Factors influencing the National School Health Policy implementation in Lao PDR: a multi-level case study.
In the last decade, a National School Health Policy (NSHP) has been formulated in several developing countries following the recommendations of the Global School Health Initiative. However, NSHP implementations across the country have not been fully shared. This study aimed to identify factors that have influenced implementation of the NSHP in Lao People's Democratic Republic (Lao PDR). We conducted key informant interviews with 20 NSHP implementers and document reviews. Data were collected at the national level and at three lower administrative levels (provincial, district and school) in three areas (north, central and south). Study areas were selected according to the history of NSHP interventions. We applied content analysis using 12 key components of successful policy implementation and a policy triangle framework. We found that scaling up to nationwide implementation was limited. Results showed the NSHP implementation in Lao PDR was influenced by nine interlinked factors, including extensive planning, resource management, monitoring cycle, the perception gap between national and lower administrative officers, national task-force ownership, ongoing coaching of district educational officers, management skills of school principals, priority of school health and decentralization. Furthermore, these nine factors could be integrated into the existing educational system. In conclusion, for sustainable and nationwide implementation of the NSHP in Lao PDR, the following three factors need to be embedded in the educational system: extensive planning with a clear long-term vision at national level, human resource management including well-organized training at each administrative level and a monitoring cycle to understand the real situation at school level.
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Junko
J
Saito
Research Office, Faculty of Education, National University of Laos, PO Box 7322, Dongdok, Vientiane, Lao PDR.
Ngouay
N
Keosada
Department of Sports and Health Sciences, Faculty of Education, Shinshu University, 6-Ro Nishi Nagano, Nagano City, Nagano 380-8544, Japan.
Sachi
S
Tomokawa
Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.
Takeshi
T
Akiyama
Office of International Cooperation (OIC), Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok 10400, Thailand.
Sethavudh
S
Kaewviset
Department of Parasitology and International Health, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa 903-0215, Japan.
Daisuke
D
Nonaka
Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok 10400, Thailand.
Jitra
J
Waikugul
Department of Global Health, School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
Jun
J
Kobayashi
Department of Primary and Preschool Education, Ministry of Education, Lao PDR, PO Box 67, Vientiane, Lao PDR.
Mithong
M
Souvanvixay
Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan mjimba@m.u-tokyo.ac.jp.
Masamine
M
Jimba
D000328:Adult; D003906:Developing Countries; D006284:Health Plan Implementation / Q000379:methods*; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D007812:Laos; D012572:School Health Services
developing countries; health promotion; school health policy; school health services