Mongolia : Improving Access to Health Services for Disadvantaged Groups Investment Program - Tranche 1

Sovereign Project | 49173-004

Tranche 1 proposed for financing under the requested periodic financing request (PFR) aims to contribute to the investment program's impact of improving the health status of Mongolians.

The investment project comprises the following outputs:

(i)urban and rural primary health care strengthened,

(ii)district and aimag hospital services improved,

(iii)health financing system strengthened, and

(iv)capacity in procurement and financial management of relevant government entities for health strengthened.

Project Name Improving Access to Health Services for Disadvantaged Groups Investment Program - Tranche 1
Project Number 49173-004
Country / Economy Mongolia
Project Status Active
Project Type / Modality of Assistance Grant
Loan
Source of Funding / Amount
Grant 0672-MON: Improving Access to Health Services for Disadvantaged Groups Investment Program - Tranche 1
Japan Fund for the Joint Crediting Mechanism US$ 3.48 million
Loan 3843-MON: Improving Access to Health Services for Disadvantaged Groups Investment Program - Tranche 1
Ordinary capital resources US$ 66.14 million
Loan 3844-MON: Improving Access to Health Services for Disadvantaged Groups Investment Program - Tranche 1
Concessional ordinary capital resources lending US$ 10.00 million
Operational Priorities OP1: Addressing remaining poverty and reducing inequalities
OP2: Accelerating progress in gender equality
OP3: Tackling climate change, building climate and disaster resilience, and enhancing environmental sustainability
OP4: Making cities more livable
OP6: Strengthening governance and institutional capacity
Sector / Subsector

Health / Health sector development and reform

Gender Effective gender mainstreaming
Description

Tranche 1 proposed for financing under the requested periodic financing request (PFR) aims to contribute to the investment program's impact of improving the health status of Mongolians.

The investment project comprises the following outputs:

(i)urban and rural primary health care strengthened,

(ii)district and aimag hospital services improved,

(iii)health financing system strengthened, and

(iv)capacity in procurement and financial management of relevant government entities for health strengthened.

Project Rationale and Linkage to Country/Regional Strategy

Sector background. Rapid urbanization in Mongolia over recent decades has increased the burden on the provision of health and social services in Ulaanbaatar and aimag centers. This has led to a shortage of human resources, funding, and equipment; and obsolete and poorly functioning health facilities that weaken the accessibility, quality, and equity of health care services. Poor urban infrastructure and weakened government capacity to provide basic social services have exacerbated the situation. Ulaanbaatar has been the main destination for migrants from Mongolia's rural areas, and now hosts more than 50% of the country's population. About 60% of Ulaanbaatar's population lives in ger areas, with limited access to running water, sanitation, and social services, including primary health care (PHC). Access to health care is challenging, especially for the poor. Out-of-pocket health expenses are high and account for 41% of total health expenditure; one-third of household out-of-pocket health expenses are for medicines because of high prices and the inappropriate use of drugs. Over 90% of the population has health insurance coverage, but the benefit package is limited to hospital services, with the result that the poor use health services 2.5 times less than the nonpoor. In 2015, government expenditure on health accounted for just 2.4% of gross domestic product, well below the 5% target of the World Health Organization. Addressing behavioral risk factors, particularly among menincluding obesity, alcohol and tobacco abuse, and gender-based violenceand their associated health impacts remains a key challenge.

The Asian Development Bank (ADB) has been Mongolia's key health sector development partner since 1993, providing five loans totaling $84.90 million, seven grants totaling $37.00 million, and 15 technical assistance (TA) projects totaling $10.65 million. The projects achieved significant results through comprehensive health system support and strengthening, including for PHC reform and investments, information and communications technology, medicine and pharmaceutical procurement reforms, establishment of health insurance, health infrastructure, human resources for health, and sector governance. ADB has also strategically supported the drafting and enactment of key health policies and laws, including the Health Law (2016) and laws related to health insurance, medicines and medical devices, and medical care and services. With support from ADB, Mongolia was able to achieve its Millennium Development Goal targets of reducing under-5 child mortality and preventing the spread of HIV/AIDS. It also made significant progress toward the Millennium Development Goal targets of reducing poverty and malnutrition, and improving maternal health.

