Modern health services in Mongolia have been developed since 1921. From 1940s the health infrastructure has expanded rapidly thoroughly country under the influence of the Soviet Union and modelled on a strong central planning process. This includes such features as the use of feldshers as paramedical personnel among scattered populations, along with a high degree of specialisation of physicians, with no category of general or family practitioner. More recently, renewed interest has also emerged in traditional medicine based on a revival of Buddhist beliefs and practices, fresh emphasis on all traditions as they represent Mongolia identity.
The population health status was dramatically improved in Mongolia through 20th century. Within this period of time infant mortality had decreased by 16 times, while maternal mortality had experienced almost a 100-fold decline, and such communicable diseases as louse-born epidemic typhus, genital lymphgranulomatosis, smallpox and poliomyelitis were eradicated, predetermining an almost four-fold increase in population number, and improvement in population health. Although such profound changes have been associated with a number of socio-economic factors, they have been unbreakably bound to the contemporary science-based health sector development in Mongolia, while the first hospital was established only in 1924 with 3 health workers and 15 beds.
Before the 1990s the health system was state owned, and centrally run with financing from general government revenues. Health care was free of charge at the point of delivery. The system was very much reliant on curative services, very resource intensive, based upon high bed numbers and large numbers of medical personnel. Despite many achievements, including improved equity and access to health care and control of communicable diseases, there were weaknesses, including low efficiency and a lack of sensitivity to consumers' rights. The acute economic distress associated with the transition after 1990 severely affected the health sector. The system experienced a major loss of resources which led to some inevitable deterioration of health services.
However, the Mongolian government has not reduced its policy commitment to the equitable provision of services and it has re-assessed its strategies in the light of experiences of transition. Therefore, the health sector ownership and financing has been diversified, a health insurance scheme and a policy shift towards greater emphasis on primary health care has been introduced in the early 1990s. In accordance with the recent amendment in the Health Insurance Law, the Scheme covers some outpatient services and hospital services, however the insured make co-payments from 5-15 per cent depending on the level of hospitals.
The family group practice (FGP) model was introduced in 1998 by the Health Sector Development Program with the support of ADB to provide primary health services free of charge to the population. Family doctors were reorganised into private group practices, with guarantees of income through risk-adjusted capitation payments from the government. In 2003 the FGPs covered 56 per cent of the Mongolian population, and were employing about 940 family doctors. The National Public Health Policy was adopted in 2001, establishing a long-term framework for public health. The health status of the people in Mongolia is relatively better than that of an average low-income country. There have been improvements in child mortality in spite of the difficulties of transition.
Infant mortality fell from 49.03 to 31.1 per thousand live births between 2000 and 2003. Maternal mortality has been relatively stable at about 161 per 100,000 live births over the last decade and it reached the lowest rate of 109 in 2003. Mongolia historically has a strong commitment to immunization which is evident from the high coverage rates (over 90 per cent for tuberculosis, DPT, measles, hepatitis B, and polio). The country is undergoing an epidemiological transition characterised by a decline in communicable diseases and a rise in non-communicable diseases in total mortality. The leading causes of mortality from 1995 up to the present are diseases of the circulatory system, cancer, accident and injuries.
Despite successful efforts, the health sector is facing problems related to the deepened marginalisation of some of the population, internal migration and the number of homeless people as well as poor living conditions which are causing the increase of poverty-related diseases such as TB and STDs. In addition, there are problems of unequal health status and access to health services between the rural and urban populations, and between different income groups. The health sector comprises of 17 specialised hospitals and centres, 4 regional diagnostic and treatment centres, 12 district and 21 aimag general hospitals, 323 soum hospitals, 18 feldsher posts, 233 family group practices, and 536 private hospitals and 57 drug supply companies/pharmacies.
A large portion of the health budget is still spent on curative services. There are weaknesses in hospital services: inefficiency, patient dissatisfaction, outdated treatment protocols and equipment. Since January 2003 the government started to implement the Public Sector Management and Finance Act, a new phase of health system organisation and financing with output-based funding. The successful implementation of the new regulations is an immediate challenge to increase cost-effectiveness and greater responsibility of health organisations in the country. Investment in the medical sector increased and 33 hospitals were built in 2002-2003 on the state budget.
A complex set of actions was taken to reduce maternal mortality and strengthen child and mother health care. Obstetric equipment increased 4 fold and special rooms for mothers-to-be have started to operate on regular basis. Accreditation of medical workers and medical organisations has also been carried out. The state-run medical institutions were involved in accreditation in 2003 and private medical establishments were covered at the end of 2003. 20.8 per cent or 115 private clinics were accredited. Over 500 million tugrigs have been spent since 2000 to renew medical technology. Rate of infectious disease is reducing. No incidence of bacterial meningitis among children has been registered since 1996.
