Reaching every district - development and testing of a health micro-planning strategy for reaching difficult to reach populations in Mongolia.

CONTEXT: Since the 1990s, Mongolia has undergone a rapid social and economic transition with migration to the urban areas of the national capital Ulaanbaatar. The main reasons for the migration are social sector decline in rural areas and the potential for employment opportunities in urban areas. There are also new internal patterns of migration in rural and remote areas relating to recent developments in the economic sector. Despite recent innovations in health system management in Mongolia, in some urban and rural and remote locations health services are not sufficiently accessed by the most socially and economically disadvantaged populations. These concerns provided the motivation for the Ministry of Health of Mongolia and development partners to attempt to access the most difficult to reach populations through the development of a micro-planning process referred to as the 'Reaching Every District strategy' (RED). This article describes and analyses RED micro-planning processes and content, and highlights the lessons learned. The main source of data for this planning system development was in the development and testing of the micro-planning process in Byanzurkh District, Ulaanbaatar in June 2008. INTERVENTION: The principal intervention developed and trialed was a health micro-planning strategy for improved access to immunization and maternal and child health services for difficult to reach populations. The planning methodology was a problem-solving approach progressing from health mapping to barrier analysis, to activity planning and costing and finally to monitoring and evaluation. LESSONS LEARNED: Main success factors in the development of the planning methodology were the use of barrier analysis and mapping approaches for data analysis and problem solving at the local level, and re-orientation of management approaches from 'inspection' to supportive supervision. Additionally, although the RED strategy is intended to be an immunization-specific intervention internationally, evidence from the development and trial of the process in Mongolia indicates its potential for wider health systems applications. This is particularly so for detecting and responding to the maternal and child health service needs of the more difficult to reach sub-populations.

Effects of interventions on community awareness and treatment of hypertension: results of a WHO study.

A WHO-coordinated study of the community control of hypertension in six countries (Cuba, Finland, France, Italy, Mongolia and Portugal) has shown that a comprehensive approach clearly improves the care of hypertensives in various populations. Hypertension control programmes were individually designed in each country and were implemented in defined communities. The intervention strategies varied between countries, the major components being: establishment of hypertension clinics and hypertension registers, involvement of health care personnel, and health education of the entire community. As a result of this programme, the blood pressure in the age group 30-59 years decreased on average by 3/2 mmHg among men and by 6/3.5 mmHg among women; the mean blood pressure level decreased twice as much in hypertensive subjects as in the entire population in the intervention areas of the study.

The community control of rheumatic fever and rheumatic heart disease: report of a WHO international cooperative project.

The feasibility and effectiveness of a programme for the community control of rheumatic fever and rheumatic heart disease were studied in a cooperative multicentre project initiated and coordinated by the World Health Organization. The programme was carried out in seven centres in various developing countries of Africa, America, and Asia according to a common protocol, and is under way in a further eight countries in Latin America. Pilot community programmes were shown to be practicable and effective in reducing the burden of rheumatic heart disease in developing countries and their extension to cover entire populations should be encouraged.

[Arterial pressure in cattle breeders living in different climatic and geographic zones of Mongolia]. / Arterial'noe davlenie u skotovodov, prozhivaiushchikh v razlichnykh klimatogeograficheskikh zonakh Mongolii.

Arterial pressure was studied in 2,540 cattle-breeders (1289 men and 1251 women) living in three different climatogeographical zones of Mongolia. It was found that the mean values of arterial pressure in cattle-breeders living in alpine regions, both according to age groups and both sexes, were higher than those in cattle-breeders living in mountain regions of middle and low height. The number of cases with systolic, and diastolic hypertension as well as the number of persons with arterial pressure in the dangerous zone are significantly increased in the alpine region as compared to these data in the other regions. In alpine regions and in mountain regions of medium height in Mongolia, the incidence of hypertension among women is higher than that among men.