1 Lao People's Democratic Republic Peace Independence Democracy Unity Prosperity Ministry of Health Department of Planning

Lao People’s Democratic Republic Peace Independence Democracy Unity Prosperity

Ministry of Health Department of Planning and Cooperation GMS Health Security Project

Cross border checkpoint (Points of entry) survey report

The department of communicable disease control of the ministry of health conducted the survey of the border checkpoints during the period of June to September 2019. The survey was to implement one of the activities of the annual operation plan 2019 supported by the health security project and funded by the Asian Development Bank (ADB).

The overall objectives of the survey were to have the information about the operation and the capacity of the border checkpoints in meeting the core capacity of the International Health Regulation for the public health emergency operation. Specific objectives were to:  Map out the location/site of each checkpoint  Assess the availability of health facilities, equipment, numbers of health staff and location of health checking counter and SOP  Collect the information of traffic volume crossing the border checkpoints  Assess the preparedness and response capacity at the PoE  See the gaps, constraints and make the recommendation for an improved capacity in disease outbreak control at the border checkpoint

I. Border checkpoints in the survey:

A totally 27 selected points of entry surveyed which included 4 international airports, 23 ground crossing points and 3 local traditional checkpoints shown in the table below:

No. Province District Check point name Shared border

Sikhottabong Wattai International airport Vientiane Hadsayfong Lao-Thai friendship bridge Nongkhai -Thailand 1 Capital (1) Sikhottabong Local traditional checkpoint Nongkhai - Thailand 2 Phongsaly Nhot Ou Lan Tui local checkpoint Yunnan - China May district Pang Hock local checkpoint Dien Fu - Vietnam 3 Luang Luang Namtha Boten international GCP Yunnan - China Namtha Houay Xay Lao-Thai friendship bridge ChiangRai - Thailand 4 Bokeo (4) Ton Pheung Golden Triangle Chiang Rai - Thailand 5 Luang Luang Prabang LB International airport Prabang City Kaenthao Nam Heuang local Thailand 7 Xayabouly checkpoint

Paklay Phou Dou local checkpoint Thailand Muong Ngeun Nam Ngeun checkpoint Thailand 6 Houaphanh Viengxay Nam Soy local checkpoint Thanh Houa -Vietnam 8 Xiengkhouang Nong Hed Nam Kanh local checkpoint Ngae An - Vietnam Pakxanh Pakxanh – Bungkarn Bung Karn - Thailand 9 Bolikhamxay Khamkeut Nam Phao Hatinh - Vietnam

10 Khammouane Thakhek Lao-Thai friendship bridge Nakorn Panom (3) Thailand Boualapha Naphao Quang binh -Vietnam 11 Svannakhet Kaysone International airport Phomvihan City checkpoint Kaysone Lao-Thai friendship bridge Moukdahan - Thailand Phomvihan City (2) Sepon Dan Savan – Lao Bao Quang Tri - Vietnam 12 Saravanh Samouay La lay Quang Tri - Vietnam 13 Sekong Duckchung Dark Ta Ork QUang Nam - Vietnam 14 Champasack Pakse City Pakse International airport Phonthong Vang Tao-Chongmeck Oubon - Thailand 15 Attapeu Phouvong Phoukeua Quang Toum - Vietnam 16 Vientiane Meune district Pakxom Loei - Thailand province

Process of survey The survey used a simple questionnaire formulated by the country technical adviser (CTA) of the project and were modified by the Department of communicable diseases control (DCDC) for some additional numbers of questions. The DCDC have established 3 level survey teams which included:

(1) Central and provincial supervising team which comprised of the general board director of the department of communicable disease control and senior technical officers of disease outbreak. The team made the decision on the approach of the survey, follow up and supervised the survey

(2) Provincial coordination team coordinated with the checkpoint authority for authorization and cooperation and appointed the technical officer of the department of health to part of the survey team

(3) On site survey team.

The survey team approached the target of survey below  Provincial head/deputy head and communicable diseases unit staff  Head and senior officer of immigration of the border checkpoints  Customs  Border checkpoint office administrative officer  Ware house manager  Food and drug and health inspectors

 Animal and plant health  Business and service operators

Prior to the survey in each province, the DCDC team consulted firstly the board of the provincial health department and other concern health officers to provide orientation on the objectives and the needs of the survey. The provincial designated team members were met to be coached on the utilization of the survey form and on active participation to the survey.

