Mongolia: Fourth Health Sector Development Project

Sovereign Project | 41243-012


The project will strengthen the hospital sector in Ulaanbaatar and improve drug safety nationwide. It complements previous Asian Development Bank (ADB) development initiatives in the health sector in Mongolia.

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Title Document Date
Fourth Health Sector Development Project Jun 2015

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Project Name Fourth Health Sector Development Project
Project Number 41243-012
Country Mongolia
Project Status Approved
Project Type / Modality of Assistance Grant
Source of Funding / Amount
Grant 0236-MON: Fourth Health Sector Development Project: Improving Sector Governance
Asian Development Fund US$ 14.00 million
Grant: Fourth Health Sector Development Project: Improving Sector Governance
World Health Organization US$ 450,000.00
Loan 2932-MON: Fourth Health Sector Development Project - Additional Financing
Asian Development Fund US$ 25.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change Governance and capacity development
Sector / Subsector

Health - Health sector development and reform

Gender Equity and Mainstreaming Effective gender mainstreaming
Description The project will strengthen the hospital sector in Ulaanbaatar and improve drug safety nationwide. It complements previous Asian Development Bank (ADB) development initiatives in the health sector in Mongolia.
Project Rationale and Linkage to Country/Regional Strategy

1. The project will strengthen the hospital sector in Ulaanbaatar and improve drug safety nationwide. The project builds on previous health sector development initiatives to continue reforming the Mongolian health sector, including health care financing, in line with the National Development Strategy and the government's Health Sector Master Plan (2006-2015). ADB's Independent Evaluation Department's (IED) sector recommendations emphasize the need for structural changes in health care delivery by rationalizing excess hospital capacity at the secondary and tertiary level, particularly in Ulaanbaatar. The project is included in the Country Operations Business Plan (2009-2012) and the Country Partnership Strategy (2010-2015, in preparation). The project is in line with Strategy 2020 and the Operational Plan for Health under Strategy 2020 addressing sector governance issues and promoting more efficient allocation of health resources.

2. ADB is the largest external financier providing assistance to the health sector, and plays a pivotal role in assisting the government to formulate and implement health sector reforms. Support from other partners tends to be focused on assisting the government to address particular diseases or to develop certain programs. ADB works in close consultation with other partners, and to improve aid effectiveness, efforts are made to support the implementation of the Health Sector Master Plan. Efforts are underway under the leadership of the Ministry of Health (MOH) and in coordination with other development partners in the sector to gradually evolve towards a more sector-based assistance. Parallel cofinancing with the World Health Organization is confirmed under this project.

3. The hospital sector absorbs the bulk of the MOH budget and is characterized by excessive capacity, inefficiencies, fragmentation, and lack of quality services. Mongolia has moved from a health service based on the Semashko model of poli-clinics and mono-profile specialist hospitals to a focus on primary health care provided by family doctors working in Family Group Practices. Public secondary and tertiary care in Ulaanbaatar is provided by over 50 hospitals. Six mono-profile hospitals managed by MOH provide tertiary and secondary care in cancer, traumatology and orthopedics, psychiatry, dermatology, pediatrics, and maternal and child care. Also, MOH manages three multi-functional hospitals that provide a wide range of secondary and some tertiary services. District hospitals, under the city government of Ulaanbaatar, provide a limited range of services, mainly internal medicine and neurology services. Deficient quality of services at primary level and the weakness of the district hospital system result in patient seeking care at tertiary level where lower level services are provided at higher costs.

4. There is a rapidly growing and poorly regulated private health sector consisting of hospitals, clinics, laboratories, and pharmacies which are primarily concentrated in Ulaanbaatar. Hospital buildings and equipment in the public and private sectors are generally in poor condition. Patients stay too long in hospitals with many inappropriate admissions. The training of specialist medical staff is not up to international good practice and the management of the hospital sector is weak. Increasing investments in the hospital sector are expected as the economic outlook for Mongolia is promising. The challenge is to ensure investments are used efficiently to improve accessibility and service quality.

