Health Sector Governance Program - Subprogram 2 Equitable and inclusive growth. The 8th Five-Year National Socio-Economic Development Plan (NSEDP) (2016-2020) aims for the Lao PDR to graduate from least-developed country status by 2020, and become an upper middle-income country by 2030.  Forecasts for 2017 indicate that the country's gross domestic product (GDP) grew 6.8%, resulting in GDP per capita of $2,579, and its poverty rate fell to 20.0%.  Significant development challenges remain, however, including (i) a high fiscal deficit, (ii) accumulated public and publicly guaranteed debt, and (iii) an undiversified resource-based economy. The government recognizes that equitable and inclusive growth requires targeted policy interventions for vulnerable groups, and the NSEDP commits sustained investment to improve access to and the quality of basic social services such as health care, with a view to improving health outcomes, especially for the poor, women, and children. Better health of the workforce results in lower absenteeism, higher labor productivity, and increased wages, all of which contribute to economic growth. Such effects are particularly important in countries where many are engaged in unskilled labor. 

Unfulfilled health targets. The Lao PDR has made good progress in achieving many health targets:  (i) life expectancy in 2015 was 68 years, and (ii) the maternal mortality ratio decreased from 905 deaths per 100,000 live births in 1995 to 206 deaths in 2015 (the MDG target is 260).  0d with other Asian countries, however, the Lao PDR fares poorly on key health indicators, including those for maternal, newborn, and child health (MNCH), which impedes full achievement of the health-related SDGs.  The country's under-5 mortality rate remains the highest in Southeast Asia at 86 deaths per 1,000 live births 2015 (the MDG target is 70), and infant mortality rate in 2016 was 48.9 deaths per 1,000 infants, above the MDG target of 45.  Child malnutrition, or underweight children under 5 years of age, dropped to 26.5% in 2011 (more recent data are not available), above the target of 20% (footnote 12). Communicable diseases such as HIV, malaria, and tuberculosis are prevalent.  The incidence of non communicable diseases, accidents, and injuries remains significant as well; the World Health Organization (WHO) reported that non communicable diseases constituted 60% of the burden of disease in 2008, while accidents and injuries accounted for 10%.  

Limited utilization of health care services. Poor health outcomes are closely linked to the limited use of health services. The overall use of public health services is reported to have increased fivefold during 2000-2013 to about 0.6 visits per person per year (footnote 12), but this is still low and gaps in coverage remain between the poor and rich, and rural and non-rural populations, especially for MNCH services, including immunization, antenatal care, skilled birth attendance, and surgery. Children in the poorest quintile are 3.6 times more likely to die before reaching age 5 0d with those in the wealthiest quintile, and children born in Phongsaly province are five times more likely to die before reaching age 5 than those born in Vientiane.