Community involvement in health in Mongolia: hospital boards and other participatory structures.

Under the Soviet central planning model that operated until 1990, the Mongolian population had little or no involvement in decision-making about health care. As part of overall health sector reform in Mongolia, hospital boards have been established, with significant community representation, to guide strategic and financial management and to assist in developing services according to community needs and expectations. We discuss experiences, and steps taken to resolve initial problems. We also describe other more recent participatory models including the family group practice initiative which involves the community choosing their doctor, community management of revolving drug finds, establishment of community health volunteer networks, and the governments information campaign strategy on the reforms. The community participation models in Mongolia are part of an ongoing process of openness and emphasise the commitment to change in that country. We argue that these experiences have the potential to guide and inform similar measures in other transitional countries.

Privatised family group practices in Mongolia: an initial assessment of service access.

Mongolia is changing the way that primary care is delivered, by replacing salaried government staff with private family group practices (FGPs) paid by risk-adjusted capitation. As part of a mid-project evaluation, we surveyed a sample of FGPs in order to assess the patterns of access to care. We found that generally satisfactory services are being provided in an equitable way, and therefore that the main goals of the new model are being achieved. However, there are some concerns. Inter alia, we argue that more should be done to establish better standards of clinical practice through the distribution of protocols and illustrative pathways, and to increase the extent to which services are organised in a manner that is sensitive to informed consumers' needs. A design limitation meant that few baseline data were available, and the survey will need to be repeated if valid conclusions are to be drawn.