Dr. Shenglan Tang, professor of medicine and global health at the Duke Global Health Institute, was appointed by the World Health Organization to lead a project that will attempt to develop the health sector of Laos. Tang and his team worked to create the National Health Sector Reform Strategy, which was presented to and recently approved by the National Assembly of Laos. Tang, who has experience researching health systems and disease control in China and other countries, is now excited to pioneer a new health care project in a location that he thinks is full of potential. The Chronicle spoke with Tang to discuss his new assignment.
The Chronicle: Where do you see the Lao health care system headed in the future?
Shenglan Tang: My vision is that by 2020— or at the latest 2025—all the people of Laos will be able to get access to essential health care, including basic health services and intensive clinical care, all at an affordable cost.
TC: How does the National Health Reform Strategy that you worked on help to realize this vision?
ST: This new strategy, which was approved by the National Assembly, will provide legitimacy and, more importantly, leverage for the minister of health. With it, he will be able to get more funding and push the minister of personnel to create a program to attract more doctors to work in rural areas with adequate compensation. I see the National Health Reform Strategy as a milestone in empowering the health sector toward implementation of our objectives. You can have a very beautiful strategy, but without the resources to implement it or the laws to enforce it, a strategy alone will not do much good.
TC: What about Laos made it a particularly interesting target for health sector development?
ST: Laos is one of the poorest countries in the world, and its health care system is very weak in terms of funding, human resources and infrastructure. In addition, because of Laos’s lack of internal funding, contributions from Western countries account for a big proportion of Laos’s health care resources. Without the support of these countries, it would not be possible to provide even the most basic health care to the vast majority of the Lao people.
However, economic growth in Laos has been exceptionally fast in recent years, which provides an excellent opportunity for the Lao government to increase its investment in health. At the moment, Laos’s spending on health only accounts for 1 percent of GDP, so there is room for the government to increase funding for the health sector, particularly if the economy continues to grow faster and faster.
TC: What is the greatest obstacle you have faced since beginning this project?
ST: From a policy perspective, I guess one of the biggest obstacles was providing a motive for inter-sector cooperation. We talk about health care development as the responsibility of the health sector, but it cannot be successful without collaborating with, for example, the minister of social security, the minister of personnel, the minister of financing and particularly the minister of planning and investment.
The minister of health cannot do everything alone. He needs the endorsement of the prime minister, money from financing and human resources from personnel. These people must all then collaborate with social security to discuss health insurance.
Because there are so many sectors involved, this is a particularly challenging aspect of the project. Currently, we are trying to persuade the minister of health to work with at least one other sector, but there is still a lot of work that must be done to reach full cooperation.
TC: What was your reaction when you heard that you would be leading a team to develop the health care system in Laos?
ST: My first reaction was that this project would be very exciting, but at the same time very challenging. At the time, I was not an expert on Laos’s health care system. Prior to beginning that assignment, I had visited Laos twice to attend meetings or workshops, but I did not have a chance to research and familiarize myself with their health sector. There are also a lot of health challenges facing Laos, so obviously this job sounded quite daunting and difficult.
TC: Could you tell me more about some of these health challenges?
ST: Aside from the people living in big cities or the capital Vientiane, the majority of people in Laos, particularly those in poor remote areas, are not given adequate access to health care. The exceptions to this are the vertical programs that Laos has to reduce risk of HIV, TB, etc., but these are not enough.
Another issue we faced was with human resources. I saw that in addition to an overall shortage of medical doctors and therefore health services, many of these practicing doctors are not willing to work in rural environments where their services may be needed the most.
TC: How did you first become interested in global health?
ST: A few years ago when I first came to the United States, I studied what was at that time called international health. I received a master’s degree in public health in the International Health Program at the University of Washington in Seattle. From there, I became interested in public health challenges in lower income countries and found that there were many such countries in Asia that I felt familiar with because of my work in China. Ten years ago, international health was renamed global health, but I have worked in this field for about 20 years now.
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