老挝人民民主共和国卫生预算执行：从瓶颈到解决方案（英）2025

Emiko MasakiChanhsy SamavongGrant BeveridgeSoulaxay Bounthideth BUDGET EXECUTION IN HEALTH:FROM BOTTLENECKS TO SOLUTIONSLAO PDRABSTRACT:The Lao People’s Democratic Republic has a high execution rate for its overall health budget,ranging from 89 to 104 percent from 2015 to 2019. Aggregated execution rates are generally highacross the main categories of spending – wage, non-wage recurrent and capital – with only acouple of outliers during the period of analysis. Some of the public financial management practicesemployed that enable these high execution rates may, nonetheless, risk lowering the quality ofspending. There is also greater variation in execution rates when considering more disaggregatedlevels of budget spending, including between the central and provincial level of government. Goodpractices that have helped budget execution include the ringfencing of spending on health andflexibility in budget laws enabling high execution of capital budgets. Key bottlenecks holding backbudget execution performance include the lack of a mechanism linking spending to the delivery ofoutputs; weaknesses in how budget allocations are set for health worker payments; delays inpayments reaching health facilities; a lack of transparency in disaggregated spending data, nopublication of audits and no reporting on the stock of arrears; inefficiencies in the availability ofresources for health facilities; and the widespread use of manual reporting which delays reportingprocesses and is prone to errors and inconsistencies.Disclaimer:The findings, interpretations and conclusions expressed in the paper are entirely thoseof the authors, and do not represent the views of the World Bank, its Executive Directors, or thecountries they represent.Correspondence Details:Emiko Masaki emasaki@worldbank.orgEmiko MasakiSenior Health Economist; Health, Nutrition and PopulationGlobal Practice, World Bank; Vientiane, Lao PDRChanhsy SamavongPFM Consultant; World Bank, Vientiane, Lao PDRGrant BeveridgeIndependent Consultant; Solomon IslandsNational University, Honiara, Solomon Islands.Soulaxay BounthidethHealth Financing Consultant; World Bank,Vientiane, Lao PDRCASE STUDY SERIES Budget execution in health: from bottlenecks to solutions© The International Bank for Reconstruction and Development / The World Bank, 20251818 H Street NWWashington DC 20433Telephone: 202-473-1000Internet: www.worldbank.orgThis work is a product of the staff of The World Bank with external contributions. The findings,interpretations, and conclusions expressed in this work do not necessarily reflect the views of The WorldBank, its Board of Executive Directors, or the governments they represent.The World Bank does not guarantee the accuracy, completeness, or currency of the data included in thiswork and does not assume responsibility for any errors, omissions, or discrepancies in the information,or liability with respect to the use of or failure to use the information, methods, processes, orconclusions set forth. The boundaries, colors, denominations, and other information shown on any mapin this work do not imply any judgment on the part of The World Bank concerning the legal status of anyterritory or the endorsement or acceptance of such boundaries.Nothing herein shall constitute or be construed or considered to be a limitation upon or waiver of theprivileges and immunities of The World Bank, all of which are specifically reserved.Rights and PermissionsThe material in this work is subject to copyright. Because The World Bank encourages disseminationof its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes aslong as full attribution to this work is given.Any queries on rights and licenses, including subsidiary rights, should be addressed to World BankPublications, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625;e-mail: pubrights@worldbank.org.Graphic design.David Lloyd Design (DLD). Unless otherwise credited, all images used in this report were created in part withMidjourney AI and overlayed with graphics created by DLD. Any resemblence to a real individual is accidental.This interactive document has been optimised for use on computers and tablets in portrait orientation.Click on this section to return to the beginning of the sectionClick on this square to return to the contents page BUDGET EXECUTION IN HEALTH:FROM BOTTLENECKS TO SOLUTIONS - CASE STUDY SERIES -LAO PDRACKNOWLEDGMENTS1. HEALTH FINANCING CONTEXT2. BUDGET EXECUTION IN HEALTH3.PUBLIC FINANCIAL MANAGEMENT CONTROLSFOR HEALTH SPENDING4. GOOD PRACTICES AND BOTTLENECKSREFERENCESLIST OF FIGURESFIGURE 1:LAO PDR DOMESTIC HEALTH FUNDING AND REPORTING FLOWSFIGURE 2:LAO PDR HEALTH FACILITY CLASSIFICATION AND AVAILABLE SERVICESFIGURE 3:LAO PDR DOMESTIC HEALTH SECTOR FINANCING BY SOURCEFIGURE 4:LAO PDR DONOR FINANCING FOR HEALTH, 2011–21FIGURE 5:LAO PDR DOMESTIC HEALTH EXECUTION RATE, 2015/16–22FIGURE 6:LAO PDR CENTRAL MINISTRY OF HEALTH PLANNED, ACTUAL,