Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 62

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system. Consistent with the worldwide pattern
of population health transition, Mongolia is
already in a stage of epidemiological transition
from communicable diseases to the NCDs, due
to the escalating prevalence of NCDs, which ac-
count for a predominant share of morbidity and
mortality (9, 21, 27). The Mongolian government
has prioritized disability and rehabilitation as one
of its key agendas. The level of funding, human
resources and health infrastructure specifically are
well developed in urban areas, but are not optimal
in rural areas (23). Since 1990, healthcare facilities
and programmes have grown exponentially in
most areas of Mongolia (11). However, the system
still emphasizes provision of healthcare through
hospitals, resulting in a fragmented and inefficient
hospital sector providing generally low-quality
care (23). This is further compounded by poorly
developed primary healthcare sector, financing
systems, human resources and planning, and
regulatory processes (23). In line with this, many
medical specialties, including PM&R are yet to
develop at the optimum level. Although there is
a PM&R department in many major hospitals,
many health professionals work in silos, and most
programmes are conjoint with and/or subjugated
by traditional medicine. The rehabilitation service
provision at the national level is fairly disjointed
within capital and aimags health departments,
NGOs and the private sector, providing services
mostly through vertically-managed disease-
specific mechanisms (13, 20, 23). Many physici-
ans, particularly PM&R specialists, international
NGOs (INGOs) and NGOs working in the field
of disability management have little coordination.
Furthermore, discernible urban-rural disparities in
healthcare delivery and an imbalance in the health
workforce compound the overall healthcare sys-
tem (20). Similar to many developing countries,
Mongolia has limited research and data on disa-
bility, impeding formulation of country-specific
policies and programmes.
Since the establishment of the National Reha-
bilitation Center (1999), and the postgraduate re-
sident training programme for PM&R at MNUMS
(in 2000), the profile of rehabilitation medicine has
improved, but remains under-developed (especi-
ally in rural settings) and poorly integrated with
the acute healthcare systems. There are limited
inpatient rehabilitation facilities (most offer am-
bulatory programmes), and limited specialized
rehabilitation facilities (e.g. spinal or acquired
brain injury rehabilitation units). The funding for
comprehensive disability management and rehabi-
litation is not optimal and is not always covered by
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the Mongolian Health Insurance systems. There is
lack of other allied healthcare professionals, such
as occupational therapists, speech therapists, pro-
sthetics, etc. There is minimal awareness regarding
rehabilitation medicine amongst the public as well
as general healthcare professionals, and it is often
confused with traditional medicine. Other barriers
include: lack of modern equipment (therapeutic
and diagnostic), limited training and professional
development prospects, and limited health services
infrastructure and human resources in rehabilita-
tion. The healthcare system itself at the national,
provincial and district levels is still patchy. At the
community level, care of PwD (including CBR)
is predominantly funded by NGOs and charitable
organizations (25).
The GDAP provides comprehensive summary
actions for disability and offers the Mongolian
government, policymakers and other relevant sta-
keholders a blueprint for implementing the recom-
mendations of the World Disability Report. The
Mongolian health sector now has the opportunity
to improve and build on existing programmes,
and