41243-012: Fourth Health Sector Development Project | Asian Development Bank

Mongolia: Fourth Health Sector Development Project

Sovereign (Public) Project | 41243-012 Status: Active

ADB is helping Mongolia improve hospital services in the capital, Ulaanbaatar, and strengthen the country's drug safety regime. The project will assist in preparing the first hospital development policy for Ulaanbaatar, strengthen medical residency training and postgraduate programs as part of human resource development, set up a drug regulatory authority, and upgrade a drug control laboratory.

Project Details

Project Officer
Jigjidsuren, Altantuya East Asia Department Request for information
  • Mongolia
  • Grant
  • Loan
  • Health
Project Name Fourth Health Sector Development Project
Project Number 41243-012
Country Mongolia
Project Status Active
Project Type / Modality of Assistance Grant
Source of Funding / Amount
Grant 0236-MON: Fourth Health Sector Development Project: Improving Sector Governance
concessional ordinary capital resources lending / Asian Development Fund US$ 14.00 million
Grant: Fourth Health Sector Development Project
World Health Organization US$ 450,000.00
Loan 2932-MON: Fourth Health Sector Development Project - Additional Financing
concessional ordinary capital resources lending / Asian Development Fund US$ 25.00 million
Strategic Agendas Inclusive economic growth
Drivers of Change Gender Equity and Mainstreaming
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

The project has made good progress in developing the legal framework for reforming the hospital sector in Mongolia and improving the hospital governance. To demonstrate the new concept of hospital care, the project is establishing the new 200 bed multifunctional hospital in Songinokhairhan district of UB city. The construction works started in 2017 and expected to be completed in 2019.

The project successfully achieved its desired outcomes under the Drug Safety component through strengthening drug regulatory functions, upgrading the drug control laboratory to international standards, upgrading the standards of good manufacturing processes for drugs, strengthening drug post-marketing surveillance and adverse drug reaction and improving drug safety governance functions of MOH.

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: Hospital Development Policy and Strategic Plan for Ulaanbaatar (UB) city. A major output of the project is the development and approval of a hospital policy for UB city, which will direct changes in the way hospitals are financed, managed, organized and deliver services. The Project assisted the MOH to prepare the Hospital Care Development Policy (2014) and its midterm strategy and implementation plan (2015). In 2017, the MOH integrated these two documents and some other policy papers into one document named _State Policy on Health_ (2017). In May 2016, the parliament also approved a new law the Law on Medical Care and Services, which stipulates semi-autonomous status of public hospitals and related institutional, financial and human resource reforms initiated by the project. The project has successfully achieved its aim to support the government in preparing the hospital development policy.

Output 2: Hospital Capital Planning System. Development of a capital planning system meant to support MOH in evidence-based decision making regarding the investments in new technologies and equipment. The project helped MOH assess the public hospital infrastructure and equipment inventory in 2012-2014. In 2015, MOH decided to reduce the task scope and focus only on the hospital equipment planning system. The project consultants developed the (i) equipment inventory database and equipment planning software for medical and information technology equipment; (ii) manual on software use; (iii) translation of the Universal Medical Devise Nomenclature or terminology; and (iv) draft regulation on use of medical equipment inventory database for prioritization and planning of investments in medical equipment. However, the software, the terminology translation and the regulation have not been finalized yet.

Output 3: Demonstration Multifunctional General Hospital Established in Songinokhairkhan District. The project aims to turn the Songinokhairkhan district hospital (SDH) of UB city into a multifunctional general hospital to demonstrate the new concept of hospital care at the district level. The SDH (i) will be a district-level hospital with 200 beds including an intensive care unit; (ii) will provide inpatient and outpatient care in the seven basic medical specialties (internal medicine, obstetrics, gynecology, pediatrics, and general surgery), traditional medicine, neurology, infectious diseases and dental care, as well as the first-level emergency care including simple traumatology care for a 150,000 population; (iii) will pilot the concepts and practice of day care and ambulatory surgery in Mongolia; (iv) will function as a referral facility for primary care family health centers; and (v) will be the sole public provider of secondary-level services in its coverage area.