Despite these achievements, Mongolia faces a continuing burden from both communicable and noncommunicable diseases, resulting in premature mortality and high levels of disability, which prevent the nation from fulfilling its economic potential. Economic growth since 2001 has been strong, but one in five Mongolians still live below the national poverty line and face significant health care challenges that need to be addressed.

Impact

Health status of Mongolians improved

Project Outcome
Description of Outcome

Access to affordable quality primary and secondary health servicesb in Khovd and Uvs aimags (provinces), Ulaanbaatar ger (traditional tent) areas, and selected soums (aimag subdistricts) improved

Progress Toward Outcome The project will build (i) four soum health centers (SHCs) in four aimags; (ii) four family health centers (FHCs) in Ulaanbaatar; (iii) a General hospital in Khan-uul district in UB; and (iv) an extension of Uvs aimag general hospital. As of September 2023, the project has prepared a detailed engineering design (DED) of 4 SHCs and will award contracts for constructing three SHCs in September 2023. Preparation of DED of 3 FHCs is ongoing; bid advertisement for the construction of these FHCs is planned for 4Q 2023. The project has prepared the DED of the Khan-uul District Hospital (KhUDH), which was approved by the state experts in Dec 2022; the bidding process is led by the Government Procurement Agency (GPA); the bid was advertised in Jan 2023; evaluation of the bids has been completed; MOH is planning to sign a contract for the construction of KhUDH in September 2023. The project also prepared the DED of the Uvs General Hospital extension, which was approved in April 2023; the bid was advertised in June; evaluation of bids by GPA is ongoing; contract award is planned in October 2023.
Implementation Progress
Description of Project Outputs

Urban and rural primary health care strengthened

District and aimag hospital services improved

Health financing system strengthened

Procurement and financial management capacity of government health entities strengthened

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

Output 1: Urban and Rural Primary Health Care Strengthened.

MOH engaged the CS01 consulting firm (JV of Monconsult LLC and GOPA Worldwide Consultants GmbH) in Dec 2021 to (i) review PHC sector analysis and reform concepts, (ii) strengthen performance-based contracting and financing, (iii) develop and pilot an integrated service model at primary and secondary service levels. CS01 prepared an assessment of the PHC system (with the involvement of 154 FHCs in UB and 206 SHCs in aimags) and proposed recommendations on improving the organization of PHC and service integration, financing, quality management, and human resources (supported by the MOH technical working group in June 2022). CS01 reviewed international experience and proposed a 'Hub and spoke (GER) model for horizontal functional (resource sharing) and organizational (merging two or more FHCs under a single administration) integrations and vertical integration of clinical services in managing four types of diseases (hypertension, diabetes, and tuberculosis) between FHCs and district health centers (discussed by MOH TWG in June and December 2022), and prepared operational procedures for the new model which were presented and discussed by family health care providers. The project will pilot the new model starting in September 2023.

MOH engaged CS02 consulting firm (Vamed Consulting) in June 2023 to (i) assess the emergency medical service (EMS) system in Ulaanbaatar, (ii) propose a sustainable model to ensure the effective operation of the EMS, (iii) link telemedicine services with EMS, and (iv) develop a concept for upgrading the existing UB city Emergency Center into a National Emergency Care Center (NECC). CS02 has prepared an inception report and initial proposal on improving the operations of the EMS.

