Mongolia: Fifth Health Sector Development Project
ADB is helping Mongolia improve the safety of patients and health workers in hospitals. The project will assist the Ministry of Health in setting up a national blood transfusion center and an improved central medical waste management facility in Ulaanbaatar. It will provide equipment for hospital sterilization and microbiology laboratories to prevent and control hospital-acquired infections.
East Asia Department
Request for information
|Project Name||Fifth Health Sector Development Project|
|Project Type / Modality of Assistance||Grant
|Source of Funding / Amount||
|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 improve patients' and health workers' safety in hospitals in Mongolia. It will (i) improve the safety of blood transfusions, (ii) strengthen medical waste management, and (iii) prevent and control hospital acquired infections. It complements previous Asian Development Bank (ADB) initiatives in the health sector in Mongolia.|
|Project Rationale and Linkage to Country/Regional Strategy||
Mongolia's economic outlook is bright, but the country is experiencing severe shortages in the provision of social services despite increasing budgetary resources. There is inadequate capacity to implement reforms to improve accessibility and service quality of hospital services. Poorer segments of the population have limited access to private hospitals due to high cost of care and limited health insurance coverage. At the same time, international support to the health sector is shrinking. The cost of reforming the hospital sector in Ulaanbaatar alone is estimated at $450 million. Patients' and health workers' safety is currently compromised by lapses in hospital hygiene, blood transfusion practices, and medical waste management in the public and private sector.
The government seeks to strengthen blood safety in hospitals and improve preparedness for emergencies in case of natural disasters. Deficiencies in aimag (province) blood banks impact on patients' and health workers' safety. Inadequate facilities, equipment, and testing materials; inadequate capacity of personnel involved in blood safety; lack of confidentiality; poor registration and reporting of adverse reactions; lack of readiness for emergencies; and lack of measures to reduce inappropriate blood transfusions are among the major deficiencies, which can result in unintentional transmission of HIV, syphilis, and hepatitis B and C.
Efforts are underway in Ulaanbaatar and in medium-sized cities such as Darkhan and Erdenet to improve hospital medical waste treatment and disposal, but the situation in the aimags is far from ideal. There is inadequate management of liquid hazardous waste produced by hospitals and laboratories. Liquid hazardous waste when poorly disposed causes harm to people and the environment, as it contains chemical substances, drugs, and pathogens. Hospital sewerage systems are not always of good quality, resulting in environmental and public health risks.
Infection control in Mongolian health care facilities is poor and hospital acquired infections are thought to be underreported. In March 2010, Mongolia experienced 28 hospital acquired infections among newborns, of whom five died, as a result of poor infection control clinical practices. Prevalence of hepatitis B and C of health care workers in Mongolia is among the highest in the world and points to breaches in health care safety. Sterilization facilities and practices in hospitals are poor, and basic hygiene measures, such as hand washing, are not commonly implemented. The surveillance system currently implemented in hospitals consists of passive reporting of hospital acquired infections. Several aspects prevent the current passive surveillance system in hospitals from being effective: (i) the disincentive associated with reporting of hospital acquired infections cases; (ii) the widespread preventive use of antibiotics for surgery and other procedures, including for newborn babies; and (iii) the lack of microbiology capacity to detect infections and sensitivity to treatment.
The government has established a legal and regulatory framework to address the above shortcomings. But it lacks investment funding; financing of operational costs; and human resources capacity to implement regulatory measures, guidelines, and plans. Several international partners are supporting the government in these areas but there are still significant gaps, primarily investments, development of monitoring and surveillance systems, and institutional and human resources capacity development. Private investors are entering the hospital market intending to offer higher standards of care for more affluent patients. Public hospitals (with a greater bed capacity) lag behind and remain a serious threat to patient and health workers' safety. This perpetuates discrimination between poorer and more affluent population groups. A central facility for the treatment and disposal of medical wastes was established as a public-private partnership in Ulaanbaatar in 2007 and has been operational since 2010. This initiative, although requiring major investments, represents a solid foundation for improved medical waste management in the capital where almost half of the Mongolian population lives. Ulaanbaatar's National Transfusiology Center (NTC), which provides blood transfusion services of acceptable quality, can play an important role in capacity development and monitoring of hospital transfusion activities in Ulaanbaatar and in the aimags.
