title: Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People's democratic republic: a qualitative study.
abstract: BACKGROUND
  To reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national 'Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services'. This paper reports on implementation constraints identified in three demonstration sites.
  
  
  METHODS
  The objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al's health system constraint framework.
  
  
  RESULTS
  In each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women's position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up.
  
  
  CONCLUSIONS
  The Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the initiative. To achieve effective implementation and scale-up a number of concurrent interventions are needed to address identified constraints. More research is needed to identify the optimal combination of interventions to improve these constraints. The broader contextual characteristics require longer-term, cross-sectoral action.
authors.affiliation: University of Health Sciences, Faculty of Postgraduate Study, Vientiane, Laos. vsychareun@gmail.com.
authors.forename: Vanphanom
authors.initials: V
authors.lastname: Sychareun
authors.forename: Sysavanh
authors.initials: S
authors.lastname: Phommachanh
authors.forename: Soudavanh
authors.initials: S
authors.lastname: Soysouvanh
authors.forename: Chaeun
authors.initials: C
authors.lastname: Lee
authors.forename: Minah
authors.initials: M
authors.lastname: Kang
authors.forename: Juhwan
authors.initials: J
authors.lastname: Oh
authors.forename: Jo
authors.initials: J
authors.lastname: Durham
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002662:Child Health Services / Q000191:economics; D002675:Child, Preschool; D003144:Communication Barriers; D003466:Cultural Characteristics; D004864:Equipment and Supplies / Q000600:supply & distribution; D005249:Fees and Charges; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006700:Home Childbirth; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007802:Language; D007812:Laos; D008297:Male; D008427:Maternal Health Services / Q000191:economics; D008875:Middle Aged; D036301:Qualitative Research; D011787:Quality of Health Care; D060926:Remuneration; D012959:Socioeconomic Factors; D014186:Transportation; D000078329:Workforce; D055815:Young Adult