Free and universal access to primary healthcare in Mongolia: the service availability and readiness assessment

Abstract

Background The government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. However, no evidence is available on the physical presence of PHC services within health facilities. Thus, the present study assessed the capacity of health facilities to provide basic services, at minimum standards, using a World Health Organization (WHO) standardized assessment tool. Methods The service availability and readiness assessment (SARA) tool was used, which comprised a set of indicators for defining whether a health facility meets the required conditions for providing basic or specific services. The study examined all 146 health facilities in Chingeltei and Khan-Uul districts of Ulaanbaatar city, including private and public hospitals, family health centers (FHCs), outpatient clinics, and sanatoriums. The assessment questionnaire was modified to the country context, and data were collected through interviews and direct observations. Data were analyzed using SPSS 21.0, and relevant nonparametric tests were used to compare median parameters. Results A general service readiness index, or the capacity of health facilities to provide basic services at minimum standards, was 44.1% overall and 36.3, 61.5, and 62.4% for private clinics, FHCs, and hospitals, respectively. Major deficiencies were found in diagnostic capacity, supply of essential medicines, and availability of basic equipment; the mean scores for general service readiness was 13.9, 14.5 and 47.2%, respectively. Availability of selected PHC services was 19.8%. FHCs were evaluated as best capable (69.5%) to provide PHC among all health facilities reviewed ( p < 0.001). Contribution of private clinics and sanatoriums to PHC service provisions were minimal (4.1 and 0.5%, respectively). Service-specific readiness among FHCs for family planning services was 44.0%, routine immunization was 83.6%, antenatal care was 56.5%, preventive and curative care for children was 44.5%, adolescent health services was 74.2%, tuberculosis services was 53.4%, HIV and STI services was 52.2%, and non-communicable disease services was 51.7%. Conclusions Universal access to PHC is stipulated throughout various policies in Mongolia; however, the present results revealed that availability of PHC services within health facilities is very low. FHCs contribute most to providing PHC, but readiness is mostly hampered by a lack of diagnostic capacity and essential medicines.

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“…On the other hand, the current readiness score (63.5%) was relatively higher compared to research findings from Mongolia 35 where the readiness index score for TB services was 53%. This was due to unavailability of diagnostic tests and essential drugs where only 44% of the health facilities could provide basic health services.…”

“…Similar results were also reported from previous studies in Ethiopia, 8,23,39,44 Ghana, 4,6,7 Mozambique, 5 South Africa, 32 Nigeria, 33 Tanzania, 43 Nepal 47 and Mongolia 35 where most of the rural health facilities had uneven health facility distribution, inaccessible, and poor readiness (lack of staff, reagents, electric power, and equipment) of health facilities.…”

“…[5][6][7][8]29 Ensuring access and quality of healthcare services is one of the main functions of a health system, but most of the developing countries failed to achieve this due to continuing poverty, [1][2][3]29,30 poor facility readiness, [5][6][7][8] and not using advanced diagnostic technologies in the health systems. 1,7,8,31 Studies from Ghana, 4,7 South Africa, 32 Nigeria, 33 Yemen, 34 Mongolia 35 and Mozambique 5 showed that majority of the health facilities were geographically inaccessible, and had no TB diagnostics.…”

Legislation and current developments in adverse drug reaction reporting in Mongolia: how far are we?

“…The health care system of Mongolia consists of state-owned, private and mixed-owned health facilities that are in charge of public health, medical care service, pharmaceuticals supply, health education, research and training. The delivery of health services is challenged by the country’s extremely low population density over a large territory[ 14 ].…”

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“…This is consonant with results reported from similar studies. Studies conducted in constraint settings divulged that facilities demonstrated lower capacity for treating NCDs as compared to infectious diseases (IHME, 2014;Jigjidsuren et al;Mutale et al, 2018). Despite NCD being biggest contributor of disease burden; it has been put on the backburner and integration on NCD interventions into framework of public health delivery has been quiescent.…”