Health System and EPI Program
Before independence, the Mongolian health care system was entirely financed out of the central budget, and all services were provided free of charge. The system is still primarily owned and funded by the Government, although the latter looks forward to an increasing share and role for the private sector as a strategic objective sector. The revised Ministry of Health a “National Program for Control of Communicable Diseases” (2011–2015) and 2005 Health Sector Strategic Master Plan focus on seven key areas of work including service delivery, support services, communication, quality of care, health financing, human resource development and management.
Mongolia started immunization services in 1961 and a national immunization program (NIP) has been operational since 1993.
The Ministry of Finance (MoF) decides the total budget to be allocated to the health sector. Decisions on financial allocations are made primarily on the basis of historical expenditure, norms and standards in the sector, and government resolutions, decrees and national health programs related to the priority areas identified. Vaccines are financed through a national Health Insurance Fund.
Over the period 2006-2011, Gross National Income (GNI) in Mongolia increased from $1110 to $2320 per capita, making it a GAVI-graduating country. According to the WHO/UNICEF-Joint Reporting Form (JRF) Database, Mongolia’s government spent $190,000 ($3 per infant) in 2007. Around the same amount was spent for the subsequent year, with a small decrease of $6,387 in government expenditures. In 2009 government expenditures increased by $345,036, translating into $9 per infant. Mongolia spent $0.17 per infant in 2010, making up 24% of the program’s total cost. In 2011 the government contributed 69% of the program’s expenditure, increasing their expenditure by $1.5 million.
Mongolia is a semi-presidential representative democratic republic with a multi-party system. Executive power is exercised by the government. Legislative power is vested in both the government and parliament. The Judiciary is independent of the executive and the legislature.
The new constitution entered into force in February 12, 1991. In addition to establishing Mongolia as an independent, sovereign republic and guaranteeing a number of rights and freedoms, the new constitution restructured the legislative branch of government, creating a unicameral legislature, the State Great Khural (SGKh). As the supreme government organ, the SGKh is empowered to enact and amend laws, determine domestic and foreign policy, ratify international agreements and declare a state of emergency. The SGKh meets semiannually. The main organizational form of the SGKh is the session. Regular sessions of the SGKh are convened once in six months. Each session shall last no less than 75 working days. SGKh members elect a chairman and vice chairman who serve 4-year terms. SGKh members are popularly elected by district for 4-year terms.
The presidential candidates are nominated by parties in the State Great Khural and from these candidates the president is elected by popular vote for a four-year term.
The prime minister is nominated by the president and confirmed by the SGKh. The prime minister chooses a cabinet, subject to State Great Khural approval. The Cabinet consists of sixteen ministries.
Mongolia is administratively divided into 21 aimags (each one with an aimag center and soums, or rural areas), 347 soums (each with a soum center and bags) and 1,681 bags. A soum has about 3,000 people and a bag about 50 to 100 families. Each aimag and soum is governed by a political assembly, which nominates a governor for central Government approval.
Administrative and budgetary powers are delegated to the aimags and soums, including education and health services.
The Constitution of Mongolia (1992) contains a number of provisions that affect the rights of children, but only four address children specifically:
Art. 17 provides for “a sacred duty for every citizen to work, protect his/her health, bring up and educate his/her children and to protect nature and the environment”
The Mongolian Constitution guarantees certain rights and freedoms, including “the right to the protection of health and health care. The procedure and conditions of free medical aid shall be defined by law.” The wording of the constitutional provision is important. In many countries, the constitutional provision declares an open right to free health services, but the Mongolian Constitution does not, rather recognizing that the right to free health care should be fulfilled by the state, the guarantor of the right, according to the availability of resources. Thus, legislation has to determine from time to time what health services should be free and to whom.
The Health Act of 1998 states that: “certain types of health care and services shall be provided to the citizens by the state free of charge, as provided in the Constitution.” The Health Law lists the services that must be provided free of charge regardless of whether or not the person is insured. These include, inter alia, emergency and ambulance services; tuberculosis, cancer, mental diseases, pregnancy, birth and postpartum care; and treatment for injuries caused by natural disasters, sudden accidents or contagious diseases.
The MOH has the authority to update the list of diseases whose treatment is free of charge and to issue regulations governing on the provision of free treatment. The Health Act of 1998 also defines “the State policy and basic principles on health and to regulate the relations raised in connection with responsibilities of organizations, business entities and individuals in safeguarding the social health and the rights of the citizens and officials of this country to health protection and medical aid and service, to regulate legal framework of activities of health organizations and employees thereof.” The Health Act is amended occasionally, most recently in 2002.
The Government passed the Law of Mongolia on Immunization in April 2000, showing its commitment to sustainable immunization. The law regulates activities for the “prevention of the Mongolia population from and immunization against infectious diseases.” An Immunization Fund has been established under this law to mobilize and manage funds for immunization from various sources. This law was amended in 2010.
The Government adopted the Government Resolution 67, which approved regulations for the establishing Immunization fund and its operations in March 2001. Same year the immunization fund is established as an independent legal entity governed by a Fund council. The fund manages the finances for non routine and emergency vaccines and handles transportation of routine and no routine vaccines to the local centers.
- June 2012: SIF Director, Mike McQuestion conducted an introductory mission to Mongolia.
- August 2012: new SIF SPO, Khongorzul Dari holds a number of introductory meetings with MoH and EPI representatives.
- October 2012: SIF Director, Mike McQuestion and SIF SPO, Khongorzul Dari held a series of meetings with their counterparts in Ulaan Bataar. They met with representatives of Parliament, Ministry of Health, and Ministry of Finance and Economics.
- January 2013: Mongolia held its first ever National Parliamentary briefing on sustainable immunization financing. Members of the Mongolian Parliament and officials from the Ministry of Health and other government departments were among those that attended. The Vice Minister of Health opened the meeting, which included several presentations on the Expanded Program on Immunization (EPI) and immunization financing.