title: Health policy evolution in Lao People's Democratic Republic: context, processes and agency.
abstract: During the last 20 years Lao People's Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally.
authors.affiliation: Department of Political Science, Lund University, PO Box 52, SE-221 00 Lund, Sweden, Ministry of Health, Vientiane, Lao PDR, Department of Public Health Sciences, Global Health, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77 Stockholm, Sweden and Department of Public Health Sciences, Global Health, and Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77 Stockholm, Sweden Kristina.Jonsson@svet.lu.se.
authors.forename: Kristina
authors.initials: K
authors.lastname: Jönsson
authors.affiliation: Department of Political Science, Lund University, PO Box 52, SE-221 00 Lund, Sweden, Ministry of Health, Vientiane, Lao PDR, Department of Public Health Sciences, Global Health, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77 Stockholm, Sweden and Department of Public Health Sciences, Global Health, and Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77 Stockholm, Sweden.
authors.forename: Bounfeng
authors.initials: B
authors.lastname: Phoummalaysith
authors.affiliation: Department of Political Science, Lund University, PO Box 52, SE-221 00 Lund, Sweden, Ministry of Health, Vientiane, Lao PDR, Department of Public Health Sciences, Global Health, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77 Stockholm, Sweden and Department of Public Health Sciences, Global Health, and Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77 Stockholm, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wahlström
authors.affiliation: Department of Political Science, Lund University, PO Box 52, SE-221 00 Lund, Sweden, Ministry of Health, Vientiane, Lao PDR, Department of Public Health Sciences, Global Health, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77 Stockholm, Sweden and Department of Public Health Sciences, Global Health, and Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77 Stockholm, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Tomson
mesh_terms: D035843:Biomedical Research; D006284:Health Plan Implementation; D006291:Health Policy / Q000331:legislation & jurisprudence*; D007812:Laos; D019982:Organizational Case Studies / Q000379:methods; D011050:Policy Making; D012189:Retrospective Studies
keywords: Health Care Law; National Drug Policy; Policy process; policy implementation; research to policy
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