ERDENET, ORKHON PROVINCE, MONGOLIA — As Bayarmaa Badarch sits in the hospital waiting room, she has more on her mind than just her ultrasound appointment. She usually receives free, regular checkups at her local family health center. But the ultrasound equipment at her family practice is broken. And because of the ongoing coronavirus pandemic, her doctor hasn’t been able to have it fixed or replaced.
This has forced Bayarmaa, who is six months pregnant, to turn to a private hospital, where she doesn’t know the doctor and treatment comes at a high cost. For her ultrasound, Bayarmaa will need to pay 45,000 Mongolian togrogs (about $16). The average monthly income in Mongolia is about 1,343,428 togrogs ($510), according to 2019 data from the national statistics office.
It’s a frustrating situation, but Bayarmaa says she has no choice. “There is no other option than this to give birth to a healthy baby,” she says.
Family health centers form the bedrock of Mongolia’s health care system, providing medical care for 70% of the population. About 2.4 million people rely on the centers for their primary health care, and Mongolians pay monthly health insurance contributions that entitle them to free treatment.
But because of the pandemic, family health centers are strained beyond capacity. “We are dedicating the majority of our annual budget to fighting against the coronavirus,” says Oyungerel Sanduijav, a doctor who works at a family health center in Erdenet, the capital of Orkhon province in northern Mongolia. As a result, she says, they haven’t been able to repair or replace broken equipment, or perform certain examinations and diagnostic tests.
Her center has run through its entire annual reserve of medicine to treat anxiety, hypertension and heart pain in just three months, she says, because patients have experienced high levels of those conditions when getting tested or vaccinated.
Khorloo Khukhnokhoi, GPJ Mongolia
The problem is national, says Khajidmaa Shagdarkhuu, executive director of the Mongolian Association of Family Medicine Specialists.
“Family health centers are working at full capacity, but some services are failing due to a lack of budget,” Khajidmaa says. “This is an issue that needs to be addressed as soon as possible.”
Patients have also become frustrated at their inability to access routine care. “It seems like there is no other disease except for coronavirus,” says Altantsetseg Batnasan, a resident of Orkhon province.
Nasanbuyan Demberelkhuu, who also lives in Orkhon province, says he has been unable to obtain a simple urine test to check the health of his kidneys. “I live without being able to enjoy my right to get medical services, even though I paid my health insurance fees monthly,” he says.
And Ulam-Orgikh Tserendorj, who was diagnosed with cerebral palsy two years ago, says he requires physical therapy every two weeks to combat his constant headaches. But he hasn’t been able to get an appointment for the past seven months.
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“When I go to the family hospital, they say that therapy would not be done because the apparatus is broken,” Ulam-Orgikh says. “They said that they would call me once the therapy is available. I do not know how long I have to wait.”
Oyungerel says the government’s focus on the coronavirus pandemic has come at the expense of patients and staff. “If they solve everything at the same time, it will be easier for us medical employees to carry out our duties,” she says.
Government officials acknowledge the challenges that medical providers face and say they are working to address the issues, but decline to offer specifics.
“We met with family health centers and got acquainted with the situation,” says Batsukh Buyantogtokh, head of the Health Care Policy and Implementation Coordination Department at the Ministry of Health. “We are working to solve the problems. It is not an easy problem to solve. It will take time to fully resolve.”
In the meantime, Khajidmaa, of the Mongolian Association of Family Medicine Specialists, says doctors and nurses will keep pushing the government to provide funding for treatment and equipment, as well as to increase pay for health care workers at family health centers.
“We will fight,” she says, “until we get these issues solved completely.”