Centre for International Child Health

Human resource capacity for child health in Lao PDR

  • A collaboration between the University of Melbourne, Lao paediatricians and the University of Health Sciences

    Background

    Lao PDR (or Laos) is a largely rural nation of 6 million people with health indicators that remain among the lowest in South East Asia. It has made significant gains towards achieving its Millennium Development Goal to reduce child mortality, yet neonatal and maternal mortality remain difficult to address.

    Furthermore, ongoing and sustainable gains in any health indicators beyond 2015 will rely on increased capacity of local health workers to deliver quality health care that is relevant to all ages and diseases of increasing complexity. This in turn is dependent on the education they receive. In 2010-11 reviews of medical education and human resource capacity in Laos identified critical deficits across curriculum, learning resources, teaching skills and resources, and assessment methods.

    In 2011 a Memorandum of Understanding was signed between the University of Health Sciences (UHS) Lao PDR and the Faculty of Medicine, University of Melbourne. This Memorandum recognised a relationship that was built over the previous 5 years and a commitment by both parties to improve human resource capacity for delivering quality health care in Lao PDR. This has been achieved so far through two streams of work;

    1. Interventions aimed at improving quality of care in Lao hospitals and;
    2. Technical support to the University of Health Science to improve medical education capacity and outcomes.

    Efforts have centred on improving paediatrics and child health and have been delivered primarily by the Centre for International Child Health (CICH), Department of Paediatrics, University of Melbourne and Lao Paediatricians. Since 2011 this work has been supported by Planet Wheeler Foundation.


    The scope of work

    Hospital care

    Between 2009 and 2011 the Centre for International Child Health supported Lao paediatricians to implement the WHO Pocketbook of Hospital Care for Children in Lao hospitals. This was the first guideline available in Lao language for treating children in hospitals and has since been implemented, through training workshops and book distribution in all 17 provinces in Lao PDR. An evaluation of this process demonstrated improvements in standards of clinical care, staff confidence and, alongside this, a change in the “reading culture” in hospitals.

    In 2015 and beyond, a new edition of the Lao WHO Pocketbook will be disseminated and efforts will focus on how to improve the impact and sustainability of Pocketbook implementation in both in-service and pre-service settings.

    As an extension of this work CICH continues to collaborate with Lao paediatricians, the World Health Organisation and the Ministry of Health to support the in the implementation of affordable oxygen systems in district hospitals, the use of a computer-based hospital mortality reporting system and, more recently, the Early Essential Newborn Care programme. In 2015 CICH began a collaboration with Save the Children to implement an integrated approach for improving care for children in district hospitals in Luang Prabang province, combining available Lao resources and guidelines in a unified quality improvement-type approach.


    Medical education

    Through hospital-based work the critical need to support and improve the education delivered in medical, and other health professional curricula was recognised. It was agreed that University of Melbourne activities should have two key areas of focus as a priority;


    1. The development of clinical skills resources and teaching capacity

    History and physical examination skills are the foundation of medical diagnosis. In the absence of easy access to diagnostic tests it is even more crucial that medical graduates are able to perform a detailed, and accurate, patient assessment. Currently in Laos there is a lack of staff capacity and educational resources to deliver clinical skills teaching. To address this need the University of Melbourne is working in several ways:

    • Supporting the placement of senior paediatric trainees from The Royal Children’s Hospital in Melbourne for 6 to 12 month placements in Laos as a Clinical Teaching Fellow, to support bedside teaching, deliver clinical skills training and support Lao teachers. In conjunction with this several clinical skills workshops have been run through UHS.

    • Undertaking a needs assessment of all faculties in the University of Health Sciences to understand student access to and use of educational material, both text-based and online, with a view to developing multimedia resources for teaching and learning clinical skills.

    2. Improved methods and standards of student assessment  

    The aim of this work is twofold. Firstly, to drive student learning in the right direction, ensuring students graduate with the desired competencies to meet the health needs of Lao PDR. Secondly, to help UHS achieve quality assessment standards that will facilitate their integration with the ASEAN community. To achieve this University of Melbourne is working in a number of ways;

    • Providing technical support for the development of student assessment, including improving the quality of assessment and ensuring key competencies for graduates are tested.

    • Working with UHS to develop improved methods of formative assessment.