Mongolia Health Profile 2012

Ministry of Health's mission, vision and objectives

The Ministry of Health is the Government’s central administrative body responsible for health policy formulation, planning, regulation and supervision, and for ensuring implementation of health-related activities and standards by its implementing institutions and agencies.

The vision of the Ministry of Health is to strive to ensure the availability, accessibility, affordability and equity of quality health care services for all Mongolians. Health care will be provided through a needs-based health system which will specifically address the health issues affecting vulnerable groups (particularly the poor), and regulate and enhance the health sector’s human resource capacity. The ultimate goal of the Ministry is to promote social and economic development through poverty alleviation.

The Ministry’s mission is to build favourable living conditions for people by upgrading the quality of health care, public health services and health care preventive actions to international standards.

Within the scope of its mission, the Ministry of Health aims to fulfil the following strategic objectives:

• To develop health laws, policies, long and midterm strategies and programmes, and provide policy guidelines;
• to ensure leadership of public administration and human resources management and create effective, accountable and transparent work conditions;
• to administer and coordinate public health policy implementation to support health-promoting settings;
• to administer and coordinate health care and services policy implementation;
• to provide financial management for the health sector;
• to carry out monitoring and evaluation of the implementation and output of health laws, policies, programmes and projects, and provide information for clients;
• to administer and coordinate pharmaceutical and medical supplies policy implementation; and
• to develop and coordinate international cooperation in line with health sector policies, priorities and strategies.

Organization of health services and delivery systems

The health care system is characterized by three levels of care and its prevailing principle is to deliver an equitable, accessible and quality health care service to every person. Primary health care is provided mainly by family group practices in Ulaabaatar, the capital city, in aimag centres, and in soum and inter-soum hospitals in aimags. Secondary care takes place in district general hospitals in Ulaanbaatar and in aimag general hospitals. Tertiary care is provided in major hospitals and specialized centres in Ulaanbaatar.

The Mid-Term Implementation Framework of the Health Sector Master Plan for the period of 2007-2010 was approved by Health Minister’s Order #43 of 2007. Seven key areas and 24 strategies have been incorporated to facilitate the delivery of socially responsive, equitable, accessible and quality services to all. The overall outcomes to be achieved by 2015 include increased life expectancy; a reduction in the infant mortality rate; a reduced child mortality rate; a reduced maternal mortality ratio; improved nutritional status, particularly micronutrient status among children and women; improved access to safe drinking water and basic sanitation; prevention of HIV/AIDS; sustainable population growth; reduced household health expenditure, especially among the poor; a more effective, efficient and decentralized health system; and an increase in the number of client-centred and user-friendly health facilities and institutions.

In 2009, policy documents, including the Hospital Waste Management Strategy, the National Strategy on Deafness and Hearing Impairment Prevention and Control, the E-Health Development Strategy, the National Strategy on Tuberculosis Prevention, and the National Strategy on Security and Sustainable Supply of Reproductive Health Drugs and Supplies, were approved.

An overview of the health sector budget for the period from 2000 to 2009 by its main sources reveals the Government (75.3%) and the Health Insurance Fund (22.0 %) as the major contributors, followed by revenues from fees for services and supplementary activities (2.7%). Due to the economic crisis, the percentage of health financing from the government budget decreased by 3.7%, while the percentage from the Health Insurance Fund increased by 4.0%.

Health insurance coverage (introduced in 1994) reached 77.6% of the population in 2009, a decrease of 5.6% from the 83.2% in the previous year. Health Insurance Fund income and expenditure have been increasing, year by year, since 2000. As of 2009, over 83.43% of Health Insurance Fund expenditure was on inpatient care, 11.07% on outpatient care, and the remaining 5.5 % on discounted drugs, sanatoriums and other costs.

In 2009, the health expenditure breakdown by level of care was: 21.7% to tertiary care, 31.7% to secondary care and 23.6% to primary health care.