Results

Vientiane Capital 2 international and 1 local traditional checkpoints: 1) Wattay International Airport – a designated international checkpoint to meet the core capacity requirement of the International Health Regulation is at the distance of 7 km away from the Centre of Vientiane capital.  The regular daily administrative working hours starts from 8:00 am to 4:00 pm. However the immigration and custom checks were beyond the official given time which depended on the arrival and departure time of the flights in the day.  The numbers of entry passengers varied from 1500 to 2000 while the exit numbers were bigger 2,000  Health inspection was not done on a regular basis. There were only few hospital medical staff who came from nearby Sikhottabong district hospital (a designated referral hospital) and worked on health inspection when the disease outbreak occurred. There was not a room designated for the quarantine in the terminal but a room to provide a small scale of medical care service for the airport staff and the travelers who needed is available.  The thermo scanner has been put in place to screen the arrival passengers during the outbreak of the severe acute respiratory syndrome (SARS) was still kept in work together with some infrared thermometers and a hand use blood pressure device. The department of communicable diseases control team has conducted a training on the standard operating procedure (SOP) and simulation exercise for the airport staff and authorities and distributed the printed manual of SOP 2) Lao – Thai Friendship Bridge 1. An international cross border checkpoint located in Hadsayfong district at the distance of 20 kilometers away from Vientiane town. The official working time was from 8:00 am to 8:00 pm with the record of a bigger volume of international traffic when compared to Wattay airport and in other Lao – Thai Friendship Bridge checkpoint. Cars and conveyances were counted for 300 of entry and 400 of exit per day. 2 medical staffs were appointed by Hadsayfong district health office. A medical room service existed and provided very little consultation service to the staff and authorities working at the checkpoints in case of needs 3) Local traditional Cross Mekong river checkpoint located in Sikhottabong district at about 12 km north of Vientiane town is a checkpoint crossed by the local residents of Sikhottabong district and those of Sangkhom district of Nongkhai province of Thailand. An average hundred people crossed the checkpoint per day for a quotidian small trade and importation mainly: food, clothes, farming materials and products, and house construction hardware. The local authority appointed 2 health and 2 to 3 animal and plant health inspectors to work every day.

Phongsaly province

4) Lan Toui local ground crossing point at 60 km away from Nhot Ou district and shares the border with Chang Seun district of Yunnan province of China. This newly opened checkpoint has 8 and half hours operation in the day starting from 8 am to 16:30 pm with a recorded of a little number crossing travelers (50) both entry and exit.  Very little numbers of cars and conveyance crossing the border – 40 entry against 10 of exit.  The provincial and district health department have posted 2 drugs inspectors but no health staff working for outbreak response.  There were 2 staffs posted by agriculture sector – 1 for animal health and 1 for plant inspection.  There was only an infrared thermometer available in the checkpoint. The passengers who needed to receive the medical were referred to Nhot Ou district hospital. 5) Pang Hock checkpoint. This sharing checkpoint Dien Bien Fu of Vietnam is located at 30 km away from May district and operates the work from 7:00 am to 19:00 pm. The numbers of entry passengers were around hundred with around same numbers of exit. Recommendations made by the PoE staff were to have the PoE health operation office in the right location which should be at the position of first hand contact with travelers before proceeding to other checking counter such as immigration and custom.

Luang Namtha province

6) Boten – Mohan International Border checkpoint is located at 46 km away from Lung Namtha provincial town and shares the border with Muongla district of Yunnan province of China. The checkpoint received the highest traffic volume when compared to other checkpoints in the north provinces of Laos.  Starting at 7:30 am to 20:30 pm, the immigration counter recorded around 2,000 entry and exit around 1,000 exit checked per day. The cars and conveyances are counted for 800 of entry and 600 of exit.  2 health staff were appointed by Luang Namtha provincial health department and providing daily medical service to the checkpoint staff.  Thermo scanner, infrared thermometer and a manual blood pressure device were in place supported by Chinese Yunnan health authority 7) Pang Hay traditional checkpoint is located in Sing district at 75 km far and shares the border with Muongla of Yunnan province of China.

