Health system strengthening through primary health care
Health servcie delivery
Health services delivery is organized under three levels based on the administrative structure of the Government at national, province or aimag and district or soum levels. There are 21 aimags, each of which is split into smaller soums, which are further divided into three to four smaller units (baghs), depending on the size of their population. Mongolia’s health system is traditionally based on the Russian model, where greater emphasis is placed on hospital and clinical care rather then on preventive and promotive care. As of 2011, there were 68.1 hospital beds per 10 000 population in Mongolia. A number of general tertiary hospitals and specialized institutions such as the National Center for Communicable Diseases, National Center for Mental Health, National Center for Cancer are operational at the central level in Ulaanbataar, with secondary-level hospitals at aimag centers and inter-soum general hospitals at soums centers. Primary health care services are mostly provided by the soum health centes, bagh feldshers (midwife) among community and family health centers in the capital city and aimag centers. Nine districts in the capital also provide primary and secondary health services.
There is growing private sector involvement in the provision of health care services. A wide range of private hospitals, out-patient clinics, traditional medicine hospitals and clinics and laboratories are being established. Challenges remain in regulating the quality and cost of such services.
In 2011, there were 20.0 physicians per 10 000 population in rural areas, and 38.8 physicians per 10000 population in the capital city of Ulaanbaatar. A shortage of physicians and other health workers such as nurses and midwives at primary health care level undermines universal access to quality health services, especially for those in greatest need. Moreover, training of human resources is not linked to policies and planning in the health sector. The training of doctors is mostly focused on curative rather than the preventive and health promotion aspect of health services. There is an insufficient skill-mix and inequitable workforce distribution.
Public source of health expenditure as a share of GDP dropped from 4.9% in 2001 to 3.1% in 2011. However, according to National Statistics Office data, per capita health expenditure increased from 33.200 MNT (US$23.00) to 119764.5 MNT (US$83) between 2005 and 2011 in real terms.
The predominant share of the health expenditure is on secondary and tertiary care, leaving only 32.15% to primary health care. In 2002, only 4.7% of total health expenditure was spent on prevention and public health services, while 77% of total expenditure on public health has been mobilized through international loan and grant aid.
An overview of the health sector budget for the period from 2000 to 2011 by its main sources reveals the Government (76.0%) and the Health Insurance Fund (21.0 %) as the major contributors, followed by revenues from fees for services and supplementary activities (3.0%) as shown in Table 4. National health accounts system has not been established. WHO Global Health Expenditure Database shows that out-of-pocket payment has been increasing since 2005 to reach 41.4% of the total health expenditures in 2010.
Social health insurance was introduced in 1994. The government pays contributions of vulnerable social groups such as pensioners, children up to 16 and citizens with disabilities. Herders, self-employed, unemployed and students pay their contributions by themselves. In recent years health coverage of the population did not see significant rises (84.9% - in 2000, 80.7% - in 2007, 77.5% - in 2009, 82.5% - in 2010). Migrants, herder populations, students and unemployed people are still not covered by social health insurance. As of 2011, 64.2% of health insurance fund expenditure was on inpatient care, 15.9% on outpatient care, 6.7% on diagnostics and tests, 3.3 % on discounted drugs, and 6.7% on day care and sanatoriums.
- Strategic priority 1: Health system strengthening through primary health care approach
- Strategic priority 2: Scaling up prevention and control of noncommunicable diseases (NCDs), injuries, violence and their determinants
- Strategic priority 3. Sustaining and accelerating the achievement of health related MDG targets
- Strategic priority 4. Strengthening health security, including control of communicable and vaccine preventable diseases
- Strategic priority 5: Strengthen Environmental health programme