Stronger Systems for Child Health in Lao PDR

Status: Active

Strengthening health systems through child death review

Through ReALiSE, Melbourne Children’s Global Health is working with the Lao Pediatric Association (LPA) and the Lao PDR Ministry of Health to improve care for children, by strengthening child death review systems to turn data into action.

Building a national child death review system

Child death review provides health workers with an opportunity to examine the circumstances surrounding a child’s death, identify contributing factors and determine practical actions that could improve future care.

Hospitals in Lao PDR have previously undertaken reviews of child deaths, but approaches have varied and findings have not been systematically shared or used to support learning across the health system. Previous review processes were also considered too complex and resource-intensive to implement consistently.

This project builds on work undertaken with the Lao Pediatric Association and Ministry of Health in 2024 to develop a simpler, structured and supported approach to child death review.

Rather than attempting an intensive review of every death, the approach combines routine reporting with detailed examination of selected cases. This allows health teams to identify recurring problems, develop practical solutions and share lessons across facilities and at a national level.

The project aims to establish nationwide child death reporting, annual review of national data and stronger capability among health teams to use their own data to improve care.

Project aims

The project aims to:

• increase access to and use of child death review data
• support health services to identify priorities for action using local and national data
• strengthen the capability of health teams to identify, implement and evaluate improvements in care
• better understand the experiences of children, families and carers as they navigate the health system
• improve understanding of inequities affecting children with disability and other potentially vulnerable groups, including those of different ethnic groups.

Strengthening child death review

Working with the Lao Pediatric Association, the project is refining and embedding a standard national approach to child death review.

Key tools include a national child death review guideline, standard presentation template and simplified data collection form.

Health providers are receiving training and mentoring to strengthen their skills in reviewing deaths, identifying contributing factors and using findings to improve clinical care and health systems.

Monthly hybrid national child death review meetings bring together central and provincial hospitals. , supported by senior Lao paediatricians and members of Melbourne Children’s Global Health.

Health facilities are also supported to establish regular local child death review meetings and collect data using the same approach.

Turning data into action

A key focus of the project is ensuring child death review leads to practical improvements rather than data collection alone.

Child death data are regularly synthesised and reviewed to identify recurring issues and priorities for action. Annual workshops bring health providers, the Lao Pediatric Association and other stakeholders together to examine findings, share learning and determine next steps.

Initiatives emerging from child death reviews include:

• targeted training and scalable simulation resources to improve the recognition and management of sepsis.
• improving referral communication between health facilities using dedicated mobile phones.
• training on leadership and communication skills.

The project uses ongoing cycles of data collection, reflection, action and evaluation, enabling partners to assess what is working and continually refine the approach.

Understanding families’ experiences of care

Child health outcomes are shaped not only by what happens within hospitals, but also by the journey families take to reach appropriate care.

In Bokeo Province, the project is undertaking an in-depth exploration of childhood deaths, bringing together information from child death reviews, medical record audits and interviews with healthcare providers and families of sick children.

This work will help identify barriers experienced before, during and after hospital care and provide a richer understanding of how factors such as geography, disability and social disadvantage influence access to services.

The findings will help ensure the perspectives of children, families and carers inform future improvements to the health system.

Expected outcomes

Through ReALiSE, the project is working towards:

• a systematic and sustainable national child death review approach, embedded within the Lao Pediatric Association and reported to the Ministry of Health
• an accessible national and facility-level child death database that can guide improvements in care
• increased use of child death data to identify and respond to health system priorities
• stronger capability among health providers to undertake child death review and translate findings into action
• greater involvement of families and carers in identifying opportunities to improve access to and experiences of healthcare.

By strengthening the connection between data, learning and action, the project aims to help Lao health services identify preventable causes of child mortality and develop locally appropriate solutions that improve the quality and equity of care.

Key partners

• Lao Pediatric Association
• Ministry of Health, Lao PDR
• Melbourne Children’s Global Health
• ReALiSE