Gender, equity and human rights

Leaving no one behind on the path towards good health in Mongolia

Landscape in Mongolia with adolescent boy riding a horse
WHO/Yoshi Shimazu

15 MAY 2017 – Around the world, many people are left behind from accessing the health services they need or they experience financial hardship as a result of using them. Some who live in remote or rural areas may need to spend money and time travelling extensive distances in order to reach services appropriate to their condition. Yet others may be forced to use the hard-earned money that goes to feeding and housing their families to pay for life-saving medications – or they may not be able to afford costs at all. Others may experience adverse gender norms, roles and relations that, especially when intersecting with factors like lower income and education, contribute to differential exposure to risk factors and impede access to services. These are just some of the barriers that can hinder and prevent adequate coverage and contribute to health inequities. In many contexts, socially and economically disadvantaged subpopulations continue to suffer disproportionately from health inequities because of discrimination based on different grounds and compounded social exclusion processes.

WHO advocates for “Leaving no one behind,” an underlying principle of the 2030 Sustainable Development Agenda. One of the ways that it does this is through its work on health systems strengthening towards the goal of universal health coverage, so that all people can get the quality health services they need without experiencing financial hardship. Applying a progressive universalism approach, so that disadvantaged subpopulations benefit at least as much as more advantaged subpopulations in reforms towards UHC, is central to this. Making health sector plans more equity-oriented, rights-based, and gender-responsive contributes to progressive universalism, as well progressive realization of the right to health.

Strengthening the focus on “Leaving No One Behind” in subnational health sector planning

With the aim of identifying subpopulations being left behind and working towards better addressing their needs, a process is being undertaken in 2016-2017 to reinforce this focus in subnational health sector planning in Mongolia. The process is co-organized by WHO in conjunction with Mongolia’s Ministry of Health, the Ulaanbaatar City Health Department and Aimags’ Department of Health, with inputs for follow-up from a range of partners.

During September – November 2016, more than 100 health managers from all of Mongolia’s 21 provinces and Ulaanbaatar’s nine districts were engaged in the workshops for a “leaving no one behind” approach. Issues brought forth by participants included but were not limited to the following in relation to disadvantaged subpopulations: enhancing the focus on health promotion and prevention, increasing outreach capacity to generate demand in disadvantaged areas, strengthening family health centres and soum health centres, improving the referral system, addressing barriers to financial protection including the costs of medicines, overcoming transportation and geographical remoteness barriers (including through mhealth), better understanding the barriers to tertiary and specialized care by poorer subpopulations, enhancing the skills of health professionals in disadvantaged areas, improving intersectoral action for addressing health inequities, fomenting social participation mechanisms accessible by marginalized communities, and enabling improved coherency and integration of measures aiming to overcome social disadvantage (facilitated by the Aimag Governor’s office).

Workshop participants
WHO/Nomin Lkhagvasuren

The workshops supported the inclusion of a strong focus on “leaving no one behind” in the health-related subnational planning for the 2017-2021 phase of Mongolia’s 2030 Sustainable Development Vision, which charts the country’s development path until 2030. The Minister of Health of Mongolia, Dr Tsogtsetseg Ayush, noted that the planning workshops on leaving no one behind were not only helpful in reflecting on those in most need, but timely in drafting the long-term State Policy on Health at the national level. The “Leaving No One Behind” principle will also be reflected in five-year health plans developed on the local level to implement the State Policy.

A handbook on incorporating the “Leaving No One Behind” principle in formulating national health programmes and policies, developed by WHO staff at all three levels, will soon be published, further detailing ways in which subnational health authorities can strengthen systems to provide quality health care when and where needed, without causing financial hardship. “It will be an invaluable tool for Mongolians and for the international community interested in Mongolia’s sub-national health system strengthening,” said Dr Soe Nyunt U, WHO Representative in Mongolia.

In January 2017, the State Policy on Health was adopted by the Mongolian Government , thus creating the framework for mainstreaming the “Leaving No One Behind” principle in health service provision. The Minister of Health has issued an order for aimags and Ulaanbaatar city districts “to revise their local plans to reflect the implementation of the State policy on health including the “Leaving no one behind” approach. All subnational plans will be approved and signed by the Minister of Health and local governor.

The WHO Country Office for Mongolia is undertaking follow-up activities supporting a strong focus on “Leaving No One Behind” in the implementation of the State Policy. For instance, the WHO Country Office has conducted regional followup trainings covering 18 aimags/provinces and follow-up visits to some aimags to provide advice on the revision of the subnational plans and advocate for the importance of bringing in multi-sectoral cooperation at local government levels and implementing a “leaving no one behind” approach. A capacity-building workshop on “Leaving no one behind in the context of subnational health system strengthening” was also organized by WHO and in collaboration with Ministry of Health on 27-28 April 2017 for international volunteers working in local health facilities. Lecturers from the School of Public Health, Mongolian National University of Medical Sciences, also attended the training workshop with the aim of including the training’s concepts in their teaching programmes.