Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.
Lao Tropical and Public Health Institute (Lao TPHI, Ministry of Health, Vientiane, Lao PDR.
BMC Health Serv Res. 2024 Sep 6;24(1):1037. doi: 10.1186/s12913-024-11513-y.
The Lao People's Democratic Republic (Lao PDR), a lower-middle income country, has a higher malnutrition rate than other Southeast Asian countries. The decentralization of healthcare is a determinant of the effectiveness of programs to reduce malnutrition, but no study has focused on this factor in this country. This organizational study explores the state of decentralization of the healthcare system in Lao PDR that underlies the nutrition programs in the country.
A qualitative study, which is based on a neo-institutional theory conceptual framework, explored factors related to dominant structure (laws, regulations, resources) and interpretative schemes (dominant ideas and beliefs) that characterize the nutrition services provided in the Lao healthcare system. Twenty-four semistructured interviews were performed with representatives of healthcare institutions involved in nutrition programs at different government levels, external donors and civil society organizations. The interviews were completed with relevant documents. The analysis focused on the convergence of interpretative schemes of the organizations concerned and the coherence between the structure underpinning the nutrition programs and the interpretative schemes.
Services deployed to reduce malnutrition in the Lao PDR remain largely centralized, despite factors specific to the country that led it to promote decentralization of its services. The convergence of interpretive schemes and the coherence between the observed structure and the interpretative schemes of actors at all governance levels ensure the stability of this state of decentralization, which has persisted for almost 50 years.
Nutrition programs in the Laos PDR are largely under the responsibility of the central government. The transformations in the healthcare system, notably with the use of new information technologies and the fact that the provinces are populated by a growing number of professionals trained in nutrition in addition to factors that push the system to be decentralized, such as ethnic diversity, the increasing availability of human resources in provinces, and the use of communication technologies, are not strong enough to change the balance of power between governance levels. The deconcentration that characterizes decentralization is therefore likely to continue for the foreseeable future.
老挝人民民主共和国（老挝）是一个中低收入国家，其营养不良率高于其他东南亚国家。医疗保健的权力下放是减少营养不良计划有效性的决定因素，但没有研究关注该国的这一因素。本组织研究探讨了老挝医疗保健系统权力下放的状况，这是该国营养计划的基础。
一项基于新制度理论概念框架的定性研究，探讨了与主导结构（法律、法规、资源）和解释方案（主导思想和信念）相关的因素，这些因素特征是老挝医疗保健系统提供的营养服务。对不同政府级别的参与营养方案的医疗保健机构、外部捐助者和民间社会组织的代表进行了 24 次半结构式访谈。访谈完成后还查阅了相关文件。分析重点是有关组织的解释方案的趋同以及支撑营养方案的结构与解释方案之间的一致性。
尽管老挝有促进服务权力下放的具体因素，但老挝用于减少营养不良的服务仍然在很大程度上是集中的。在所有治理层面上，参与者的解释方案趋同以及观察到的结构与行为者的解释方案之间的一致性，确保了这种权力下放状态的稳定性，这种状态已经持续了近 50 年。
老挝的营养方案在很大程度上由中央政府负责。医疗保健系统的变革，特别是新信息技术的使用，以及除了推动系统权力下放的因素（如民族多样性、省中越来越多的受过营养培训的专业人员、以及通信技术的使用）之外，各省人力资源的日益增加，不足以改变治理层面之间的权力平衡。因此，分权特征的权力分散可能在可预见的未来继续下去。
