Publication: Lao PDR Budget Execution in Health: From Bottlenecks to Solutions
Loading...
Published
2025-07-15
ISSN
Date
2025-07-15
Editor(s)
Abstract
The Lao People's Democratic Republic has a high execution rate for its overall health budget, ranging from 89 to 104 percent from 2015 to 2019. Aggregated execution rates are generally high across the main categories of spending - wage, non-wage recurrent and capital with only a couple of outliers during the period of analysis. Some of the public financial management practices employed that enable these high execution rates may, nonetheless, risk lowering the quality of spending. There is also greater variation in execution rates when considering more disaggregated levels of budget spending, including between the central and provincial level of government. Good practices that have helped budget execution include the ringfencing of spending on health and flexibility in budget laws enabling high execution of capital budgets. Key bottlenecks holding back budget execution performance include the lack of a mechanism linking spending to the delivery of outputs; weaknesses in how budget allocations are set for health worker payments; delays in payments reaching health facilities; a lack of transparency in disaggregated spending data, no publication of audits and no reporting on the stock of arrears; inefficiencies in the availability of resources for health facilities; and the widespread use of manual reporting which delays reporting processes and is prone to errors and inconsistencies.
Link to Data Set
Citation
“Masaki, Emiko; Samavong, Chanhsy; Beveridge, Grant; Bounthideth, Soulaxay. 2025. Lao PDR Budget Execution in Health: From Bottlenecks to Solutions. © World Bank. http://hdl.handle.net/10986/43457 License: CC BY-NC 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Democratic Republic of the Congo Budget Execution in Health(Washington, DC: World Bank, 2025-07-15)The Democratic Republic of Congo is committed to achieving Universal Health Care by 2030. Progress toward this goal faces challenges due to limitations in the execution and allocation of the country's health budget. This contributes to health spending being predominantly financed by households and donors rather than the government. The only part of the government health budget that is consistently executed in line with allocations is for health worker payments. Execution rates for other spending categories are volatile and generally low. Many parts of the budget are not executed at all, while some activities are implemented without having been included in the budget. Budget execution within the Ministry of Health is influenced by both internal and external factors. Inconsistencies between strategic planning, budget preparation, and execution processes hinder effective financial management; inaccurate cost estimations; heavy reliance on exceptional procedures for spending and over-execution of specific budget lines to the detriment of otherwise planned activities. External challenges include a systematic over-estimation of national revenue; the highly centralized nature of budget execution processes; the dominance of health worker payments in budget allocations; the non-respect of budget management rules and cumbersome procurement and expenditure execution procedures.Publication Budget Execution in Health(World Health Organization and the World Bank, 2025-03-11)This report builds on a joint WHO-World Bank initiative on budget execution challenges (described in more detail in Appendix 1). Following the introduction, section 2 provides an overview of core concepts from both a public financial management perspective and a health financing perspective and discusses how budget execution challenges can differ in countries with a separate purchasing agency, varying degrees of decentralization and significant donor funding. The trends and patterns in health budget execution data are analyzed and discussed in section 3. The analytical approach is detailed in Appendix 2. Section 4 identifies challenges that hinder good budget execution in health. These are drawn from an extensive literature review and a set of case studies. A summary of the case studies is provided in Appendix 3. Policy responses to these challenges are offered in section 5. This section lays out a pragmatic approach that Ministries of Finance, Ministries of Health and local governments can take to address six of the most frequently encountered budget execution challenges and points to examples from cases studies. Section 6 offers an engagement approach to address budget execution challenges. A four step diagnostic-to-solution model is proposed that guides an analyst through the process of identifying the right questions, data, and policy options in a structured manner. Section 7 concludes with a call to action for countries to embrace a more purposeful and collaborative budget implementation approach that involves finance, health and local government stakeholders. The compiled dataset used for the analysis is being released jointly with this report to support complementary analytical efforts.Publication Pakistan Budget Execution in Health(Washington, DC: World Bank, 2025-07-15)Pakistan’s overall national health budget had a high rate of execution from 2016 to 2019, averaging 95 percent. However, execution rates between provinces as well as between categories of spending varied significantly. At the health facility level, execution of spending is notably challenging, particularly for non-wage expenditure. Good practices that facilitated better budget execution included strong integration of payroll and personnel records in most provinces as well