MONGOLIA COUNTRY REPORT
RDFs were established in two pilot sums in 1995. Expansion to ten other sums was planned for 1996.
I. Overall Goals and Objectives
○ Meet immediate essential drug needs of women and children
○ Revitalize health system through community participation
○ Strengthen drug procurement capacity at both central and aimag levels
○ Introduce cost analysis and resource use approach to rural health services
II. Achievements against Specific Objectives for Current Reporting Period
| Specific Objective |
|
Achievement |
| 1. Enhance drug management system to ensure availability and affordability of drugs from the aimag (provincial) level down through the sum and bag levels |
|
Acquired and disseminated necessary tools and materials (i.e. computer equipment, laser printers, mini vans); trained pharmacists in use of inventory software |
| 2. Improve quality of health care services by disseminating treatment guidelines, providing guidance on preventive care to health practitioners, and educating health workers and families on rational drug use |
|
Held workshops on rational drug use for doctors and pharmacists; made physicians standard treatment guidelines on 139 drugs available to all; made available drug formulary describing rational use of all essential drugs; preparing newsletters and pamphlets on preventive care, treatment guidelines and promotion of rational use; used mass media to educate the public on disease prevention, immunization, etc.; purchased midwifery kits for all feldshers; trained feldshers in infant disease management and maternal/infant care |
| 3. Reinforce capacity in financial management, accounting and resource use in twelve project sums |
|
Conducted workshops in all aimags; held national seminar on cost analysis and resource use for 101 health managers and physicians; MOH developed and distributed training curriculum and manual on methodology for cost management and resource use; equipped Health Management Training Institute with computer for data processing and data forms for reporting |
| 4. Encourage community participation in management of health services at all levels with establishment of experimental multipurpose RDFs |
|
|
| 5. Strengthen revolving funds mechanism through establishment of accounting system on a pilot basis |
|
Not yet accomplished. UNICEF currently seeking certified public accountant in the Peace Corps to develop necessary software |
| 6. Develop community-based information and micro-planning systems, improve monitoring and evaluation of various project components |
|
Conducted national workshop; MOH developed manuals for data collection at sum and bag levels |
III. Problems Encountered
○ Personnel at sum pharmacies are currently being paid by the aimag drug company or by the government. In the future, the RDF will probably have to pick up some of the cost, which will deplete the fund.
○ In pilot sums, sales revenues sit in banks, being depleted by inflation.
○ It is unclear whether health personnel understand the MOH directive to spend money exclusively on essential drugs and drug-related products for sum clinics and inhabitants.
○ Financial and accounting software are currently not available
○ Fifty percent of the general population buys drugs without prescription from local and government pharmacies, leading to disease resistance. Such purchases, as well as prescriptions issued at the feldsher level, are not covered by insurance. Since the poor cannot fully cover the cost of the drugs they consume, RDF funds are being depleted.
○ The meaning of “community participation” is commonly understood to mean local government leaders, health care professionals, union heads, etc. Only in bags does there appear to be any leadership from community members outside these groups.
IV. Future Plans
○ Expand RDF project; see table
Table. Expansion Plan for RDF Project in Mongolia
| |
1996 |
1997 |
1998 |
1999 |
Total |
| Number of sums |
12 |
90 |
100 |
110 |
312 |
| Percentage of provincial sums |
4 |
33 |
65 |
100 |
|
| covered |
|
|
|
|
|
| Drug needs(thousands US$) |
156 |
1,170 |
1,300 |
1,430 |
4,056 |
| Percentage of national drug needs |
2 |
18 |
35 |
55 |
45 |
Short Term Goals
○ Make national guidelines on expenditure of funds and drug use more precise; make sum RDF committees directly responsible for accurate and complete reporting on financial activities; impose sanctions if funds are misused
○ Adapt existing software or develop new software on financial accounting and auditing systems for monitoring finances at local level
○ Conduct additional training sessions in sums on appropriate RDF management
○ Involve communities in decision making, fundraising and the exercise of control over fund utilization
○ Build capacity of government staff for future expansion and extension of project concepts throughout country
Long Term Goals
○ In alliance with and in support of Mongolia's Essential Drug Policy, restrict sales of potentially dangerous drugs (e.g. antibiotics) to prescription holders
○ Work with National Health Insurance to modify regulations regarding reimbursement policy as well as treatment of outpatients
○ Reinforce and expand concept of community participation; develop concrete projects that encourage community involvement
○ Promote concept of decentralization; give more autonomy to local levels in management of community development
○ Develop cooperative programs (especially with the Poverty Alleviation Programme and the Asian Development Bank) at the sum level to strengthen role of the community and improve health services