5. The cost of reforming the hospital sector in Ulaanbaatar is estimated at about $450 million. A central question is how to use the limited budget available to the project in a strategic way to ensure an efficient use of future investments. A vision, a hospital policy, and a clear hospital reform plan for Ulaanbaatar (including legal, regulatory, and institutional reforms; capacity building needs; and potential financing sources) are missing. Decision-makers have little understanding on how to improve hospital sector management, rationalize hospital services, and especially how district hospitals could be turned into multi-profile hospitals.

6. Mongolia suffers from illegal importation of drugs and circulation of substandard and counterfeit medicines in the market. Drug regulatory functions are fragmented and local drug manufacturers lack compliance with good manufacturing practices. Public information, drug promotion, and post-marketing surveillance are significantly under-developed. The social and economic costs of unsafe drugs sold on the market are high and there is little awareness among decision-makers. Drug safety needs government's interventions as market forces alone will not solve the problem. Mongolia requires investments and technical support as domestic skills in the area of drug safety are scarce.

7. The need to reform the hospital sector has been identified for more than 10 years (with little achievements), although it is clearly reflected in the government's Health Master Plan (2006-2015). The prospects for meaningful health sector reform are greater now than at any time in the past for several reasons. First, public-private partnerships to tap capital and management for the health system are now possible; second, public demand for reform is mounting; and finally, political leaders are starting to recognize the urgency of improving the system. The project will assist Mongolia in preparing future reforms and ensuring decent socio-economic returns of future investments. The project will improve governance in the sector by improving public investment planning, providing decent and efficient hospital services, protecting the population against fake and substandard drugs, and facilitating the public's access to information on hospital performance and drug safety. At the same time, hospital reforms give the government a unique opportunity to establish a public-private collaboration for the benefit of the population. The project will deliver tangible benefits to women by ensuring their active participation in institutional processes to reform the hospital and drug safety sub-sectors.

Impact Improved health status of the Mongolian population, including the poor
Project Outcome
Description of Outcome Improved health sector efficiency, governance, and drug safety
Progress Toward Outcome

MOH approved the Hospital care development policy by ministerial order in February 2014.

The National Medicines Policy is approved by the Parliament in October 2014.

Strategic plan for Hospital Care Development Policy was approved by Ministerial order in May 2015.

Implementation Progress
Description of Project Outputs

Component 1: Strengthened Hospital Services in Ulaanbaatar

1.1. Hospital development policy and strategic plan for Ulaanbaatar

1.2. A hospital capital investment planning system is established and operational

1.3. A demonstration multifunctional general hospital established in Songinohairkhan district

1.4. Increased hospital governance

Component 2: Strengthened Human Resource Development

2.1. Strengthened postgraduate specialist structure and residency programs

2.2. Hospital management module integrated in a local training institution

Component 3: Strengthened Drug Safety Regime

3.1. A drug regulatory authority established

3.2. Strengthened drug regulatory functions

3.3. Upgraded drug control laboratory, including accreditation system

3.4. Implementation of good manufacturing practice (GMP)

11. Strengthened post-marketing surveillance and adverse drug reaction monitoring

12. Strengthened drug safety governance function at MOH

Status of Implementation Progress (Outputs, Activities, and Issues)

Output 1.1.

A major output of the Project is the development and approval of a hospital policy for Ulaanbaatar city which will direct changes in the way Ulaanbaatar city hospitals are financed, managed, organized and deliver services. The policy was intended to cover private sector participation, governance and autonomy issues and future public sector investment. MOHS working group with the support from Project consultants developed a draft policy, which was discussed and commented in 2012 by a high level strategic planning committee.

In June 2012, the MOH decided to extend the document to cover hospitals nationwide and the policy document underwent extensive discussion and review at the ministry level throughout 2013. A shorter version of a "Hospital Care Development Policy" document was approved through a ministerial order in February 2014. Strategic plan for Hospital Care Development Policy was approved by the Ministerial order #181 in May 2015. The hospital policy and the strategic plan are supported by specific covenants of the grant agreement.

Output 1.2.

