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former Soviet Union) to a more decentralized model. Unfortunately, the move towards decentralization has seen more administrative than financial success( 19). Currently, the Mongolian health system is a single statutory system divided in principle according to 2 main administrative divisions: aimags and the capital city. Aimags are divided into soums, and soums into baghs. The health system delivery is based on a 3-tier model that provides health services at primary, secondary and tertiary levels, with varying complexity and advancement( 13, 20). Mongolia has more than twice the mean number of hospitals than that of other similar transition countries in Europe. It has a higher number of beds, at 68.1 per 10,000 population( 2011)( 10). Although the majority of health services are delivered by the public sector, the number of private healthcare providers( hospitals and clinics) has increased significantly in last decade( almost doubled from 683 in 2005 to 1184 in 2011)( 20). The majority of these, however, are small hospitals with 10 – 20 beds and outpatient clinics( 20).
The National Rehabilitation Center( established in 1999), consists of 4 different departments, and has been the main organization in the field of vocational and medical rehabilitation for PwD( 24). The community-based rehabilitation( CBR) programmes are generally funded by an Italian NGO, the Associazione Italiana Amici di Raoul Follereau( AIFO) and implemented by the Community Development Department( 24, 25). The CBR programme covers 18 aimags and 8 soums, and is planned to extend to all aimags throughout the country by 2018( 24). Many inclusive education training support programmes for PwD( their families) have been organized( 24).
Healthcare human resources. In general, Mongolia has well-developed healthcare infrastructure and human resources( 13, 20). Although Mongolia has a large number of health workers, most are concentrated in urban areas. In 2010, the number of doctors working in Ulaanbaatar was 3.94 per 1,000 population while, in aimags, almost half of this number( 1.85 per 1,000 population)( 13). In 2011, there were an estimated 3.4 primary healthcare doctors per 10,000 population working in soums and family health centres, and 1,677 doctors working in 1,184 private health facilities. In rural areas and villages, care for nomadic herdsmen, families and communities is provided by bagh feldshers, trained mid-level health personnel paid by the soum health centres( 20). In 2011, there were 1,058 bagh feldshers working at soum health centres and soum hospitals( 20).
Rehabilitation medicine is an emerging field in Mongolia. There are no definite official data on the PM & R specialist workforce. However, there are over 200 rehabilitation physicians and over 100 physiotherapists( PTs) registered in the Mongolian Society of PM & R( established in 2005). Since 2000, MNUMS commenced a postgraduate residency-training programme in the Department of PM & R, and each year approximately 8 – 12 medical doctors graduate as rehabilitation physicians( 26). There are PM & R departments in every major hospital, but almost all provide consultancy and ambulatory care( not inpatient care), and work conjointly with traditional medicine. The number of traditional medicine doctors has increased dramatically since 1990 following recognition by the Mongolian government and currently make up 10 – 15 % of all medical graduates( 20).
Interactive workshop on the Global Disability Action Plan
All participants( n = 77) contributed actively to the group discussion and consensus method. Most were newly trained rehabilitation specialists and many( especially PTs) were not familiar with the GDAP, and had limited knowledge of disability programmes in Mongolia. The participants agreed that the GDAP provides comprehensive summary actions for the government, policymakers, clinicians and PwD. The participants provided multiple responses( in writing) across each GDAP objective. Overall, for GDAP objective 1, participants indicated 42 potential challenges / barriers and 31 potential facilitators / enablers; for objective 2: 51 challenges / barriers and 44 facilitators / enablers; and for objective 3: 20 challenges / barriers and 18 facilitators / enablers. A number of common suggested“ terms” were coded, based on participants’ feedback and consensus agreement. There was significant overlap with regards to the terms amongst the 3 GDAP objectives. Hence, the final set of“ terms” was formulated collating all“ terms”, which included 38 potential challenges / barriers and 36 potential facilitators / enablers. The final set of potential facilitators and challenges in implementation of the proposed standard actions in the GDAP for rehabilitation are summarized in Table I.
DISCUSSION
This paper presents narrative findings on disability and PM & R status, and outlines potential barriers and facilitators for implementation of the GDAP from the Mongolian perspective. Mongolia has a multi-tiered and mixed-healthcare delivery www. medicaljournals. se / jrm