The detailed work plan will be made by the new local consultant and the international
consultant in consultation with the (deputy-) team leader of the consultancy team. A report on
activity 1 (Review of the private sector) can hopefully be completed before the end of 2009,
and preparation for activities 2 and 3 be made.
6 RISKS AND ASSUMPTIONS
It is assumed that the Master Plan and its Implementation Framework are the guiding documents for health care reform in Mongolia and that the government remains fully committed to them. However, there is a risk of political and other obstacles to stated objectives of health care reform, especially concerning sensitive subjects such as rationalisation of the hospital sector, strengthening of the position of PHC in the health care system, gate keeping, and health financing reform. In every country there are professionals, politicians and ordinary citizens who oppose such objectives, and such opposition will have to be managed.
The THSDP is not the only vehicle for health care reform. Many reform activities are ongoing, by the Ministry of Health and by other ministries, institutions and projects, and they have different approaches and timelines, for example in primary care and in health financing reform. It is a risk that different reform activities follow parallel paths, and it is an assumption that all those involved in health care reform are ready to co-operate and co-ordinate.
We assume that the Government of Mongolia and the Ministry of Health will remain committed to the strengthening of primary care in Mongolia, which includes a clarification of the legal status of primary care providers, improved technical capacity of primary care, and an increased share of the public budget for health care.
There is a risk that hospital rationalisation in Ulaan Baatar will be delayed until well into the 4th Health Sector Development Project, leading to an insufficient shift of funds from the hospital sector to primary care during the THSDP.
Consensus and co-ordination among the Ministries of Health, Social Welfare & Labour, and
Finance will be a key risk/success factor for health financing reform.
7 REFERENCES
ADB. Program Completion Report on the HSDP in Mongolia. September 2004.
ADB. Proposed Asian Development Fund Grant - Mongolia THSDP. October 2007.
ADB. Mongolia HSDP: Performance Evaluation Report. February 2008.
ADB. THSDP Project Information Document, 2008.
ADB. Health and Social Protection - Rapid Sector Assessment. October 2008.
ADB, Ministry of Finance, World Bank. Manual on mid-term planning, output and program based budgeting for public organizations. Ulaan Baatar 2009.
Bolormaa T et al. Mongolia: Health system review. Health Systems in Transition, 2007;
9(4):1-151.
Byambaa R. Inappropriate admissions at hospitals of tertiary and secondary level of care in Ulaanbaatar. No date.
Fuenzalida-Puelma HL. Private sector regulatory and institutional issues in Mongolian health reform. Ulaanbaatar, April-May 2004.
Government of Mongolia, Ministry of Health. Health Sector Strategic Master Plan 2006-2015.
Ulaanbaatar, 2005.
Government of Mongolia, Ministry of Health. The Implementation Framework of the Health Sector Strategic Master Plan 2006-2010. Ulaanbaatar, 2007.
Government of Mongolia. Millennium Development Goals-based comprehensive national development strategy of Mongolia. Ulaan Baatar 2008.
Government Resolution no. 172. The guidelines on selection of health organisations to provide health services which are funded from government budget and Health Insurance Fund. Ulaan Baatar 2008.
Healy J, McKee M. Chapter 4 - The role and functions of hospitals. In: McKee M, Healy J (eds). Hospitals in a changing Europe. Buckingham/Philadelphia, Open University Press, 2002.
Hindle D, Khulan B. New payment model for rural health services in Mongolia. Rural and Remote Health, 2006;6:434 (online).
Implementing Agency of the Government of Mongolia, Department of Health. Health indicators 2008. Ulaan Baatar, 2009.
Intersectoral Committee on Health Sector Human Resource. Information package. Ulaan Baatar, 2008.
Joint Ministerial order No 73/53/33: The payment rates for health services to be funded from the Health Insurance Fund. Ministries of Health, Finance, and Social Welfare & Labour, March 2009.
Ministry of Health. Order nr. 277. Health sector human resource development policy 2004-2013. 27 November 2003.
Ministry of Health, Government of Mongolia. Synthesis paper (second revised reprint). March 2004.
Ministry of Health. Ministerial order no. 37. The list of health insurance funded health services
to be provided by private health organizations and the evaluation criteria for selection of private
health organizations to be funded from the Health Insurance Fund. February 2009.
Ministry of Health. Ministerial order no. 180: The list of DRGs to be funded from Health Insurance Fund and their cost weight (App.1). The payment methods for health insurance funded health services and the guidelines for estimating health insurance payment rates (App.2). June 2009.
Ministry of Health and ADB. Memorandum of Understanding - proposed Project Preparatory Technical Assistance Mongolia - Fourth Health Sector Development Project. March 2009.
