According to the Bank’s website, the proposed Provincial Health Service Strengthening and Modernization Project will support the government of Mongolia in expanding high quality health service delivery to rural areas of Mongolia through the establishment of four aimag (province) level hospitals to serve as regional diagnostic and treatment centers (RDTCs) in regional hubs.The project is expected to assist the Ministry of Health (MOH) in development and implementation of the health sector human resource policy, establishment of the training system for hospital managers, building capacity for establishment of emergency medical services system, and building capacity to ensure sustainability of the national health insurance system.

Mongolias health system suffers from long-standing health system constraints. This includes but is not limited to inadequate provision and quality of primary health care, especially in rural areas, lack of access to quality secondary health services in rural areas, financial barriers to seeking health care and remaining public hospital governance challenges. Urban health facilities are overcrowded as well, due to internal migration to seek health care. There is a growing need to redirect health services away from urban centers, to regional and rural areas. While Mongolias regional health services consist of aimag general hospitals, and a few regional diagnostic and treatment centers (RDTC) which are supposed to provide more specialized health services, these have not developed into more advanced institutions, and currently, their functions and capabilities are similar to those of aimag general hospitals. RDTCs receive only a limited number of referrals from neighboring aimags and do not serve the intended purpose of being regional referral hubs. In addition, referral and coordination systems are weak, resulting in inefficiencies. Capacity in the hospital sector is low, because directors and managers are not explicitly trained in hospital management, including human resource and finance management. The recent reforms in the health sector grant greater autonomy to public hospitals and require management teams to manage hospital operations efficiently. The lack of managerial skills and experience negatively affects hospital performance, quality of services, and cost efficiency. Primary, secondary, and tertiary levels of health care suffer from a weak referral system and poor gatekeeping mechanisms. Individuals often bypass primary health services in favor of more expensive secondary and tertiary services, due to public perception that health service quality and diagnosis of these levels is often better than primary levels. This health seeking behavior leads to increased costs for the health system. In the absence of strong incentives to ensure that patients are properly referred, secondary and tertiary hospitals often provide care to all patients without referrals, thus leading to increased health care costs. The lack of a coordinated health services network and shared human resources in rural areas hinders the support secondary facilities could provide to primary ones, missing an opportunity to enhance service delivery.

Loan (Ordinary capital resources): US$ 110.00 million
Loan (Concessional ordinary capital resources lending): US$ 115.00 million

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