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Integrating mobile health care to strengthen PHC in hard-to-reach communities in Mongolia

Pays
Mongolie
Sources
WHO
Date de publication
Origine
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Expanding the use of mobile health technology

Due to its geography and demography, Mongolia faces barriers to providing equitable health care service delivery, especially to remote, vulnerable and low-income populations such as herders and informal small-scale miners.

Mongolia has implemented health sector reforms to boost public–private partnerships, increase access to public health and medical services and mobile health services, ensure more effective financing, and develop capacity in the health workforce. To make health services geographically, financially and administratively accessible to marginalized populations, enhancing PHC has been high on the country’s agenda. As a result, all the lowest administrative units comprise PHC facilities, which are fully funded by the State. Prevention, control and treatment of communicable and noncommunicable diseases (NCDs) are covered under the essential service package by PHC providers, regardless of the health insurance status of the user.

Drawing on the country’s well-developed fiber optic connections and relatively high use of internet technology, the government started an initiative on “Expanding the use of mobile health technology at PHC towards UHC” in 2016 to reach remote populations. This initiative is supported by WHO through the Universal Health Coverage Partnership and the Korea Foundation for International Health Care and Community Chest of Korea. It aims to serve hard-to-reach populations through improved access to and quality of people-centred PHC services. Mobile health services have also expanded from 22 PHC centres in 2016 to 302 (56% of all PHC centres) in 2021.

Under the initiative, PHC providers offer integrated health services through home visits, mobile health services combined with home visits and health centre services. These include diagnosis and health promotion activities related to communicable diseases and NCDs as well as reproductive, maternal and child health services. People living in remote, rural areas have benefitted from mobile health services accompanied by home visits, resulting in early detection and treatment. As stated by Dr Chuluuntsetsetseg Erdenechuluun, Head of the Mandakh Soum Health Center, Dornogobi Province:

“Thanks to the mobile health initiative, quality of and access to preventive health examinations among local people have improved in the last two years. In 2019, coverage of preventive health examinations reached 90% of the population. Most remote herders live 130 kilometers away from the soum (sub-provincial) health centre and health workers mainly reach them through the mobile health service delivery.”

COVID-19 has highlighted the importance of innovative approaches to ensure continuity of routine essential health services. Enhancing mobile health care is also contributing to preparedness for future health emergencies.

The example of tuberculosis treatment coverage

Due to expansion of mobile health services, PHC service providers can rapidly diagnose communicable and NCDs at the community level and refer patients to a hospital at district or provincial level to confirm, treat and follow up, ensuring an effective continuum of care.

Mongolia has the fourth highest TB burden in the WHO Western Pacific region with an estimated prevalence of 757, incidence of 428 and mortality of 10 per 100 000 population, respectively (1). The risk of developing TB is higher among lower socio-economic groups, a population already experiencing limited access to quality, affordable and timely care.

The government has prioritized a wide range of interventions for TB in the National Strategy for Prevention and Control of Communicable Diseases 2017-2021. SDG3 GAP signatory agencies the Global Fund and WHO have been jointly supporting the Mongolian Ministry of Health to strengthen preventive care at the primary level by scaling up active case finding and promoting compliance with treatment.

The two agencies have supported the government to introduce and scale up directly observed therapy (DOT) for TB at district and provincial health centres since the late 1990s. New mobile health technology enables better screening of potential TB cases to ensure early access to treatment. This is complemented by home-based DOT to ensure that a trained health care worker provides the prescribed TB drugs and follows the treatment of a patient, which has significantly improved continuity of treatment. In 2021, with support from the Global Fund, 51% of TB patients were treated at TB dispensaries, 25% at facility and soum health centres, and 23% through home visits. WHO also supported scale-up of TB service delivery by establishing consulting units in two districts in 2021 to ensure patient-centred quality care and social and psychological services.

Some tangible achievements resulting from the collaborative efforts by the SDG3 GAP signatory agencies in supporting the National Tuberculosis Programme include:

  • A treatment success rate of 89% by the end of 2021; and
  • A decline in TB-related mortality from 8 to 5.5 per 100 000 population between 2011 and 2021. (2)

WHO is also supporting PHC providers, especially in rural remote areas, in the provision of essential services through training and supply of mobile devices. This is expected to expand mobile technology for early detection and linking diagnostic services with full completion of treatment via referral services for prevention and control of TB, in addition to HIV, STIs and hepatitis in hard-to-reach populations.

Technical and financial support from SDG3 GAP signatory agencies including the Global Fund and WHO, together with country leadership, have contributed to the delivery of more people-centred integrated PHC services in Mongolia. Enabling factors for mobile health services at PHC level include the legal environment and the availability of PHC facilities and human resources to provide mobile health service and home visits. Integrating mobile health technologies to strengthen PHC services has been an effective and low-cost approach to address inequities and ensure that marginalized communities receive the health services that they need. Community engagement has also been valuable for understanding people’s needs, collecting feedback and empowering communities to take responsibility for their health.

Looking forward

Three priorities require attention to sustain the progress made so far:

  • Strengthening capacity of PHC providers to deliver integrated services including health promotion, examination, treatment, prevention and control of communicable diseases, NCDs, reproductive, maternal and child health, elderly care, rehabilitation care and health emergencies;
  • Continued provision of essential medical equipment, including mobile health technologies and updates; and
  • Enhancing and expanding outreach services using mobile health technology for reaching under-served communities.

The Mongolian government, with support from partner agencies, will continue to expand mobile health services to strengthen early diagnosis of diseases and link to full completion of treatment via referral services. It will also continue to promote multisectoral collaboration to reach the SDG3 targets, underpinned by the principle of leaving no one behind.

What is the SDG3 GAP?

The Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP) is a set of commitments by 13 agencies that play significant roles in health, development and humanitarian responses to help countries accelerate progress on the health-related SDG targets. The added value of the SDG3 GAP lies in strengthening collaboration across the agencies to take joint action and provide more coordinated support aligned to country owned and led national plans and strategies. A “recovery strategy” (Oct 2021) serves as a strategic update on the SDG3 GAP in the context of achieving an equitable and resilient recovery from the COVID-19 pandemic to the health-related SDG targets.

The purpose of GAP case studies is to monitor SDG3 GAP implementation at country level.

References

  1. National TB prevalence survey, 2015
  2. Source: NTP 2011 and 2021