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