The project will build (i) four soum health centers (SHCs) in four aimags; (ii) four family health centers (FHCs) in Ulaanbaatar, three of which will have low-carbon technologies (LCT), and (iii) a National Emergency Care Center (NECC). As of September 2023, the project consultants CS03 (Khatanbaatar LLC), engaged in Feb 2022, have prepared a detailed engineering design (DED) of 4 SHCs and are about to award contracts for constructing three SHCs in September 2023. Development of DED of 3 FHCs in Ulaanbaatar by CS03 is ongoing. The project will apply LCT in FHCs without access to central heating systems by installing ground-source heating pumps. In December 2021, the MOH engaged CS10 consultants (JV of Azusa Sekkei Co.Ltd., Kokusai Kogyo Co.Ltd, and PCDP LLC) to assist in installing a ground source heating pump in FHCs.

Output 2: Improve District and Aimag Hospital Services.

Khan-uul District Hospital. In May 2021, the government proposed using the detailed design of the model Songinokhairkhan District Hospital (SDH) for the new Khan-Uul District Hospital (KhUDH). Consultant (CS16) proposed some changes and modifications based on new standards and construction requirements enforced by the government since 2015 after the approval of the detailed design of SDH. The design was also reviewed regarding the application of LCT, such as energy-efficient HVAC systems, high-insulation windows, and solar photovoltaic rooftops. The DED was developed by CS18 (Building Technology LLC) by reflecting above mentioned recommendations and was approved by the state experts in Nov 2022. The construction of KhUDH requires demolishing five small buildings in the hospital compound. The UBMO approved the budget (MNT 185 million) and contracted a company to demolish them; the demolition work was completed in Aug 2023. Per the loan agreement, the State Procurement Agency (SPA) leads the procurement of construction work for KhUDH. The bid for the construction of KhUDH was advertised in January 2023; bids were opened in March 2023; the BEC evaluated the technical and financial proposals. The contract signing is planned for September 2023.

Uvs aimag general hospital. MOH engaged the CS04 consulting firm (Intermed Medical LLC) in Dec 2021 to (i) conduct feasibility studies and needs assessments for Khovd and UVS Aimag hospitals, (ii) develop service planning functional design for the Uvs and Khovd hospital extensions, and (iii) assist in the operational management of hospitals with a focus on quality management and assets management. CS04 developed a concept design and functional plan for Uvs Aimag General Hospital (UAGH) extension. MOH recruited CS06 and developed the DED for UAGH extension; PIU prepared bidding documents and advertised the bid for the construction of UAGH in June 2023; evaluation of bids by GPA has been completed; contract signing is planned in October 2023.

The project consultants CS04 conducted a situational analysis of the hospital governance and management systems, including operational and financial management systems, risks, and challenges in providing quality healthcare services in UAGH and KhUDH. CS04 finalized the design of a semi-autonomous hospital management system and the development of relevant procedures and regulations. The consultants developed a training plan covering core areas of hospital management, such as hospital governance, management systems, quality control, human resources, and medical equipment maintenance.

Output 3: Health Financing System Strengthened.

In Aug 2020, the Great Khural of Mongolia approved principal changes in the law on health, the law on medical care and services, and the health insurance law to allow the switch to a strategic purchasing system in the health sector. Therefore, instead of planned activities related to the development and design of the legal framework, the project will focus on strengthening the capacity of the health insurance organization and building the ability of the government entities involved in the health financing cycle. The project will engage several individual consultants to address gaps in the specific needs of government officials of MOH, MOF, and the General Agency for Health Insurance (GAHI).

The project developed a capacity-building training program for government officials. In 2021, 66 staff of MOH (68%) received 2-module training on the strategic purchasing system. MOH also selected and trained 20 national trainers (ToT) to conduct on-the-site coaching training for all (50) public hospitals on the new health financing model and assist them in preparing annual financial planning budget proposals. As of today, ToTs conducted training for 2315 staff of 115 health care organizations, including aimag/city health insurance branches, aimag/city health departments, aimag/district general hospitals, and tertiary level state hospitals. The project also developed a capacity-building program for GAHI in strategic purchasing and conducted seven capacity-building training for 163 staff of the GAHI (80.9% of them were female). The training covered key concepts in the new legal reforms, including selecting healthcare organizations, contracting, service quality, and claim review, defining health services packages, reimbursement, and calculating demand.

