1. Health

 

Coordinating Agencies: UNFPA, UNICEF, WHO

Government Counterparts: Ministry of Health and Social Welfare

Implementing Partners: MONGOLIMPEX, the RH Unit, the aimag,

soum authorities and health system.

Location of Initiative: All affected aimags

 

E.1 Background and Context

 

Each disaster-affected aimag has a specialised central hospital. Each soum has a small hospital (20–25 beds). In the soums, outreach services are provided by feldshers (primary health care workers) and by local doctors. The doctors usually travel by jeep, the feldshers by motor cycle or horse, to provide preventive and emergency care.

 

For the last several years, health budgets throughout the country have been very low. As a result, all health facilities have chronic severe shortages of everything: basic medical equipment, pharmaceuticals, consoumables (e.g. gloves, dressings) and fuel for vehicles.

 

All health facilities in the dzud-affected areas are facing severe additional strains:

 

  1. Although in most health facilities staff levels are high, several soum hospitals in the affected areas have no physicians. The Ministry of Health and Social Welfare (MOHSW) has therefore instructed the aimag hospitals to send medical teams to work in those areas.
  2. The feldsher system has been in decline for several years. For example, in Uvurkhangai aimag, only about 55% of the feldsher posts are occupied. Because they have lost their horses, those feldshers still working are unable to visit rural families. In addition, feldshers must maintain animal herds to supplement their meagre income. Many are now preoccupied with trying to save their own stock.
  3. Some soum hospitals are under increased financial strain because many people have temporarily migrated into their area and are seeking medical care. Although the hospitals have been instructed by MOHSW to provide free services to these people, they have not yet received additional funds or supplies to do so.
  4. Because of the lack of funds, 34 affected soums have no ambulances. All soums lack funds to purchase fuel and to send vehicles on emergency calls or to transport severely ill patients to the aimag hospital.
  5. Because priority is being given to transporting urgent cases, preventive health services have been particularly affected. In some soums, routine vaccination programs for children have temporarily ceased.

 

So far, the dzud has had only a limited direct impact on the population’s health, although there are isolated reports of herders dying from exposure while searching for lost animals, and of people (especially young children) perishing from pneumonia because of the delay in obtaining appropriate medical care. Human health is expected to deteriorate during the coming months, however, for the following reasons:

 

  1. Because families have lost their horses, they are unable to readily access health facilities. They must walk many hours (up to three days) to receive medical assistance. Pregnant women find it increasingly difficult to receive regular antenatal care and to travel to maternal rest homes to await the onset of labor. The number of home deliveries without professional assistance will probably increase over the coming months with a resultant increase of maternal and neonatal morbidity and mortality.
  2. Drugs are not provided free in the Mongolian health system. Because the herders have used all their cash reserves to purchase food and tonics for their animals, they have nothing left to buy medicines for themselves. Unless migrating families have carried all their documents with them, they are unable to purchase medicines subsidized by the National Health Insurance system.
  3. The psychological impact on the whole population is severe. Deaths of animals from starvation affect the whole community almost as deeply as the death of human friends.
  4. As food shortages become widespread, people will become increasingly malnourished. They will become more prone to infections, and other chronic conditions will be exacerbated.
  5. During summer, most fluid intake is in the form of fermented milk. Because milk will not be available this year, people will congregate near functioning wells, increasing the risk of water contamination and gastrointestinal infections.
  6. At the end of summer, people will increasingly hunt marmots, both as a source of food and for their pelts. They will be exposed to the risk of contracting bubonic plague, which is endemic among these rodents and the cause of annual outbreaks in many areas.

 

E.2: Objective

The multiple health related objectives include:

 

To ensure that rural populations have reliable access to essential health care through the provision of essential drugs and medical consumables, reproductive health kits, vehicles and fuel.

To prevent the transmission of infectious disease by continuing priority immunization programs and through health education.

To provide therapeutic feeding for severely malnourished persons requiring hospitalization.

To assist MOHSW to monitor the dzud’s impact on human health, the distribution of medical supplies and to evaluate the impact of the intervention activities.

 

E.3. Strategy for Implementation

The World Health Organisation (WHO) will supply essential drugs for all aimag and soum hospitals in the affected areas as well as small first aid medical packs for rural families to mitigate against their loss of access to medical services. The UN Population Fund (UNFPA) will supply essential reproductive health equipment and medicines for aimag and soum hospitals in the affected areas, and for feldshers. UNICEF will supply essential drugs (See previous section), micronutrients and oral rehydration salt. Distribution of these items will be organised by the MOHSW and MONGOLIMPEX, the government’s drug distribution agency, with technical assistance from the Reproductive Health unit, UNFPA, UNICEF and WHO staff.

 

Vehicles and fuel will be provided to selected soums for both emergency transport and to ensure the continued provision of routine preventive health care.

 

UNFPA, UNICEF and WHO will provide technical assistance to MOHSW to identify key indicators and to develop a MIS framework to monitor the health impacts of the dzud, to track the distribution of assistance, and to evaluate the impact of the interventions. Technical staff from the three agencies will assist MOHSW to organize and conduct surveys and other monitoring activities in the affected areas.

Activities:

  1. Procure and distribute essential drugs (WHO/UNICEF), RH supplies and equipment (UNFPA) to all affected areas (MOHSW and MONGOLIMPEX).
  2. Support mobile medical teams to visit aimag hospitals and soum hospitals as required (MOHSW).
  3. Provide vehicles and fuel for primary health care, monitoring and emergency medical transport with a focus on displaced persons (MOHSW).
  4. Strengthen the health surveillance system (WHO, MOHSW).
  5. Conduct health surveillance surveys as required (UNFPA, UNICEF, WHO, MOHSW).

 

E.4: Budget for Implementation

 

Item

Unit Cost

US$

Total Cost

US$

Essential drugs/medical consumables for 6 months

 

585,000

Family medical kits for isolated households

3.72 x 52,500

195,300

Reproductive health subkits (incl. freight to Ulaanbaatar)

 

24,200

Russian Jeeps to function as ambulances

4,500 x 10

45,000

Fuel for ambulances for 26 weeks (124 soums)

 

104,500

Transportation cost for drugs/medical consumables/kits

 

4,000

Monitoring/evaluation (143 soums)

 

23,000

Monitoring visits to disaster areas (143 soums)

 

14,000

Total

995,000

 



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