Most health sector human resource issues require the involvement and cooperation of multiple sectors. In that regard, a high level Intersectoral Coordinating Committee on Health Sector Human Resources, comprising representatives of the Government, ministries and international donors, has been established with a view to improving political commitment and donor support and funding to coordinate the implementation of health sector human resource policies and strategies at the national level. Priority areas and a strategy for action for the Committee have been approved by the Prime Minister and the Committee Chairman. Within the action plan, priority actions have been identified, including, among others, introducing a separate and independent labour-norm- and performance-based salary system for health professionals, varying according to differences in responsibility and geographical location; developing multiple-choice incentive packages to encourage specialists to work in rural, remote areas; and revising and renewing the accreditation criteria for medical training institutions.
Partnerships

The Government has begun implementing a health project supported by the Millennium Challenge Account. The project aims to decrease mortality and morbidity due to noncommunicable diseases and injuries and to increase the length and quality of life of Mongolians by decreasing behavioural risk factors among the population; supporting prevention and early detection of arterial hypertension, myocardial infarction, stroke, diabetes, cervical and breast cancer; and improving the quality and accessibility of NCD care.

Information technology contributes greatly to the health sector in terms of upgrading health service quality, providing patient-friendly health services, easing the workloads of health professionals, and improving the efficiency and quality of health information. In recent years, there has been an intensive programme to introduce the latest information and communication technologies into the health sector to keep up with current e-health development. Unfortunately, because of a lack of proper coordination, and standardization, instead of making things simpler and easier, some efforts have led to additional workload and have made matters more complicated. As a developing country, donor support is required to develop e-health, and a number of projects are under implementation. There is a rising need to define priority action areas to develop e-health, as well as rational and efficient resource allocation.

On the basis of the above-mentioned needs, the Ministry of Health has developed the E-Health Strategy for 2010-2014, which will play a central role in defining the direction for the renewal and development of e-health; defining its structure and content; defining the direction for use of information communication and technology; and providing coordination for implementation. The E-Health Strategy has defined priority action areas for e-health in the field of developing the health workforce, improving the quality of health care services through the use of telemedicine and other e-health applications; developing e-information systems and an infrastructure for e-health; creating an enabling environment for e-health; and promoting health education for the population.

HEALTH & DEVELOPMENT
Impediments to poverty reduction Despite the positive trends in economic growth, thousands of Mongolians lead highly insecure lives. There have been growing disparities between rural and urban areas (including discrepancy within urban areas). These disparities are reflected in many dimensions including poor access to basic social services in underserved sub-urban and rural areas, in urban housing and infrastructure, and in access to information. Effective public provisioning in rural areas have to face the challenges of long distances, scattered populations and nomadic lifestyles.
Burden of communicable diseases Overall communicable diseases have decreased over the years, though still account for high proportion of overall DALYs and are of significant socio-economic importance due to their potential for causing outbreaks and health emergencies.

Burden of noncommunicable diseases (NCD) Mongolia is experiencing an epidemiological and demographic transition with decline in morbidity and mortality from communicable diseases and an increase in burden due to chronic and noncommunicable diseases as reflected in the five leading causes of mortality.

Maternal and child health The Government of Mongolia has placed a high priority on achieving Millennium Development Goal 5. Some of the major achievements of implementing the above strategies are associated with high coverage of antenatal care (87.7%) and delivery by skilled birth attendance (99.8%). However, providing maternal services to mobile and migrant population is a challenge.

Health sector responsibilities A long-term policy framework, the Health Sector Strategic Master Plan (2006-2015),
was approved in 2005. The overall outcomes to be achieved by 2015 include increased life expectancy, a reduction in the infant, child and maternal mortality rates, improved nutritional status, particularly micronutrient status among children and women, improved access to safe drinking water and basic sanitation, prevention of HIV/AIDS, sustainable population growth, reduced household health expenditure, especially among the poor, a more effective, efficient and decentralized health system, and an increase in the number of client-centred and user-friendly health facilities and institutions.