title: Challenges for strengthening the health workforce in the Lao People's Democratic Republic: perspectives from key stakeholders.
abstract: The Lao People's Democratic Republic is facing a critical shortage and maldistribution of health workers. Strengthening of the health workforce has been adopted as one of the five priorities of the National Health Sector Strategy (2013-2025). This study aims to identify, explore, and better understand the key challenges for strengthening the Laotian health workforce.
  
  
  
  This study applied exploratory and descriptive qualitative methods and adapted a working life-span framework. Twenty-three key stakeholders with particular insights into the current situation of the health workforce were purposively recruited for in-depth interviews. Important policy documents were also collected from key informants during the interviews. Thematic analysis was employed for the textual data using MAXQDA 10.
  
  
  
  The overarching problem is that there is a perceived severe shortage of skilled health workers (doctors, nurses, and midwives) and lab technicians, especially in primary health facilities and rural areas. Key informants also identified five problems: insufficient production of health workers both in quantity and quality, a limited national budget to recruit enough health staff and provide sufficient and equitable salaries and incentives, limited management capacity, poor recruitment for work in rural areas, and lack of well-designed continuing education programs for professional development. These problems are interrelated, both in how the issues arise and in the effect they have on one another.
  
  
  
  To improve the distribution of health workers in rural areas, strategies for increasing production and strengthening retention should be well integrated for better effectiveness. It is also essential to take the Laotian-specific context into consideration during intervention development and implementation. Furthermore, the government should acknowledge the inadequate health management capacity and invest to improve human resource management capacity at all levels. Finally, assessment of interventions for health workforce strengthening should be developed as early as possible to learn from the experiences and lessons in the Lao People's Democratic Republic.
authors.affiliation: Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China.|Fudan Global Health Institute, Fudan University, Shanghai, 200032, People's Republic of China.|Key Laboratory of Health Technology Assessment (Ministry of Health), Shanghai, 200032, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Qian
authors.affiliation: Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China. fyan@shmu.edu.cn.|Fudan Global Health Institute, Fudan University, Shanghai, 200032, People's Republic of China. fyan@shmu.edu.cn.
authors.forename: Fei
authors.identifier: 0000-0002-7730-8383
authors.initials: F
authors.lastname: Yan
authors.affiliation: Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Community and Family Medicine, Duke University, Durham, NC, United States of America.
authors.forename: Shayna
authors.initials: S
authors.lastname: Clancy
authors.affiliation: National Institute of Public Health, Vientiane Capital, Lao People's Democratic Republic.
authors.forename: Kongsap
authors.initials: K
authors.lastname: Akkhavong
authors.affiliation: National Institute of Public Health, Vientiane Capital, Lao People's Democratic Republic.
authors.forename: Manithong
authors.initials: M
authors.lastname: Vonglokham
authors.affiliation: National Institute of Public Health, Vientiane Capital, Lao People's Democratic Republic.
authors.forename: Somphou
authors.initials: S
authors.lastname: Outhensackda
authors.affiliation: Department of Community and Family Medicine, Duke University, Durham, NC, United States of America.|Center for Aging Research and Education, Duke-NUS Medical School, Singapore, Singapore.|Duke Global Health Institute, Duke University, Durham, NC, United States of America.
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
mesh_terms: D002017:Budgets; D004496:Education, Continuing; D006076:Government; D006282:Health Personnel; D006801:Humans; D059232:Laboratory Personnel / Q000600:supply & distribution; D007812:Laos; D009042:Motivation; D009721:Nurse Midwives / Q000600:supply & distribution; D009726:Nurses / Q000600:supply & distribution; D010560:Personnel Selection / Q000191:economics; D010820:Physicians / Q000600:supply & distribution; D057766:Policy; D011320:Primary Health Care; D019035:Rural Health Services; D012424:Rural Population; D012456:Salaries and Fringe Benefits; D013192:Staff Development; D000078329:Workforce
keywords: Health workforce; Lao People’s Democratic Republic; Qualitative research