Bokeo province

8) Lao – Thai Friendship Bridge number 4 – An International checkpoint which connecting Houayxai district and Chiangkhong district of Chiang Rai province of Thailand. The checkpoint is located at 12 km away from Huayxai town.  12 hours of works per day from 7:00 pm to 6:00 pm and the immigration has recorded 500 entry checks against 450 of exit.  The number of the cars and conveyances were 70 – 50 of entry against 40 of exit.  Of the total 6 health officers designated to operate the health services at the checkpoint, 3 were appointed by the district health office and the rest were sent

by the provincial health department. There was no one working on human health quarantine for suspected travelers.  A manual blood pressure device and an infrared thermometer were put in place for health checking but the thermo scanner was lacking. 9) Golden Triangle checkpoint is an international checkpoint located in Ton Pheung district at the opposite border side Chiang Sen district of Chiang Rai province - Thailand. The operation time was 12 hours per day starting from 8 am to 20 pm. The number of entry crossing passenger were 400 and number of exit passengers were 200 per day. There was an infrared and a hand use thermometer available.

Recommendation made by the three checkpoints: o The health screening counter should be set up before all other designated checking desk o There will is a need to provide the training on the PoE health operation before being sent to work o Provide the minimum package of essential medicines o Need to have a motorbike for transportation of the staff to work o Need to be provided with the SOP for working o Computer for work record with the access to the internet for reporting and internet support cost

Luang Prabang

10) Luang Prabang International Airport.  The operation time started from 8:00 am to 8:00 pm with 800 – 1000 entry and 800 exit checks per day  1 nurse and 1 primary health care officer were posted by the health office of Luangprabang City. The nearest referral hospital is the military hospital, 2 km away from the airport.  There is a room for basic medical care operated by a nurse  The thermo scanner, a manual blood pressure device were available but no infrared thermometer  There was a monthly regular meeting of all officers and leaders of the checkpoint

Recommendations were to have:  Operation manual and SOP for outbreak response at the airport  Personal protection equipment  Infection prevention and control equipment and material  Disinfectant products and first aid kits  Printed IEC materials.  Training on the response to the outbreak at the airport.  Health uniform for PoE staff

Xaybouly province

11) Nam Ngeun cross border checkpoint  An international checkpoint between Ngeun district of Xayabouly and Nan Province of Thailand. The distance between the capital city and the checkpoint is 135 km.

 The operation time started from 8:00 am to 8:00 pm with an approximate 650 entry and 650 exit immigration checks; 200 cars in and 200 out per day  Only one food and drug inspector was appointed by Ngeun district health office, one animal and plant health were appointed by the department of agriculture.  A room for medical service is available but not in operation. The nearest health medical service is district hospital at 2 km far away from the checkpoint  Thermo scanner, infrared thermometer, blood pressure device and first aid kits were not in place 12) Phoudou cross border checkpoint. An international checkpoint between Paklai district and Ban Khok district of Outtradit province – Thailand, 200 km away from Sayabouly provincial administrative.  Operation time starts from 8 am to 16:00 pm  500 travellers entry checks against 400 exits  60 entry cars and 50 exits  2 health staff, 1 animal health and 2 plants health inspectors were sent from Paklai district authorities  There is room for basic medical service with only a hand use blood pressure device but not any indispensable drug available. The nearest referral hospital is the district hospital of Paklai  The checkpoint still lacks of thermo scanner, infrared thermometer 13) Namheuang. An International Cross Border checkpoint between Kenethao district of Xayaboury and Loei district of Thailand. The distance from Xayabouly provincial capital city to the checkpoint is 216 km. The working starts from 8:00 am to 6:00 pm with the numbers of entry and exit travelers of approximately 260 per day.  Numbers of cars in and out were 200. Three health staffs were in place including one health and two drug inspector appointed by Kenethao district health office.  There is a room allocated for medical care service with only manual blood pressure device.  It was lucking of thermo scanner, infrared thermometer.  The meeting for staff, officers and authorities of all sectors in the PoE was organized once a month and the meeting for the authorities of both sides of the border took place in every quarter

14) Namsoy International ground crossing point. Located at 80 km from Viengxay district, the checkpoint links to Quan Seun district of Thanh Hoa province of Vietnam. The work opens at 7:30 and closes at 17:30 pm.  There were a very small numbers of travelers crossing this checkpoint – 100 of entry and 90 of exit perday. Cars and lorries passing through were 80 per day

 2 health officers were posted by the provincial health department at the checkpoint but not clear job description.  2 staff posted by the district office of agriculture and forestry – 1 animal health and 1 plants health.  A room is available to provide medical consultation for the staff working at the checkpoint.  There was a manual blood pressure device, infrared thermometer but no thermo scanner, SOP and other manual to guide the PoE operation  A monthly regular meeting was organized for all PoE staff and an annual cross border meeting.

