A/HRC/41/39/Add.2 A. Health 45. Access to affordable health care and health insurance is crucial to ensuring that health costs do not push people into poverty. Recent improvements in access to low-cost health care represent real progress. However, the Special Rapporteur has received consistent reports of low-quality health care, inadequate health coverage in rural areas and the inability of many people to afford even basic urgent care. 46. The Government is not adequately funding health care or providing sufficient funds to ensure that people in poverty can acquire access to treatment. Health expenditure as a percentage of GDP is among the lowest in the region. 31 The World Bank found that, among those in or near poverty, 13 per cent were in that situation because of a health shock. 32 During the Special Rapporteur’s visit, officials of the Ministry of Health said that 94 per cent of people were covered by the Health Insurance Fund, which provides free childbirth coverage and treatment for children under 5 years of age, 33 however, they could not say how many of them had actually acquired access to health care. 34 47. The accessibility of health care remains very uneven. People from the poorest wealth quintile and those in rural areas have limited access. 35 Even in villages with health centres, people consistently reported that they were obliged to travel to district or provincial hospitals for non-minor medical issues and, for many of them, the costs of health care and transportation prevented them from seeking treatment. In one district, government officials acknowledged that 22 of 78 villages could not acquire access to health care during the rainy season. 48. The Government should increase health spending in line with regional trends and develop a detailed profile of populations that do not have adequate access to health care. It should adopt a plan to systematically improve access for those groups, enable remote health centres to cope better with the challenges of the rainy season and develop a plan to make transportation from village centres to nearby hospitals affordable. B. Education 49. Meaningful access to high-quality education is essential to creating a route out of poverty for Lao children and to developing a skilled workforce. Although the Ministry of Education and Sports is committed to improving access and has reported progress in enrolment and student retention rates, the inadequate resources allocated for education undermine the prospects for sustained improvement. 36 50. Those with the least education have the lowest chance of transitioning out of poverty and the highest likelihood of falling below the poverty line. 37 Access to education can increase a family’s agricultural productivity or allow them to transition out of agricultural work, however, those in poverty have far less access to education. Only 58 per cent of children in the poorest quintile complete primary education, compared with 98 per cent of 31 32 33 34 35 36 37 12 World Health Organization, “Health Financing”. Available from http://www.wpro.who.int/laos/topics/health_financing/en/. World Bank, “Lao Poverty Policy Brief: Taxonomy of the Poor and its Usefulness in Policy Design,” December 2017, p. 8. Available from http://documents.worldbank.org/curated/en/114211505815281554/pdf/119794-WP-taxonomyPovertyReport-PUBLIC-ENGLISH-and-LAO-ENGLAOfinal.pdf. Association for Development of Women and Legal Education, “Capacity Assessment Report: CEDAW Implementation in Lao PDR”, June 2016, p. 10. Available from http://adwlelaos.org/wpcontent/uploads/2017/09/SRP001_Cedaw-Assessment_EF-14-07-2016-ENG.pdf. Meeting with the Ministry of Health, 26 March 2019. Lao People’s Democratic Republic, Statistics Bureau, “Lao Social Indicator Survey II”, p. 24. World Bank, “Lao PDR Economic Monitor,” January 2019, p. 47. Available from http://documents.worldbank.org/curated/en/818841549314902040/pdf/134324-LEM-Jan-2019-finalfor-online.pdf. Ibid., pp. 34–35.