Mongolia's system-wide health reforms:lessons for other developing countries

Abstract

Mongolia is a poor country that lost 30% of its GDP when the Soviet Bloc collapsed in 1990. Its health care systemhad the typical weaknesses of centrally planned economies - quantity rather than quality, excessive medicalspecialisation, dominance of the hospital sector, weak policy and management capabilities, little communityparticipation in decision making, and so on.This paper describes Mongolia's attempts to resolve these problems through a radical program of reform that began in1998. There have been significant successes in spite of almost overwhelming difficulties, and this may be aconsequence of the strong sense of community that has been present for five hundred years and re-emerged intact atthe end of 70 years of Soviet dominance.We argue, however, that good design and skilful implementation of the reform program may have made acontribution. Its notable features have included the use of a comprehensive and integrated model rather thanpiecemeal reform, the generation of political support for change through social marketing campaigns, a team approachusing local and international experts, and co-ordination of international donor activities. Some of these features maybe relevant to other transitional and developing countries.