Country Programme on Viral Hepatitis Prevention and Control

Background

Mongolia is one of the countries in WHO Western Pacific Region with high burden of viral hepatitis. Hepatitis A was the most common cause of acute jaundice reported until 2012, then year when hepatitis A immunization among children was introduced. Hepatitis B and hepatitis C are endemic in the adult population of Mongolia. It is estimated that about 400,000 people are infected with hepatitis B and C. As a result of the successful hepatitis B immunization program introduced in Mongolian in 1991, the prevalence of hepatitis B in 5-year-olds in 2011 has dropped to 0.53% which exceeds the 2017 WHO Western Pacific Region’s “less than 1%” target. Mongolia has the highest rate of liver cancer and liver cancer mortality in the world. Over 95% of liver cancer cases are associated with hepatitis B and/or C infection.

WHO’s support to address viral hepatitis in Mongolia

WHO identified as one of the priority countries to address burden of viral hepatitis. In the end of 2014 WHO and Centers for Disease Control and Prevention, USA (CDC) undertook an assessment of current situation and response to viral hepatitis in Mongolia and provided recommendations in areas of policies and strategies, screening and testing, care and treatment, laboratory and financing. The main national stakeholders discussed assessment findings and recommendations and identified a need of developing a new strategy for viral hepatitis prevention and control from 2015 onwards.

WHO in collaboration with the CDC provided technical and financial support to the Ministry of Health and Sports to conduct stakeholders’ technical meeting on viral hepatitis. The main objective of this meeting was to discuss the burden of viral hepatitis, liver-related diseases including liver cancer, and to develop strategic actions for combatting viral hepatitis. Ulaanbaatar, 12 September 2014

The assessment also proposed to undertake demonstration initiatives including screening, care and treatment, key programmatic, monitoring and evaluation mechanisms to be tested in one selected district and one province. As a follow up to this recommendation, WHO explored possible collaboration with the US public health institutions on implementation of the demonstration initiative in Mongolia holding discussions with US National Institute of Health (NIH) and CDC during Mongolia-US scientific workshop on “Viral Hepatitis and Primary Liver Cancer” held in Ulaanbaatar in September 2015. Currently, WHO continues to provide support in development of a proposal of the demonstration initiative.

At the Consultative Meeting on National Viral Hepatitis Strategy. Ulaanbaatar, 21-22 January 2015

With new developments in hepatitis C care and treatment the Ministry of Health and Sports initiated policy discussions with the Parliamentary Standing Committee on Social Policy, Education, Culture and Sciences. WHO provided technical support during this policy dialogue and proposed to have a multistakeholder dialogue to discuss viral hepatitis financing options in Mongolia. The financing dialogue concluded the necessity of conducting economic analysis of hepatitis B and C care and treatment. WHO in collaboration with the Ministry of Health and Sports and the Centre for Disease Analysis completed hepatitis C burden and economic modelling exercise. Its results were used for costing of the “Comprehensive National Programme on Prevention, Control and Treatment of Viral Hepatitis 2016-2025” developed in 2015.

At the stakeholders’ technical meeting on viral hepatitis. Ulaanbaatar, 12 September 2014

National Sub-programme on Viral Hepatitis Prevention and Reducing Liver disease-related Morbidity and Mortality 2016-2025

The Mongolian Government approved a new programme “National Sub-programme on Viral Hepatitis Prevention and Reducing Liver disease-related Morbidity and Mortality 2016-2025” on 16 November 2015. This Sub-programme aims to prevent viral hepatitis, conduct early detection of hepatitis infection and reduce transmission and mortality due to liver diseases including chronic hepatitis, cirrhosis and primary liver cancer. It focuses on prevention of viral hepatitis, strengthening surveillance, expanding immunization services to high risk groups, improving infection prevention control in health sector, screening, early diagnosis and treatment of viral hepatitis by providing evidence-based, quality, accessible, comprehensive health services, implementation of research and innovation, and strengthening public and private partnerships.

WHO continues to provide technical support in implementation, monitoring and evaluation of the approved Sub-programme. Further discussions on financing options for viral hepatitis programme will be held in collaboration with Ministry of Health and Sports, World Hepatitis Alliance and other development partners. WHO also will provide support in advocacy, development and updating of the National Guidelines on Hepatitis B and C, conducting economic analysis for hepatitis B care and treatment, strengthening capacity of health providers, and strengthening hepatitis information system and surveillance.

The Mongolian government has enabled the newly available treatment for hepatitis C through setting up a tired pricing policy on two types of drugs registered in Mongolia later last year. The government has been studying all available financial options to reduce the burden of treatment.
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