In March 2012 a review of the current capital planning system was carried out by an international consultant. An assessment of public infrastructure and equipment in Ulaanbaatar was carried out covering 37 hospitals of various types. The assessment intended to provide a basis for estimation of infrastructure investment needs and contribute to a strategic development plan to reform the hospital sector in Ulaanbaatar. Capital planning procedures developed by international consultant and the assessment of the infrastructure investments needs of the Government are available. As a next step, by the end of 2015, the MOH will define the future capital planning system which would address institutional, human resources, information technology, financial requirements and investments to restructure and develop the hospital sector, as well as the types of processes needed.

Output 1.3.

The development of a model multifunctional general hospital in Songinokhairkhan district is intended to assist in the ongoing health and hospital sector reform by instituting best management practices, organizational processes, and restructured clinical services. The original plan was to renovate the existing hospital and have a restructured facility operational by June 2015. In 2012 the government requested additional funding of $25 million as a concessional loan for a new hospital, instead of renovating and appending new wings to the existing structure. The FHSDP-AF, the additional loan, became effective on 14 June 2013.

The Project has engaged SIMED (the Netherlands), an international hospital planning and design consulting firm, to develop the concept design and functional requirements, and Junglim Architecture Co.,Ltd (Republic of Korea) for the development of engineering and architectural design of model multifunctional general hospital in Songinokhairkhan district. Architectural detailed design of the demonstration hospital, which was developed by Junglim Architecture Co.,Ltd, was approved by the joint MOHS/UB City working group in May 2015 and is currently pending State expertise approval. Technical conditions for external heating, external electricity, external communications, external water supply and sewerage were approved by respective agencies in June 2015. Bidding document for the construction of the demonstration hospital is under preparation. The construction work will take place in 2016-2018.

The WHO has agreed to support hospital experts (4 months input to be split between developing the Songinokhairkhan hospital development plan and developing and introducing internal operating plan and new policies and procedures). The MOH will finalize the Songinokhairkhan hospital development plan by the end of 2015.

Output 1.4.

Licensing issues were addressed largely as a result of the Third Health Sector Development Project (THSDP) through ministerial orders (no. 143, 145) in April 2013 on regulating public and private health organizations. These orders included recommendations on certificates of need, licensing and regulatory frameworks for both public and private hospitals and clinics and other healthcare facilities.

Output 2.1.

International consultants reviewed the postgraduate training system and proposed a draft institutional framework to address system limitations. At a consensus meeting, the Ministry of Education, the Ministry of Health and Sports, hospitals and teaching universities agreed on the recommendations to extend the period of specialty training; to remunerate residents undergoing specialist training; to adopt the revised curricula; and to define the legal basis for medical education in the Health Law. But the issue of the institutional base for organizing postgraduate education has still not been agreed. The OPM and WHO consultants have proposed in-service hospital based training as the most preferred approach for improved specialty training. However, major stakeholders have not reached a consensus on this issue and this issue could be resolved only by improving respective laws and regulations (the Health law, the Law on Higher Education). Framework for establishing institution for governing and implementing postgraduate medical specialty training is included in the draft hospital care law in May, 2015.

Project consultants reviewed residency training program and curricula in four clinical areas (internal medicine, general surgery, obstetrics-gynaecology and paediatrics); recommendations for improvement were discussed and agreed by working groups comprised of specialists in these clinical areas. The postgraduate training for nurses was also reviewed by consultants, and training curricula for nursing streams were reduced from 26 to 9 with a strong emphasis on in-service training in the hospital. The trainers curriculum was developed to improve leadership skills in senior nurse managers (nurse director, chief nurse and ward manager). Translation rights for medical textbooks on internal medicine, general surgery, obstetrics-gynaecology and paediatrics were obtained from publishers in May 2015.

Output 2.2.

Project consultants assessed hospital management training in Mongolia. Among the limited number of institutions which provide management training with various degrees of quality, the program offered by the School of Public Health of the Mongolian National Medical Science University was preferred for institutionalization as the hospital management training. The School of Public Health in association with the Association of Public Health Specialists and Management Academia developed a training curriculum, which was approved by MOH. The hospital managers training was organized in September 2013, and the training of the first batch of 25 managers (with 20 female participants 80%) was undertaken between October 2013 and January 2014, and the second batch of 25 was undertaken in May 2015. The hospital managers training curricula consists of 6 modules and is based on an enquiry-based learning approach. The participants are expected to have hands-on experience in hospital management.

