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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