The project builds on hospital sector reforms initiated under previous ADB-funded operations in Mongolia, including the Fourth Health Sector Development Project to strengthen hospital services. ADB sector recommendations emphasize the need for structural changes in health care delivery by rationalizing excess hospital capacity at the secondary and tertiary levels, particularly in Ulaanbaatar. The Fourth Health Sector Development Project is engaged in reforming the hospital sector but hospital rationalization needs to be complemented with increased quality and safety of hospital services to provide effective care and lower resistance to sector reforms. The project will deliver tangible benefits to women by ensuring higher safety standards to protect staff, the majority of whom are women, against hospital acquired infections and improving safety of blood transfusions in hospitals.
ADB is the largest external financier of the health sector in Mongolia, and plays a key role in assisting the government to formulate and implement health sector reforms. Support from other partners tends to focus on assisting the government to address particular diseases or develop certain programs. ADB works in close consultation with these partners to support the coordinated implementation of the Health Sector Master Plan (2006-2015). The World Health Organization, with global expertise in all three focus areas of the project, will assist the project mainly by providing consulting services. The German Federal Ministry of Health, which is supporting a small scale hospital hygiene project in Mongolia, will support the project by providing advisory services for policy development, monitoring and evaluation, and training activities in Mongolia and Germany.
The project builds on previous ADB health sector development initiatives and policy reforms under the Social Sectors Support Program to continue reforming the Mongolian health sector in line with (i) the National Development Strategy in achieving the Millennium Development Goals (MDGs), MDG 4 (Child Health) and MDG 5 (Maternal Health), and more directly MDG 6 (HIV/AIDS and tuberculosis), and MDG 7 (environmental health and sanitation); and (ii) the government's Health Sector Master Plan (2006-2015) for improving hospital services. The project is included in the country operations business plan (2012-2014) and is consistent with the current country partnership strategy (2012-2016), which emphasizes social development through efficient delivery of health services.
|Impact||Improved quality of health services in Mongolia|
|Description of Outcome||Improved patient and health worker safety in project-supported hospitals in Mongolia|
|Progress Toward Outcome||The MOH has recruited a consultant (package CS01) to develop the warehouse facility's conceptual design. The draft concept design has passed the first round of discussions by the working group of MOH. The working group's main comment was to reduce the parameters of the proposed facility to better adapt to the available land. The warehouse facility's construction will be on the territory of the National Zoonotic Diseases Center, with no land acquisition and resettlement. The final concept design and functional plan for the warehouse facility was approved by the State Secretary of MOH. Package CW02 on Design and Build for warehouse facility for emergency medicines and supplies was advertised in Feb 2021 and completed the evaluation of quotations in May 2021. The civil works for construction of Medical warehouse facility is ongoing.|
|Description of Project Outputs||
Component 1: Safe Blood Transfusion
1. The new national transfusiology center is established in Ulaanbaatar and internationally accredited.
2. Aimag (province) general hospitals and soum (administrative subdivision of the aimag) health centers transfuse safe blood.
Component 2: Medical Waste
Output 4. The national medical waste management system is strengthened and the project hospitals meet the requirements of national standards.
Component 3: Hospital Hygiene and Infection Prevention and Control
Output 5. Microbiology laboratory capacity of project-supported hospitals meets national requirements.
6. Basic infrastructure and equipment for ensuring IPC in the project-supported hospitals are available.
7. An effective surveillance system for hospital-acquired infections is operational.
8. Awareness, knowledge, and capacity of health authorities, health care workers, and administrative staff on IPC have substantially improved.
9. IPC is ensured by strengthening the quality management system in hospitals and developing the capacity of the General Agency for State Inspection (GASI).
10. Diagnostic and treatment capacity of hospitals to manage Severe Acute Respiratory Infections (SARI) patients increased.
11.National stockpiles for medical countermeasures established.