The project engaged SIMED to develop the concept design and functional plan of SDH (March 2015). Junglim Architecture Co., Ltd, prepared architectural drawings (approved by the state expertise in January 2016). In May 2017, MOH signed the civil works contract with Vamed Engineering GmbH, Austria. MOH engaged the UB city Investment Department to carry out on its behalf the Client supervision over the construction works. The Junglim Architecture Co., Ltd, is performing the Author's supervision. In addition, the PIU engaged a civil work coordinator to (i) inspect and monitor the civil works, and (ii) coordinate the stakeholder activities at the construction site. The hospital construction commenced on 1 September 2017. As of today, the contractor completed 20 percent of the works, including fundament and basement concrete work of the main and technical buildings. The mission visited the construction site, met with the representatives of contractor and both supervising agencies.

WHO, the project co-financier, provided technical assistance to develop (i) _Songinokhairkhan District Hospital Establishment Plan_ to guide the establishment of the SDH (approved by the UB city Vice-Mayor in March 2016), (ii) a 5-year financial forecast for SDH, and (iii) hospital financial management manual.

The PIU started the training of medical staff for the new SDH. In consultation with MOH and the Mongolian National University for Medical Sciences (MNUMS) it was agreed that clinical residency training in 4 specialties will be conducted using a new curriculum developed by the project. Training of 37 medical doctors in 17 specialty areas is ongoing. The trainees were selected by MOH and signed a contract with MOH (client), MNUMS (training institution) and UB city Health Department (on behalf of the hospital-recipient) and the project (financier). Training of 123 nurses in 11 clinical areas started in 2018.

Output 4: Improved Hospital Governance. The project achieved its aim to improve hospital governance by updating the hospital licensing system and improving the public hospitals' governance arrangements. The government regulations on hospital licensing were updated in 2013. The revised Health Law (2016) and the new Law on Medical Care and Services (2016), which were prepared with the technical support of the project, refined the hospital licensing system by (i) inclusion of the _certificate-of-need_ processes, whereby new hospital facilities or high cost services must be justified in terms of population health and clinical needs, and (ii) involvement of non-government agencies in conducting needs assessment. The new laws provide legal basis for the hospital sector governance reform proposals initiated under the project. These include (i) changing the way the public hospitals are managed by introducing hospital boards that will have a right to select and appoint hospital managers based on their performance; (ii) granting a decision-making authority to public hospitals regarding the hospitals' financial and human resources; and (iii) giving flexibility in managing the hospitals' financial residuals.

Output 5: Strengthened Postgraduate Specialist Structure and Residency Programs. The project consultants developed the institutional and regulatory framework for postgraduate specialist training. The framework describes the roles and functions of institutions involved in postgraduate training planning, accreditation and training. Based on the regulatory framework, the government revised the Health Law (2016) to (i) stipulate the establishment of a regulatory agency under MOH that will be responsible for all regulatory functions on postgraduate specialist training, such as planning, selection of training institutions/hospitals, financing, monitoring and evaluation of training quality, and examination and licensing of the graduates; (ii) refine the status of clinical residents as of the host hospitals' contractual staff; and (iii) define the funding sources and financing mechanisms for residency programs.

The project consultants, jointly with the MOH working group members, have revised the residency training curricula in four clinical areas (internal medicine, general surgery, obstetrics-gynecology and pediatrics) and developed new 10 nursing curricula to make them compatible to the internationally accepted levels. The new curricula have substantial differences in terms of content, training structure, funding mechanism, duration, and requirements for the training institutions, trainers and trainees. The new residency training and the revised postgraduate nursing training curricula were supported by professional associations in 2015. MOH decided to pilot the new curricula in the residency training of new doctors for SDH that has been organized by the project. The Scientific committee of the MNUMS approved the new residency training curricula in October 2016 and started the piloting in 2016. To support the new curricula, the project translated four core textbooks and, after reviewing and editing, submitted them for publishing.

Output 6. Hospital Management Module Integrated in a Local Training Institution. The School of Public Health, in association with the Association of Public Health Specialists and Management Academia, organized two trainings for senior and middle level hospital managers in 2014 and 2015. A total of 50 managers have been trained as planned under the project. However, institutionalization of the hospital management training is not yet in place yet.

