By Tsogtbaatar B
Health stands among the most essential and common social goods in Mongolia. Yet, there is often displeasure among the Mongolian public for how health services are delivered and doubts where the overall sector’s policies are headed. The public health concept as the most promising gateway to better development of health sector and population health is still understudied and underutilized. Quickly analyzing the health platforms of several parties with seemingly comprehensive proposals on health that were submitted to the National auditing office I offer the following categorization of priorities and loopholes.
Progressive
- SMART (specific-measurable-attainable-realistic-timebound) approach seen to be considered within some objectives: “Enact policies specific to improving access of mobile clinic, telemedicine and public health centers’ services to remote and marginalized communities.” (KhUN)
- Logical continuation of a strategy or an intervention that has previously been successfully or adequately implemented such as the next phase of risk-based health screening and early detection that was proposed by the MPP, “National programs – Healthy liver, Healthy teeth” (MPP), “Improving the implementation of performance-based financing” (DP)
- Innovation and recognition of healthy environment for population health took place in “mitigating the environmental health impacts through the advancement of technology and PPP” (NC), use of AI in disease prevention , “Introduction of national program-Cervical cancer free Mongolia” (both MPP)
- Specific interventions proposed such as further developing the emergency care to the international level through PPP on air-emergency care (MPP and NC), “establishment of Health promotion centers to mitigate post-COVID impacts” (DP)
- DP has declared mental health problems as an underlying challenge and proposed to strengthen national capacity to diagnose, treat, monitor and prevent. AI is proposed to be used in doing so.
- DP has identified a need to revise and implement the State Policy on Health, necessary treatment guidelines and regulations in line with international standards. 80+ Ageing strategy and very important health professionals’ liability insurance law proposed to be developed.
- Highlighted the need to develop and implement comprehensive human resources program including capacity building, social aspect and job security (DP)
- NC segregated its activities based on demographic groups which makes their target and resources more efficient and realistic. Such public health interventions by the same coalition such as “Monging Milk” and “Nutritious Lunch” are specifically targeted at lowering the child obesity and poor dental health among children.
Stagnant
- Generic such as “Modernization and standardization of health facilities and infrastructure” (KhUN) “establishment of New diagnostic centers at the regional level to save people’s time and hassle” or “Provide policy support to the establishment of traditional medical hospitals by the private sector” (NC) which all have been works-in-progress for few decades in the health sector with varied success rates.
- Inaccurate word selections, crude literal translations, disengagement, typos such as “Improving diagnostic capacity, treatment choice and patient’s result through improving quality assurance for health equipment, technology and pharmaceutical products” (Khun), “To reform health sector’s administration system and improve regulatory environment-..Эрүүл мэндийн салбарын удирдлагын тогтолцоонд рефорт хийж..” (MPP). This is very confusing and begs for better wording and conceptualization in the latter sentence which could be “To reform/refine develop health system governance” as it is the overarching concept that refers to processes, structures and institutions that are in place to oversee and manage overall healthcare system including administration and leadership aspects within.
- Too vague, general, obvious or unclear such as decreasing the burden of preventable disease through the promotion of prevention initiatives including health education and detection (Khun), “Building capacity of health professionals and improving coverage of care through investment of specialized and continuous training” (Khun),“Reforming the health insurance system to alleviate financial hardship for citizens” (MPP), “Strengthening the public health system to prevent from diseases and to promote healthy lifestyles such as exercising regularly and eating healthy” (MPP). Wish these were not too symbolic and vague, Instead, were direct, targeted and segregated.
- Too symbolic, impractical or misleading: “Promotion of universal health care so that all citizens can receive necessary health services without any financial barrier” (KhUN). Over the few decades, Mongolia has gradually been attempting to move away from the Universal health system free-of-charge by systematically introducing a balanced mix of social health insurance system and out-of-pocket system. “To decrease morbidity and mortality of preventable diseases by 35%” (DP)
- Flat-out ineffective, not-cost-efficient or overpromising: “To increase financial support of those who are required to be treated overseas due to certain illnesses that are not treatable in Mongolia. And to sign collaboration agreement with hospitals overseas to send Mongolians to” (MPP). This non-cost-efficient overpromise, triggered by politicians in the past, would simply go against the very objective of State Policy on Health to invest into and build national capacity in decreasing the number of medical procedures that are not diagnosed and treated within Mongolia. Unmet need in this regard can be unbearable under the current morbidity burden and scarce economic capability, nationally, as well as the general public’s very critical approach on the selection of a few who ends up getting the monetary support.
“To implement policies to train 3000 doctors, 10000 nurses and 500 care takers internationally and locally” (MPP). Apart from nurse practitioners, Mongolia is regarded to have more than enough health professionals per capita. Instead, the main flaw rests upon equal distribution and improving the quality of existing undergraduate, graduate and residential level training at the national academic and teaching medical institutions as well as improving their fair compensation in line with the workload and labor security.
“Building the reference level hospitals in every regional center” (MPP). This can be better conceptualized as Strengthening the current capacity of health professionals, equipment and financial mechanisms of Regional Diagnostic and Treatment Centers (RDTC) and improving the patient-referral system between the provincial health facilities and RDTCs, since RDTCs have been built in all 5 regions, years back.
- Lack of current scenario, data, and clarity: “bring the state portion of social health insurance premium to a medium level” (KhUN, DP)
Overall, these portfolios can be applauded for their mention of leading causes of mortality and some morbidity and their relevant interventions among the general population. A largely vague but very common mention of how crucial public health and prevention of disease are. MDP provocatively believes that some hospital buildings need to be auctioned off and modernized. Health is rightfully prioritized and positioned in the opening sections as a standalone chapter.
However, they generally and chronically lack the following: 1) Accurate diagnosis of Mongolian health system, its current state and challenges, and threat to population health 2) Accumulated and emerging flaws in governance, financing and service delivery 3) Prioritized, clear strategies and actions to fix existing flaws at the national policy level as well as service delivery levels 4) Failure to link and address inadequate social determinants of health and adverse environmental health problems as triggering factors of particular diseases and their preexisting health risks. There are no clear division nor linkage between the layers of proposed policy/challenges/ intervention/ activities /objectives/expected result.
These flaws were further weakened by the absence of sound data, clear implementation strategy, achievable goals/targets as well as both adequate financial resources and motivated human resources, within the next 4-year timeframe.
Grades
KhUN: C (innovative, jumped throughout, vague, lacks backbone)
Green party: F (seemingly complete cloning of the Khun’s proposal which is a big red flag)
MPP: B (innovative, continued implementation proposed, vaguely written, left pores, over promising)
DP: B+ (better summarized and systematized, emphasized on policy level, redundancy of vaguely “improving” concept, vague in areas, overpromising)
NC: C+ (progressive, didn’t cover broad policy areas, but specific in those touched upon, overpromising)
About Tsogtbaatar
Dr. Tsogtbaatar is an experienced PhD with a demonstrated history of working for the Academic, State, Non-profit and International institutions in the areas of Public health, Health policy and Health Administration. He was involved in the development of the State policy on health as well as Election flatforms back in 2016 and 2020. Dr. Tsogtbaatar has received 3 degrees in health from prestigious institutions in 3 countries and is currently residing in Colorado.
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