as the contracting out of the provision of primary healthcare services to the private sector in Sindh, Baluchistan, and Punjab Provinces. This approach has facilitated more consistent budget execution rates and evidence of resources reaching the facility level. There remain challenges, however, with ensuring the accountability of how these resources are used. The main bottlenecks holding back the quality of budget execution include an inability to track primary, secondary, and tertiary healthcare budgets and their execution; systematic over-estimation of resources by the provinces; weaknesses in budget preparation processes; inefficiency in spending control processes; lack of autonomy for primary healthcare facilities; insufficient integration of vertical programs in local health systems; and lack of a process for capturing spending arrears.Publication Ethiopia Budget Execution in Health(Washington, DC: World Bank, 2025-07-15)Ethiopia achieves a high overall rate of execution of its health budget. From 2016 to 2021 the health budget execution rate averaged 95 percent of the original budget allocation. The health budget execution rate was higher than the execution rates for overall government spending. The execution rate also increased each year. Nonetheless, the execution rate for regions was lower than for the federal government. The execution of the capital budget was also weaker, particularly at the regional and woreda levels. Data on execution rates for specific government programs are not available and may involve much more volatility than aggregated execution rates. Development partner spending managed outside of the federal Treasury also had much higher volatility in execution. Good practices that underpin Ethiopia's high execution rates include relatively low levels of arrears; reasonable turnaround times for payroll changes and high accuracy of payroll expenditures; timeliness and good communication of budgeting processes; and shortening of timeframes for transfers from federal to decentralized levels. Areas that hold back the quality of budget execution include limited transparency on execution data; capacity constraints at the facility and woreda levels; external resources being managed outside of government systems; limited flexibility of spending for health facilities; and overly simplified procurement processes that prioritise only the lowest price.Publication Solomon Islands Budget Execution in Health(Washington, DC: World Bank, 2025-07-15)The Solomon Islands government plays key roles in the health sector, as a funder, regulator, and provider of nearly all health services. Health services are funded, managed, and delivered by the Ministry of Health and Medical Services (MHMS). The MHMS also allocates resources (such as funding, staff, and supplies) to its provincial health services, which are part of the MHMS rather than the provincial governments, to deliver health services in the provinces on behalf of the MHMS. Most health facilities are government-owned, with a few operated by churches. However, church-owned facilities receive annual budget allocations, human resources, medical supplies, and capital investments from the government. There are privately owned outpatient facilities, but these are mainly found in urban areas. There is no social health insurance or separate agency for buying healthcare services.
Users also downloaded
Showing related downloaded files
Publication Democratic Republic of Congo (DRC) Country Climate and Development Report(Washington, DC: World Bank, 2023-11-16)This Country Climate and Development Report (CCDR) aims to support DRC's efforts to achieve its development goals within a changing climate by quantifying the impacts of climate change on the economy and highlighting policies and interventions needed to strengthen the country's climate resilience on many different levels. The report captures the interplay between DRC's development, climate challenges, and climate policies, with the objective of identifying synergies and tradeoffs. The CCDR supports the strategic vision of the Government of DRC as articulated in its 2030 National Strategic Development Plan ("Plan National Stratégique de Développement" (PNSD)) to reach middle-income country (MIC) status by 2035, and by 2050, become a diversified inclusive economy spurred by sustainable growth. It identifies the priorities needed in order to launch the most impactful, cost-effective actions to boost adaptation, build resilience, and foster low-carbon growth, while delivering on broader development goals. These are critical objectives, especially in fragile countries such as the DRC.Publication Mongolia Country Climate and Development Report(Washington, DC: World Bank, 2024-10-22)Mongolia’s development prospects are uniquely challenged by both the impacts of climate change and the global shift toward a low-carbon economy. The country’s efforts toward decarbonization pose significant challenges given the structurally high-emission intensity of its economy. While challenging, climate action also presents Mongolia with opportunities to achieve important development benefits. The effects of climate risks and the shift away from coal will have diverse impacts across different regions, communities, and socioeconomic levels. The report assesses the critical interconnections between Mongolia’s development ambitions and climate change action and identifies ways to transition to a more economically diversified, inclusive, and resilient development path. It highlights key climate and transition risks affecting Mongolia’s future development and presents a pathway to enhance climate mitigation and adaptation. The report also