Output 7 and 8: Drug regulatory authority (DRA) and strengthened drug regulatory functions. Establishment and institutional development of the Drug regulatory agency - an integrated authority with strengthened regulatory functions to improve coordination and quality of medicines - was one of core project outputs. The concept is incorporated in several policy documents: (i) Government Action plan 2012-2016; (ii) National Medicines Policy, approved by parliament in October 2014; and (iii) draft revision of the law on medicines and medical devises, submitted to parliament in 2015. However, the DRA is not established yet due to (i) resistance of the General Agency for State Inspection (GASI) to shift its mandate over inspection and control of medicines to the DRA, (ii) extended political debate on whether a DRA or FDA (food and drug authority) or a DRA/FDA but with separated inspection under GASI should be established, and (iii) because of the government decision do not establish any new agencies to decrease government administrative costs by cutting down civil servants and merging some government agencies.

Output 9: Upgraded drug control laboratory and accreditation system.

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. 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, and recommended appointment of a full time quality assurance manager (implemented in mid-2013 and personnel changed subsequently). The Mongolian Agency for Standardization and Metrology has accredited DCL with ISO-17025 during a national assessment in 20147. In 2015, the ANSI-ASQ National Accreditation Board (ANAB-ACLASS) of USA conducted pre- and post-assessment of DCL against international accreditation standards ISO-17025. The DCL received an international accreditation in December 2016. The project supported the establishment of a Laboratory Information Management System (LIMS) in DCL.

Output 10: Implementation of Good Manufacturing Practices (GMP). The Project invited independent international expert to assess quality of GMP inspection (under GASI). The expert concluded that GASI would require further investment to strengthen its quality management system, which is not in place yet, although it would deepen further duplication of functions with the Human Drug Council at the MOH. The project provided policy recommendations based on international experience, capacity building activities, upgrading of existing standards and regulations, and independent expert opinion in regard to GMP inspection. The final decision will rest with the government whether to keep the GMP inspection under GASI or bring it under the Medicines Regulatory Division under MOH together with other regulatory functions.

The project assisted in upgrading the National GMP standard (approved in 2015) and GMP procedure (approved by MOH in 2013). GMP guidelines for pharmaceutical products, biological products, on GMP for heating, ventilation and air-conditioning systems for non-sterile products, and for sterile pharmaceutical products were translated into Mongolian and published. To assist local drug manufacturers to be certified by the upgraded GMP standard, the project has conducted assessments in the 6-7 most promising manufacturers throughout 2013-2014. For each audit an extensive report was prepared with observations on how the GMP reference requirement can be met, and recommendations on corrective actions. The IVCO-parenteral solution manufacturing company received a national GMP certification according to new approved GMP standard in Feb 2015. Other four companies are making significant investments and will likely comply with GMP in near future. Under the project consultation, the MOH developed and approved the GMP implementation program for 2015-2020, according to which local manufacturers will be closed down if they do not obtain GMP certification by the end of 2020.

The project assisted in development of new GMP training program in partnership with School of Pharmacy of the National University of Medical Sciences and Mongolian Pharmaceutical Association. In 2012-2015, 30 lecturers and 258 technical staff of the local drug manufacturers and GASI inspectors were trained in basic and advanced GMP trainings.

Output 11: Strengthened post marketing surveillance and adverse drug reaction (ADR) monitoring. The project targeted strengthening post marketing surveillance and ADR monitoring system in Mongolia through upgrading the system and capacity training of professionals. The project consultants reviewed overall pharmacovigilance system, identified bottlenecks, determined feedback system and corrective and preventative actions in Sep 2012. The upgraded working procedures for documentation of ADR reports were endorsed by MOH in 2013. A national Strategy of pharmacovigilance for 2014-2016 to establish drug safety monitoring system and enable a provision of high quality, safe standard drugs to Mongolian population, as well as prevention of drug association risks were approved by MOH in 2014.