The recommendation made for: o The personal protection equipment and disinfectants liquid o Patient examination table o Training on PoE operation o Expansion and amelioration of working room

Xiengkhouang

15) Nam Kan international ground checkpoint is located in Nong Hed district at the distance of 138 km from Xiengkhouang administrative and 14 km from the district.  Working hours were from 7:00 am to 16:00 along which approximately 150 entry and exit travellers, 250 cars and transport trucks were recorded.  2 health staff posted by the provincial health department, 3 animal health and 2 plant health inspectors were sent by the provincial department of agriculture and forestry.  A room allocated for PoE staff medical service is equipped with an infrared thermometer, a hand use blood pressure device and minimum package of essential medicine  There is not the thermo scanner in place  A monthly meeting  An annual or be annual meeting between the two side

Recommendations were to  Have the manual or guideline for the outbreak response at the PoE  Have the PoE office posted at the frontward of other checking counters  Have the screening and quarantine room  Have the medical equipment, PPE, disinfectants, and minimum package of essential medicines  Provide the training on PoE’ health emergency preparedness and response

Bolikhamxay

16) Pakxan – Bungarn Cross border checkpoint  A Cross Mekong river checkpoint at the distance of 1 km from Pakxan town links with Bungarn province of Thailand.  Opens from 7:00 am to 6:00 pm, the checkpoint has recorded around 75 entry and 200 exit travelers. Cars and trucks were 20 of entry and 12 of exit  Only one female medical doctor designated by the district health office is in the duty of travelers’ health checking mainly temperature and blood pressure. 7

 2 animal and 2 plant health inspectors were posted  A monthly meeting of all sectors PoE staff and quarterly meeting of either sides authority

Recommendations were to: o Have the manual or guideline for the outbreak response at the PoE o Have the PoE office posted at the frontward of other checking counters o Have the screening and quarantine room o Have the medical equipment, PPE, disinfectants, and minimum package of essential medicines o Provide the training on PoE’ health emergency preparedness and response

17) Namphao – Kaocheo International border checkpoint. The Border checkpoint is between Khamkeut district of Bolikhamxay province and Huang Seun district of Ha Tinh province of Vietnam. The distance from Bolikhamxay provincial administrative is 212 km. The operation starts at 7:00 am and closes at 22:00 pm with the traffic volume recorded below:  400 Entry travelers against 449 exits  134 entry and 123 departure cars  1 health inspector was posted by the district health office and 1 drug inspector was from the provincial health department.  2 animal and 2 plant health inspectors were working at the checkpoint  There was a medical consultation service for the staff who needed with small items of essential medicines which was a self - supply of the checkpoint administrative.  A monthly meeting of all sectors of PoE and a quarterly meeting of both sides PoE authority

Khammouane province

18) Lao – Thai Friendship Bridge number 3. An international border checkpoint located at the distance of 15 km far from Khammouane provincial town.  The work operation starts from 6:00 am to 22:00 pm  About 300 travelers checked in and 300 checked out per day  Entry cars and trucks were 500 and exit cars were 300  The total numbers of staff working at the checkpoint were 113 including: o 63 immigration officers o 40 custom officers o 2 health officers appointed by the provincial health department o 4 veterinarians and 4 plant health officers  There is a room allocated for health medical consultation with a limited numbers of equipment available such as digital infrared thermometer, a manual blood pressure device.  The nearest referral health center is at the distance of 2 km  The meeting is organized once a month for all sectors’ staff and a cross border meeting was held once a year.

Recommendations were to have the availability of the personal protection equipment, disinfectants and antiseptic liquids, and first aid kits. There should have the training on the standard operation procedure for PoE health staff.

