kinds of core information providers (central and county administrators, county and county administrators, healthcare administrators and healthcare professionals) were used to help facilitating the interviewing process.

The IDI' was carried out by the main investigator in English and Laos with a research associate who is proficient in both English and Laos and has extensive healthcare research expertise. An important political document was the strategy for the development of human resources for healthcare until 2020 and the handbook of healthcare professions and education programmes. It has been used to study problems from various sources: political decision-makers, administrators and healthcare professionals.

The Ethics Committee of the School of Public Heath at the University of Fudan has issued the permit (reference number: IRB#2014-09-0532). MOH' s most important information officers reported that there are two major categories of healthcare personnel in the Lao People's Democratic Republic: public servants and contractual healthcare personnel.

Officials in the healthcare system have an officially recognised role in the healthcare system and receive a steady wage, while contractual healthcare personnel have no formal status and no pay. The most important source of information said that the main issue was the serious lack of healthcare personnel, especially in the countryside and outlying areas.

Shortcomings were greatest among healthcare professionals and lab assistants. In addition, most well-educated healthcare workers worked in central and parochial healthcare institutions, not at the mainstream. The main reasons for the lack of information were the inadequate budgets at country policymakers' offices and the lack of attractiveness for work in healthcare centres and outbuildings.

Many of the main whistleblowers report that the incentive for healthcare personnel was inadequate and unfair for different kinds of healthcare personnel. Salaries of public servants in the healthcare sector were mainly dependent on their "rank", which was set by the Ministry of Finance on the basis of their training and professional experience.

That meant that public servants in the healthcare sector of the same level would be paid similar wages regardless of the institution in which they worked. Pensioned officials earn approximately 60-70% of their initial pay per month. In addition to the rank-based pay, many important whistleblowers felt that the other forms of monetary incentive for different kinds of public servants in the healthcare system were not fair (see chart).

Hospital healthcare personnel could also receive funding stimuli from other resources, such as bonuses for on-call times, working with dangerous materials and counselling and counselling as well. Only on-call bonuses, counselling and lump-sum payouts for outcome benefits were received by healthcare personnel in healthcare Centres. An administrator said that some healthcare centre employees could generate additional revenue through part-time work in individual drugstores or hospitals.

Employees in the healthcare and healthcare administration departments were only paid a rank-based wage and a daily flat rate. Contractual healthcare personnel only receive standby and per Diem benefits. As well as the monetary incentive, the "outstanding" employees in the healthcare system were given a higher ranking as extra non-financial incentive, taking part in advanced education or courses of study in medicine and enrolling in medicine meetings.

Payment would be slowed down due to insufficient state managerial skills and complex funding and allocation procedures. Employees in the healthcare sector often depended on their family to make a livelihood in time. The most important whistleblowers thought that healthcare professionals, especially in healthcare centres, were diligent and committed, even during the time they were not paid.

In addition, the parishioners were seen as happy with the healthcare system and have established good relations with healthcare personnel. Two of the most important success drivers were location and staffing levels. Because of the lighter life circumstances and the assistance of the families, the employees on site can provide better benefits than the employees on site.

MOH can send a healthcare professional to a less attractive area, even if he or she is not eligible for this post due to a lack of specialists. Several respondents also raised other issues affecting benefits, such as pay levels, healthcare, living standards and individual reputations.

Following the political decision-makers' discussion, the assessment was carried out at two levels: the institution and the healthcare personnel layers. Performances of the healthcare institutions were evaluated on the basis of standardised check lists of superordinate healthcare administrations, which mainly covered business, finance and technology issues. An issue that has been raised by some political decision-makers has been that there has been no standardised way of assessing healthcare personnel, and healthcare institutions have had to establish their own assessment schemes for various issues.

Several of the healthcare centres used local church feedbacks, while others had no benchmark. The majority of important whistleblowers stated that assessment has a limiting impact on healthcare personnel. Instead of being dismissed, employees with poor performances had to think about their performances and were given training on how to adapt their behaviour in the new year.

The" Handbook of Public Occupations and Training Programmes" shows that the Lao People's Democratic Republic has established a complex system of training for public healthcare professionals that includes in-depth key competences, curricula structures and careers for each category[19]. It has been devised to provide training for four major personnel categories, which include healthcare and dentistry personnel, nurses and midwives, paramedics and management and auxiliary personnel[19].

Political decision-makers mirrored the fact that the average graduate year was around 2000 in all classes, from 10 healthcare educational institutions (1 medicinal college, 5 universities of medicine and 4 healthcare schools). An issue raised by several political decision-makers was that the provision of low-level healthcare staff was stopped because the authorities had been planning to raise the educational levels of healthcare staff by no longer manufacturing low-level healthcare staff.

