Delivery Health Service Utilization and Barriers to Access in Lao People’s Democratic Republic (PDR): An Analysis of MICS Data 2023

Lili  Amaliah; Supriatin Supriatin; Mohamad  Sadli; Maretalinia Maretalinia

doi:10.56303/jhnresearch.v4i1.345

Authors

Lili Amaliah Nursing Program, Sekolah Tinggi Ilmu Kesehatan Cirebon, Indonesia
Supriatin Supriatin Faculty of Nursing, Lincoln University College, Kota Bharu, Kelantan, Malaysia
Mohamad Sadli Public Health Program, Sekolah Tinggi Ilmu Kesehatan Cirebon, Indonesia
Maretalinia Maretalinia Ph.D. Program in Demography, Institute for Population and Social Research, Mahidol University, Thailand

Keywords:

Maternity, Health service utilization, Barriers to access, Lao People's Democratic Republic, Delivery health service

Abstract

Technological advances and accessibility influence the utilization of health services in today's world, but barriers still exist. This study aims to comprehensively analyze the utilization of maternal health services and the barriers that hinder access in the Lao People's Democratic Republic (PDR). This study analyzed 2023 MICS data from 3,754 women in the Lao People's Democratic Republic, examining maternal health service utilization. The dependent variable was categorized as utilization or non-utilization, while the independent variables included demographics, geography, decision-making power, and health system factors. Descriptive statistics, chi-square tests, and binary logistic regression were used for data analysis. This study found that of the 3,754 respondents, 2,930 people used health services to give birth. The chi-square test showed that age, education, residence, region, decision making, insurance ownership, and wealth index were significantly associated with using maternal health services. Multivariate analysis showed that higher education was the strongest predictor of health service use (OR = 20.90), with geographic factors, wealth inequality, and shared decision-making. Areas without road access and the poorest wealth groups were less likely to use services, while shared decision-making increased the likelihood by 45%. It is recommended that higher education be promoted, road access improved, and shared decision-making be encouraged to increase the utilization of maternal health services, especially among the poorest communities and those living in rural areas.

Downloads

Download data is not yet available.

References

World Health Organization. WHO guideline on self-care interventions for health and well-being, 2022 revision [Internet]. World Health Organization; 2022 [cited 2025 Mar 27]. Available from: https://iris.who.int/bitstream/handle/10665/357828/9789240052192-eng.pdf?sequence=1

Ahissou NCA, Nonaka D, Takeuchi R, de los Reyes C, Uehara M, Khampheng P, et al. Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People’s Democratic Republic from 2006 to 2017: MICS data analysis. Trop Med Health. 2023 Oct 19;51(1):56.

Liverani M, Phongluxa K, Phommasone K, Chew R, Chandna A, Pongvongsa T, et al. Prospects for the development of community-based care in remote rural areas: a stakeholder analysis in Laos. BMC Health Serv Res. 2024 Jan 11;24(1):55.

World Health Organization. WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas [Internet]. World Health Organization; 2021 [cited 2025 Mar 27]. Available from: https://iris.who.int/bitstream/handle/10665/341130/9789240025318-eng.pdf

Kapheak K, Theerawasttanasiri N, Khumphoo P, Sriwongphan R, Ritthimon W, Chayaseng C, et al. A Qualitative Study of Women’s Perspectives of Antenatal Care in Rural Areas of the Lao PDR. Journal of Population and Social Studies. 2025 Jan 3;33:803–21.

Kapheak K, Theerawasttanasiri N, Khumphoo P, Sriwongphan R, Ritthimon W, Chayaseng C, et al. Perspectives of Healthcare Providers in Maternal and Child Health Services in BokeoProvince, Lao People’s Democratic Republic: A Qualitative Study. Journal of Population and Social Studies. 2023 Dec 27;32:329–45.

Aryal A, Clarke-Deelder E, Afriyie DO, Phommalangsy S, Fink G. Factors influencing healthcare facility selection in an urban setting in Lao PDR: Findings from a qualitative study. SSM - Health Systems. 2025 Jun;4:100062.

Kawaguchi Y, Sayed AM, Shafi A, Kounnavong S, Pongvongsa T, Lasaphonh A, et al. Factors affecting the choice of delivery place in a rural area in Laos: A qualitative analysis. PLoS One. 2021 Aug 2;16(8):e0255193.

Phongluxa K, Langeslag G, Jat TR, Kounnavong S, Khan MA, Essink DR. Factors influencing sexual and reproductive health among adolescents in Lao PDR. Glob Health Action. 2020 Jul 30;13(sup2):1791426.

Wungrath J, Sriwongphan R, Kapheak K, Ritthimon W. Home Births Among Ethnic Minority Communities in Bokeo Province, Lao People’s Democratic Republic. Kesmas. 2024;19(4):264–71.