National Audit Office. Report on health care financing and user charges. Ulaan Baatar, October 2008
Orgil B, Hindle D, O’Rourke M, Batsuury R, Sonin S. Privatised family group practices in Mongolia: an initial survey of service access. Australian Health Review 2002;25(4):19-30.
O’Rourke M, Mira M, Orgil B, Jeugmans J. Developing family medicine in Mongolia. Asia Pacific Family Medicine 2003;2:65-70.
Sodnom Bekhbat, Ross Sutton. Towards donor coordination in the health sector in Mongolia.
No date.
Ulikpan A, Mirzoev TN, Narula IS. Is the Mongolian health sector ready for a sector-wide approach? Asian Social Work and Policy Review 2008;2(2):111-25.
WHO. Mongolia. Country Health Information Profiles, pp. 243-258 (online).
World Bank. The Mongolian health system at a crossroads; an incomplete transition to a post-Semashko model. Washington DC, January 2007.
World Bank. Public expenditure financial management review. Chapter: the health sector.
September 2007.
Family medicine experiences in other countries with a Semashko background
Atun R et al. Review of experience of family medicine in Europe and Central Asia: Moldova case study. World Bank, May 2005.
Curochicin G et al. Management of human resources in primary care in Moldova. September 2008.
Kalda R. The current system of primary care, role of the Estonian Society of Family Doctors.
June 2006.
Liseckiene I et al. Primary care in a post-communist country 10 years later. Comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004. Health Policy 2007;83:105-13.
Rese A et al. Implementing general practice in Russia: getting beyond the first steps. BMJ 2005;331:204-7.
Schaapveld K. A comprehensive view of primary care reform in Georgia. April 2005.
ANNEX A – TERMS OF REFERENCE
Component 1. Strengthened health services
Expected Outputs of THSDP (Ref pg 6-7 of RRP)
• Strengthened FGPs
• Strengthened SHCs in providing primary care
• Upgraded district and aimag general hospitals International Consultant for Component 1/Team Leader
The international consultant responsible for the areas of expertise for Component 1 will also carry out the functions of a Team Leader and be responsible for the overall management. Under the direct supervision of the Project Manager and as a counterpart of the Planning and Human Resource Officer of the THSDP, the Team Leader will undertake the following managerial tasks
1:
1. To manage the in-country consultant team and to coordinate, and supervise the activities of international and local experts/ consultants;
2. To assist the PIU to establish and operationalize appropriate procedures for ensuring effective collaboration with the relevant departments of the MoH and other partner agencies involved in the health sector for each project component.
3. To assist the PIU to ensure the timely undertaking of the planned project's activities using wherever possible a capacity building working group approach;
4. To assist the PIU with the programme internal monitoring using the PPMS;
5. To ensure that all reports mentioned in the section H of this Terms of Reference are prepared and submitted to the MoH/PIU and ADB Headquarters in a timely manner 6. To provide technical assistance and support in the relevant areas of expertise in
addition to carrying out the team leader tasks.
Activities to undertake:
2A. Family group practice
1. Assist in consolidating family medicine in Mongolia by strengthening legal basis and performance contract arrangements for FGP.
2. Assist in institutionalizing FGP financing and remuneration via risk-adjusted capitation.
3. Assist in development of FGP gatekeeper role with appropriate referral arrangements and mechanisms.
4. Assist in development of FGP training programs with supporting clinical guides, standards, and materials to improve FGP staff clinical and practical skills.
5. Assist in identifying essential PHC equipment for FGP and district hospital support for PHC.
6. Assist in developing model FGPs to guide future family medicine service provision.
7. Assist in strengthening family doctor training and education at Health Science University of Mongolia and Ulaanbaatar City Health Department and in developing advocacy structures for FGP.
1Please refer to the Annex at page 8
2For Team Leader/International Consultant under Component 1
8. Assist in preparing a national information campaign on FGPs.
9. With HR consultant, help to develop vocational training and specialty arrangements for family medicine.
B. Soum Health Centres and PHC
31. Assist in developing plans to restructure SHCs as ambulatory centers, based on provision of PHC, defined catchment populations, access and outreach, and role delineation for SHC staff and services.
2. Assist in developing training programs and structures for SHC staff with appropriate public health, health promotion, clinical, and management materials and guides to improve skills and practice.
3. Assist in developing admission and treatment guides, referral, and network arrangements between SHCs and specialists.
4. Assist in identifying essential PHC equipment for SHCs and aimag hospital support for PHC.
5. Assist in developing SHC primary care via trials and demonstration programs.
6. Assist in developing continuing medical education and clinical rotation programs for SHC staff to improve clinical and practice skills.
7. With HR consultant, help develop clinical fellowship programs to enhance skills.
C. Hospital Support for Primary Health Care
41. Assist in identifying essential PHC equipment for FGPs and SHCs, and for aimag and district hospital support for PHC.
