Exploring Health Care Disparities in Mongolia

Mongolia, the world's second-largest landlocked nation, presents a complex health care landscape shaped by its geographical features and historical context. With nearly half of its population residing in Ulaanbaatar, the capital, and the remainder spread across extensive semi-desert regions like the Gobi Desert, the country faces significant challenges in achieving equitable health care access.

The stark contrast in health care quality is evident between urban centers and remote rural areas. In urban locales, modern health facilities are prevalent, while rural communities often contend with limited resources and challenging travel distances, sometimes exceeding 95 kilometers over difficult terrain to reach medical services.

A recent study published in the Journal of Global Health, led by a research team from Sophia University in Japan, delves into these disparities. The research examines the unique cultural, geographical, and historical factors that influence health care delivery in Mongolia, identifying both strengths and weaknesses within the system, and suggesting actionable strategies for improvement.

Despite the challenges, the study highlights several strengths in Mongolia's health care framework. The country enjoys a relatively young and robust demographic, bolstered by early retirement policies for women with multiple children. Furthermore, universal health care coverage allows all citizens free access to primary care through a centralized system reminiscent of the Soviet model.

Additionally, traditional Mongolian medicine--integrated with influences from Indian, Chinese, and Tibetan practices--plays a significant role in health care, particularly in remote areas. This form of medicine provides culturally relevant treatments and is recognized at the national level, with specialists receiving formal training.

However, the study reveals critical challenges in rural health care delivery. A notable shortage of health care professionals in these areas severely impacts service availability. In some communities, like Altanshiree, a handful of professionals is responsible for the health care needs of entire populations, often requiring them to traverse difficult landscapes to reach patients in traditional yurts.

The hierarchical structure of the health care system also poses limitations. Since 2010, there has been a gradual increase in advanced degree holders among faculty members in nursing education. However, a significant majority of nursing faculty are still doctors, leading to a perception that nurses are merely assistants to physicians, thus restricting their ability to provide independent care.

In remote areas, health care is frequently delivered by mid-level practitioners, known as assistant doctors, who occupy a space between doctors and nurses. The challenges of accessing care are compounded by the need for residents to travel by horseback or on foot for extended periods to reach the nearest health facility.

Preventive health care also requires attention, as leading causes of mortality include diseases affecting the respiratory, digestive, and circulatory systems. Currently, preventive screenings for conditions such as hypertension and diabetes are not routinely featured in national health guidelines, and dietary habits contribute to these health issues.

To combat these challenges, the research team proposed several strategies. Strengthening Mongolia's "third neighbor policy" could foster health care partnerships with nations such as the U.S. and Japan, enhancing health education and workforce development. Additionally, leveraging technology and telemedicine could bridge the gap between urban expertise and rural needs.

Moreover, expanding the roles and autonomy of nurses and midwives can optimize the limited health care resources available in rural areas. Integrating health screenings into community events could also facilitate access to preventive care in a culturally sensitive manner.

By recognizing the unique challenges it faces while capitalizing on its existing strengths, Mongolia has the potential to cultivate a health care model that effectively serves its entire population.