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Health Care for All
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ULAANBAATAR, MONGOLIA
TAKING CARE Women are major beneficiaries of the small, locally placed clinics called family group practices
At first glance, Mongolian women do not appear to face serious problems. Women make up more than half of the workforce, and educational attainment among women is higher than among men; fewer young women drop out of school, and more go on to tertiary education. Many women are employed by or own businesses, particularly small and informal enterprises. According to the Mongolian Employers’ Federation, women owned more than a quarter of the private businesses. Women have also seen a modest increase in political participation—with nine women members in the current parliament.
While this all sounds good, the reality for many is often starkly different. Women tend to have less job security and less access to information. They are more likely to be poor if they are heads of households and suffer higher unemployment rates than men.
Increases in unemployment during the economic transition placed a heavy burden on women, who must spend more time caring for young, sick, and elderly members of families. Women were the primary victims of the social dislocation, alcoholism, and physical abuse that accompanied the initial sharp economic contraction.
One of the most serious issues facing Mongolian women is poor health and nutrition, particularly among the poor. The maternal mortality rate is still high compared with other Asian countries. Despite the general decrease in infant and child mortality rates, the level is high in rural areas and among mothers with low educational level. Five percent of all births are delivered at home. Pregnant women suffer from high incidences of associated diseases of the kidney and heart, and pregnancy complications are common.
Family group practices provide essential, basic health services free of charge
The Mongolian health sector, which had an extensive network of public hospitals providing curative services, has not dealt effectively with these problems. The success of the system was mainly measured by inputs—numbers of doctors, hospital beds per population—not by outputs of service delivery and health indicators.
The sector was plagued by budget deficits, deterioration of physical infrastructure, poorly trained doctors, and a lack of equipment. Badly designed large hospitals and other facilities had chronic problems with heating and high maintenance costs. The situation required urgent reforms of service delivery, management, and financing.
The Government is meeting this challenge through the Asian Development Bank-financed Health Sector Development Program. The development of family group practices (FGP) is a key component of the reform agenda. FGPs—small, locally placed clinics—move doctors from overstaffed hospitals to practices in the community, particularly in poorer areas, and shift the emphasis from curative care to preventive care.
FGPs provide essential, basic health services free of charge. FGPs sign contracts with local governments, which pay quarterly capitation payments per patient depending on the person’s age, sex, and poverty status. All districts in Ulaanbaatar are now covered by FGP's, and with an FGP in each provincial capitol. A total of 234 FGPs have been established under the project. Women are major beneficiaries from the services provided by FGPs. A third of the total registered FGP clients were women aged 16–49 in 2003.
During a recent visit to one FGP in Tuv Province, Ms. Chuluuntsetseg, Chief FGP Doctor, noted that women often seek FGP services for gynecological procedures, antenatal care, and child growth monitoring.
FGPs have made a big difference in the lives of many women—including the poor—and will remain an important institution for many years to come.
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