Output 3.1. and 3.2.

The Project's aim is to establish a drug regulatory authority and strengthen regulatory functions to improve coordination and quality. An amended drug law passed in 2010 includes provision for the establishment of a Drug Regulatory Agency (DRA) with 10 regulatory functions under MOH. The core of a new DRA with 18 staff was established in 2011 in the Drug Regulatory Division of the Department of Health (DOH/DRD). It was abolished in September 2012. Currently only 8 of the regulatory staff have been retained in the MOH Pharmaceuticals and Medical Devices Division (PMDD).

OPM provided technical assistance to initiate the DRA including a draft strategic plan, concept note, organizational structure and financing arrangements, and assistance with a draft medicines bill.

In strengthening regulatory functions, the OPM consultants have trained and mentored the original DOH/DRD staff and the interim regulatory staff in PMDD; several technical guidelines have been revised and approved (Good Manufacturing Practice, Good Distribution Practice and Good Pharmacy Practice). A baseline review of drug regulatory functions was undertaken using the WHO methodology in late 2011 and results were presented to relevant stakeholders. Mongolia s score of 46.9% in drug regulation show the need to strengthen drug regulatory functions. A team of local experts under WHO international experts guidance conducted a nationwide survey on the prevalence of unsafe drugs in the market in 2012. The survey revealed that 29% of medicines circulating in Mongolia are illegal (unregistered) or substandard. Project consultants developed and revisited drug regulatory procedures and some of them (registration procedures, adverse drug reaction reporting) were approved by MOH. A new National Medicines Policy, developed with technical support of OPM, endorsed by the Cabinet and ratified by the Parliament in October 2014, was the foremost achievement of this component. The National Medicines Policy covers core areas in medicine regulation such as medicines quality and safety, rational use, access, provision, distribution, and governance. The Project aim of establishing a website on the DRA and drug governance, along with an E-library was postponed until a DRA is established. The Project is assisting MOH in upgrading the drug regulatory database LICEMED that would lead to improved quality data base of registered products, licensed providers, and specialists available online.

A one-day conference on strengthening drug safety and human resource development with 70 representatives from MOHS, MOF, GASI, NUMSM, city department of health, center for health development, health insurance department at SSIGO, pharmaceutical and medical professional associations, health department and of general hospital Songinokhairkhan district, and representatives from international agencies was organized on 13 May 2015. During the conference the key implementing parties were informed about OPM project accomplishments, lessons and further recommendations from the project to ensure sustainability and collaboration.

Output 3.3.

Upgrading and strengthening of the Drug Control Laboratory (DCL) of the GASI is an important element for drug safety, and steady progress has been made in this field. The DCL moved to the new building built with the support of the Government of PRC in January 2013; new equipment provided by the Project was installed in November 2013 with on the job training from supplier companies. OPM consultants developed a Strategic Plan and ISO-17025 Accreditation Action Plan which were approved by DCL. For preparation of the lab accreditation, SWOT analyses and baseline Good Laboratory Practice assessment of the medicine laboratory were conducted in January 2013. Project consultants developed a laboratory quality management system including quality manual, standard operational procedures, record and reporting forms for the DCL. The Mongolian Agency for Standardization and Metrology has accredited DCL with ISO-17025 during a national assessment.

Output 3.4.

The Project aims for GMP are to upgrade standards, inspectorate, regulations and manufacturer capabilities with a target of at least five local drug manufacturers certified at international GMP standards by 2015. Project consultants conducted a gap analysis against the WHO GMP Guidelines and developed a new national GMP standard (MNS 5524:2014) which was approved by the Mongolian Agency for Standardization and Metrology. A GMP certification procedure was developed and approved by MOH.

