Facts and Figures

Lao People’s Democratic Republic (PDR) is a landlocked country located in south east Asia. Lao PDR shares its borders with Vietnam in the east, Thailand in the west, China and Myanmar in the north and Cambodia in the south.

Lao PDR is a long and narrow country, stretching more than 1,700 kilometres from the north to south and just 140 to 500 kilometres from east to west. The north of the country is dominated by densely forested mountains, falling to high plateaus along the eastern border and fertile plains in the west and south west. Approximately 70% of the country is mountainous.

The land is crossed by many rivers including the well known Mekong River that flows south along the western border which is shared with Thailand. Most main towns, including the capital city of Vientiane, are located along the Mekong River. Lao PDR’s climate is tropical and subject to monsoons with most rain falling between the months of May to October.

Administratively Lao PDR is divided into four tiers: central, provincial/municipal, district and villages. There are 17 provinces, 139 districts and 10,552 villages.

People

Lao PDR’s population is estimated to be just over 5.6 million people with an annual growth rate of 2.1%. The population density of 24 people per square kilometre is relatively sparse and most people (nearly 80%) live in rural areas. 

The country has one of the youngest populations in the south east Asian region with around 43% of the population aged 15 years or younger and just 5% aged 60 years or older. Around 47 different ethnic groups exist in the country and ethnic Lao is the dominate culture in the lowlands and plains, making up around 60% of the country’s population.

The mountain tribes of Miao-Yao, Austro-Asiatic, Tibeto-Burman, Hmong, Yao, Akha, and Lahu are located in the north of Lao PDR. In the central and southern mountains the Mon-Khmer tribes predominate, with some Vietnamese and Chinese minorities remaining, particularly in the towns. Approximately 60% of the population are Buddhist (Theravada) and 40% are animist or other (including various Christian denominations 1.5%)

Lao is the official language of Lao PDR and other languages include French, English and various ethnic languages. Some people do not speak Lao in the remote areas of the four northern provinces. People living in the highlands generally suffer from greater levels of poverty and poorer health than those living on the plains.

Politics and the Economy

Lao PDR was founded in 1975 following decades of colonisation and civil war. The country is a one-party socialist state governed by the Lao People’s Revolutionary Party, under the leadership of the President, the Prime Minister and a ten member 'Politburo' drawn from a central committee of party members. 

The party introduced reforms in 1986 and again in 1991 to establish a market economy, guaranteeing citizens the right to own property and to provide protection for private foreign and domestic investment.

While some progress has been made, Lao PDR is one of the poorest countries in the south east Asian region. In 2004 the Gross Domestic Product (GDP) per capita was just US$423 compared to US$550 and US$2,539 in neighbouring Vietnam and Thailand respectively. The proportion of people living below the poverty line has fallen steadily over the past decade, down from 46% in 1992-1993 to 32% in 2002-2003.

Lao PDR's economic growth was severely undermined in the late 1990s when the Asian region experienced a severe downturn. Domestic inflation in Lao PDR soared to 128% in 1999. Tight management by the Lao PDR Government has since reduced inflation and is slowly boosting economic growth and private investment in the country. However, agriculture, including forestry, accounts for more than half of the GDP and around 80% of the population relies on subsistence farming.

Lao PDR was ranked 133 out of 177 countries in the United Nations’ Development Program Human Development Index in 2006.  This ranking is the lowest among East Asia countries.

Sources: Association of Southeast Asian Nations Secretariat, DFAT, Human Development Report 2006, UNDP, United Nations, World Health Organization

Population: 5.8 million
Urban population: 20.3%
Life expectancy:  55.1 years
Infant mortality rate (per 1,000 births): 65
Literacy rate: 68.7%
Percentage of population living on less than $2 a day: 74.1%
Percentage of population which is undernourished: 21%
Number of doctors (per 100,000 people): 59

Most of Lao PDR’s health and social indicators fall below the average for low-income countries. In 2004, life expectancy in Lao PDR was just 55.1 years in comparison to a life expectancy of 70.3 years in Thailand and 70.8 years in Vietnam.

Similarly, the infant mortality rate in Lao PDR was 65 deaths per 1,000 live births compared to 17 and 18 deaths in Vietnam and Thailand respectively.

The main health problems facing Lao PDR’s population are malnutrition and communicable diseases. Approximately 40% of children have stunted growth and malaria is the single biggest cause of death and morbidity, followed by pneumonia, gastric illness and diarrhoea. Tuberculosis, dengue fever and cholera are also common.

Health problems are more extreme in the highlands and mountainous regions where people are poorer and access to heath care is limited and sometimes non-existent. The public health system is administered by the Ministry of Health which oversees the provincial health services and sets the country’s national health policies and priorities.

According to the Lao PDR Government, the public health system in 2004 consisted of 3 central hospitals, five regional hospitals, 17 provincial hospitals and 139 district hospitals. In the same year, there were 310 doctors with post-graduate qualifications, 1,710 diploma graduates, 3,860 technically trained clinical staff and 5,656 certificate-level staff.  There were also 730 Health Centres, 16,618 village health volunteers and 534 village doctors. 