Output 4: Procurement and Financial Management Capacity of Government Health Entities Strengthened. In October 2022, the MOH engaged two individual consultants (one international and one national) to improve the procurement and procurement-related risk management capacity of MOH and GPA. The consultants conducted a training needs assessment of MOH and GPA staff and prepared the capacity-building program and training materials. As of today, the consultants trained 68 staff of MOH on procurement and procurement risk management.

Geographical Location Ulaanbaatar
Safeguard Categories
Environment B
Involuntary Resettlement C
Indigenous Peoples C
Summary of Environmental and Social Aspects
Environmental Aspects
Involuntary Resettlement
Indigenous Peoples
Stakeholder Communication, Participation, and Consultation
During Project Design
During Project Implementation
Business Opportunities
Consulting Services The MOH is responsible for selecting, engaging, and supervising consultants. Eight packages for consulting services will be tendered and Consulting firms will be recruited following a quality and cost-based selection (QCBS) procedure with a quality / cost ratio of 90:10. International and national individual consultants (excluding PIU staff) will be engaged using individual consultant's selection procedure.
Procurement

All procurement of goods and works will be undertaken in accordance with ADB Procurement Policy (2017, as amended from time to time) and established commercial practice to obtain optimal results (quality / price ratio). The implementing agencies will also ensure that goods and services to be financed by project funds are procured from ADB member countries. Relevant sections of the ADB Anticorruption Policy (1998, as amended to date) will be included in all procurement documents and contracts.

A 10-year MFF procurement plan indicating thresholds and review procedures, describing contract packages for goods, works, and consulting services as well as national competitive bidding guidelines is presented in Section C. Prior review and approval by ADB of the OCB and RFQ procurement documents (advertisements and invitations, bidding documents, draft contract) are required for the first three procurements, while for the remainder a post review will be used.

Responsible ADB Officer Jigjidsuren, Altantuya
Responsible ADB Department East Asia Department
Responsible ADB Division Mongolia Resident Mission (MNRM)
Executing Agencies
Ministry of Health (formerly Ministry of Health and Sports)
Timetable
Concept Clearance -
Fact Finding -
MRM 18 Dec 2018
Approval 24 Oct 2019
Last Review Mission -
Last PDS Update 19 Sep 2023

Grant 0672-MON

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
24 Oct 2019 27 Dec 2019 04 Mar 2020 30 Jun 2025 31 Dec 2026 -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 3.48 Cumulative Contract Awards
ADB 0.00 23 Jan 2024 0.00 0.61 17%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 3.48 23 Jan 2024 0.00 0.16 5%

Loan 3843-MON

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
24 Oct 2019 27 Dec 2019 04 Mar 2020 30 Jun 2025 31 Dec 2026 -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 66.96 Cumulative Contract Awards
ADB 66.14 23 Jan 2024 45.19 0.00 68%
Counterpart 0.82 Cumulative Disbursements
Cofinancing 0.00 23 Jan 2024 2.46 0.00 4%

Loan 3844-MON

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
24 Oct 2019 27 Dec 2019 04 Mar 2020 30 Jun 2025 31 Dec 2026 -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 10.00 Cumulative Contract Awards
ADB 10.00 23 Jan 2024 6.08 0.00 61%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 23 Jan 2024 0.00 0.00 0%

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 Access to Information Policy (AIP) 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.


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 Access to Information Policy (AIP) 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.

