"Ten Minimum Requirement": A Management Tool to Improve Quality of Healthcare Services in Lao People Democratic Republic (Lao PDR).

In Lao People's Democratic Republic (PDR), the mortality rate among children under 5 years of age is high (131 per 1000 live births in 2003), partly as a consequence of poor basic services provided by district hospitals. A simplified management tool, "Ten MR (Minimum Requirement)", was developed in Lao PDR. The tool assured the quality of health services including the processes of planning, implementing, self-monitoring, supervision, reporting and evaluation. The tool focused on ten basic services, integrating stakeholders from district hospitals and governing agencies. Each district hospital develops feasible annual activities, assigning responsibility to people based on a consensus between hospital staff and local governing agencies. Hospitals can self-monitor their activities on a monthly basis. Supervisory visits to district hospitals by local governing agencies improved activities and communication between staff. Visualization of progress promoted the sharing of achievements between staff and highlighted activities in need of more work. In 2004, district hospitals in Vientiane and Oudomxay provinces initiated the application of the tool. These district hospitals included primary care hospitals for outpatients, emergency care and in-patients, with a capacity of 10-20 beds, providing care for a population of between 30,000 and 80,000 people. The Ministry of Health recognized the effectiveness of Ten MR and implemented the expansion of the tool to all district hospitals in Lao PDR from 2011. Ten MR benefits district hospitals and governing agencies. Ten MR focuses on the daily routine work, enhancing team work and communication among all stakeholders.