2. Assist in prioritizing and costing essential equipment and preparing procurement plans and documentation.
National Consultants:
In collaboration with the international consultant the national consultant will undertake the following tasks:
5A. Family group practice
1. Assist in consolidating family medicine in Mongolia by strengthening legal basis and performance contract arrangements for FGP.
2. Assist in institutionalizing FGP financing and remuneration via risk-adjusted capitation.
3. Assist in development of FGP gatekeeper role with appropriate referral arrangements and mechanisms.
4. Assist in development of FGP training programs with supporting clinical guides, standards, and materials to improve FGP staff clinical and practical skills.
5. Assist in identifying essential PHC equipment for FGP and district hospital support for PHC.
6. Assist in developing model FGPs to guide future family medicine service provision.
7. Assist in strengthening family doctor training and education at Health Science University of Mongolia and Ulaanbaatar City Health Department and in developing advocacy structures for FGP.
8. Assist in preparing a national information campaign on FGPs.
3 Referred in Appendix 11 of RRP as Public Health/Health Management 4 Referred in Appendix 11 of RRP as Equipment and Procurement 5For National Consultants/Local Experts under Component 1
9. With HR consultant, help to develop vocational training and specialty arrangements for family medicine.
10. To closely work with thematic working group established by MoH (Working group #1) to provide with guidance and facilitation of follow up actions.
B. Soum Health Centres and PHC
6:
1. Assist in developing plans to restructure SHCs as ambulatory centers, based on provision of PHC, defined catchment populations, access and outreach, and role delineation for SHC staff and services.
2. Assist in developing training programs and structures for SHC staff with appropriate public health, health promotion, clinical, and management materials and guides to improve skills and practice.
3. Assist in developing admission and treatment guides, referral, and network arrangements between SHCs and specialists.
4. Assist in identifying essential PHC equipment for SHCs and aimag hospital support for PHC.
5. Assist in developing SHC primary care via trials and demonstration programs.
6. Assist in developing continuing medical education and clinical rotation programs for SHC staff to improve clinical and practice skills.
7. With HR consultant, help develop clinical fellowship programs to enhance skills.
8. To closely work with thematic working group established by MoH (Working group#1) to provide with guidance and facilitation of follow up actions.
C. Hospital Support for Primary Health Care
7:
1. Assist in identifying essential PHC equipment for FGPs and SHCs, and for aimag and district hospital support for PHC.
2. Assist in prioritizing and costing essential equipment and preparing procurement plans and documentation.
Component 2. Improved health care financing and health insurance Expected Outputs of THSDP (Ref pg 7-8 of RRP)
• Strengthened health resource allocation and purchasing
• Improved financial protection and expanded health insurance coverage
International Consultant
Activities to undertake:
A. Health care financing and modelling
1. Develop, review and get an approval for national health financing model.
2. Develop the single purchaser model and pooling.
3. Assist in MOH/MOF/MSWL MOU signing on pooling and single purchaser.
4. Plan on health financing reform submitted to ADB to meet conditionality.
5. Assist to conduct training on implementation of a single purchaser mechanism.
6. Assist in designing conducting and evaluating of the single purchaser in pilot sites.
7. Assist in developing relevant guidelines for scaling up the application of the single purchaser model.
6 Referred in Appendix 11 of RRP as Public Health/Health Management 7 Referred in Appendix 11 of RRP as Equipment and Procurement
B. Health insurance system
1. Analyze and review health insurance situation and coverage.
2. Assist in developing options to increase and extend health insurance coverage to the uninsured and to promote participation in the Health Insurance Fund.
3. Develop and undertake training, with appropriate materials, on health insurance purchasing and optimal use.
4. Assist in developing regulation of private health insurance.
5. Assist in developing hospital financial efficiency mechanisms and processes.
6. Assist in implementing efficiency initiatives in pilot hospitals.
7. Organize and conduct workshops, training, and materials on improving hospital financial management and efficiency.
National Consultant on Health Care financing and modelling
In collaboration with the international consultant the national consultant will undertake the following tasks:
1. Develop, review and get an approval of national health financing model.
2. Assist in development of training materials and develop and implement capacity building plan on single purchaser mechanism.
3. Develop a plan on health financing reform submit to ADB to meet conditionality.
4. Assist to develop a single purchaser model and pooling.
5. Assist in MOH/MOF/MSWL MOU signing on pooling and single purchaser.
6. Assist in designing, conducting and evaluating of the single purchaser in pilot aimags.
7. Assist in developing relevant guidelines to scale up the single purchaser model.
National Consultant on Health insurance system.
