1. FINANCIAL OPTIONS FOR TB CONTROL IN MONGOLIA
Dr D. Narangerel, Director of Public Health Division, MoH
The 9th Technical Advisory Group and National TB Programme Managers meeting for TB control in the Western Pacific Region
Manila, Philippines
9-12 December 2014

2. CONTENT Demographic, economic and health indicators
Overview of health service delivery
Health financing system
Legal and policy framework
Current health financing
Financing of TB control in Mongolia

3. DEMONGRAPHIC AND HEALTH INDICATORS
MONGOLIA
SOURCE
Population size
2,9 million
Health indicators 2013, MOH
Gross domestic product (GDP) per capita (USD)
4,056 USD (2013)
World bank
% of population living under poverty line
27% (2013)
World Bank, National Statistical Office of Mongolia
Maternal mortality (modelled estimate, per 100,000 live births)
68 (2013)
WHO Global Health Statistics, 2014
Under 5 mortality (per 1000 live births)
28 (2012)
Life expectancy (male/female)
64/72 (2012)

4. STRUCTURE OF HEALTH SERVICE DELIVERY
Primary level
FGPs in urban areas and soum (village)/intersoum hospitals, bag feldshers in rural areas
Secondary level
Ulaanbaatar (capital) city health department – 9 district health centers and hospitals, private sector
21 Provincial health departments – provincial hospitals and ambulatories, private sector
Tertiary level
Specialized centers/ hospitals, private sector in urban areas
Regional diagnostic and treatment centers in rural areas

5. HEALTH FINANCING SYSTEM
Legal and policy framework
Budget Law
Health law
Law on citizens’ social health insurance
Law on social insurance
Law on special foundation
Government and ministerial orders, resolutions, guidelines

6. HEALTH FINANCING SYSTEM
Two main sources of financing:
Social health insurance
State budget

7. Health expenditure as % of GDP

8. HEALTH FINANCING SYSTEM
Health insurance benefits cover mainly:
Curative care at secondary and tertiary level hospitals
Limited outpatient services and outpatient drugs
State budget:
primary health care services in family group practices (FGPs), soum hospitals
specific services at secondary care level in provincial and city district public hospitals and health centres
specialized public hospitals at tertiary care level in Ulaanbaatar (capital)

9. HEALTH FINANCING SYSTEM
Health services and treatment of diseases financed by state budget
Health services and treatment of diseases funded through health insurance
Consultation, diagnostics and treatments
related to pregnancy and childbirth until the end of the postnatal period
Inpatient and outpatient services at
secondary and tertiary care levels
Medical services for children provided by
public hospitals
Day care at secondary care level.
Treatment of tuberculosis, cancer,
HIV/AIDS and mental illness
Rehabilitation services for patients
admitted to sanatoria.
Epidemiological and sanitation measures
for communicable diseases, including
disinfection and routine immunization
Traditional inpatient treatment.
Long-term care for patients admitted to
sanatoria and rehabilitation centres.

10. FINANCING OF TB CONTROL
TB services are free
60% of funding from state budget, 40% from GF and WHO in 2014
Government gradually increases its financial commitment to TB control (90% of first-line drugs, drugs for management of side effects, 50% of laboratory reagents and diagnostics, inpatient and outpatient care, health workforce)
GF: 100% MDR-TB, 50% of laboratory reagents, patient support (lunch DOT and home DOT, transportation cost), capacity building, infection control, TA, M&E)

11. HEALTH SECTOR REFORM
Revision of Health Law and Law on social health insurance law are in the process
TB financing options have been discussed
Keep financing for TB control from state budget
High TB burden and ongoing transmission of TB in the community
70% of TB cases are poor people living under poverty line
High risk groups for TB are not insured, no residential registration
Health insurance system is not optimal, needs improvements

12. CHALLENGES Sustainability of TB control after end of the GF support
Continue keeping TB control in high political agenda
More work is needed to strengthen collaboration with non-health sector (Min. of Population Development and Social Welfare, Min. of Justice, Min. of Education, Min. of Defense)
Lack human resources

13. Thank you for your attention