Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

International Journal for Equity in Health

John Grundy¹  Diana Chang Blanc⁶  Surenchimeg Vanchinkhuu⁴  Enkhtuya Budbazar⁵  Tserendolgor Choijiljav³  Khandsuren Lhamsuren² 

[1] Public Health Consultant, Nossal Institute for Global Health, The University of Melbourne, Cambodia Office, Phnom Penh, Cambodia;Chief Pediatrician, Bayanzurkh District Health Department, Ulaanbaatar City, Mongolia;Deputy Director, Bayanzurkh District Health Department, Ulaanbaatar City, Mongolia;Health and Nutrition specialist, UNICEF, Ulaanbaatar City, Mongolia;Officer EPI team, National Centre for Communicable Diseases, Ministry of Health, Ulaanbaatar City, Mongolia;Regional Immunization Specialist, UNICEF East Asia Pacific Regional Office, Bangkok, Thailand

关键词: Reaching Every District;    Mongolia;    Health System Strengthening;    Urban Health;    Health Inequities;   

Others  :  1146628
DOI  :  10.1186/1475-9276-11-15

 received in 2011-10-19, accepted in 2012-03-20,  发布年份 2012

【 摘 要 】

Introduction

In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning.

Methods

Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers.

Findings

The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies.

Conclusions

Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor.

【 授权许可】

   
2012 Lhamsuren et al; licensee BioMed Central Ltd.

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