19) Naphao – Chalo. International cross border checkpoint that links Boualapha district of khammouane province with Chalo district of Quang Binh provice of Vietnam.  Operation started from 7:00 am to 7:00 pm  Immigration record counted for around 200 travelers of entry and around 150 of exit per day  Vehicles counted for 178 of entry and 192 of exit  Total numbers staff were 74 included 39 immigration officers, 29 custom, 2 veterinarians, 2 Plant inspectors, 1 Health and 1 drug inspector  There is a room for medical service operated by the above said health inspector  Equipment such as manual blood pressure device, thermometer for body temperature were in place but lacked of the thermo scanner  A monthly meeting of all sectors PoE staff and quarterly meeting of cross border

Savannakhet provice.

20) Savannakhet Intenational Airport Checkpoint is located in Kaysone Phomvihane City. Three days operation per week according the flight schedule which started from 8:00 am 16:00 with only one flight in each operating day. Immigration checks counted for an average of 20 of arrival passengers and 5 to 15 of departure. One health staff was appointed to take care of screening the arrival travelers using the newly installed thermo scanner. An infrared thermometer, and a manual blood pressure were also available 21) Lao-Thai Friendship Bridge 2. An International Cross River Checkpoint between Kaysone Phomvihane City and Mookdahan Mookdahan province of Thailand. The checkpoint opens at 8:00 and closes at 22:00 pm with:  Around 1400 entry and 1500 exit travelers. Cars and trucks counted for 500 in against 300 out.  2 health staff were posted by the provincial health department  3 animal health inspectors  2 plant health inspectors  The provincial hospital serves a referral hospital  There was a quite large office room jointly used for both medical consultation service and for drug shipping clearance  Thermo scanner, infrared thermometer, a manual blood pressure device were available  The provincial hospital serves a referral hospital  The meeting for Lao staff is organized once a year and every six months for both side checkpoint authorities. 22) Dansavan – Lao Bao. International Cross Border Checkpoint between Sepon district of Savannakhet province and Heuang Hoa district of Quang Tri province of Vietnam is located at the distance of 287 km from Kaysone Phomvihan City. Opening at 7:00 am and closing at 22:00 pm the checkpoint recorded about:  400 entry and 250 exit travelers. Cars and trucks checked numbers were around 100 of entry and 70 of exit.

 2 health and 3 food and drug inspectors were posted by the provincial health department, and 2 animal plus 3 plant health inspectors  Thermo scanner, infrared thermometer, a manual blood pressure device were available  An annual meeting of all sectors’ staff and quarterly meeting of both side checkpoint authorities

Recommendation of all three checkpoints was to have:  The Health checking and screening must be done before immigration check  Need to have more training on the utilization of equipment for the screening of the travelers  Sufficient supplies of essential medicines for the staff at the checkpoint  The motorbike for health staffs to move from home to work  Vietnam side proposed to have the MOU signed for the development of a suitable health declaration form

Saravanh province

23) Lalay International cross border checkpoint is located at the border of Samouay district at the distance of 147 km from the provincial town and links with Dackrong district of Quang Tri province of Vietnam. Opening at 7:00 am and closing at 7:00 pm, the checkpoint has recorded very low volume of international traffic  Around 150 entry and 20 exit travelers, 20 to 25 entry cars and trucks and 5 to 10 outgoing cars and trucks.  There was only one drug and food inspector sent by the provincial health department. There was no room for health medical service.  Only one infrared thermometer to screen the passengers’ temperature.  lacking of thermo scanner, sphygmomanometer.  The nearest health center is at a half km from the checkpoint  3 animal and 2 plant inspectors were posted  The meeting of the staffs of Lao side was held once a year and the cross border meeting was organized twice a year

24) Pak Taphane – Paksae. The local traditional cross Mekong river border checkpoint between Lakhonepheng district and Natane district of Oubon province of Thailand. This is a checkpoint utilized by the local residents of two sides. There were a hundred people crossed the checkpoint for a traditional exchange between 2 sides, mainly food, clothes, agriculture equipment and materials, fruits and plants. There had not any health screening equipment and not health staff working at the checkpoint.