The Project aimed to upgrade the GASI medicines inspectorate, guide inspections and company certifications. GASI inspectors were involved in GMP assessments by the international GMP consultant, and invited to all GMP trainings. According to the OPM consultants, GASI inspection procedures are not compatible with WHO Good Inspection guidelines and the methods of GASI s GMP inspection are problematic. The MOH will engage GMP qualification experts from WHO in the first part of 2015 to get professional opinion in regard to the existing quality management system for GMP inspection (under GASI).

OPM consultants assisted in developing manufacturer capabilities to upgrade facilities and train personnel. Training on GMP principles and good practices was done in 2012-2014 with participants from local drug manufacturers (production and quality control managers), medicines control laboratory and pharmaceutical associations. Consultants have also conducted a regular assessment in the 7 most promising local drug manufacturers since 2011 to support them to be certified by the upgraded GMP standard.

WHO GMP inspector worked in April 2015 to assess quality system of Mongolian GMP inspectorate and implement joint inspection with GASI inspectors for drug manufacturers assessed by FHSDP consultants previously. This GMP assessment of the selected companies confirmed that some potential facilities have made a progress, particularly in terms of green sites' (new construction), however there are still gaps in key areas especially control of active ingredients, HVAC qualification, classification of production areas, utilities and validation of sterilization cycles and other key processes such as cleaning of equipment. None of its licensed companies is meeting international GMP and therefore this situation poses severe (reputational) risk on the government. Options were discussed and it was agreed by the stakeholders that a GMP road map' for Mongolia to reach acceptable GMP standards (for initially 5 sites) by 2018 and further (10 sites) by 2020.

GMP international consultant recruited by the Project reviewed the quality manual of GASI to see if some sections had to be changed or improved. Several aspects of the roadmap for the GMP implementation, as defined after the WHO inspection, were discussed. Recommendations to progress on the GMP implementation in the local manufacturers were made and these recommendations reflected in the draft GMP implementation program of MOHS for 2015-2020.

Output 3.5.

The aim is to establish a basis for monitoring and reporting on adverse drug reactions to increase awareness of the problem and to institute preventive and corrective measures in hospitals. MOHS with support of project consultants developed and approved in 2013 a National Pharmacovigilance strategy and a ministerial order on Procedure on adverse drug reaction reporting and periodic safety update report of medicine. Trainings for medical professionals and members of hospital drug committees were conducted in 2013-2014. The number of reported ADRs has increased 4-times since the ADR training and publication of the ADR reporting manual. Twenty ADR case reports were filed in Vigibase (the global ADR database in Uppsala, Sweden) enabling Mongolia to attain full membership in the WHO International Drug Monitoring Programme.

Trainings on adverse drug reaction reporting activity and its significance for drug therapeutic committee members of hospitals and pharmacists of Tuv and Dornogovi aimags were organized in June 2015.

Output 3.6.

The objective of this output was to achieve strengthened drug safety governance functions at MOH with a pharmaceutical management information system. In 2010, WHO conducted a Country case study on Good Governance in the Pharmaceutical Sector in Mongolia. The results showed a moderate vulnerability to corruption with 6.169 and 6.208 ratings , meaning that registration, promotion, inspection, selection and procurement of medicines in Mongolia are conducted according with specific rules and legal acts. But violations are not properly punished even though the legal acts provide necessary provisions; there is no system for enabling the public to have equal and accessible information; and availability and accessibility of the instructions for the members of the drug registration, selection and tendering committees are insufficient. Project has initiated a review of a good governance of the pharmaceutical sector using WHO Good Governance Medicines Framework process in 2012. The MOH built the principles of a Good governance functions into the National Medicines Policy, approved by Parliament in October 2014. Project consultants assessed the current strategy to fight against illegal, counterfeit and/or substandard drugs and introduced recommendations to MOH, along with results of the national counterfeit drug survey undertaken in 2012. The MOH approved the anti-counterfeiting strategy in 2012.

Pharmacovigilance workshop on Regulation issues of safety of registered medicines for 100 representatives of pharmaceutical procuring company and drug manufacturers of UB city was organized in June 2015. The participants were introduced about issues related with reporting the periodic safety update information of procured or produced medicines by pharmaceutical companies. Handbook for periodic safety updates report (92 pages) was developed by Pharmacovigilance consultant, 500 copies were published and used as a training reference for Pharmacovigilance workshop.