In the meantime, healthcare personnel had to improve their educational standards through training programmes. But some of the present healthcare personnel had problems rearming because they were older people. A number of the educational programmes have been offered as long-term training programmes, but for a short period than the programmes for those starting directly.

There are four main areas of short-term development programs: healthcare, districts, provinces and headquarters. Programmes at the healthcare institution scale included on-site trainings with different frequency between institutions. Furthermore, healthcare personnel would be sent to higher-level healthcare institutions or other nations for long-term educational programmes, usually dependent on the possibilities of scholarships.

With regard to further learning, some important informers mirrored the fact that attendance of further learning programmes for healthcare personnel is not mandatory to keep their licence. Providing services to healthcare institutions and the provision of resources to assist vocational schooling are the most important influential elements. In some cases, excellent healthcare professionals were encouraged to participate in further educational programmes.

Most respondents' primary focus on healthcare training was the separation between healthcare training and the need for healthcare workers. MSDs were not actually required and healthcare faculty members were educated in less important fields. In addition, there was a lack of healthcare educational institutions and instructors, and the pupils did not even have enough opportunity to perform preclinical exercises.

As a result, the training programmes were qualitatively restricted and inadequate to provide training for skilled healthcare professionals. Political decision-makers as well as administrators report that there were two kinds of healthcare personnel recruiting patterns: top-down from the MOH and bottom-up from healthcare institutions. Top-down recruiting comprised healthcare personnel sent by the MOH to the healthcare institutions.

Top-down recruiting consisted of making an advertisement, holding examinations and interviewing for applicants, evaluating and recruiting suitable applicants on the basis of the available official posts and assigning post. Applicants had to take an examination of the Ministry of the Interior and an examination of the MOH in order to be able to work in the healthcare system.

A lot of respondents said that the location was the main determinant for the MOH to assign healthcare personnel to particular healthcare institutions. While the MOH took into account the candidate's preference, they prefer to return the alumni to the healthcare institutions in their home region. Most of the posts were awarded by the regional public healthcare authorities.

The majority of the top-down healthcare workers were officials. Bottom up recruiting means when a candidate who could not obtain a public service post through the MOH applies directly to healthcare institutions for contractual posts. Then, the healthcare institutions can ask MOH for a job for these employees, but this can take several years while the employees are working in a contractual role.

The majority of students of medicine would use the top-down system because they could get the post directly from the MOH, instead of using the bottom-up model to get a non-pay. A number of administrators said that only about half of the students of medicine could obtain a public service post through the MOH and the remainder usually became contractual healthcare personnel in healthcare institutions, as the currently available public service posts were not sufficient to accommodate those already educated.

The most important whistleblowers noted that many healthcare practitioners prefer to work in mental healthcare institutions at the main or the province level rather than in mainstream healthcare institutions such as healthcare centres or healthcare institutions in remote areas. There was a major problem with the low appeal of working in prime healthcare institutions and the countryside.

This was due, among other things, to the fact that there was no accommodation for non-local healthcare personnel, bad life circumstances, uncomfortable commute due to the bad transport system and a feeling of insecurity without being supervised in the countryside. Many new alumni felt themselves confronted and unready to take up jobs in the countryside because they had to address all clinical pictures, even very complex cases, on their own.

Those who were willing to take up the position in the countryside were mainly because they came from the region and they were able to recruit officials there. The majority of respondents agree that the overall commitment of healthcare personnel, as well as healthcare personnel in the countryside, is good. However, healthcare personnel who had established good relations with locals and patient groups remained in their post.

A number of healthcare professionals saw a stable and stable careers and a good social image as important for employee loyalty. The move with the familiy was the main cause for the healthcare personnel to move to another job. A MOH employee suggested that peasant healthcare professionals be granted bonus and supporting monitoring in doctor's offices to better assist them in their work in isolated areas.

The majority of important whistleblowers reported that the most important source of financing for the running of healthcare institutions came from the state, which included the cost of healthcare staff wages, on-call pay, infrastructures and essential healthcare supplies. Most of the funds for outcome care in the healthcare centres came from the regional administration. Furthermore, some multinational organisations or businesses finance healthcare institutions for outcome or special healthcare promotional activities.

Funds for outcome management or healthcare promotional activities were awarded every three months and requested that healthcare centres present a plan with their budgets. The majority of important whistleblowers saw the inadequate budgets for healthcare personnel as a challenge. Governments could not provide adequate employment for officials to recruit healthcare leavers, and salaries and benefits for existing healthcare employees were inadequate.

