Protecting the rural poor against economic consequences of major illness: a challenge for Asian transitional economies. Notes fr

20. Oct 2008

Kristina Jönsson,Ph.D, Researcher,Centre for East and South-East Asian Studies, Lund University, SwedenDespite substantial economic development and successful poverty reduction in many low- and middle-income countries in Asia, the urban-rural gap continues to widen. Many poor and near poor are becoming increasingly vulnerable to unexpected expenses, not the least illness. Illness has become an important cause of household impoverishment in countries such as China, Cambodia and Lao PDR, largely because of low levels of government health-care funding and the rising cost of medical care. However, the governments in all three countries have announced major initiative to address this problem: China in line with a “harmonious society” and Cambodia and Laos in line with poverty reduction strategies and the fulfilment of the Millennium Development Goals.

From 4 to 10 October 2008 I participated in the annual meeting of the research consortium POVILL (poverty & illness)[1] in Vientiane, Lao PDR. The purpose of POVILL is to assist the initiatives by the three governments and to and assess their performance by in-depth studies in Cambodia, Laos and two provinces in Central China. The first five days were devoted to sharing preliminary research findings among the project researchers, while the two last days were committed to a conferences open to policymakers, donor representatives, NGOs, media and other stakeholders. The discussions were intense and many lessons were shared. It was concluded that while many of the problems in three countries are similar, there are also substantial differences that must be taken into account when designing social protection programmes for the poor.

In conjunction with the conference the first larger output of the project was launched, namely the book Health and Social Protection of the Poor: Experiences from Cambodia, China and Lao PDR (can be downloaded at The book addresses the challenge of applying social protection concepts to health, and explores the challenge of managing pro-poor health system development in transitional economies. The authors are scholars and policy actors from Asia, Europe and Australia from disciplines as diverse as public health, health system research, public administration, economics, political science, sociology and anthropology.

When we were not busy with meetings, we could enjoy the festivities of the up-coming boat festival Bun Nam. The event marks the end of the Buddhist rains retreat, and during the festival boat races are held on the Mekong river with teams not only from Lao PDR but also from the neighbouring countries. Although I missed the actual boat races, I could benefit from all the food stalls, temporary discos, carnival games (notably throwing darts at balloons), and beer gardens. Staying at the Lane Xang Hotel next to the Mekong River I did not even need to leave the hotel but could enjoy the festivities form my balcony. This was a very different city from the normally very quiet Vientiane I have come to know over the years.

[1]  POVILL is a four year European funded international partnership of ten organisations in six countries set up to contribute to international knowledge about how to help households to cope with major illness, and to contribute to efforts to reduce severe poverty due to illness and improve access to health services (see