The fight against malnutrition in a single-party decentralized country: the case of the Lao People’s Democratic Republic (Lao PDR)

Abstract Background Lao PDR, a low-middle income country, has a higher malnutrition rate than other Southeast Asian countries. Decentralization of healthcare is a well-known determinant of the effectiveness of programs to reduce malnutrition, but no study has focused on this factor in Lao PDR. Methods A qualitative study was conducted based on a neo-institutional theory conceptual framework. Twenty-four semistructured interviews were performed with actors from different government levels, external donors and civil society. The information obtained from the interviews was supplemented with an analysis of relevant documents. Data were analyzed using NVivo 11 software. The validity of the results was ensured through credibility, transferability, reliability and confirmability. Results The services in charge of combating malnutrition in Lao PDR remain largely centralized, despite factors specific to the country that are leading it to promote a certain decentralization of its services. The coherence between the observed structure and the interpretative schemes of the actors concerned, at all levels of governance, ensures the stability of this state of centralization, which has persisted for almost 50 years. However, the socioeconomic changes that the country is undergoing suggest that the centralized structure will become more decentralized in the near future. Conclusion The centralization of public programs such as the fight against malnutrition is expected in countries whose system is based on the concept of democratic centralism and that lack expert resources capable of working regionally. However, the institutional environment in which Lao health services are offered is changing. Socioeconomic changes are expected to increase the capacity of public health professionals at regional levels to take more responsibilities in the near future. As a result, the health care structure underlying public health programs such as nutrition programs may become less centralized.