At the same time, most healthcare facility managers claimed that the funding provided by the state was also inadequate, making it an important obstacle to healthcare institutions providing healthcare with a tight budgets. Centres could use the gains from the sales of medicines or the billing of benefits to the patient to pay for care or incentive to healthcaregivers.

The use of more than 1 million kips ( US Dollar) per months, however, requires the consent of the county public healthcare authority. An administrator said that there was a lack of coordination between outside financing from multinational organisations or businesses and the administration, leading to inappropriate use.

Externally funded by an organisation or company and public funds were used for similar uncoordinated actions, doubling the effort, reflecting insufficient financial mismanagement. A serious shortage of professionals (doctors, nursing staff and midwives) and laboratory assistants, especially in basic healthcare institutions and in the countryside, is seen as an overall issue.

Firstly, the output of healthcare personnel is both quantitatively and qualitatively understaffed. Secondly, the state purse is not enough to hire enough healthcare staff and to offer them adequate and fair wages and benefits, and payments are often slow. Thirdly, the poor governance of healthcare personnel and this shortage of capacities is a great obstacle to the provision of healthcare personnel.

Fourthly, while the countryside has good employee loyalty in the healthcare sector, especially among healthcare personnel of regional origins, these areas are not appealing to most outcasts. There are two possible causes for inadequate output of healthcare personnel, both in quantitative and qualitative terms.

Due to insufficient capacities in healthcare personnel managment, the scheduling of healthcare personnel is not adequately evaluated to meet the actual need for healthcare personnel. For example, the training programmes are not actually geared to actual needs and most of them are insufficient to provide healthcare personnel with appropriate expertise and aptitudes.

It is particularly important for those who are supposed to practise in the countryside where healthcare personnel have to handle all kinds of medicinal problems on their own. In the meantime, the number of available healthcare educational institutions and educators is not sufficient to educate skilled healthcare personnel, but this is not taken into account when recruiting new people.

MOH has restricted the budgets in order to enlist all new healthcare officials and to offer adequate pay and benefits. Consequently, almost half of the new school leavers are compelled to work as contracted healthcare employees who are paid low and under-represented. In addition, wages and benefits are often deferred for month because of insufficient finance-managing capacities and complex funding and allocation procedures.

Inadequate and late pay compels healthcare workers to be dependent on their family; therefore, the location becomes an important element in attractiveness and loyalty, especially in the countryside. Four possible causes for the low attractiveness of work in prime healthcare institutions and countryside. No shelters for non-native healthcare workers, bad life and uncomfortable commute due to the bad traffic system.

Furthermore, healthcare professionals may be lacking self-confidence without oversight in the countryside. Moreover, the present system of assessment of performance does not particularly motivate healthcare professionals to enhance their own performances and to identify low-performing employees. The unequal division between town and countryside should continue to be a political prioritisation for the improvement of healthcare in the Lao PDR, as the scarcity of skilled healthcare professionals in isolated and countryside areas can prevent a large part of the populations from accessing healthcare and could result in inequalities in healthcare results between those in town and countryside[20, 21].

There is a similar issue of misallocation in many counties, emphasising the need to train more healthcare professionals in the countryside. Experience from other nations, however, shows that the provision of more healthcare professionals is not sufficient to distribute the workload. Nepal has opened new healthcare colleges to expand the availability of healthcare professionals in the countryside, but this has led to surplus output and migration of healthcare students[21].

In 2010, China started a peasant medical team to increase the staff of country healthcare centres and to provide applicants with a free study, room and cost of life grant pack that requires them to work in their own community healthcare centre for 6 years. However there was a high fluctuation among the alumni of this programme who were still interested in working in high-level healthcare institutions in municipal locations[22].

Indonesia's authorities carried out a scheme to raise the number of people employed in healthcare in rural areas, which found that women were less willing to work in isolated areas, even if they received twice the pay of healthcare personnel working in city areas[23, 24]. Lao PDR has its own unique features and factors that should be taken into account when developing the HRH policy to make sure that the selection of intervention is appropriate to the area.

It is not so appealing to work in the countryside, as has already been mentioned, but there is still a fairly good commitment of healthcare personnel in these areas. It may therefore make sense to accept more foreign nationals, as their background is a crucial element in both the attractiveness and loyalty of these people in the countryside.

As well as the low attractiveness determinants found in this survey, earlier studies also emphasised that new healthcare professionals who have graduated from higher education institutions tend to work in urban settings rather than in healthcare centres in the countryside, where they have more part-time jobs to supplement low wages with public employment[6, 10].

