Independent Evaluation

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Evaluation on the Health Sector Development Program in Mongolia
Completed: 2008

This evaluation determined lessons from a sector-wide, reform-based program in a country that had undergone transition from central planning to a market economy. The Health and Sector Development Program (HSDP) aimed to transform and rationalize the outmoded social model of hospital-based health services in Mongolia to improve quality and efficiency, and adapt to a market economy.

Summary of Findings

• Overall, the HSDP was rated "successful" but on the low side.



• The Program was rated "highly relevant" to the critical needs of the sector, government priorities at that time, and the ADB country strategy.



• The Program was rated "less effective" in the short term since implementation of reforms in many areas has been inadequate to achieve sustainable impact. It is "likely to be effective" in the longer term given the Government's commitment to improve the quality of the health care system and the continued support provided by ADB to implement and consolidate reform initiatives under the HSDP to further strengthen Mongolia's health care system. However, a major concern is that the Family Group Practices established under the HSDP to provide health services in urban areas continue to face significant challenges in terms of viability, staffing, and quality of services.



• The Program was rated "less efficient". Although most of the outputs were produced as planned and on time, the HSDP has been less efficient in achieving the desired outcomes. Policy reforms towards rationalization of hospitals and health personnel, which would increase efficiency and generate cost savings, remain unfinished.



• The HSDP is "likely sustainable". The major thrust of HSDP-supported reform initiatives to shift health system priority to primary health care (PHC) is likely to be sustained given ADB's continuing assistance in the sector under the Second and Third Health Sector Development Projects, and the adoption of the Government's Health Sector Master Plan, which places a central emphasis on PHC and further strengthening of the Family Group Practices system.

Lessons Identified

• Project experience in implementing health sector reforms underscore the importance of sufficient consideration of the social, political, cultural, and economic context within which reforms are to take place.



• The HSDP illustrates that when program objectives are overambitious given the challenges to be addressed, project successes and achievements are likely to be obscured by failure to achieve many of the program goals.



• The PHC model would have been more effective and sustainable if the Government had proceeded in a phased manner. The Government should have first established public clinics under urban local governments, and when these were already well established and accepted, the PHC model could then be gradually extended to allow private practitioners to tender contracts to provide PHC services for the state in competition with state clinics.



• No equipments should be procured without a service warranty period and for complex equipments, without training provided by the supplier.



• Consultants should be able to work in a participatory manner with middle-level and higher-level managers in executing agencies.