Door-to-door diagnosis—part of Mongolia’s push towards universal health coverage

Bayarjargal Norov, 44, is from Dersene-Us—a remote village some 800 kilometres south of Ulaanbaatar, the Mongolian capital. Bayarjargal is a herder and he is also the governor of Dersene-Us.

When not looking after his livestock, Bayarjargal meets with residents, explains state policies, supports their implementation, and listens to people’s grievances. What he often hears is that people have neither the time nor the means to have regular health check-ups.

Many people in Bayarjargal’s community only go to the doctor when they have an urgent need, such as for childbirth, injury or serious illness. Mongolia is one of the most sparsely populated countries in the world, and Dersene-Us is 80 kilometres from the closest health centre. Going to hospital can be costly and time-consuming.

“People often reach health services too late, when diseases such as cancer—especially liver cancer and cirrhosis, of which Mongolia has a high burden—are advanced,” says Mongolia’s Minister of Health, Ms Sarangerel Davaajantsan. “In 2015, WHO helped the Government to start the m-Health initiative to bring screening for common diseases to people in their homes, starting with the most remote rural herder families and the most disadvantaged urban households who are often unable to afford health checks.”

People in these communities are offered testing for communicable and noncommunicable diseases including viral hepatitis, tuberculosis, HIV and other sexually transmitted infections as well as blood cholesterol tests, blood sugar tests for diabetes, blood pressure measurement, electrocardiograms for heart problems and ultrasounds for pregnant women and for internal chronic and acute diseases. Doctors and nurses from the soum or sub-province health centre go door to door, offering the mobile screening services.

“M-Health is a very suitable and cost-effective approach for delivering health care, particularly in Mongolia with its remote populations scattered through the vast territory and the disadvantaged urban populations. We’re very grateful to WHO and partners who supported us in implementing this initiative and are keen to replicate it throughout the country,” says Minister Sarangerel.

Dersene-Us is one of three soums selected by Mongolia’s Ministry of Health and WHO to pilot m-Health. Since July 2016, the mobile screening team has been conducting health checks for the herder community.

Temperatures in Mongolia range from 40 degrees Celsius in summer to minus 40 degrees in winter. Bayarjargal built an extra ger—a traditional round-shaped tent—as a more private and comfortable location for herders and their families to undergo health checks. He also helped spread the word about the service. He led by example and was among the first to be screened.

The test results showed that Bayarjargal’s gall bladder and kidneys were inflamed, so despite losing one day of work, Bayarjargal agreed to make a trip to the soum health centre for additional testing. His diagnosis was confirmed and Bayarajargal received a treatment plan and medication. He will need to come back to the soum health centre after treatment to undergo retesting.

“Because of the mobile health screening, I was diagnosed early and got timely treatment. My family has been very supportive," says Bayarjargal. Moreover, he added that the health professionals’ advice for healthy living has helped him and his family make changes to their lifestyle and abandon some unhealthy habits, such as too much salt and animal fat in their meals. The initiative—which is financially supported by the Korea Foundation for International Healthcare and the Community Chest of Korea—has been successful in detecting illnesses among Mongolia’s remote and disadvantaged populations and ensuring people receive the care they need, when and where they need it, in line with the aims of universal health coverage. Over the course of a year, more than 14000 people in three countryside locations and two subdistricts in the capital city of Ulaanbaatar received early screening, and thousands received timely medical care.

“Guided by the principle of leaving no one behind, WHO is supporting Mongolia’s efforts to advance towards universal health coverage by setting a further goal to reach people with quality services where and when they need them,” says Dr Sergey Diorditsa, the acting WHO Representative in Mongolia.

Dr Unurjargal Tsenddoo, Director of the Department of Health of Umnugobi province, where Dersene-Us is located, shared her plans for expanding access to m-Health: “We were able to deliver screening to people in three of the most remote soums using mobile technologies, thanks to the WHO-supported initiative. We want to expand the use of m-Health technologies to all 14 soums in the province so that we leave no one behind.”

Related links:

Leaving no one behind: Health and the SDGs in Mongolia
May 2017
http://iris.wpro.who.int/handle/10665.1/13588

Leaving no one behind in planning local health care strategies in Mongolia
March 2017
www.wpro.who.int/mongolia/mediacentre/releases/20170315-leaving-no-one-behind

Subnational health system strengthening in Mongolia
November 2016
www.wpro.who.int/mongolia/mediacentre/releases/subnational_health_system_strengthening_in_mongolia

Mongolia State Policy on Health 2017-2026 mainstreams universal health coverage
January 2017
www.wpro.who.int/mongolia/mediacentre/releases/20170118-state-policy-on-health-mainstreaming

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