Economics & Development

In Lao People’s Democratic Republic (PDR), primary health care (PHC) is the main pathway toward universal health coverage (UHC). Despite progress in maternal and child health, major gaps persist for non-Lao Tai ethnic groups in remote areas, including challenges in accessing maternal care, nutrition services, and safe WASH practices. With support from the World Bank, the Government of Lao PDR has launched the Health and Nutrition Service Access II (HANSA II) Project to strengthen the quality and equity of PHC, particularly for underserved communities. Central to the project, the government has prioritized integrating essential health services - antenatal and postnatal care, immunization, nutrition support, WASH, and family planning - for improved ease of delivery and access to better address the health needs of these remote, disadvantaged communities. This report summarizes qualitative research conducted in two districts of Lao PDR to better understand the needs, beliefs, and barriers experienced by select non-Lao Tai groups (and the community actors who influence them) to improve access to and utilization of quality essential health services. Addressing this challenge called for approaches that can unpack its inherent complexity and point toward practical, implementable solutions fit for purpose and context. The applied Human-centered design (HCD) and systems thinking lens surfaced deeply dependent, multisectoral challenges across nutrition and the environment, social protection, cultural norms and more. It identified key areas requiring concerted intervention, including cultural barriers to the adoption of desired health and nutrition behaviors among the most traditional families (those with distinct challenges and needs within the broader non–Lao-Tai populations), structural issues with outreach programs, and health center readiness to respond to the demand motivated by the outreach programs.

This background note outlines enhancements to the International Monetary Fund (IMF) - World Bank (WB) Debt Sustainability Framework for Low-Income Countries (LIC-DSF) to ensure it remains fit for purpose and future-proof in the face of heightened debt vulnerability, greater heterogeneity across LICs, and analytical advances since the 2017 Review. The proposals which have been guided by regular engagements with the IMF and WB Boards and benefitted from extensive engagement with external stakeholders aim to enhance the framework’s predictive power, transparency, and policy relevance, while preserving continuity, tractability, and its role as an early-warning tool for debt stress and unsustainable debt.

This framework outlines key priorities for strengthening Initial Teacher Education (ITE) systems. It emphasizes making ITE programs more attractive and selective by targeting high-potential candidates, while ensuring relevant and impactful program content delivered by skilled teacher educators. The approach highlights the importance of incorporating quality field placements to enhance practical teaching experience. It also focuses on aligning institutions to be responsive, efficient, and quality-driven. Finally, it underscores the need to strengthen quality assurance processes to maintain high standards in ITE. Collectively, these measures aim to improve teacher preparation and support effective, high-quality education systems.