Tenders

Tender Title Type Status Posting Date Deadline
Costing and payment mechanisms specialist Individual - Consulting Closed
Benefit package specialist Individual - Consulting Closed
Health Financing expert Individual - Consulting Closed
Quality monitoring specialist Individual - Consulting Closed
Health system expert Individual - Consulting Closed
Loan 3843/3844-MON: "Improving Access to Health Services for Disadvantaged Groups Investment Program” – Tranche 1 Invitation for Bids Closed
Employer's supervision for SHCs of (Erdene) Dornogovi, (Bayan-Undur) Uvurkhangai, FHC in 26th khoroo SHD, and NECC Firm - Consulting Closed
Loan 3709-MON: Strengthening Information and Communication Technology Systems for Efficient and Transparent Public Investment and Tax Administration Project Invitation for Bids Closed
Loan-3843/Grant-0672-MON: "Improving Access to Health Services for Disadvantaged Groups Investment Program” – Tranche 1 Invitation for Bids Closed
Procurement consultant 2 Individual - Consulting Closed
Procurement consultant 1 Individual - Consulting Closed
Resettlement specialist Individual - Consulting Closed
G0672-MON, L3843/3844-MON: Improving Access to Health Service for Disadvantaged Groups Investment Program – Tranche 1 Other Notice
Infection control expert Individual - Consulting Closed
Detailed Engineering Design and Supervision for Aimag general hospitals Firm - Consulting Closed
Resettlement specialist Individual - Consulting Closed
Consulting services for design and supervision of six SHCs and 10 FHCs and EMS national center Firm - Consulting Closed
Resettlement specialist Individual - Consulting Closed
Improving Access to Health Services for Disadvantaged Groups Investment Program - Tranche 1 Individual - Consulting Closed
Concept design for Khan Uul District Hospital Individual - Consulting Closed
Resettlement specialist Individual - Consulting Closed
Consulting services for hospital planning and management Firm - Consulting Closed
Improving Access to Health Services for Disadvantaged Groups Investment Program - Tranche 1 Firm - Consulting Closed
Social development and gender expert Individual - Consulting Closed
Environmental expert, national Individual - Consulting Closed
Improving Access to Health Services for Disadvantaged Groups Investment Program - Tranche 1: Ground Source Heat Pump Expert Individual - Consulting Closed

