Disability and rehabilitation in Mongolia 361 lacking . According to the Mongolian Law on the Social Protection of Persons with Disabilities , PwD are defined as “ those persons with limited physical or mental abilities , either genetically inherited or acquired during life , persons born with deformations or disability caused by illness or accident which limits full ability to work , mute persons or person officially diagnosed with sight , hearing , or body or mental disabilities ” ( 7 , 18 ). Based on the Economic and Social Commission for Asia and the Pacific ( ESCAP ) Disability Survey 2015 , the disability-prevalence rate in Mongolia is 3.9 % ( 108,071 persons ) ( 18 ). Of these , majority have a physical disability ( 29 %), 19 % mental / intellectual , 15 % visual , 12 % hearing , and 6 % speech-related disability ( 18 ). The majority of PwD ( 52 %) are aged > 40 years ( 18 ). However , based on the World Report on Disability disability prevalence rate estimation of 15 % ( or 1 in 7 people ) ( 1 ), there are an estimated 450,000 PwD in Mongolia . There are no current employment data for PwD . However , according to the Ministry of Social Welfare and Labour ( 2001 ), of the 39,700 PwD categorized as persons able to work , only 13 % ( 5,200 ) were employed and an estimated 88 % were living below the poverty line ( 7 ). More recent data show that 80 % of PwD aged > 15 years are unemployed ( 19 ). Furthermore , PwD are 4 times as likely to be employed in the informal sector ( 7 , 18 ). The level of education of the PwD population is lower than that of the total population , with almost 22 % of PwD aged over 10 years being uneducated ( 19 ).
Similar to other developing countries , Mongolia is experiencing a transition in disease burden , from communicable diseases to chronic and non-communicable diseases ( NCDs ) ( 8 ). The prevalence of disability in Mongolia is escalating due to an ageing population , and an increase in chronic conditions , and injuries ( 8 , 9 , 20 ). In 2010 , the top 3 causes of overall disabilityadjusted life years ( DALYs ) in Mongolia were : ischaemic heart disease ( IHD ), lower respiratory infections , and cerebrovascular disease ( 9 , 21 ). The leading 5 causes of “ years lived with disability ” ( YLDs ) were : major depressive disorder , low back pain , alcohol use disorders , neck pain , and other musculoskeletal disorders ( 22 ). Diseases of the circulatory system , neoplasm and injury , poisoning and others accounted for 73.3 % of all deaths in Mongolia ( 8 ). Leading causes of death included : IHD (> 4,000 deaths in 2012 ), and cerebrovascular diseases ( stroke ) with over 3,000 deaths ( 9 ). These conditions contribute to significant economic and social costs for PwD , their families , and the community ( 13 , 20 , 22 ).
Disability policies and legislation . In the last 2 decades , Mongolia has made steady progress in improving the health of its population , through support from several international and national partners . The Ministry of Health is responsible for formulating and monitoring health policies and programmes ( 8 ), while the Ministry of Social Welfare and Labour implements state policy for vulnerable groups including PwD ( 7 ). Other national government agencies ( such as METH the National Centre for Health Development , National Public Health Institute , National Maternal and Child Health Center ) and health institutions play a significant role in implementing health policy and programmes ( 7 , 8 , 23 ). Other government organizations ( Mongolian National Coordination Committee on Disabilities , Poverty Alleviation Fund Council , the Local Development Fund and the Employment Promotion Fund ) support disabled job-seekers and employees ( 7 ). Furthermore , many local and international NGOs contribute to implementation of health service delivery at various levels .
The Mongolian government embraced the issue of disability as a priority and in the first democratic Mongolian Constitution ( 1992 ), acknowledged equal rights for all citizens ( 7 ). The Health Law ( 1998 , 2006 , 2011 ) signifies the right to primary and maternal healthcare , and public health services to all citizens regardless of socio-economic status and health insurance coverage ( 7 , 20 ). The first Mongolian Social Security Law for People with Disabilities ( 1995 , 1998 ) adopted the Law on Social Protection of People with Disabilities ( 2005 ) ( 7 ) for social assistance and benefits for PwD in Mongolia . The Social Security Law includes : provision of identification cards , clearly defined government agencies and type of support for individuals , rehabilitation and after-care , employment , recreation and social services for PwD ( 7 ).
Mongolia became a signatory to the Proclamation on the Full Participation and Equality of People with Disabilities in the Asian and Pacific Region in 2001 ( 7 ), and in 2009 ratified the UN CRPD ( 18 ). The government established the Health Insurance Fund in 1994 , funded by compulsory contribution of 4 % of income in the formally employed sector and a flat contribution rate for herdsmen , students and the self-employed . This scheme , however , does not include rehabilitation and has challenges in the informal sector .
Healthcare service delivery . In the 1990s , the Mongolian health system transitioned from the centralized Semashko model ( inherited from the
J Rehabil Med 50 , 2018