Lao PDR COVID-19 Response
Above: Teachers contribute to a survey undertaken to support the installation of handwashing facilities and ongoing educational activities. Image: ChildFund Laos.
While Laos managed to avert COVID-19 deaths for the first year of the pandemic through a strong public health response and strict border quarantine, from April 2021 cases in the country increased, fanned by the fast-spreading Delta variant. Community transmission rose sharply in markets, restaurants and other public spaces, while the country’s vaccine rollout slowed down in areas outside of the capital Vientiane due to vaccine hesitancy and resource challenges.
As of December 2021, Laos recorded some 90,000 cases of COVID-19, and around 250 deaths. 42% of the population had received two doses of the vaccine, while 51% had received at least one dose (Source: Our World in Data). The majority of these doses were delivered in urban areas, emphasising the need for ‘last mile’ vaccination for rural and remote communities, which are particularly vulnerable due to a lack of health services.
On top of the public health implications of the pandemic, Laos faced a significant economic shock. According to the World Bank, the country’s poverty rate increased by 1.7 percentage points during 2020, while a drop in trade and tourism reduced available jobs. Food prices also increased, putting extra pressure on households.
The Australian Humanitarian Partnership launched an initial response in 2020, focusing on COVID-19 prevention and the economic fallout of the pandemic. In late 2021, a new activation, with funding from the Australian Government’s Vaccine Access and Health Security Initiative (VAHSI), began working on vaccination hesitancy and rollout challenges.
The AHP Response
The first phase of the AHP Lao PDR COVID-19 Response ran from July 2020 to September 2021, implemented by a consortium led by CARE Australia. It was supported by AUD1.5 million from the Australian Government. Other consortium partners were Save the Children and Plan International Australia (with assistance from ChildFund). Partners provided health, nutrition, gender-based violence, education and livelihoods support in four provinces, reaching more than 18,000 people.
The second phase of the response, which commenced in November 2021, had a strong focus on supporting the national COVID-19 vaccine rollout. This phase was implemented by Oxfam Australia and CAN DO in partnership with seven local NGOs, with a commitment of AUD2.55 million from VAHSI.
This phase aimed to increase COVID-19 vaccination coverage across four provinces of Laos by strengthening communications, community outreach and local systems. Activities focused on improving risk communications and community engagement, training sub-national health staff on vaccine delivery, and addressing barriers to vaccine access for vulnerable populations, such as women, people with disability, marginalised ethnic groups, youth and the elderly.
Response Highlights
Due to the evolving nature of the COVID-19 pandemic, the response was forced to adapt when government priorities in Laos shifted from COVID-19 prevention towards general vaccination support. The response adapted its approach from an initial focus on RCCE, to increasing support for routine vaccination coverage. This enabled the response to align with government priorities. This pivot also enabled a focus on groups with the lowest vaccination coverage, such as ethnic minorities and other vulnerable groups who may not have had access to vaccinations previously. A key strategy to ensure inclusive access was to provide a mobile vaccination service for vulnerable groups such as the elderly, people with disabilities, pregnant women and children, rather than facilitating their travel to health centres. These mobile clinics administered a total of 55,145 doses of COVID-19 and routine vaccines during the response. Mobile vaccine clinics also received essential equipment such as surgical tools and wheelchairs to ensure a fully equipped holistic vaccination service.
AHP partners made a significant effort to increase capacity and knowledge of the local healthcare workforce by strengthening health systems from the village to national level. This ensured integrated, sustainable service delivery, which will continue to have a positive effect on communities in Laos long after the program closure. In particular, the program focused on building the capacity of over 800 village health volunteers through training and communication materials. These workers have showed increased confidence in community vaccine distribution and knowledge of inclusive service delivery, enabling the mobilisation of a grassroots-led movement for vaccine coverage. The response also supported the local healthcare workforce through the distribution of equipment and materials, as well as logistical support. More than 146 sets of medical equipment and PPE was delivered to 16 district hospitals, 91 health centres and four district health offices.
The response consortium worked in partnership with several local Civil Society Organisations (CSOs), community-based networks and the Lao Department of Hygiene and Health Promotion in the Ministry of Health. These partnerships ensured a community-focused and inclusive response through a participatory approach. By utilising the local and contextual knowledge of these organisations and the communities they interacted with, RCCE communication remained culturally appropriate and was delivered by trusted voices within the community.
AHP Partners noted the crucial role that traditional media can play in health promotion. While digital communications were also utilised through this response, traditional media formats of radio and loudspeaker usage significantly increased the reach of health messaging in remote villages. Partners noted it was important to leverage traditional channels when communities are hard to reach due to limited internet access and other barriers.
Village and community leaders were found to have a significant impact on driving community behaviour change. AHP Partners encouraged the participation of these leaders in training given to village health volunteers. Their active participation and support made a considerable difference to driving the community uptake of health services and vaccinations. For future projects, AHP Partners will continue to involve local community leaders to leverage their influence for broader impact.