Recommendations were made for:  To provide the training on PoE health operation  To have transportation for work  Need to have IT equipment for communication and for submission of the work report

Sekong

25) Dark Ta Ork. The International Cross border checkpoint located at the border between Dark Chung district and Nam Yang district of Quang Nam province of Vietnam  150 km away from the Saravane provincial town  Opens from 7:00 am to 7:00 pm  100 of entry travelers and same numbers of exit per day with very few numbers of cars crossing in and out – around 10/6  1 health inspector and 2 drug inspectors  1 animal and 1 plant health inspector  One health care room with small provision of essential medicine  Digital infrared thermometer is available Recommendations were made for:  To provide the training on PoE health operation  To have transportation for work  Need to have IT equipment for communication and for submission of the work report Attapeu

26) Phou Keua. International cross border checkpoint localizes in Phouvong district and links with Ngoc Hoei district of Quang Toum province of Vientnam. The distance away from the provincial town is 112 Km  Operation time from 7:00 am to 19: 00 pm  Around 200 entry and 195 exit per day with an average of 45 entry and exit cars and trucks  2 drug and food inspectors appointed by the provincial health department, 24 custom officers, 25 immigration officers, 3 animal and 1 plant health inspectors  No medical service room, no thermo scanner and no essential medicine available. The only medical equipment existed was the infrared thermometer.  The nearest health service is the health center at 13 km away from the checkpoint  An annual regular meeting of all working staffs and a bi annual meeting with the other side staffs

Recommendations were to:  Have proper medical/health office with proper location at the checkpoint for first hand checking the travelers  Have established a quarantine room and well equipped  Health staff to be well trained with regard to PoE health operation  Have exposure to PoE works in neighboring countries where the experiences have already been more in advance  The Border checkpoint is far from home of the staff – need to have a motorbike for traveling to work

Champasack

27) Pakse International airport checkpoint. Located at 2 km from the heart of the City. Opens at 8:00 am and closes at 16:00 pm

 Both entry and exit passengers counted for around 40 to 45 per day  There was not indicated how many flight in a day  There has no health medical room service, however one health staff appointed by the provincial health department to take care of a thermo scanner and an infrared thermometer.

28) Vang Tao – Chong Meck. The international ground crossing point linking the border of Phon Thong district of Champasack province to Sririnthone district of Ubon Rajthany province of Thailand. The border is about 48 km from the district.  Opens at 6:00 am and closes at 20:00 am  Entry travelers were 700 – bigger than exit travelers 250 per day  Cars and trucks in 120 against 50 of exit  43 custom and 45 immigration officers  1 health staff appointed by the district health office, 2 animal and 2 plant health inspectors appointed by the provincial department of agriculture and forestry  Medical devices (hand use blood pressure device and infrared thermometer) were available but the thermo scanner was lacking. A very small package of essential medicines was observed.  There was not an established health medical room for health service. The travelers’ temperature screening is done in the tent outside the building. The nearest health center is located at the distance of 15 km away from the checkpoint.  A meeting for all staff takes place once a month and the meeting with the opposite side is organized every quarter.

Recommendation  The travelers should be at first hand checked by health checking counter before proceeding to immigration and custom checks  Request the personal protective equipment  Need to have various training courses for staff appointed to work at the checkpoint  Need to have the SOP

29) Nong Nockhian – Tapiankria. International border checkpoint linking Khong district with Tapiankria district of Strungteng province of Cambodia. 160 km from Pakse City. Open at 7:00 am and close at 6:00 pm with small number of entry and exit travelers around 120 and very few number of cars  2 health and 1 food and drug inspectors appointed by Khong district health office  3 animal health inspectors  1 health care service room with an infrared thermometer and a hand use blood pressure device. There is no thermo scanner available  The nearest healthcare service is located at 24 km away from the checkpoint  A monthly meeting for all staff and a month year meeting with the opposite side staff

Recommendation  The equipment for screening the passengers, mask and other personal protective equipment, antiseptic liquid and the essential medicines

 Training on PoE health emergency operation and SOP

Vientiane Province

30) Mun - Pakxom local checkpoint between Mun District, Vientiane province and Pakxom district of Loei province of Thailand. It is at 80 Km away from Vientiane province. Similar level of operation with Sikhottabong traditional checkpoint in Vientiane capital, this checkpoint was used by the population of the two sides of the Mekong River for traditional exchange.  No health staff in place  1 animal and 1 plant inspectors  Infrared thermometer and manual blood pressure available.