The health priorities of the Lao PDR Government focus on the need for improved coordination and integration of all levels of public health care. A strategy has been developed which aims to improve the general health of Lao PDR’s population by the year 2020. The strategy focuses on improving and extending the health network, addressing disease prevention and making health care accessible to poor and isolated communities. 

Sources: Human Development Report 2006, Lao Embassy to the US, UNDP, World Health Organization

Number of blind people: 56,221
National blindness prevalence: 1%
Main causes of blindness: Cataract (60% of blind population), corneal scarring, glaucoma and childhood blindness.
Number of people with cataract blindness (backlog and annual incidence): Backlog is estimated to be 28,500 cases and the annual incidence is estimated to be 5,700 cases annually
Number of cataract operations performed annually: 4,831
Reasons for low cataract surgical rates and backlog: Low awareness about eye health care, poor distribution of services, a lack of trained staff in remote areas, high costs of providing eye care and a general fear within the community
Percentage of blind population with glaucoma: 10%
Percentage of blind population with corneal scarring:  13%
Percentage of blind population with childhood blindness:  7%

A Rapid Assessment of Avoidable Blindness (RAAB) survey will be undertaken, with the support of The Fred Hollows Foundation, in late 2007 to obtain more accurate data on the prevalence and main causes of blindness in Lao PDR.

In 2006 Lao PDR’s backlog of cataract cases was 28,500 with an annual incidence of 5,700. The current capacity to perform cataract surgery is approximately 4,800 cases annually, which makes it impossible to reduce the backlog of cataract blindness cases.

The major barriers to an increased number of operations is the lack of awareness of eye health care services, accessibility and affordability of surgery, the limited number of trained eye health personnel and government funds allocated to eye health. These obstacles are exacerbated by the poverty levels of rural patients, the high costs of providing eye health care and a general fear of cataract operations within the community.

Eye Health Human Resources

Number of ophthalmologists: 9
Number of Basic Eye Doctors (BEDs): 14
Number of ophthalmic nurses: 131
Number of refractionists: 13
Number of Primary Eye Care (PEC) workers: 3,096

In 1984, there were just one ophthalmologist and three cataract surgeons in Lao PDR who were all based in the capital of Vientiane. Currently there are nine ophthalmologists (and six medical graduates in an ophthalmology residency program), 14 BEDs, 131 ophthalmic nurses and 13 refractionists. 

While most specialist ophthalmologists are located in urban areas, around two thirds of cataract surgeons and ophthalmic nurses are located in rural areas, mostly at district hospitals where facilities are limited.

The Vision 2020 target for Lao PDR is to have at least four ophthalmologists per million people. Based on the current population this equates to at least 22 ophthalmologists. Lao PDR’s national plan sets its own target of 20 ophthalmologists and nine BEDs by the year 2020.

Eye Health Infrastructure

Number of tertiary eye care facilities: 2
Number of secondary eye care facilities: 17

Eye care in Lao PDR is integrated into public health care as a strategy of the Ministry of Health. There is some support for eye care from NGOs, however this has limited coverage and the majority of people with cataracts live in remote areas with no access to the subsidised eye care services.

At the tertiary level, the National Ophthalmology Centre (NOC) is responsible for planning blindness prevention, research, training and the local production of eye drops. The Centre has 30 beds for surgical and rehabilitation patients and also coordinates mobile eye care clinics to remote areas of Lao PDR.

Several training programs are conducted at the Centre for eye care personnel in Lao PDR and there are specialist expertise in areas such as retina, glaucoma and childhood blindness.

The Sethathirath University Hospital (SUH) is one of the largest hospitals in Lao PDR, which functions as a tertiary-level referral hospital for regional hospitals. The SUH is located in Vientiane and has around 175 beds and 290 staff, including two ophthalmologists and ophthalmic support staff. It is a core medical hospital as well as a site for the training and education of medical personnel.

At the secondary level, there are eye departments in 17 Provincial Hospitals. When they are fully functional, eye departments can treat common eye diseases and perform cataract surgery. These hospitals also assist the NOC with the coordination of mobile eye care clinics to remote areas of Lao PDR.

At the primary level, there are approximately 139 District Hospitals, 730 Health Centres as well as a village health worker (VHWs) network. While no surgery is undertaken at the primary level, some district hospitals are staffed by ophthalmic nurses who are trained on how to identify and treat minor eye problems and to refer patients to higher levels for treatment of complex conditions.

There has been very limited training in primary eye care delivered to VHWs, which severely restricts the flow of patients from the village to provincial level for treatment.

While there are currently no permanent eye care services outside the district hospitals, several mobile eye clinics, coordinated by the NOC and provincial hospitals, have offered some relief to rural populations along the Mekong River and to isolated highland communities.

The clinics are partially funded by the Ministry of Health, which covers staff salaries and infrastructure. Additional financial support is gained from various non-governmental organisations in Lao PDR.

There are officially no private sector ophthalmology services in Lao PDR. 

Sources: CBMI, Lao PDR Ministry of Health