Mongolia's system-wide health reforms:lessons for other developing countries

Abstract

Mongolia is a poor country that lost 30% of its GDP when the Soviet Bloc collapsed in 1990. Its health care system had the typical weaknesses of centrally planned economies--quantity rather than quality, excessive medical specialisation, dominance of the hospital sector, weak policy and management capabilities, little community participation in decision making, and so on. This paper describes Mongolia's attempts to resolve these problems through a radical program of reform that began in 1998. There have been significant successes in spite of almost overwhelming difficulties, and this may be a consequence of the strong sense of community that has been present for five hundred years and re-emerged intact at the end of 70 years of Soviet dominance. We argue, however, that good design and skillful implementation of the reform program may have made a contribution. Its notable features have included the use of a comprehensive and integrated model rather than piecemeal reform, the generation of political support for change through social marketing campaigns, a team approach using local and international experts, and co-ordination of international donor activities. Some of these features may be relevant to other transitional and developing countries.

Emerging Infectious Diseases in Mongolia

“…Since that time, its economy has been changing from a centrally planned socialist system to a free market economy with healthcare delivery reflecting that transition ( 1 , 2 , 4 – 6 ). …”

Community involvement in health in Mongolia: hospital boards and other participatory structures

“…One of the major vehicles for health service reform in the country is the Health Sector Development Program (HSDP), an initiative funded by Asian Development Bank loans (O'Rourke and Hindle 2001). The HSDP includes the promotion of primary health care, private sector involvement in the delivery of health services, rationalisation of health facilities, rationalisation and retraining of the health workforce, refinement of health care financing and management capacity, and protection of access to health services for vulnerable groups (RRP 1997).…”

Health Sector Reform and Sexual and Reproductive Health Services in Mongolia

“…Improved links with Bag Feldshers, and development of their public health and referral roles will increase access to nomadic herding communities. 22 With 38% of maternal deaths occurring at Soum Hospital level, and late referral contributing to deaths at higher levels, the interventions have the potential to significantly enhance reproductive health outcomes for the rural poor.…”