makes a case for strengthening policies to enhance resilience to climate change and ensure a just transition, particularly for the most vulnerable. The report is structured as follows: section 1 gives introduction. Section 2 delves into the linkages between development and climate in Mongolia and presents model-based findings on the economic and poverty impacts of climate change under different scenarios. Section 3 covers four in-depth sectoral analyses. The first two mainly focus on adaptation to climate change in the agriculture and water sectors. The third considers prospects for the extraction sector, while the fourth sectoral analysis focuses on decarbonizing power and heat generation. Section 4 shifts the focus to how the government can boost resilience for climate-vulnerable populations. Section 5 outlines options for mobilizing private and public financing and private investments to support the green transition. Section 6 examines the existing institutional and governance structure for climate action and presents recommendations to improve its effectiveness, and section 7 concludes with a framework for prioritizing the policy actions outlined in this report.Publication Gabon Country Climate and Development Report(Washington, DC: World Bank, 2025-11-01)Gabon has a unique opportunity to drive inclusive growth, reduce poverty, and build a resilient post-oil economy, with climate action accelerating progress toward these goals. The country’s main development challenge is achieving higher growth and poverty reduction, as stronger growth is needed regardless of projected climate shocks to create jobs, raise living standards, and enable a viable post-oil economy. While pursuing growth-promoting economic reforms, climate action that prioritizes people must remain central to its development pathway. However, climate change risks exacerbating poverty and regional inequalities in a country already facing long-term challenges in expanding economic opportunities and basic public services, especially in rural areas. Climate shifts compound these challenges, making stronger private sector-led growth driven by reforms essential for resilience, diversification, job creation, and poverty reduction, though targeted investments in adaptation will still be required to mitigate climate shocks. Using a whole-of-economy approach, the Gabon Country Climate Development Report (CCDR) estimates that climate change impacts could result in GDP losses of 3.5 to 5.3 percent per year through 2050 compared to a business-as-usual baseline trajectory.Publication Jobs in a Changing Climate: Insights from World Bank Group Country Climate and Development Reports Covering 93 Economies(Washington, DC: World Bank, 2025-11-05)The World Bank Group’s Country Climate and Development Reports (CCDRs) provide a crosscutting look at how countries’ development prospects, and the job opportunities they offer to their people, can be threatened by climate impacts and supported by climate policies. Climate change and policies affect jobs through impacts on productivity, energy and material efficiency, and physical, human, and natural capital. They can also transform employment opportunities, especially through complementary measures that help workers and firms adapt to and benefit from new technologies and production practices. Prepared by the World Bank, the International Finance Corporation (IFC), and the Multilateral Investment Guarantee Agency (MIGA), CCDRs integrate country perspectives, climate science and economic modeling, private sector information, and policy analysis to assess how countries can successfully grow and develop their economies and create jobs despite increasing climate risks and while achieving their climate objectives and commitments. Each CCDR starts from the country’s development priorities, opportunities, and challenges, and is developed in close consultation with governments, businesses, and civil society, ensuring the recommendations reflect national priorities. By combining evidence on adaptation, resilience, and emissions pathways, CCDRs highlight where climate action can reinforce development and job creation, and where targeted policies are needed to manage risks and smooth labor market transitions. Taken together, these elements can help create local jobs, ensure economic transitions are just and inclusive, and equip workers and firms to navigate the disruptions and opportunities of a changing climate and changing technologies.Publication Global Economic Prospects, June 2025(Washington, DC: World Bank, 2025-06-10)The global economy is facing another substantial headwind, emanating largely from an increase in trade tensions and heightened global policy uncertainty. For emerging market and developing economies (EMDEs), the ability to boost job creation and reduce extreme poverty has declined. Key downside risks include a further escalation of trade barriers and continued policy uncertainty. These challenges are exacerbated by subdued foreign direct investment into EMDEs. Global cooperation is needed to restore a more stable international trade environment and scale up support for vulnerable countries grappling with conflict, debt burdens, and climate change. Domestic policy action is also critical to contain inflation risks and strengthen fiscal resilience. To accelerate job creation and long-term growth, structural reforms must focus on raising institutional quality, attracting private investment, and strengthening human capital and labor markets. Countries in fragile and conflict situations face daunting development challenges that will require tailored domestic policy reforms and well-coordinated multilateral support.