Despite government promises that the urban-oriented health system inherited from the RLG would be expanded to support rural primary health care and preventative programs, little money had been allocated to the health sector as of 1993. According to figures from 1988, less than 5 percent of the total gÍÍÍÍovernment budget was targeted for health, with the result that the Ministry of Public Health was unable to establish a management and planning system to facilitate the changes envisioned. UNICEF considered the effort to construct a primary health care system to have failed entirely.

Official statistics identified hospitals in fifteen of the sixteen provinces, plus several in Vientiane, and clinics in 110 districts and more than 1,000 tasseng (subdistricts--see Glossary). In reality, most subdistrict clinics are unstaffed, unequipped, and unsupplied, and in 1989 only twenty of the district clinics actually provided services. The physical condition of the facilities is poor, with clean water and latrines unavailable at most health posts, and electricity unavailable at 85 percent of district clinics, rendering vaccine storage impossible. Drugs and equipment stored in the central warehouses are seldom distributed to outlying provinces, and in most situations, patients had to purchase Western pharmaceuticals from private pharmacies that imported stock from Thailand or Vietnam.

The number of health care personnel has been increasing since 1975, and in 1990 the ministry reported 1,095 physicians, 3,313 medical assistants, and 8,143 nurses. Most personnel are concentrated in the Vientiane area, where the population per physician ratio (1,400 to one) is more than ten times higher than in the provinces. In 1989 the national ratio was 2.6 physicians per 10,000 persons.

Training medical personnel at all levels emphasizes theory at the expense of practical skills and relies on curricula similar to those used prior to 1975. International foreign aid donors supported plans for a school of public health, and texts were written and published in Lao. As of 1990, however, the school did not exist, because of delays in approval of its structure and difficulties in finding trainers with the appropriate background.

Rural and provincial health personnel work under conditions similar to their counterparts in education: salaries are low and seldom paid on time, necessary equipment and supplies are unavailable, and superiors offer little supervision or encouragement. In these circumstances, morale is low, job attendance sporadic, and most health care ineffectual. In general, the population has little confidence in the health care sector, although some village medics and a few district or provincial hospitals are respected by their communities.

Use of traditional medical practitioners remains important in urban as well as rural locations. Healers who know how to use medicinal plants are often consulted for common illnesses. The Institute of Traditional Medicine of the Ministry of Public Health formulated and marketed a number of pre 470parationons from medicinal plants. Spirit healers are also important for many groups, in some cases using medicinal plants but often relying on rituals to identify a disease and effect a cure. Many Laotians found no contradiction in consulting both spirit curers and Western-trained medical personnel.

In the absence of a widespread system of health workers, local shops selling drugs became an important source of medicines and offered advice on prescriptions. However, these pharmacies are unregulated and their owners unlicensed. As a consequence, misprescription is common, both of inappropriate drugs and incorrect dosages. In rural areas, vendors commonly make up small packets of drugs--typically including an antibiotic, several vitamins, and a fever suppressant--and sell them as single-dose cures for a variety of ailments.

Data as of July 1994