Abstract
IntroductionIn recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning.MethodsPrincipal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers.FindingsThe main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies.ConclusionsLessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor.
Highlights
In recent years, the country of Mongolia has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration
Barriers to health access in Ulaanbaatar The case studies in the Additional file 1 to this paper outlines the social context for health inequities in Ulaanbaatar, as described by district health staff
Disability, unregistered status, the unemployed, dormitory students, the homeless and school drop-outs are some of the categories of the vulnerable described in these case studies, with a wide disparity in living circumstances including apartment blocks, ger neighborhoods, riverside dwellers and street dwellers
Summary
The country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. Since the early 1990s, following the end of the Soviet era, Mongolia (population 2.8 million) [11] has been undergoing a rapid social transition Main elements of this transition include a rapid pace of urbanization, decentralization and a gradual opening up of the economic, social and political system. In line with this transition, there has been significant economic growth in recent years which has been averaging nine percent annually in the past five years (2003-2008). The proportion of people living below the national poverty line has remained persistently high over the past 18 years [13], with the most recent estimate (2008) placing it at 35% [14] Along with this pattern of uneven economic growth across social groups, there have been major demographic changes. The average annual growth rate of Ulaanbaatar’s urban population during 2003- 2006 was approximately 3.6%, which was triple the rate of growth amongst the total Mongolian population (1.2%) and nearly four and a half times that of the aimag (provincial) centers (0.8%) [15]
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