Mongolia
I. Background
Since 1991, the Ministry of Health has been carrying out the National Essential Drug Policy with the support of WHO. Mongolia has developed and adopted an essential drug list consisting of 220 drugs. Presently, the state owned pharmaceutical corporation, Mongolemimpex, which is under the Ministry of Health, has sole reponsibility for procurement and distribution of drugs in Mongolia.Mongolemimpex gives first priority to the purchase and distribution of drugs on the National Essential Drug List.Mongolemimpex pharmacies are located in all aimags and sums. Since 1992, all drug donations are channelled through Mongolemimpex and, in consultation with the MOH and MOF, these donated drugs are priced and solid to hospitals and the population at large in order to generate internal funding for future procurement.
In 1994, Mongolia was one of the first Asian countries where the Bamako Initiative was introduced. A project proposal was developed by the UNICEF Ulaanbaatar office in close collaboration with the MOH. The aims of the project were to supply essential drugs, strengthen the drug procurement capacity at the central, aimag and sum levels, revitalize the health system through community participation, and introduce cost analysis and resource usage in rural health services.
II. Key Objectives of the Project
This project was designed to bring Bamako Initiative principles to six rural provinces and twelve communities. The key objectives are:
□Meet immediate needs in essential drugs for the population
□Improve rural health services through community participation
□Strengthen drug procurement capacity at the sum and bag levels
□Introduce cost analysis and resource-use approach in rural health services
The objectives of UNICEF and the MOH to improve maternal and child health among the families of nomadic cattle breeders and to strengthen the sustainability of rural health services, managerial capacity and capability, have a significant impact on the project's performance.
III. Achievements Against Objectives
□Mongolia procured urgently needed essential drugs equivalent to US$ 1 million in 1994. The same amount was expected for 1995.
□In the selected provinces community participation in the improvement of health services is being highly encouraged. Members of rural communities are participating in kind support to purchase vehicles for sum hospitals or monocycles and horses for bag feldshers. Midwifery kits for 350 bag feldshers selected from the six aimags were distibuted in order to improve service quality.
□In August of 1995, revolving drug funds valued at US$ 22,000 were established for two selected sums using Nippon Foundation support.
□A methodological handbook on the cost of rural health, based on UNICEF, was developed. The first national seminar was held in July of 1995, using cost data from the selected six aimags and twelve sums.
IV. Problems and Constraints
□Shortage of some essential drugs at central and rural stores
□Lack of experience in community-based health services, cost sharing and revolving drug funds in communities
□Absence in some locations of a full-time person for project implementation
□Lack of harmonization of some project activities with existing structures or networks
□Increasing poverty and low cash income among population
□Difficulties in periodic monitoring of project activities due to seasonal conditions and distance
□Weak management tools and information flows for evaluation of project activities
□Lack of healthy economic management capacity and capability at aimag, sum and bag levels
□Lack of information or methodological guidance in Bamako Initiative experiences
V. Issues for Discussion and Resolution
□Development of information network among countries participating in Bamako Inititiave, enabling information and experience exchange
□Development of common indicators which would measure Bamako Initiative activities and achievements
□Costing of basic package of rural health services
□Regular newsletter or booklet containing updates and other necessary information
□Regular meetings and project site visits in other countries implementing Bamako principles
VI. Future Plans
□Improve supply of essential drugs since shortages still occur
□Improve project monitoring and site visits
□Strengthen cost analysis in all aimag and sum hospitals
□Establish revolving drug funds in 40 sums of the selected six aimags
□Further encourage community participation in all selected sums and bags
