Mongolia launches the National Strategic Plan for TB 2024-2028, anchored on the systems optimization approach

The Ministry of Health launched the new National Strategic Plan for Tuberculosis (TB), anchored on a system-wide approach for delivering the TB cascade of care.

_{Dr Socorro Escalante, WHO Representative to Mongolia, delivers remarks at the launch of the National Strategic Plan for TB, emphasizing the system optimization approach. © WHO Mongolia}

_{Dr B.Demberel, advisor to the Minister of Health, emphasizes the importance of the National Strategic Plan for TB 2024-2028. © WHO Mongolia}

Mongolia faces one of the highest TB burdens in the Western Pacific Region, with an incidence rate of 491 per 100 000 population, nearly four times the regional average. Nearly 82% of TB cases remain undetected and/or under-reported, treatment coverage is as low as 18%, and catastrophic costs affect 69% of TB-affected families¹. 

The key challenge is the historical reliance on a centralized dispensary model. While this model was once the norm, it made it difficult for people in remote or underserved areas to access timely diagnosis and treatment. As a result, many cases went undetected or untreated, allowing the disease to continue spreading in the community. The model also left hospitals and primary health care facilities under-utilized. These resulted in: 

• Low treatment coverage and outcomes

Mongolia has a very low TB treatment coverage rate with treatment success rates also lagging. In a centralized dispensary system, patients are required to travel to designated facilities for TB testing, diagnosis, and daily treatment administration.

The often considerable distance to these dispensaries creates significant access barriers, resulting in delayed health-seeking behavior, missed diagnoses, and poor treatment adherence – factors that collectively contribute to low TB treatment coverage and sub-optimal treatment success rates. Rural herder populations, border communities, and linguistic minorities face additional barriers due to geography, stigma, and language differences.  

_{Participants from government agencies, international organizations, and partner institutions attend the launch event. © WHO Mongolia}

• High burden of multi-drug-resistant TB (MDR-TB)

In a centralized dispensary system, the requirement for patients to travel long distances for daily treatment poses significant challenges leading to treatment discontinuation or irregular treatment uptake, and higher chances of resistance amplification and transmission. Mongolia is one of high MDR-TB burden countries, and MDR-TB accounts for 6.7% of new cases. 

• Financial burden

Patients often incur substantial out-of-pocket expenses due to repeated travel to centralized dispensaries for diagnosis and daily treatment, including transportation costs, lost income, and accommodation when distances are long. In Mongolia, 69% of TB-affected families face catastrophic costs. 

These systemic weaknesses highlight the urgent need for optimizing the health care and social systems to ensure people-centered and equitable access to TB services. 

_{Dr Shalala Ahmadova, Coordinator for IDC of WHO Mongolia, shares insights and discusses key priorities during the session. © WHO Mongolia}

Strategic shift towards system optimization

In response to these challenges, the Government of Mongolia endorsed the National Strategic Plan (NSP) for TB Prevention, Control, and Care (2025–2028), marking a decisive shift toward the system optimization approach. This strategic shift was developed jointly by the World Health Organization (WHO) and the Ministry of Health and the National Center for Communicable Diseases (NCCD). It aims to reorient TB care away from the dispensary model toward a system-wide, people-centered approach, utilizing all levels of the health care system, while enhancing the role of primary health care.

The NSP outlines the following priorities: 

• System-wide streamlining of TB services – strengthening the role of the three levels of health care system in detection, diagnosis and treatment. The strategy is underpinned by the deployment of rapid diagnostics, including GeneXpert and AI-powered X-rays at the primary health centers.
• Mandatory TB notification system – ensuring all cases are reported across all levels of the health system to reduce missed diagnoses.
• Immediate treatment initiation – starting treatment without delay once a diagnosis is confirmed, to reduce transmission and improve outcomes.
• Active case-finding – scaling up screening among high-risk groups such as smokers, alcohol users, diabetics, students, and herders, combined with expanded use of chest X-rays and molecular diagnostics.
• Integration into primary health care and preventive services – embedding TB screening into annual check-ups and routine outpatient visits at all health facilities.
• Multisectoral and community engagement – strengthening collaboration with education, social welfare ministries and local governments, and promoting community-led monitoring for accountability.

_{Dr B. Tsetsegsaikhan, Director of the Public Health Policy Implementation department at the Ministry of Health, Mongolia, presents an overview of the current TB burden, including progress and challenges in diagnosis and treatment. © WHO Mongolia}

With the renewed NSP, Mongolia is now positioned to embark on a transformative shift toward health system optimization to deliver TB services, integrating innovative digital tools, and strengthening primary health care and community engagement, to address delayed diagnosis and inequitable access to services. 

The NSP sets ambitious targets, including reducing TB incidence to 197 per 100 000 population and TB mortality to 4.5 per 100 000 by 2028, and achieving treatment success rates of 92% for all forms of TB by the end of NSP.

Looking further ahead, the country’s long-term goal is to achieve an 80% reduction in TB incidence by 2030 compared to 2015 levels, in line with the WHO End TB Strategy.

_{Provinces receive new laboratory equipment to strengthen TB diagnosis. © WHO Mongolia}

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¹The Global Tuberculosis Report 2024