A deep dive into health care in Mongolia

Mongolia, the world’s second-largest landlocked country, presents a unique health care landscape owing to its distinctive geography and historical influences. Nearly half of its population is concentrated in the capital city of Ulaanbaatar, and the remainder is scattered across vast semi-desert areas known as the Gobi Desert. Because of this, Mongolia faces significant challenges in delivering equitable health care.

On top of this geographical divide, the lingering impact of Soviet and Chinese health care models has created a system of stark contrasts—modern facilities abound in larger urban centers, while limited resources are common in remote areas, where travel distances to health care can exceed 95 km over rough terrain.

In a paper published in the Journal of Global Health, a research team led by Associate Professor Yae Yoshino from Sophia University, Japan, examined these and other unique features of the Mongolian health care system.

Their comprehensive analysis goes over how Mongolia’s unique geographical, cultural, and historical circumstances have shaped its health care delivery system, reviewing its core strengths and weaknesses and offering practical recommendations to improve health care access across the country.

Despite the above-mentioned challenges, the researchers identified several strengths in Mongolia’s approach to health care. The country maintains a relatively young and strong population thanks to early retirement policies, particularly for women with four or more children.

Mongolia also provides universal health care coverage with free access to primary care for all citizens through a “semashko”-style centralized system established during the Soviet era.

Moreover, traditional Mongolian medicine, which has been influenced by Indian, Chinese, and Tibetan traditional medicine, remains deeply embedded in cultural practices and serves as a primary health care resource in remote areas, offering treatments that are both culturally appropriate and easily accessible. At the national university, specialists in traditional medicine are trained and hold national qualifications.

However, in many remote areas, health care delivery often faces substantial obstacles. “The shortage of health care providers in rural areas is a significant concern,” notes Dr. Yoshino.

“The limited workforce strains the system and hampers the ability to offer timely and comprehensive medical services in rural communities.” In some remote areas like Altanshiree, fewer than ten health care professionals serve entire communities, often traveling directly to patients living in traditional yurts across challenging terrain.

The researchers also highlight structural issues within the health care profession itself. Since 2010, there has been a slight increase in the number of faculty members who have completed master’s and doctoral programs at overseas graduate schools and are now teaching. However, more than 90% of the faculty members at nursing universities are doctors.

“Nurses in Mongolia are still largely viewed as assistants to doctors and are unable to act independently in patient and perinatal care without a doctor’s orders. In remote areas, health care is often provided by mid-level professionals known as assistant doctors, who serve roles between those of doctors and nurses. Reaching care can be challenging—residents sometimes travel by horse, motorcycle, or on foot for more than half a day to access the nearest clinic,” explains Dr. Yoshino.

This hierarchical structure undermines the potential contributions of these professionals, especially in rural areas where they could significantly expand access to health care.

Disease prevention is another significant challenge. The leading causes of death in Mongolia include respiratory, digestive, genitourinary, and circulatory system diseases, yet preventive screenings for conditions like hypertension, diabetes, and colon cancer are not routinely included in national health guidelines. Unfortunately, cultural dietary practices, including salty milk tea, sweet desserts, and heavy meat consumption, contribute to this problem.

To address these issues, the paper outlines multiple practical recommendations. The authors argue that Mongolia could strengthen its “third neighbor policy,” which promotes relationships beyond Russia and China, to build health care partnerships with countries like the U.S. and Japan.

These collaborations could improve health care education and workforce capacity, and encourage the implementation of WHO guidelines on disease prevention.

Technology represents another area with potential for improvement, as online platforms could help connect urban expertise to remote locations through telemedicine.

Expanding the professional roles and autonomy of nurses and midwives would also help optimize Mongolia’s scarce health care resources in such places. Meanwhile, integrating health screenings into community and religious events could make preventive care more accessible and culturally relevant.

“These strategies could lead to a more robust, accessible, and culturally sensitive health care system, improving the well-being of individuals and communities across Mongolia,” concludes Dr. Yoshino.

The research team emphasizes that by acknowledging Mongolia’s unique challenges while building on its existing strengths, the country can develop a health care model that effectively serves all citizens.

