Mongolia’s National Immunization Programme is evaluated as well-established amid existing challenges

The joint national-international comprehensive review of Mongolia’s National Immunization Programme (NIP) conducted from 17-31 May concluded that the country has a “well-established and integrated NIP, that incorporates other preventive services and motivated staff interested in reaching goals”. Ten international monitors from WHO headquarters, WHO Western Pacific Region, WHO and UNICEF Representatives’ Offices in Mongolia and USA Centres for Disease Prevention and Control have worked hand-in-hand with the national counterparts to aid the country in assessing its NIP.

The review aimed at evaluating achievements in vaccine preventable diseases control and exploring ways to improve implementation of immunization activities in the country. The review incorporated not only quantitative assessment but put an emphasis on qualitative analysis.

“This review covered all administrative levels of the NIP at the national, provincial, capital Ulaanbaatar city, district and sub-district levels and included assessment of the work of immunization units in family health centres, soum health centres and maternity wards, including private health facilities providing immunization. For this task eight teams were deployed all over the country,” said Dr Sergey Diorditsa, Coordinator of the Extended Programme on Immunization Unit at WHO Western Pacific Regional Office and the NIP review team lead.

The evaluators concluded that Mongolia ensured vaccine security with a quality vaccine supply. At the same time the review revealed a number of challenges in the NIP. Among those an importance of having costed midterm immunization plan to inform annual plans of the Ministry of Health (MoH) and developing effective mechanisms for multisectoral resource mobilization were mentioned. “One of the findings is that the data should be systematically used for planning immunization activities,” commented Eric Laurent, the WHO senior consultant suggesting that data should be better used “for action directed at outreach and catch-up immunization” or identifying the unimmunized. Mr Laurent also added that surveillance being the intelligence of the NIP should be improved in the country. “Without intelligence we are blind,” he said.

Mongolia became the first country in the world where a standard NIP review was combined with its financial sustainability analysis. “Mongolia still has an inputs-based instead of the resources-driven system,” said David Sulaberidze, the lead evaluator of the financial sustainability component of the NIP. According to him it’s been challenging to evaluate sustainability of the Programme due to difficulties to find out the real expenditures for immunization as “all immunization-specific costs in Mongolia are integrated into more general items”. The expert warned that not identifying the real resource requirements may present difficulties in introducing new vaccines as IPV (injectable vaccine against polio), PCV (vaccine against pneumococcus) and HPV (a vaccine preventing development of cervical cancer).

“Based on the NIP review outcomes and recommendations the MoH with support of WHO, UNICEF and other partners is going to develop a five-year long costed comprehensive programme on immunization that would include new vaccines,” says Dr Narangerel Dorj, the head of the Emergency Operations Centre at the MoH.

Introduction of new vaccines to the NIP is currently being planned by the Ministry of Health and now needs support from Mongolia’s parliament. Therefore it was recommended to better inform decision-makers about importance of vaccines as a cost-effective preventive measure and advocate for required funding. It was also recommended to improve public communication about benefits of new vaccines. Mongolia’s Vice-Minister of Health, L.Byambasuren, thanked the team of experts for conducting a significant amount of work in a limited time and issuing a set of valuable recommendations to the country. “The previous NIP review was conducted in 2002. Since then the NIP in Mongolia had many achievements as well as learned lessons. It’s been very useful to have the work of the past 15 years evaluated,“ said Mrs. L.Byambasuren. “The experts have shown us the way to fill in the gaps in the NIP and we are going to establish a working group that will ensure the implementation of the recommendations including ensuring the financial sustainability of the Programme”.