Regional Stakeholders’ Consultation Meeting for the

SIOG Global Policy 2019

LAO PDR Country Presentation

Lao PDR Country Profiles

• 236,800 km², 70 % mountainous

• Population 7 millions • Density 29.5/km² • Diversity of 50 official group ethnics

• Urban 38.6% (2015) and could reach

50% in 2030

Country Profiles • Life expectency at birth 65.8 years in

2015 and would not reach 70 years until

2036 • Ageing of the population is not yet an

issue for Lao PDR (only 4% are 65+)

• The population is relatively young with median age of 22 and 58% under 25

National Development • Lao PDR is classified as a lower-middle-

income economy • one of the fastest growing economies Goals to achieve:

- Graduate from Least Developed Country by 2020

- Attain UHC by 2025 - Achieve SDGs by 2030

NCDs in Lao PDR NCDs are estimated to account for 48% (2012) and 60%(2016) of all dealths, all ages, both sexes

NCDs 2012 2016 Cardiovascular diseases 22% 27% Cancers 11% 12% Chronic respiratory Diseases 5% 5% Diabetes 2% 12% Other NCDs 8% 12%

Lao NCD Risk Factors

* Percentage who ate less than 5 servings of fruit and/or vegetables on average per day

0

25

50

75

100

Tobaccosmoking

Alcoholconsumption

Unhealthydiet*

Low level ofphysicalactivity

Overweight Raised bloodpressure

Raisedfasting blood

glucose

Raised totalcholesterol

Pe

rce

nta

ge

Male Female

Source: Lao PDR 2013, STEPwise approach to surveillance (STEPS)

Surveys on Risks factors of NCDs

Risks Factors M F T Tobacco smoking (2011) 48.4% 3.5% 25.7% Alcohol consumption (litre) (2010) 12.5 2.3 7.3 Raised Blood pressure (2008) 24.1% 20.4% 22.2% Obesity(2014) 1.8% 4.1% 3.0% Physical inactivity (2010) 3.1% 14.6% 9.0% Household solid fuel use (2012) 98.0%

National systems response to NCDs

• To date, Lao PDR has applied a disease-specific approach to NCDs prevention and control

• Disease-specific treatment institutions are being proposed

- Lao-Luxembourg Heart Institute - Mittaphab Hospital Cancer center

- Treatment Unit for diabetes in some hospitals

Lao National NCDs policy

Lao Ministry of Health organized workshops that involved stakeholders from Health and Non-Health sectors in order to plan a project coordination on the control and solve the problem of NCDs in Lao PDR. The draft of Lao National NCDs policy and MSA plan 2014-2020 was developed with WPRO technical assistance

Lao National NCDs policy’s Objectives

1. To establish a national multisectoral mechanism and action plan (MSA) for prevention and control of NCDs in Lao PDR.

2. To build national capacity for prevention and treatment of NCDs.

3. To provide legal support and financial resources for NCDs prevention and control

Lao National MSA Plan 2014-2020

GOALS:

To reduce premature deaths and disability from Laos’ four main non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes), and reduce the prevalence of four of their shared causes (tobacco, alcohol, diets&physical inactivity, infections causing cancer).

Lao National MSA Plan 2014-2020

Objectives: 1.To reduce the population prevalence of common factors for NCDs 2. Strengthen governance & resourcing for NCDs 3. NCDs prevention and control through healthy cities and settings 4. Pursue cost-effective detection, treatment, rehabilitation and palliative care 5. Enhance NCDs surveillance

Raised blood pressure

25%

Salt/ sodium intake

30%

Tobacco 30%

Physical inactivity

10%

Harmful use of alcohol

10%

Medicines and technologies

80%

Drug therapy and counseling

50%

Premature mortality from NCDs

25% reduction

Mo

rtal

ity

and

m

orb

idit

y

Ris

k fa

cto

rs

Nat

ion

al

syst

em

s re

spo

nse

Diabetes/ obesity

0%

WHO’s set of 9 voluntary global targets for NCD prevention and control (by 2025)

Bio

logi

cal

Be

hav

iora

l

Lao national targets from 2014 to 2025

2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 WHO

targets

Percentage who

engage in heavy

episodic drinking

(male)

67.0 66.4 65.9 65.3 64.8 64.2 63.7 63.1 62.5 62.0 61.4 60.9 60.3 10%

Physical

inactivity

10.4 10.3 10.2 10.1 10.1 10.0 9.9 9.8 9.7 9.6 9.5 9.4 9.4 10%

Current daily

tobacco smoking

(both sexes)

29.8 29.1 28.3 27.6 26.8 26.1 25.3 24.6 23.8 23.1 22.4 21.6 20.9 30%

Current daily

tobacco smoking

(male)

59.1 57.6 56.1 54.7 53.2 51.7 50.2 48.8 47.3 45.8 44.3 42.8 41.4 30%

Current daily

tobacco smoking

(female)