The project assisted in development of curriculum and training materials on pharmacovigilance for Drug Therapeutic Committee (DTC) members at hospitals. The project conducted trainings on pharmacovigilance for 50 hospital's DTC members, MOH staff, GASI inspectors and Pharmacological Subcommittee of Human Drug Council. Pharmacovigilance trainings were conducted for 385 medical professionals in eight provinces (Uvurkhangai, Umnugovi, Uvs, Khentii, Tuv, Dornogovi, Dornod and Sukhbaatar) in 2013-2014. Another 135 pharmacists working in the field of pharmaceutical manufacturing and wholesaling organizations were trained and provided by _Handbook on managing drug safety update reports for pharmaceutical manufacturers and wholesalers_ developed by the project. As a result of trainings, the number of reports from hospitals' drug committees on potential ADRs is increasing.

Output 12: Strengthened drug safety governance functions at MOH. The MOH has included standard indicators recommended by WHO for assessing pharmaceutical systems in countries in the National Medicines Policy Implementation and Monitoring plan (approved by MOH in 2014). Project consultants reviewed the good governance practice in pharmaceutical sector using WHO Good Governance Medicines Framework process (2015). The project consultants support MOH in development of the _Pharmaceutical sector Indicators_ with important for the public information on (i) certified pharmacies and wholesale companies, (ii) registered medicines by name, producers, suppliers; (iii) drug quality control related information, (iv) reported adverse drug reactions, (v) substandard and counterfeit drugs, (vi) essential medicines and (vi) rational use of medicines. The Pharmaceutical sector Indicators were incorporated into the _Health Indicators_ issued by MOH on annual base.

The Project assisted MOH in reviewing and upgrading the drug regulatory database LICEMED to improve quality data base of registered products, licensed providers, and specialists available online. Consequently, public awareness and knowledge about activities related to registration and permission of pharmaceutical products and medical devices was increased.

Geographical Location Ulan Bator
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 (i) the environmental implications of the construction of the new Songinohairkhan District Hospital (SDH), and (ii) the New Drug Control Laboratory (DCL). The possible adverse environmental impacts have been prevented or minimized to acceptable levels, through the implementation of the environmental management plan (EMP) that includes adequate mitigation and monitoring arrangements. The Environmental Management Plan (EMP) of the project was updated several times based on review mission recommendations. The implementation of EMP has been regularly monitored and corrective actions were taken as required. The status of EMP were disclosed to the public.

The establishment of a new Drug Control Laboratory completed in 2016. No environmental issues were reported during and after the construction of the DCL. The environmental assessment process achieved significant value added by (i) catalyzing, through policy dialog with GASI, the implementation of the project's activities associated establishment of new DCL building, and (ii) developing comprehensive management systems for the collection, storage, and treatment of hazardous chemical waste.

The establishment of the SDH is ongoing. The Grievance Redress Mechanism (GRM) guidelines were developed in accordance with the ADB's environmental regulations. With the start of construction of SDH, the project updated the GRM team, organized seminar for project stakeholders on project GRM and training on environmental management, health and safety for GRM team. Information boards and suggestion boxes were placed in the construction site and the current hospital to inform about GRM and receive complaints. In June 2017, the project received two complaints. The first compliant came from residents of apartment No.106 located in the south side of the planned hospital main building. The residents concerned about close location of the hospital building. The boundary points of architectural planning assignment of SDH were in accordance to standard requirements and the construction site scheme was approved by UB city Urban Development and Master Planning Agency in 2015. However, to resolve this complaint, PIU updated the construction site scheme and master plan of the planned building. A boundary point of architectural planning assignment was relocated by 3 meters to the north and 7 meters to the west. The Master plan and construction site scheme of SDH were updated and approved by the UB city Urban Development and Master Planning Agency. The second compliant was about a guardhouse, which is built near to 1st and 2nd floors and closing window of apartment No.106. A guardhouse was moved away from the apartment by 6 meters. GRM reports are available.