In collaboration with the international consultant the national consultant will undertake the following tasks:
1. Analyze and review health insurance situation and health coverage
2. Develop options to increase health insurance coverage to the uninsured and to promote participation in Health Insurance Fund.
3. Develop appropriate training materials on health insurance and undertake trainings.
4. Assist in developing a regulation on private health insurance.
5. Assist in developing hospital financial efficiency mechanism and processes.
6. Assist and facilitate in implementing efficiency initiatives in pilot hospitals.
7. Develop, and facilitate training materials development and organize trainings on hospital financial management and efficiency.
8. To closely work with thematic working group established by MoH (Working group #2) to provide with guidance and facilitation of follow up actions
Component 3. Improved human resources development Expected Outputs of THSDP (Ref pg 8 of RRP)
• Improved health HR management
• Upgraded incentives to improve rural health care
International Consultant
Activities to undertake:
HR management and organizational development
1. Assist in developing workforce planning, as well as HR development plans and
strategies.
2. Organize and conduct training on HR management and organizational development, supported by relevant guides and material.
3. With public health consultant, establish and support long-term clinical fellowships for AGH and district specialists.
4. Assist High Level HR Committee to develop HR strategies for the health sector.
5. Assist (with FGP consultants) in developing options and structures for institutionalizing postgraduate training and for development of family medicine as a vocational specialty.
National Consultant on HR management, incentives and organizational development (1
stPosition)
In collaboration with the international consultant the national consultant will undertake the following tasks:
1. To develop workforce planning as well as HR development plans and strategies.
2. Organize and conduct training on HR management and organizational development, supported by relevant guides and materials.
3. With public health consultant, establish and support long-term clinical fellowships for AGH and district specialists.
4. Assist High level HR committee to develop HR strategies for the health sector.
5. Assist (with FGPs/SHC consultants) in developing options and structures for institutionalizing postgraduate training and for development of family medicine as a vocational specialty.
6. To closely work with thematic working group established by MOH (Working group #3) to provide with guidance and facilitation of follow up actions.
7. Review and develop training incentives and subsidies for places in training schools to increase rural health staff numbers.
8. Research and develop incentive packages with financing and welfare components to develop strategies to encourage staff transfers to rural areas and implement staff transfers via incentive funding.
9. To closely work with thematic working groups established by MOH (Working group
#1,#3)
National Consultant on HR management, incentives and organizational development (2
ndPosition)
In collaboration with the international consultant the national consultant will undertake the following tasks:
1. To develop workforce planning as well as HR development plans and strategies.
2. Organize and conduct training on HR management and organizational development, supported by relevant guides and materials.
3. With public health consultant, establish and support long-term clinical fellowships for AGH and district specialists.
4. Assist High level HR committee to develop HR strategies for the health sector.
5. Assist (with FGPs/SHC consultants) in developing options and structures for institutionalizing postgraduate training and for development of family medicine as a vocational specialty.
6. To closely work with thematic working group established by MOH (Working group #3) to provide with guidance and facilitation of follow up actions.
7. Review and develop training incentives and subsidies for places in training schools to increase rural health staff numbers.
8. Research and develop incentive packages with financing and welfare components to develop strategies to encourage staff transfers to rural areas and implement staff transfers via incentive funding.
9. To closely work with thematic working groups established by MOH (Working group
#1, #3)
Component 4. Sector capacity development and management Expected Outputs of THSDP (Ref pg 8 of RRP)
• Improved private sector policy and guidelines
International Consultant on Private sector management Activities to undertake:
1. Review private health sector situation and develop relevant regulatory mechanisms and processes to increase private sector accountability, licensing, monitoring, and quality control.
2. Assist in developing institutionalized regulatory frameworks for the private health sector.
3. Assist in identifying and developing options for increased public-private partnerships (PPP).
4. Assist in finalizing the regulatory framework (financing from HIF, accreditation system and contract services with private entities the State budget) for public private partnerships for sharing with MOF before submitting to ADB to ensure consistency in PPP approaches across sectors.
5. Plan and implement measures to promote well balanced private and state owned health care services.
National Consultant
In collaboration with the international consultant the national consultant will undertake the following tasks:
1. Review private sector health sector situation and develop relevant regulatory mechanisms and processes to increase private sector accountability, licensing, monitoring and quality control.
2. Assist in developing institutionalized regulatory frameworks for the private health sector.
3. Assist in identifying and developing options for increased public-private partnerships (PPP)
4. Assist in finalizing the regulatory framework (financing from HIF, accreditation system
and contract services with private entities the State budget) for public private
4. Assist in finalizing the regulatory framework (financing from HIF, accreditation system
and contract services with private entities the State budget) for public private
In document
THIRD HEALTH SECTOR DEVELOPMENT PROJECT
(Page 18-60)