The Mongolian health system at a crossroads :
an incomplete transition to a post-Semashkom Model
Paper No. 2007-1 - The World Bank –
Available online PDF [91p.] at:
“….This report presents the state of health of the Mongolian population and of the challenges facing the government as it reforms the health system. This chapter examines the recent deterioration in certain key health outcomes. Chapter 2 explores the factors that have contributed to these outcomes, while Chapter 3, provides recommendations for both short-term and long-term actions that the Government of Mongolia can take to rectify many of these perceived problems in the health sector. Finally, in Chapter 4, several specific ways in which the international donor community can support the government in carrying out these reforms are put forward. …”
• Nearly half of all Mongolians are engaged in herding or agriculture. Harsh winters and periodic droughts have adverse
effects on livestock and agricultural output, which together account for at least 20 percent of GDP.
• Per capita income is under US$600 and one-third of the population lives below the poverty line.
• A severe economic downturn (from 1990 to 1994) increased unemployment, crime, homelessness and alcoholism and
reversed improvements in health and education indicators achieved during the Soviet era.
• Adult mortality is rising, with cancer, cardiovascular disease and accidents acting as the biggest contributors to this rise.
• Maternal mortality rates are fluctuating instead of gradually decreasing and are particularly high for women giving birth in hospitals.
• MOH statistics reporting a steady decline in infant and child mortality rates appear to be inaccurate, raising concerns about the country’s health information systems.
• Poor people and those living in rural areas are the worst affected by health system failures.
CHAPTER 1: HEALTH OUTCOMES AND CHALLENGES
1.2 Health Indicators
1.3 Correlation between Poverty, Education, and Health Outcomes
1.4 Geographic Variation in Health Outcomes
CHAPTER 2: UNDERSTANDING
2.1 Constraints due to the Soviet Legacy
2.2 Health Finance Diagnostics
2.3 Service Delivery Diagnostics
2.4 Public Health Diagnostics
2.5 Pharmaceutical Diagnostics
CHAPTER 3: LEGAL, REGULATORY AND INSTITUTIONAL FRAMEWORK
3.1 Legal Framework
3.2 Administrative Structure
3.3 Regulating the Private Sector
3.4 Government Strategies Affecting the Health Sector
CHAPTER 4: RECOMMENDATIONS
4.1 Health Financing Options
4.2 Short-term Options for Improving Service Delivery
4.3 Long-term Service Delivery Issues
ANNEX 1: Mapping Geographic Variations in Health Outcomes and Health Spending
ANNEX 2: Optimization: A Focus on UB
ANNEX 3: 2002 Mongolian Health Sector Overview – Preliminary Data
ANNEX 4: Supporting Statistical Tables
This paper was prepared by Michael Borowitz, Bradford Else, Hernan Fuenzalida, Yvengiy Samushkin, Jan Both, and Naoko Ohno. Significant support provided by Uuganbileg Erdene, Altantsetseg Shiilegmaa, Rekha Menon, April Harding, Elizabeth King, Jennica Larrison, Xiaoqing Yu, Magnus Lindelow, and Arindam Dutta. It was supervised by Fadia Saadah, the Sector Manager for Health, and Emmanuel Y. Jimenez, the Director for Human Development.
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