Involuntary Resettlement No involuntary resettlement effects are foreseen, and the project is classified as a category C project. The construction of the multifunctional hospital is curried out on existing government land and do not affect local residents or residential buildings. No resettlement plan and framework are 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 Two local NGOs (_Monconsult_ LLC and _Shagdui_ LLC) have been engaged to implement the project consultation and participation activities and to foster community participation and involvement. Shagdui LLC has developed (i) information, education and communication (IEC) materials on drug safety and hospital care policy, and (ii) prepared the draft communication strategy for hospital policy reform and drug safety. Monconsult LLC has been implementing the community awareness program to raise awareness among the community of focus on the ongoing hospital reform and drug safety issues, and to ensure community participation for the monitoring and feedback purposes in Songinokhairkhan district. A baseline patient satisfaction survey was done in 2015, and the end line survey is planned in 2019. Community Score Card (CSC) surveys were conducted in 2015, 2016 and 2017. A number of outreach activities was conducted in 2017 with assistance of 64 outreach workers trained by the project.
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 Jigjidsuren, Altantuya
Responsible ADB Department East Asia Department
Responsible ADB Division Mongolia Resident Mission
Executing Agencies
Ministry of Health (formerly Ministry of Health and Sports)
[email protected]
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 20 Mar 2018

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 2020 -
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 8.91 0.00 64%
Counterpart 3.70 Cumulative Disbursements
Cofinancing 0.00 29 Nov 2010 5.64 0.00 40%
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 2020 -
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 21.18 0.00 91%
Counterpart 2.00 Cumulative Disbursements
Cofinancing 0.00 05 Nov 2012 7.76 0.00 33%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating Satisfactory - - Satisfactory - Satisfactory

Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.

The Public Communications Policy (PCP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.

The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.

In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.

Title Document Type Document Date
Fourth Health Sector Development Project: Procurement Plan Procurement Plans Jan 2017
Fourth Health Sector Development Project: Audited Project Financial Statements (January-December 2015) Audited Project Financial Statements Oct 2016
Fourth Health Sector Development Project - Additional Financing: Audited Project Financial Statements (January - December 2014) Audited Project Financial Statements Sep 2015
Amendment to Loan Agreement for Loan 2932-MON: Fourth Health Sector Development Project - Additional Financing Loan Agreement (Special Operations) Jun 2015
Fourth Health Sector Development Project - Additional Financing Procurement Plans Jun 2015
Amendment to the Loan Agreement for Loan 2932-MON: Fourth Health Sector Development Project - Additional Financing Loan Agreement (Special Operations) Mar 2015
Amendment to the Grant Agreement for Grant 0236-MON: Fourth Health Sector Development Project Grant Agreement Jun 2014
Fourth Health Sector Development Project (Additional Financing) Project/Program Administration Manual Jul 2013
Эрүүл мэндийн салбарыг хөгжүүлэх IV төсөл : Төслийн Мэдээллийн Тайлан Translated PDS Feb 2013
Loan Agreement for Fourth Health Sector Development Project – Additional Financing Loan Agreement (Special Operations) Feb 2013
Fourth Health Sector Development Project - Additional Financing Reports and Recommendations of the President Oct 2012
Fourth Health Sector Development Project - Additional Financing Gender Action Plans Oct 2012
Fourth Health Sector Development Project (Additional Financing) Project/Program Administration Manual Oct 2012
Fourth Health Sector Development Project (Additional Financing) Initial Poverty and Social Analysis Aug 2012
Grant Agreement for Fourth Health Sector Development Project: Improving Sector Governance between Mongolia and Asian Development Bank dated 10 December 2010 Grant Agreement Dec 2010
Fourth Health Sector Development Project Reports and Recommendations of the President Nov 2010
Fourth Health Sector Development Project: Gender Action Plan Gender Action Plans Nov 2010
Fourth Health Sector Development Project Project/Program Administration Manual Nov 2010
Fourth Health Sector Development Project Summary Poverty Reduction and Social Strategies Nov 2010

Safeguard Documents See also: Safeguards

Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.

Evaluation Documents See also: Independent Evaluation

None currently available.

Related Publications

None currently available.

The Public Communications Policy (PCP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.

Requests for information may also be directed to the InfoUnit.


No tenders for this project were found.

Contracts Awarded

No contracts awarded for this project were found