Contracts Awarded

Contract Title Approval Number Contract Date Contractor | Address Executing Agency Total Contract Amount (US$) Contract Amount Financed by ADB (US$)
CW08: Construction of Khan-Uul District General Hospital with Equipment Installation Inclusive of Advanced Low-Carbon Technologies Loan 3843 22 Dec 2023 China Railway First Group Co., Ltd. | No. 1, Yantabeilu Rd., Beilin District, Xi'an City, Shaanxi Province, China Ministry of Health 34,573,738.81 34,573,738.81
Contract CS20: Employer's supervision for Uvs aimag general hospital Loan 3843 08 Dec 2023 Construction Development Center (SOE) | CDC Building, Ikh Toiruu, Khoroo 2, Chingeltei District, Ulaanbaatar, Mongolia Ministry of Health 199,817.71 199,817.71
Contract CW10: Construction of Expansion Building of Uvs Aimag General Hospital Loan 3843 03 Nov 2023 JV of City Landmark LLC and Happy Building LLC | LS Plaza, Room 205, Khan-Uul District, Khoroo 18, Ulaanbaatar Ministry of Health 4,996,505.72 4,996,505.72
Contract CW05: Construction of Soum Health Center 4 in Dashinchilen Soum, Bulgan Aimag Loan 3844 08 Nov 2023 JV of Tsonbon Toosgo LLC and Modernkhas Co., Ltd. | Union Building, Room 403-2, Sunny Road, Sukhbaatar District, Khoroo 1, Ulaanbaatar Ministry of Health 1,517,826.16 1,517,826.16
CW02: Construction of Soum Health Center in Tarialan Soum, Khuvsgul Aimag Loan 3844 31 Oct 2023 Iderchandmani LLC | Bag 8, SB Center, Room 505, Murun, Khuvsgul Aimag Ministry of Health 1,582,358.75 1,582,358.75
CW03: Construction of Soum Health Center 2 in Bayan-Undur Soum, Uvurkhangai Aimag Loan 3844 20 Oct 2023 TED Construction LLC | Khan-Uul District, Khoroo 3, Uildveriin Gudamj, Riverstone Town, 24a-412 Ministry of Health 1,639,642.78 1,639,642.78
CW04: Construction of Soum Health Center 3 in Erdene Soum, Dornogobi Aimag Loan 3844 31 Oct 2023 JV of Bako Construction LLC and Morinsuvd Construction LLC | Khan-Uul District, Khoroo 20, Sumber Tower, Floor 11, Room 1111, Ulaanbaatar, Mongolia Ministry of Health 1,287,562.85 1,287,562.85
CS28: Adjustment of DED of Khan-Uul District Hospital for Chingeltei Hospital Loan 3843 11 Sep 2023 Building's Technology LLC | Ulaanbaatar, Mongolia Ministry of Health 105,343.23 105,343.23
CS19: Employer's Supervision for Khan-Uul District Hospital (Time-based contract) 3843 30 Jun 2023 Investment Department of Capital City (SOE) | Bodi Tower, Floor 5, Room 503, Jigjidjav Street 7/1, Chingeltei District, Ulaanbaatar, Mongolia Ministry of Health 407,489.66 406,825.37
CS02: Engagement of consulting firm for Establishment of EMS from 16 June 2023 to 15 June 2025 3843 30 Jun 2023 VAMED Management und Service GmbH (Austria) in association with Heart for Health International BV (Netherlands) | Sterngasse 5, 1230 Vienna, Austria Ministry of Health 443,485.21 409,370.96
CS06: Engagement of consulting firm for detailed engineering design and supervision for Uvs and Khovd aimag general hospitals Loan 3843 26 Sep 2022 Tatakh Khuch LLC | Room 1305, Floor 13, Grand Plaza, Bayangol District, Ulaanbaatar Ministry of Health 199,309.25 195,665.02
Lump sum contract CS18: Engagement of a firm thru DC for design revision for Khan-Uul District hospital Loan 3843 10 Aug 2022 Building's Technology LLC | Ulaanbaatar, Mongolia Ministry of Health 162,405.00 160,916.54
Time-based contract CS18: Engagement of a firm thru DC for design author's supervision for Khan-Uul District Hospital Loan 3843 10 Aug 2022 Building's Technology LLC | Ulaanbaatar, Mongolia Ministry of Health 187,103.29 185,388.47
Engagement of consulting firm for design and supervision of six SHCs, ten FHSs and EMS center Loan 3843 07 Mar 2022 Khatanbaatar LLC | Khatanbaatar Building 601, 45/5 Seoul Street, Khoroo 2, Bayangol District, Ulaanbaatar Ministry of Health 262,729.00 255,960.29
Engagement of the consulting firm for Low-Carbon Technology under JFJCM financing Grant 0672 27 Dec 2021 JV of Azusa Sekkei Co Ltd and KOKUSAI KOGYO Co Ltd in association with PCDP LLC | 10-11 Haneda Asahi-Cho Ota-Ku Tokay 144-0042 Japan Ministry of Health 525,834.00
Engagement of the Consulting Firm for Primary Health Care Development Loan 3843 27 Dec 2021 JV of Monconsult LLC (Mongolia), GOPA Worldwide Consultants GmbH (Germany) in association with Macroeconomics and Health Research and Consulting NGO (Mongolia) | Monconsult Building, Namyanju Street 4/1, Ulaanbaatar 133335 Ministry of Health 771,105.50 701,005.00
Engagement of the consulting firm for Hospital Planning and Management Loan 3843 27 Dec 2021 International Medical Center LLC | Khan-Uul District, Khoroo 15, Chinggis Avenue, Ulaanbaatar Ministry of Health 1,534,610.00 1,395,100.00

Procurement Plan