Additional Output. Project Management.
|Status of Implementation Progress (Outputs, Activities, and Issues)||The project coordination by the PIU is satisfactorycompletedcompletedcompletedcompletedcompletedcompletedCompletedCompletedUnder L2963-MON: As of 28 Feb 2021, the EA completed renovations of CSSDs in 27 project sites. All 27 CSSDS in project hospitals are functioning. Under L3921-MON: As of 31 Mar 2021, EA completed the procurement for design and renovation of CSSDs in four aimags hospitals of Bayan-Ulgii, Govi-Altai, Arkhangai, Zavkhan in November 2020. The procurement for design and build of CSSDS for remaining three aimag hospitals of Tuv, Govisumber and Dundgovi completed in December 2020. The detailed working drawings for renovation of 7 CSSDs was prepared and approved by State expertise. The renovation works is expected to be completed by end of October 2021. The procurement for supply of equipment for CSSDs in 7 aimag hospitals was completed and the contract was awarded in Jan 2021. Fourteen types of 91 pieces of sterilization and disinfection equipment arrived in UB. As of 30 June 2021 the supplier started delivering CSSD equipment to the hospitals where the equipment will be stored in safe and appropriate conditions until their installment. Installment of equipment will be integrated with civil works.completed.completedcompletedcompletedcompletedThe procurement under package CW02 on Design and Build for warehouse facility for emergency medicines and supplies is completed and ADB accepted quotation evaluation report and contract in May 2021. The civil works for construction of Medical warehouse facility is ongoing.completedcompletedThe procurement process is ongoing. As of date the protective wear for healthcare professionals, intensive care unit equipment and ventilators, diagnostic and treatment equipment for risk patients and COVID-19 affected patient procured through nine contracts have been supplied to respective hospitals.The package for procurement of ambulance cars was canceled. The bidding for procurement of angiography system, diagnostic and treatment equipment for COVID-19 affected patients, CSSD equipment for Maternal and Child Health Center-2 and Burn Treatment Center are ongoing. Not yet duecompletedcompleted|
|Geographical Location||Nation-wide, Arhangay Aymag, Bayan-Olgiy Aymag, Bayanhongor Aymag, Bulgan, Bulgan Aymag, Central, Darhan, Dzavhan Aymag, East Aimak, East Gobi Aymag, Erdenet, Govi-Altay Aymag, Govi-Sumber, Hentiy Aymag, Hovd Aymag, Hovsgol Aymag, Khovd, Middle Govi, Omnogovi, Ovorhangay, Selenge Aymag, Suhbaatar Aymag, Ulaanbaatar Hot, Ulan Bator, Uvs Aymag|
|Summary of Environmental and Social Aspects|
|Environmental Aspects||The project is classified as category B. An initial environmental examination including an environmental management plan (EMP) was prepared in compliance with ADBs Safeguard Policy Statement (2009) and the Mongolia regulatory framework and was posted on the ADB website on 21 August 2012. The initial environmental examination addresses environment impacts, and risks related to (i) the Ulaanbaatar central medical waste management facility; (ii) the new National Center for Transfusion Medicine; (iii) smaller blood safety, infection prevention and control, medical waste facility installations in project aimags; and (iv) project associated facilities. The main adverse impacts and risks during the construction and operation phase include limited standard construction impacts, and risks related to unsafe collection, storage, treatment, and disposal of medical and chemical liquid waste generated by health facilities. These impacts and risks have been addressed through the implementation of the Environmental Management Plan (EMP) that includes adequate mitigation and monitoring arrangements, responsibilities for EMP implementation and supervision, environmental training and capacity building, and budgets for implementation of EMP. The EMP has been updated during the project implementation. 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 project will have significant environment, health, and safety benefits. Mongolia's medical waste management system, including liquid hazardous waste, will be significantly strengthened by improving medical waste management systems within health care facilities, and by upgrading the central medical waste management facility in Ulaanbaatar to meet internationally accepted standards.|
|Involuntary Resettlement||No involuntary resettlement effects are foreseen and is classified as a category C project. The National Center for Transfusion Medicine was established on existing government land and did not affect residents or residential buildings. The blood banks are located within aimag/district hospitals.|
|Indigenous Peoples||The project is classified as category C for indigenous peoples. The assessment determined that there will not be any negative impact on indigenous peoples. The project will carry out an assessment of and implement effective ways to design and deliver information, education, communication activities to the public to ensure social inclusiveness and effective communication.|
