National Policy on Health Impact Assessment, Lao PDR

1. National Policy on Health Impact Assessment, Lao PDR 1st HIA for ASEAN Workshop “Understanding Health Impact Assessment (HIA): A Foundation for the Well-being of the ASEAN Community” 13-14 February 2012, Thailand by Dr TayphasavanhFengthong Dr SoutsakhoneChanthaphone Dr BountangDuangtaphak MrSisavathKongmy

2. Contents • Country description • Environmental health status • What we have done so far in the context of HIA • The way forward

3. Country description Lao PDR is a land-linked country, and shares border with China, Vietnam, Cambodia, Thailand and Myanmar. Total area : 236,800 km2 Population: 5.62 mill Density : 24 p/sqkm 17 provinces Capital: Vientiane Climate: Rainy and Dry seasons Religion: Buddhism Population in rural areas: 72.8%

4. Adult literacy rate: (F: 50%; M:74%) Population growth rate: 2.5% per year Life expectancy: 61 years (F: 63; M: 59) Country description 47 ethnic groups, covering 120 ethnic sub-groups and languages 11,000+ small villages and mostly with poor road access Agriculture = 80% of jobs, mostly subsistence farming in remote areas

5. Lao Government Policy Economic Growth Harmonious “triangular” approach to developmentof Government Social/ cultural development Conservation of natural resources

6. The Sixth National Socio-Economic Development Plan (NSEDP 2006-2010) identifies health as one of the four priority sectors for development. Agriculture and Forestry 4 main sectors in National Growth and Poverty Eradication Strategy(NGPES) Education Health Infrastructure (Rural Road)

7. Health situations Total fertility rate: 4.04% Crude birth rates: 29.9% (LRHS 2005) Crude death rates: 5.4% (LRHS 2005) Considerable progress has been achieved over the past ten years in improving the health system in the Lao PDR which are Maternal, infant and under five infant mortality rates (MMR, IMR and U5MR, respectively) have dropped significantly 1995 2000 2005 2005 (LRHS 2005) MMR 656 530 405 IMR 104 82 70 56 U5MR 170 106 98 68 Source: Census 2005

8. Child and maternal malnutrition The malnutrition rate in children under five in Lao PDR is very high compared to other countries in South East Asia and Asia in general. Almost two in every five children under age five in Lao PDR are moderately and severely underweight (37.9%) Stunting: 41.2% Wasting: 7.4% Northern part 34% Middle part 33% Southern part 50% Source: MICs3 2006

9. Dam project Mining • Road construction Water supply Development • Industrial • production • Tourism • Irrigation, • Fisheries • Livestock Environment Health

10. Source: Lao PDR Development Report 2010, Natural Resource Management for Sustainable Development

11. Source: Lao PDR Development Report 2010, Natural Resource Management for Sustainable Development

12. Implementation progress on HIA Developed HIA policy and approved by Prime Minister on March 2006 Shared experiences and learning with other countries about HIA Established HIA Team and focal point Developed a Practical Guideline for HIA Appraised IEE or EIA of many development projects

13. Implementation progress on HIA Increased HIA capacity for MoH staffs and different sectors Good HIA model of Namtheun2 Harmonization of HIA with the existing EIA • Carried out case studies: • Health impacts of traditional artisanal mining activities • Health impacts of indoor air pollution • Health Vulnerable Assessment of climate change Field monitoring with others sectors

14. Degree of Prime Minister, No: 54/MP, 23/03/2006 on the Declaration of use and Implementation of National Policy on HIA

15. 31 mining projects 41 dam projects 7 power line extension 4 industry projects 97 IEE and EIA reports 9road projects 3agricultural projects 1 sustainable Tourism Development project 1 Bank Erosion Protection projects

16. Organization Structure on HIA Ministry of Health Department of Hygiene and Prevention Environmental & Occupational Health and Safety Division Health Impact Assessment Unit Technical back up team within Ministry of Health Focal points in other ministries

17. Constraints Awareness of HIA still limited Lack capacity to do HIA of many development projects Limited HIA funding support

18. Policy/Program/project Poverty Environment Social Institutional Individual Economy Assessment Screening HIA Reporting/ Dissemination Scoping M/E 2005 2020 • Life expectancy (y): 72 • CDR/1000: 5.3 • MMR/100 000: 200 • IMR/1000: 32 • U5MR/1000: 40 • Stunting (%): 28 • Wasting (%): 2 • Underweight (%): 15 • Life expectancy (y): 61 • CDR/1000: 9.8 • MMR/100 000: 405 • IMR/1000: 56 • U5MR/1000: 68 • Stunting (%): 40.7 • Wasting (%): 6.4 • Underweight (%): 37.1 Commu Dis Non Comm Dis Injury/acc Malnutrition Mental dis

19. The Way Forward • Short term: • Review the community health impacts from the existing development projects in terms of public health action plan including M/E • Strengthening HIA capacity for HIA Team and provincial staffs • Conduct HIA advocacy meeting with high levels from different ministries • Sharing knowledge and experiences on HIA with other countries • Considering HIA of small projects (SME, Land fill sites etc,.) • Long term: • Develop a HIA long term action plan to get funding support

20. Conclusion Human health is not only the responsibility of the health sector ! We need a cross-sectoral responsibility for health

21. Thank You for kind attention