Free and universal access to primary healthcare in Mongolia: the service availability and readiness assessment

Altantuya Jigjidsuren,Tetsuyoshi Kariya,Tumurbat Byambaa,Enkhjargal Altangerel,Eiko Yamamoto,Yu Mon Saw,Suvd Batbaatar,Nobuyuki Hamajima

doi:10.1186/s12913-019-3932-5

Abstract

BackgroundThe government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. However, no evidence is available on the physical presence of PHC services within health facilities. Thus, the present study assessed the capacity of health facilities to provide basic services, at minimum standards, using a World Health Organization (WHO) standardized assessment tool.MethodsThe service availability and readiness assessment (SARA) tool was used, which comprised a set of indicators for defining whether a health facility meets the required conditions for providing basic or specific services. The study examined all 146 health facilities in Chingeltei and Khan-Uul districts of Ulaanbaatar city, including private and public hospitals, family health centers (FHCs), outpatient clinics, and sanatoriums. The assessment questionnaire was modified to the country context, and data were collected through interviews and direct observations. Data were analyzed using SPSS 21.0, and relevant nonparametric tests were used to compare median parameters.ResultsA general service readiness index, or the capacity of health facilities to provide basic services at minimum standards, was 44.1% overall and 36.3, 61.5, and 62.4% for private clinics, FHCs, and hospitals, respectively. Major deficiencies were found in diagnostic capacity, supply of essential medicines, and availability of basic equipment; the mean scores for general service readiness was 13.9, 14.5 and 47.2%, respectively. Availability of selected PHC services was 19.8%. FHCs were evaluated as best capable (69.5%) to provide PHC among all health facilities reviewed (p < 0.001). Contribution of private clinics and sanatoriums to PHC service provisions were minimal (4.1 and 0.5%, respectively). Service-specific readiness among FHCs for family planning services was 44.0%, routine immunization was 83.6%, antenatal care was 56.5%, preventive and curative care for children was 44.5%, adolescent health services was 74.2%, tuberculosis services was 53.4%, HIV and STI services was 52.2%, and non-communicable disease services was 51.7%.ConclusionsUniversal access to PHC is stipulated throughout various policies in Mongolia; however, the present results revealed that availability of PHC services within health facilities is very low. FHCs contribute most to providing PHC, but readiness is mostly hampered by a lack of diagnostic capacity and essential medicines.

Highlights

The government of Mongolia mandates free access to primary healthcare (PHC) for its citizens
The physical presence of a health infrastructure in the two districts sampled indicated that the number of health facilities and health personnel is 2–3 times higher compared to international benchmarks; only 44.1% of health facilities had the capacity to provide basic health services at minimum standards
We argue for the role of private clinics and sanatoriums in providing health services

Summary

Introduction

The government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. The first two major government reforms initiated in the early 1990s were the mobilization of additional financial resources through establishing a health insurance system (i.e., in order to overcome financial shortfalls due to withdrawal from Soviet social assistance) and shifting priorities toward PHC while encouraging participation from the private sector in terms of service delivery with the aim of increasing efficiency. With the support of international development organizations, the Asian Development Bank (ADB), the Mongolian government has established family group practices (FGP), which are groups of primary care physicians that provide PHC services in Ulaanbaatar (the Mongolian capital), province centers, and other cities. A need to reform PHC in urban cities was urged by increasing rural to urban migration, which contributed to increases in the “urban poor” population [5], along with health inequalities due to a lack of access to basic healthcare [6]

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Results

Discussion

Conclusion