Intervention that provides additional stimuli in the countryside is another possible way to stimulate non-local healthcare staff to practise in this area. In addition, the administration could also consider introducing hospital rotation in the countryside while pupils are still at university. Revising syllabuses that address countryside healthcare would help pupils to build trust in the practices in the countryside and be acquainted with the medicine in the countryside.

Concern about maintaining expertise and skill should also be taken into account for existing healthcare staff in the countryside, as these could decline due to a lack of oversight and a relatively segregated exercise area. Therefore, training programmes for healthcare staff in the countryside should be devised. Insufficient healthcare managment capacities, particularly at the sub-national level, are also important, as the realization of measures by healthcare staff depends heavily on expert HR management[20].

A possible cause for the weakness of sub-national healthcare governance in the Lao PDR could be that the vast majority of healthcare administrators in the provinces and districts are physicians without appropriate managerial training[10]. A further important factor was that the decentralisation of the healthcare system took place more quickly than the development of municipal managerial capacities.

In this context, there is also a shortage of assistance from the mainstream, i.e. there were no subnational planning and budgeting policies for province and county leaders for many years after the decentralisation of the healthcare system[6]. Therefore, it is necessary to invest in order to improve the capacities of personnel managements at all tiers.

There is a need to improve monitoring capacities in the countryside to create a supporting workspace for the retention of healthcare specialists through leadership training activities. There are certain measures taken by the Lao authorities to tackle the problem of public healthcare staff. In 2006, the HRH policies were adopted by the federal administration to encourage the recruitment and retention of healthcare personnel in isolated areas, particularly in the 47 least prosperous districts[25].

In addition, the decentralised education of healthcare personnel was extended to the counties in order to encourage the recruiting and retaining of personnel close to their places of residence in 2009[6]. By 2012, the goverment started a new program requiring doctors, nurses, midwives, pharmacists and dentists to work in the countryside for three years before being licensed[26].

It also provides an incentive for high quality healthcare personnel in the countryside and draws new school leavers to pursue their services in the countryside after the necessary services[26]. It is the government's intention to progressively raise the number of posts in healthcare institutions, particularly in the countryside, and to make available posts for officials to the present contract healthcareers. The number of new posts would reach 4000 in 2013.

The impact of operations may vary when they are carried out at different locations and the transfer of experience from other Lao People's Democratic Republic to Laos may produce surprising results. Proper supervision and assessment should be seen as an important element, as the experience and teachings from the Lao People's Democratic Republic could be very useful.

It is the first quality methodological survey to investigate and better understanding the challenges facing healthcare workers in the Lao People's Democratic Republic. Participants involved a number of different important interest groups with an insight into the issue of healthcare personnel in the Lao People's Democratic Republic and caught their broad view.

A total of ten issues related to working lives were grouped together in theme guidelines and examined in order to obtain extensive information on healthcare personnel. Recruitment of keys from three provincial counties due to budget and timing restrictions, some information about regional conditions may not be representative of the whole county, but adequate quality information about the nation's healthcare staff was gathered by other keys.

The report identifies the issues and issues facing healthcare workers in the Lao People's Democratic Republic and examines the root causes and relationships between the issues. There is a need to recognise this and the main healthcare personnel issues in the Lao PDR before new policy and measures are implemented.

In order to increase the allocation of healthcare personnel in the countryside, policies to increase productivity and strengthen staff loyalty should be well incorporated to increase efficiency. In addition, the authorities should recognise the insufficient capacities of healthcare managers and should allocate funds to improving the capacities of personnel managers at all tiers. There is also a need to increase monitoring capacities in the countryside to create a supporting workspace for retaining healthcare practitioners through leadership training activities.

The evaluation of measures to strengthen healthcare personnel should also be undertaken as early as possible in order to summarise the experience and teachings in the Lao People's Democratic Republic. Increased quantity and quality research is needed to better and more fully describe and understanding the human resources of the Lao People's Democratic Republic.

Since the Lao PDR is seeking to increase its staff's level of healthcare, research should also concentrate on the efficiency of the measures taken and assess them. We would like to thank Prof. Shenglan Tang and Prof. Xu Qian for making the cooperation between the National Institute of Public and Duke Global Institutes and Fudan Global Institutes easier.

Part of the funding for this trial was provided by the Fudan Global Health Institute and Duke Global Health Institute for trial development and population. The Ethics Committee of the School of Public Health at the University of Fudan has granted permission (reference number: IRB#2014-09-0532). Unless otherwise indicated, the Public Domain Commons Public Domain Certification Wizard (http://creativecommons.org/publicdomain/zero/1. 0/) is valid for the information provided in this item.

WHO. Healthcare inequalities.