Mongolia, the world’s second-largest landlocked country, presents a unique health care landscape owing to its distinctive geography and historical influences. Nearly half of its population is concentrated in the capital city of Ulaanbaatar, and the remainder is scattered across vast semi-desert areas known as the Gobi Desert. Because of this, Mongolia faces significant challenges in delivering equitable health care.

On top of this geographical divide, the lingering impact of Soviet and Chinese health care models has created a system of stark contrasts—modern facilities abound in larger urban centers, while limited resources are common in remote areas, where travel distances to health care can exceed 95 km over rough terrain.

In a paper published in the Journal of Global Health, a research team led by Associate Professor Yae Yoshino from Sophia University, Japan, examined these and other unique features of the Mongolian health care system.

Their comprehensive analysis goes over how Mongolia’s unique geographical, cultural, and historical circumstances have shaped its health care delivery system, reviewing its core strengths and weaknesses and offering practical recommendations to improve health care access across the country.

Despite the above-mentioned challenges, the researchers identified several strengths in Mongolia’s approach to health care. The country maintains a relatively young and strong population thanks to early retirement policies, particularly for women with four or more children.

Mongolia also provides universal health care coverage with free access to primary care for all citizens through a “semashko”-style centralized system established during the Soviet era.

Moreover, traditional Mongolian medicine, which has been influenced by Indian, Chinese, and Tibetan traditional medicine, remains deeply embedded in cultural practices and serves as a primary health care resource in remote areas, offering treatments that are both culturally appropriate and easily accessible. At the national university, specialists in traditional medicine are trained and hold national qualifications.

However, in many remote areas, health care delivery often faces substantial obstacles. “The shortage of health care providers in rural areas is a significant concern,” notes Dr. Yoshino.

“The limited workforce strains the system and hampers the ability to offer timely and comprehensive medical services in rural communities.” In some remote areas like Altanshiree, fewer than ten health care professionals serve entire communities, often traveling directly to patients living in traditional yurts across challenging terrain.

The researchers also highlight structural issues within the health care profession itself. Since 2010, there has been a slight increase in the number of faculty members who have completed master’s and doctoral programs at overseas graduate schools and are now teaching. However, more than 90% of the faculty members at nursing universities are doctors.

“Nurses in Mongolia are still largely viewed as assistants to doctors and are unable to act independently in patient and perinatal care without a doctor’s orders. In remote areas, health care is often provided by mid-level professionals known as assistant doctors, who serve roles between those of doctors and nurses. Reaching care can be challenging—residents sometimes travel by horse, motorcycle, or on foot for more than half a day to access the nearest clinic,” explains Dr. Yoshino.

This hierarchical structure undermines the potential contributions of these professionals, especially in rural areas where they could significantly expand access to health care.

Disease prevention is another significant challenge. The leading causes of death in Mongolia include respiratory, digestive, genitourinary, and circulatory system diseases, yet preventive screenings for conditions like hypertension, diabetes, and colon cancer are not routinely included in national health guidelines. Unfortunately, cultural dietary practices, including salty milk tea, sweet desserts, and heavy meat consumption, contribute to this problem.

To address these issues, the paper outlines multiple practical recommendations. The authors argue that Mongolia could strengthen its “third neighbor policy,” which promotes relationships beyond Russia and China, to build health care partnerships with countries like the U.S. and Japan.

These collaborations could improve health care education and workforce capacity, and encourage the implementation of WHO guidelines on disease prevention.

Technology represents another area with potential for improvement, as online platforms could help connect urban expertise to remote locations through telemedicine.

Expanding the professional roles and autonomy of nurses and midwives would also help optimize Mongolia’s scarce health care resources in such places. Meanwhile, integrating health screenings into community and religious events could make preventive care more accessible and culturally relevant.

“These strategies could lead to a more robust, accessible, and culturally sensitive health care system, improving the well-being of individuals and communities across Mongolia,” concludes Dr. Yoshino.

The research team emphasizes that by acknowledging Mongolia’s unique challenges while building on its existing strengths, the country can develop a health care model that effectively serves all citizens.