Health-Care Systems

Mongolia's government has made great efforts to provide modern medical care to the inhabitants. In the 1980s, medical care was free and was provided through a hierarchy of clinics and hospitals. In rural areas, the lowest level of the system was a medical station, staffed by a physician's assistant, serving people within a thirty- to forty-kilometer radius. Above this was a somon medical station, staffed by a physician, serving a forty- to sixty-kilometer radius; an inter-somon hospital, serving a seventy- to eighty-kilometer radius; and an aymag general hospital covering a 150- to 200-kilometer radius. The higher the level in the system, the more numerous the medical specialties and the more sophisticated the diagnostic equipment available. The lowest levels concentrated on acute care, public-health work, and screening and referring cases up the hierarchy.

As of 1985, Mongolia had approximately 4,600 physicians, 24.8 per 10,000 people. There were also about 8,500 nurses and 3,800 physician's assistants; many of the nurses and the physician's assistants specialized as midwives, although some medical personnel were trained in midwifery only. Medical care was provided by almost 1,200 clinics staffed by physician's assistants, 290 clinics staffed by physicians, and by 1986, 112 hospitals. The structure of medical specialties reflected both the needs of the young and rapidly growing population and the concentration of scarce resources on public health, control of epidemic diseases, and the health of the working population. The most common medical specialty was pediatrics, which accounted for 21 percent of all physicians in 1985. The next most common were general practitioners, 15 percent; obstetricians, 6 percent; public health specialists, 6 percent; and physicians specializing in the prevention and treatment of epidemic diseases, 6 percent. Government statistics listed only twenty-seven (0.5 percent) oncologists and no cardiologists; however, the existence of a large cancer research facility and the practice of bypass surgery techniques suggest a greater interest in these areas than the statistics indicate.

In spite of efforts to distribute medical facilities and specialists evenly, there was a marked concentration of physicians and hospitals in Ulaanbaatar and other major cities. In 1981 Ulaanbaatar had 49 percent of Mongolia's physicians and an average of 42.9 physicians per 10,000 people. The cities of Darhan and Erdenet had 21.7 and 18.8 physicians, respectively, per 10,000 people; low ratios of 9.5 physicians per 10,000 in Uvs Aymag and 10.2 per 10,000 in Hovsgol Aymag were also reported.

Mongolia cooperated closely with the Soviet Union in medical research and training. Soviet specialists held seminars in Mongolia and helped to build and to operate such special facilities as an oncology center and a 600-bed isolation hospital for infectious diseases in Ulaanbaatar. Mongolia was an active member of Comecon's Commission on Cooperation in Public Health, and it participated in World Health Organization (WHO) projects on maternity and child health, environmental protection, and training of medical technicians and mid-level health-care personnel.

By 1981 Mongolia claimed to have eliminated smallpox, typhus, plague, poliomyelitis, and diphtheria, and to have reduced sharply the incidence of other infectious diseases. In the past, disease was spread through the use of contaminated drinking water and from such sources as lice, which were common among the herders, who seldom bathed or washed their clothing. Clean drinking water for the herders, who often shared water sources with their animals, continued to be a problem, but much effort was put into health education. The Mongolian Red Cross, an organization that cooperated with the Mongolian Revolutionary Youth League, focused on preventive medicine and health education. It sent mobile teams to factories and herding collectives to teach hygiene and sanitation and to hold special workshops on infant care and the health needs of the elderly. Although traditional Mongols were averse to bathing, their modern descendants patronized a network of spas. Following the Soviet and East European pattern, Mongolia established sanitoriums where workers and such deserving individuals as holders of the Order of Maternal Glory went to rest, to take the waters, and to follow a medically prescribed regimen of swimming, sunbathing, and moderate exercise. The Council of Mongolian Trade Unions operated a network of sanitoriums that used the country's many hot springs and mountain lakes. The network annually could accommodate 20 percent of the country's factory and office workers during the brief summer season. So popular were the spas that aymag authorities established their own sanitoriums to provide therapeutic holidays for collective herders.