Hose I, Durham J, Phengsavanh A, Sychareun V, Vongxay V, Xaysomphou D, et al. Perceptions and management of postpartum haemorrhage among remote communities in Lao PDR. Rural Remote Health. 2020 Jan 10;

Haenssgen MJ, Elliott EM, Phommachanh S, Phomkong S, Kounnavong S, Kubota S. Trust in healthcare: methodological and conceptual insights from mixed-method research in Lao People’s Democratic Republic. BMJ Glob Health. 2024 May;9(5):e014640.

Phommachanh S, Essink DR, Jansen M, Broerse JEW, Wright P, Mayxay M. Improvement of Quality of Antenatal Care (ANC) Service Provision at the Public Health Facilities in Lao PDR: Perspective and Experiences of Supply and Demand Sides. BMC Pregnancy Childbirth. 2019 Dec 22;19(1):255.

Win PP, Hlaing T, Win HH. Factors influencing maternal death in Cambodia, Laos, Myanmar, and Vietnam countries: A systematic review. PLoS One. 2024 May 17;19(5):e0293197.

Dawkins B, Renwick C, Ensor T, Shinkins B, Jayne D, Meads D. What factors affect patients’ ability to access healthcare? An overview of systematic reviews. Tropical Medicine & International Health. 2021 Oct 21;26(10):1177–88.

Vongsaly C. Basic Education in Lao People’s Democratic Republic. In 2024. p. 459–85.

Thongmixay S, Essink DR, Greeuw T de, Vongxay V, Sychareun V, Broerse JEW. Perceived barriers in accessing sexual and reproductive health services for youth in Lao People’s Democratic Republic. PLoS One. 2019 Oct 29;14(10):e0218296.

Sato C, Phongluxa K, Toyama N, Gregorio ER, Miyoshi C, Nishimoto F, et al. Factors influencing the choice of facility-based delivery in the ethnic minority villages of Lao PDR: a qualitative case study. Trop Med Health. 2019 Dec 5;47(1):50.

Nagpal S, Masaki E, Pambudi ES, Jacobs B. Financial protection and equity of access to health services with the free maternal and child health initiative in Lao PDR. Health Policy Plan. 2019 Oct 1;34(Supplement_1):i14–25.

Enticott J, Johnson A, Teede H. Learning health systems using data to drive healthcare improvement and impact: a systematic review. BMC Health Serv Res. 2021 Dec 5;21(1):200.

Khatri RB, Assefa Y. Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC Public Health. 2022 Dec 3;22(1):880.

Raghupathi V, Raghupathi W. The influence of education on health: an empirical assessment of OECD countries for the period 1995–2015. Archives of Public Health. 2020 Dec 6;78(1):20.

Mohd Rosnu NS, Singh DKA, Mat Ludin AF, Ishak WS, Abd Rahman MH, Shahar S. Enablers and Barriers of Accessing Health Care Services among Older Adults in South-East Asia: A Scoping Review. Int J Environ Res Public Health. 2022 Jun 15;19(12):7351.

Verma VR, Dash U. Geographical accessibility and spatial coverage modelling of public health care network in rural and remote India. PLoS One. 2020 Oct 21;15(10):e0239326.

Gordon T, Booysen F, Mbonigaba J. Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa. BMC Public Health. 2020 Dec 4;20(1):289.

Hashemi G, Wickenden M, Bright T, Kuper H. Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries, a Meta-synthesis of qualitative studies. Disabil Rehabil. 2022 Apr 10;44(8):1207–20.

Folland S, Goodman AC, Stano M, Danagoulian S. The Economics of Health and Health Care. New York: Routledge; 2023.

Hodge A, Firth S, Bermejo R, Zeck W, Jimenez-Soto E. Utilisation of health services and the poor: deconstructing wealth-based differences in facility-based delivery in the Philippines. BMC Public Health. 2016 Dec 6;16(1):523.

Yaya S, Bishwajit G, Shah V. Wealth, education and urban–rural inequality and maternal healthcare service usage in Malawi. BMJ Glob Health. 2016 Aug 16;1(2):e000085.

Zakayo SM, Njeru RW, Sanga G, Kimani MN, Charo A, Muraya K, et al. Vulnerability and agency across treatment-seeking journeys for acutely ill children: how family members navigate complex healthcare before, during and after hospitalisation in a rural Kenyan setting. Int J Equity Health. 2020 Dec 10;19(1):136.

Resnicow K, Catley D, Goggin K, Hawley S, Williams GC. Shared Decision Making in Health Care: Theoretical Perspectives for Why It Works and For Whom. Medical Decision Making. 2022 Aug 16;42(6):755–64.