8.9 8.7 8.5 8.2 8.0 7.8 7.6 7.3 7.1 6.9 6.7 6.5 6.2 30%

Salt intake 6.5 6.3 6.2 6.0 5.9 5.7 5.5 5.4 5.2 5.0 4.9 4.7 4.6 30%

Raised

BP/Hypertension

18.3 17.9 17.5 17.2 16.8 16.4 16.0 15.6 15.3 14.9 14.5 14.1 13.7

25%

Obesity 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 5.4 maintain

2013

level

Diabetes 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 maintain

2013

level

Main Challenges

• Previous Lao government contract with TOBACCO Company to keep low tobacco price

• Difficulty to tobacco excise tax

• Powerful alcohol company influence in Lao PDR • Harmful alcohol drinking

• Capacity building issues • Insufficient staff dedicated on NCD activities

• insufficient local funding available for NCD activities • Rely on WHO funding assistance • Proposal of 2% of tobacco tax for NCD activities

• Low human resources allocated in Primary Care • Difficulty for appropriate WHO PEN implementation

Cancer in Lao PDR (Source: GLOBOCAN 2018) Males Females Both sexes

Population 3 473 601 3 487 607 6 961 208 Number of new cancer cases 3 769 3 941 7 710

Age-standardized incidence rate (World) 166.4 145.6 154.3 Risk of developing cancer before the age of 75 years (%) 17.5 15.2 16.2

Number of cancer deaths 3 079 2 471 5 550 Age-standardized mortality rate (World) 140.0 95.8 115.9

Risk of dying from cancer before the age of 75 years (%) 14.9 10.5 12.5 5-year prevalent cases 5 417 7 825 13 242

Top 5 most frequent cancers excluding non-melanoma skin cancer Liver Breast Liver

(ranked by cases) Lung Colorectum Breast

Stomach Liver Lung

Colorectum Cervix uteri Colorectum

Oesophagus Thyroid Stomach

Pathology Based Cancer Registration

Figure 1: Number of Lao cancer patients by year of diagnosis (n=915)

2010 2011 2012 2013 2014 2015

12

54 55

101 86

5 20

103 122

237

213

17

Number of Lao cancer patients by year and gender b of

diagnosis

Male Female

17

Pathology Based Cancer Registration Figure 1: Number of Lao cancer patients by year of diagnosis (n=915)

Cancer patients 2017

6 8 8 10 10

18

26

18

29

5 10 11

0

5

10

15

20

25

30

35

Cancer patients N=207, both sexes

Cancer patients 2018

0

5

10

15

20

25

30

35

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Cancer Patients N=249 (Both sexes)

Famale Male

Lao PDR Cancer situation

Limited cancer data: only some Pathology-based cancer registry

Cancer treatment facilities are primitive: only one Cancer Center that provides limited services (chemotherapy, palliative care, radiotherapy). Surgery is done for some cases in hospitals. No community/home care.

Patients used to travel to neigboring countries for treatment (Thailand, Vietnam,...)

Lao PDR Cancer situation

Few cancer plans, monitoring and surveillance - Lao PDR finalizes the national action plan to eliminate asbestos-related diseases among workers. (April 2018)

- Lao Government should integrate national cancer-control programme in existing health systems

Cancer primary prevention policies:

- Tobacco control

- Reducing harmful use of Alcohol

- Immunisation (Hepatitis B, HPV)

Lao PDR Cancer situation Cancer screening and early detection:

available in some facilities (PAP smear, clinical breast exam, tumor marker, radio diagnosis, pathology lab.)

Shortage of human resources (Oncologits/technicians):

- Only 7 pathologists - Needs many kinds of oncology staff (

Hemato, Surgical, Gyneco, Clinical, Radiation therapy staff, onco-pharmacist, oncology nursing staff, palliative care specialist,....) -

Researches on NCDs/Cancer

Only some publications available: for example

Survey-based cancer mortality in the Lao PDR. (Nguyen TL et al. 2007-2008)

Retrospective appraisal of cancer patients from Vientiane capital Lao PDR seeking for treatment in Thailand

(Chareunvong K.et al. 2013)

Non communicable diseases risk factors in Lao PDR

( Siengsounthone L.)

Researches on NCDs/Cancer

Two institutions are main responsible for Health Research in Lao PDR:

1. National Institute of Public Health and Tropical Medicine, Ministry of Health

2. Institute of Research and Educational Development, University of Health Sciences

Registered Researches can be found at LAO PDR Health Research Portal

SUMMARY

Lao PDR has young population and Ageing is not yet an issue. (Median age =22 and 58% under 25. Life expectency = 65.8 and only 4% aged 65+)

NCDs (including Cancer) are increased and surpassed Communicable diseases and caused premature mortality

Necessity to review curricula for Doctors and nurses about NCD/Geriatric and provide more in-service trainings.

Lao PDR had policy and plan for NCDs/cancer prevention and Control but shortage of human resources and financial support are the challenges (Health expenditure only 2.2% of GDP, Out of pocket 40% and USD 76 per capita.)

THANK YOU FOR YOUR ATTENTION

RADIOTHERAPY CENTER