|Stakeholder Communication, Participation, and Consultation|
|During Project Design||Three workshops were held with related governmental departments, beneficiaries, environment protection bureau, local governments, etc., to inform the project design. The poverty and social analysis involved focus group and key informant interviews with health care workers, patients, and the general public. Development of the environmental impact assessments and environmental management plan (EMP) involved two rounds of public consultations. The gender action plan (GAP) has been prepared and discussed with the Ministry of Health. The GAP and EMP set out detailed ongoing public participation plans.|
|During Project Implementation||Public disclosure of all project documents was made at the project management office and on the ADB website, including the project information document, design and monitoring framework, consolidated environmental impact assessment, report and recommendation of the President, public sector legal agreement, project administration memorandum, and environmental monitoring reports. The GAP and EMP indicate how consultation will continue throughout implementation.|
|Consulting Services||The Borrower is responsible for selecting, engaging, and supervising consultants engaged under the loan funded by ADB. All consultants will be recruited according to ADB's Guidelines on the Use of Consultants (2010, as amended from time to time). A consultant firm to provide a total of 129 person-months of consulting services (37 international, 92 national) is recruited to support the executing agency in project implementation and capacity development for all project components. Three consulting firms will be engaged under lump sum contracts using consultants' qualification selection (CQS) for facilitating international accreditation of the National Transfusiology Center, architectural support for project facilities and environmental assessment of the central medical waste management facility. In total, 33 person-months of national consultants will be recruited for all three components following individual consultant selection procedure for providing safeguards, social, technical, legal, and monitoring support to the project.|
|Procurement||All procurement of goods and works will be undertaken in accordance with ADB's Procurement Guidelines (2010, as amended from time to time). International competitive bidding 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. Works and goods contracts with values less than $100,000 will be procured using ADB's shopping procedure.|
|Responsible ADB Officer||Jigjidsuren, Altantuya|
|Responsible ADB Department||East Asia Department|
|Responsible ADB Division||Mongolia Resident Mission|
Ministry of Health (formerly Ministry of Health and Sports)
1st Floor, Government Building VIII
Olympic Street 2, Ulaanbaatar
|Concept Clearance||07 Oct 2011|
|Fact Finding||03 Jul 2012 to 06 Jul 2012|
|MRM||07 Sep 2012|
|Approval||10 Dec 2012|
|Last Review Mission||-|
|Last PDS Update||21 Sep 2021|
|Approval||Signing Date||Effectivity Date||Closing|
|10 Dec 2012||07 Feb 2013||14 Jun 2013||31 Dec 2018||28 Feb 2021||-|
|Financing Plan||Loan Utilization|
|Total (Amount in US$ million)||Date||ADB||Others||Net Percentage|
|Project Cost||38.38||Cumulative Contract Awards|
|ADB||30.00||24 Sep 2021||27.00||0.00||99%|
|Cofinancing||0.67||24 Sep 2021||27.14||0.00||100%|
|Status of Covenants|
|Approval||Signing Date||Effectivity Date||Closing|
|07 May 2020||14 May 2020||07 Jul 2020||30 Apr 2022||-||-|
|Financing Plan||Loan Utilization|
|Total (Amount in US$ million)||Date||ADB||Others||Net Percentage|
|Project Cost||34.43||Cumulative Contract Awards|
|ADB||30.00||24 Sep 2021||24.23||0.00||77%|
|Cofinancing||0.00||24 Sep 2021||16.87||0.00||54%|
|Status of Covenants|
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.
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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.
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ADB Provides $1.4 Million to Strengthen Mongolia's COVID-19 PreparednessULAANBAATAR, MONGOLIA (17 March 2020) — The Asian Development Bank (ADB) has reallocated $1.4 million from a health project in Mongolia to procure essential medical equipment for early detection, emergency care, and management of severe respiratory diseases in wake of the novel coronavirus (COVID-19) pandemic. ADB also approved a $225,000 small-scale technical assistance to strengthen Mongolia’s national capacity for infection prevention and control.
Safe Blood Transfusions for Mongolia's PatientsThe Asian Development Bank is helping Mongolia improve the safety of patients and health workers in hospitals, focusing on the safety of blood products, also known as hemovigilance.