Geographical Location
Safeguard Categories
Environment B
Involuntary Resettlement C
Indigenous Peoples C
Summary of Environmental and Social Aspects
Environmental Aspects

An environmental assessment has been carried out in accordance with the Mongolia regulatory framework and ADB's Safeguard Policy Statement (2009). A consolidated initial environmental examination (IEE) report was prepared, which assesses and addresses the environmental implications of the rehabilitation and expansion of the Songinohairkhan District Hospital and the New Central Laboratory. The team and project counterparts agreed to specify the whole laboratory building as an associated facility. This allowed conducting necessary due diligence for the building, resulting in the conduct of the necessary domestic environmental assessment, ensuring compliance with the Mongolian law. The consolidated IEE summarizes the findings of the New Central Laboratory Environmental Impact Assessment (EIA) and the Songinohairkhan District Hospital Initial Environmental Examination (IEE), and a due diligence review of project associated facilities. Potential adverse impacts during the construction and operation phase include limited standard construction impacts; and occupational and community health and safety issues, especially the unsafe collection, storage, treatment, and disposal of medical and chemical hazardous waste. The possible adverse environmental impacts will be prevented or minimized to acceptable levels, through the implementation of the environmental management plan (EMP) that includes adequate mitigation and monitoring arrangements. Following up the Inception mission, project national environmental consultant had reviewed the Environmental Management Plan (EMP) of the project and updated relevant sections based on mission recommendations and results of situation analysis and submitted to ADB in June.

The environmental assessment process achieved significant value added by (i) catalyzing, through policy dialog with MNET and GASI, the development of an EIA for the project's associated new central laboratory building; (ii) developing comprehensive management systems for the collection, storage, and treatment of medical and hazardous chemical waste; and (iii) developing a substantial consolidated IEE report which defines environmental mitigation measures, monitoring requirements, institutional responsibilities, and training and capacity building requirements.

The Inception mission reviewed the progress of project preparation with regard to environmental safeguards, and agreements were reached on the next steps and responsibilities. Field visits were conducted to the Songinokhairkhan district hospital, the new Central Laboratory, and the medical waste treatment facility operated by Element Company.

The Grievance Redress Mechanism (GRM) guidelines were developed in accordance with recommendations and templates provided by the ADB environmental specialist and submitted to ADB on 9 June and received feedbacks and incorporated them into the guidelines. GRM section of EMP was also revised.

