“Ten Minimum Requirement”: A management tool to improve quality of healthcare services in Lao People Democratic Republic (Lao PDR)

ABSTRACT

In Lao People's Democratic Republic (PDR), the mortality rate forchildren under 5 years of age is high (131 per 1000 live births in 2003),partly as a consequence of poor basic services provided by district hospitals.A simplified management tool, “Ten MR (Minimum Requirement)”, was developed inLao PDR. The tool assured the quality of health services including theprocesses of planning, implementing, self-monitoring, supervision, reportingand evaluation. The tool focused on ten basic services, integratingstakeholders from district hospitals and governing agencies. Each districthospital develops feasible annual activities, designating responsible peoplebased on a consensus between hospital staff and local governing agencies.Hospitals can self-monitor their activities on a monthly basis. Supervisoryvisits to district hospitals by local governing agencies improved activitiesand communication between staff. Visualization of progress promoted the sharingof achievements between staff and highlighted activities in need of more work.In 2004, district hospitals in Vientiane andOudomxay province initiated the introduction of the tool. These districthospitals included primary care hospitals for outpatients, emergency care andin-patients, with a capacity of 10-20 beds, providing care for a population ofbetween 30,000 and 80,000 people. The Ministry of Health recognized theeffectiveness of Ten MR and implemented the expansion of the tool to alldistrict hospitals in Lao PDR from 2011. Ten MR benefits district hospitals andgoverning agencies. Ten MR focuses on the daily routine work, enhancing teamwork and communication between all stakeholders.