|Tender Title||Type||Status||Posting Date||Deadline|
|Supply logistics specialist for medical storage facility||Individual - Consulting||Closed||27 Aug 2021||06 Sep 2021|
|Consultant on medical supply logistics specialist for medical storage facility||Individual - Consulting||Closed||27 Aug 2021||06 Sep 2021|
|Detailed environmental impact assessment||Individual - Consulting||Closed||16 Apr 2021||22 Apr 2021|
|LOAN 45009-002 (MON): Fifth Health Sector Development Project||Invitation for Bids||Closed||11 Jul 2019||23 Aug 2019|
|Loan 2963-MON: Fifth Health Sector Development Project [G2]||Invitation for Bids||Closed||13 Dec 2017||25 Jan 2018|
|Loan 2963-MON: Fifth Health Sector Development Project [G1]||Invitation for Bids||Closed||12 Dec 2017||23 Jan 2018|
|Contract Title||Approval Number||Contract Date||Contractor||Contractor Address||Executing Agency||Contract Description||Total Contract Amount (US$)||Contract Amount Financed by ADB (US$)|
|CW02: DESIGN AND BUILD FOR WAREHOUSE FACILITY FOR EMERGENCY MEDICINES AND SUPPLIES||Loan 3921||26 May 2021||MAGNUS CENTURION CONSTRUCTION LLC||MONGOLIA||Ministry of Health||CONSTRUCTION||2599806.725||2599806.725|
|G01: EQUIPMENT FOR CSSDS IN 7 AIMAG HOSPITALS||Loan 3921||11 Feb 2021||JOINT VENTURE OF INTER SCIENCE LLC AND RENOSE||MONGOLIA||Ministry of Health||SUPPLY OF GOODS||1948564.91||1948161.357|
|G03: DIAGNOSTIC AND TREATMENT EQUIPMENT FOR RISK P ATIENTS -GROUP 1||Loan 3921||01 Feb 2021||VAMED ENGINEERING GMBH||AUSTRIA||Ministry of Health||SUPPLY OF GOODS||2569999.94||2569999.94|
|SUPPLY AND INSTALLATION OF STERILIZATION AND STORAGE EQUIPMENT TO CENTRAL STERILIZATION SERVICE DEPARTMENTS (CSSDS) OF 7 PROJECT HOSPITALS||Loan 2963||16 Dec 2019||JV OF SINOPHARM INTERNATIONAL CORPORATION||FORTUNE TOWER 1, NO.4 HUI XIN DONGJIE, CHAO YANG DISTRICT,BEIJING, CHINA,PEOPLE'SREP.OF||Ministry of Health||SUPPLY OF GOODS||1122781.26||1122781.26|
|THE SUPPLY, DELIVERY AND INSTALLATION OF CULTURING AND ID/AST INSTRUMENT TO MEDICAL EQUIPMENT FOR MI CROBIOLOGY LABORATORIES OF 20 PROJECT HOSPITALS||Loan 2963||07 Nov 2018||JV OF LIFETRONIK LLC||GYALS R&D CENTER, DANDARBAATAR ST.32,UL AANBAATAR,TEL:75754422/1177 MONGOLIA||Ministry of Health||SUPPLY OF GOODS||1651196||1651196|
|SUUPLY AND INSTALLATION OF STERILIZATION AND STORA GE EQUIPMENT TO CENTRALIZED STERILIZATION SERVICE DEPARTMENTS (CSSDS) OF 20 PROJECT HOSPITALS||Loan 2963||05 Oct 2018||SHANDONG WEIGAO GROUP MEDICAL POLYMER CO.,LTD||18 XINGSHAN ROAD HIGH-TECH INDUSTRIAL D EV'T ZONE,264210,WEICHAI CITY,SHANDONG P CHINA,PEOPLE'SREP.||Ministry of Health||SUPPLY OF GOODS||3085672||3085672|
|GENERAL LABORATORY EQUIPMENT AND FURNITURE SUPPLY TO MICROBIOLOGY LABORATORIES OF 20 PROJECT HOSPITA LS.||Loan 2963||27 Sep 2018||JV OF MEDIMPEX INTERNATIONAL LLC||UNION BUILDING, 13TH FLOOR,UNESCO ST 62 SUKHBAATAR DISTRICT,ULAANBAATAR MONGOLIA||Ministry of Health||SUPPLY OF GOODS||1518109||1518109|
|SUPPLY AND INSTALLATION OF DECONTAMINATION, ASSEMB LING AND PACKAGING EQUIPMENT TO CENTRAL STERILIZAT ION SERVICE DEPARTMENTS OF 20 PROJECT HOSPITALS||Loan 2963||18 Sep 2018||JV OF MEDMONGOL LLC &MMM (MUNCHENER MEDIZIN||SUKHBAATAR DISTRICT,1STKHOROO,EMBASSY ST 14-1, ATLANT BUILDING,SUITE 102,ULAANBAA MONGOLIA||Ministry of Health||SUPPLY OF GOODS||2250747||2250747|
|Title||Document Type||Document Date|
|Fifth Health Sector Development Project: Procurement Plan||Procurement Plans||Nov 2020|