Involuntary Resettlement No involuntary resettlement effects are foreseen and the project is classified as a category C project. The upgrading of the facilities of the multifunctional hospital will be on existing government land and will not affect local residents or residential buildings. A resettlement plan and framework are therefore not required. Should there be any change in scope or other changes with unanticipated resettlement impacts during project implementation, land acquisition and resettlement activities will be implemented in accordance with ADB's Safeguard Policy Statement.
Indigenous Peoples The project will not have any negative impact on indigenous peoples and is therefore classified as a category C project. No further actions are therefore required.
Stakeholder Communication, Participation, and Consultation
During Project Design Consultations with key stakeholders were held during project preparation including focus groups with beneficiaries such as local community member and hospital patients, in-depth interviews with family general practice doctors, hospital directors, and specialist doctors in Ulaanbaatar. The first series of consultations investigated current access to health services and medical drugs by the poor, and the findings are included in the poverty and social analysis section above. The second round of interviews and focus groups were held with hospital doctors and inpatients to solicit their views, suggestions, and recommendations regarding the proposed project design to establish a multifunctional hospital and a drug regulatory body. The multifunctional hospital will involve establishing new patterns of service delivery which will be complex and there may be risks associated with it. For this reason effective ways of defining and measuring the quality of hospital care will be established and systems will be put place to redress poor quality service should it arise.
During Project Implementation The plan includes: (i) patient satisfaction surveys, (ii) community monitoring and awareness raising linked to the pilot multifunctional hospital in the Songinohairkhan district, and (iii) drug safety information and outreach activities in Ulaanbaatar. The tools that will be used to assess the performance of the pilot hospital services will be patient satisfaction surveys and community score cards. The results will be part of the project's monitoring and evaluation system. The patient satisfaction survey will collect information on (i) the availability, reliability, and quality of hospital services received; (ii) the responsiveness of hospital service providers; (iii) hidden costs, such as a demand for informal payments; and (iv) affordability. The community score card will address similar issues and suggestions for addressing complaints. Improved drug safety. A communication and media framework will be established so that the general public and stakeholders will have access to the annual reports and public reporting on the website. A local nongovernment organization experienced in drug safety and consumer affairs will raise awareness through outreach programs and local public meetings about drug regulatory control. The project will hire a local nongovernment organization to implement the activities and the project implementation unit will support a gender specialist for gender mainstreaming project activities (including the gender action plan). The consultation and participation plan will be implemented over the 5 years of the project at a cost of $50,000.
Business Opportunities
Consulting Services The Recipient is responsible for selecting, engaging, and supervising Consultants engaged under the loans and grants funded by ADB. All consultants will be recruited according to ADB's Guidelines on the Use of Consultants (April 2010, as amended from time to time).
Procurement All procurement of goods and works will be undertaken in accordance with the Asian Development Bank's (ADB) Procurement Guidelines (2010, as amended from time to time). International competitive bidding (ICB) will be applied to goods contracts estimated to cost $2,000,000 or more and works contracts estimated to cost $5,000,000 or more. Goods contracts with values less than $2,000,000 and works contracts with values less than $5,000,000 will follow national competitive bidding (NCB). Works and goods contracts with values less than $100,000 will be procured using ADB's shopping procedure. NCB procurement will be carried out on the basis of NCB procedures, in accordance with the Mongolian Procurement Law, subject to modifications agreed with ADB. Before the start of any procurement, ADB and the government will review the public procurement laws of the central and state governments to ensure consistency with ADB's Procurement Guidelines. The internationally tendered equipment packages will include the necessary technical support for ensuring proper installation, testing, commissioning, and training of operational staff as part of the related contracts. In accordance with ADB requirements, foreign contractors may participate in bidding for NCB contracts. For NCB, the first draft English language of the procurement documents (prequalification, bidding documents, draft contract) should be submitted for ADB approval regardless of the estimated contract amount. Subsequent procurement are subject to post review. All ICB contracts are subject to prior review. Prior review and approval of ADB of the procurement documents (prequalification, bidding, contract) is required.
Responsible ADB Officer Altantuya Jigjidsuren
Responsible ADB Department East Asia Department
Responsible ADB Division Mongolia Resident Mission
Executing Agencies
Ministry of Health_and Sports
1st Floor, Government Building VIII
Olympic Street 2, Ulaanbaatar
Concept Clearance 04 Jun 2010
Fact Finding 18 May 2010 to 20 May 2010
MRM 03 Sep 2010
Approval 29 Nov 2010
Last Review Mission -
PDS Creation Date 19 Oct 2010
Last PDS Update 10 Sep 2015

Grant 0236-MON

Approval Signing Date Effectivity Date Closing
Original Revised Actual
29 Nov 2010 10 Dec 2010 03 Mar 2011 31 Dec 2016 31 Dec 2018 -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 17.70 Cumulative Contract Awards
ADB 14.00 29 Nov 2010 3.97 0.00 28%
Counterpart 3.70 Cumulative Disbursements
Cofinancing 0.00 29 Nov 2010 3.67 0.00 26%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating Satisfactory - - Satisfactory - Satisfactory

Loan 2932-MON

Approval Signing Date Effectivity Date Closing
Original Revised Actual
05 Nov 2012 07 Feb 2013 14 Jun 2013 31 Dec 2016 31 Dec 2018 -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 27.00 Cumulative Contract Awards
ADB 25.00 05 Nov 2012 1.00 0.00 4%
Counterpart 2.00 Cumulative Disbursements
Cofinancing 0.00 05 Nov 2012 0.88 0.00 4%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating Satisfactory - - Satisfactory - Satisfactory

Evaluation Documents

See also: Independent Evaluation

No documents found.

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