NV in Darkhan, Mongolia - Show Version

8/9/2019 NV in Darkhan, Mongolia - Show Version

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Advancing the Roles of Local Health VolunteersAdvancing the Roles of Local Health Volunteersin the Health Care Delivery System of Darkhanin the Health Care Delivery System of DarkhanHealth Department, MongoliaHealth Department, Mongolia


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Almost 300,000Almost 300,000residents ofresidents ofUlaanbaatarUlaanbaatar

live inlive inshantytownsshantytowns

known asknown as"Ger districts","Ger districts",

named afternamed afterMongolia's feltMongolia's felt

tents.tents.


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HygieneHygienestandardsstandardsin Ger districtsin Ger districtsare very low dueare very low due

to lack of runningto lack of runningwater and airwater and airpollution.pollution.

70% of women living in Ger districts suffer from respiratory70% of women living in Ger districts suffer from respiratoryproblems because of smoke from their wood/coal stoves.problems because of smoke from their wood/coal stoves.


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One of our greatestOne of our greatestdifficulties is we dodifficulties is we do

not get propernot get propermedical servicesmedical services

because they are notbecause they are not

adequate andadequate andaccessible. So we tryaccessible. So we try

not to get sicknot to get sick -- but itbut itis impossible".is impossible".


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Unemployment, unhealthy lifestyle and poverty are rampant inUnemployment, unhealthy lifestyle and poverty are rampant inthese districts, so are the feelings of hopelessnessthese districts, so are the feelings of hopelessness

amongst its population.amongst its population.


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Countrywide, the top 5 leading causes of hospitalisation areCountrywide, the top 5 leading causes of hospitalisation arealarmingly lifestylealarmingly lifestyle--related:related:

CardioCardio--vascularvascular problemsproblems

HypertensionHypertensionLungLung andand liverliver diseasesdiseasesKidneyKidney disordersdisordersInjuriesInjuries throughthrough roadroad andand homehome accidentsaccidents

LifestyleLifestyle diseasesdiseases areare preventablepreventable byby properproper diet,diet, regularregularexercise,exercise, hygiene/sanitationhygiene/sanitation andand cessationcessation ofof smokingsmoking andandexcessiveexcessive intakeintake ofof alcoholalcohol..


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Among other things, alcoholism and domestic violence are twoAmong other things, alcoholism and domestic violence are twoof the countrys perennial problems.of the countrys perennial problems.


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Aside from lifestyle diseases, the following factsAside from lifestyle diseases, the following factsare also alarming:are also alarming:

High incidence of Tuberculosis continues, 270 per 100,000;High incidence of Tuberculosis continues, 270 per 100,000;

Infant mortality is 58 per 1,000;Infant mortality is 58 per 1,000;

Maternal mortality is 160 per 100,000;Maternal mortality is 160 per 100,000;(worrying statistics when one takes into consideration(worrying statistics when one takes into consideration

that 97% of births are attended by health professionals)that 97% of births are attended by health professionals)


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1/3 of women have experienced domestic violence;1/3 of women have experienced domestic violence;(and more than one tenth have been beaten by their partners)(and more than one tenth have been beaten by their partners)

The number of people with STIs is increasing rapidly;The number of people with STIs is increasing rapidly;

During winter, it is common

for residents to go weekswithout taking a full bath. This

can sometimes result inskin problems (scabies, etc.).


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25% of children are under25% of children are under--height for their age; andheight for their age; and

Undernourished people make up 38% of the population.Undernourished people make up 38% of the population.


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At a temperature ofAt a temperature of--3030Celcious duringCelcious during

winter, homeless kidswinter, homeless kids

stay in sewers to keepstay in sewers to keepthemselves warm.themselves warm.


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There are more doctors than necessary and fewerThere are more doctors than necessary and fewernurses than there should be*. Nurses and doctors still donurses than there should be*. Nurses and doctors still dohouse to house visits to promote healthy lifestyle andhouse to house visits to promote healthy lifestyle and

treat patients.treat patients.**Mr. Robert HaganMr. Robert Hagan

Country RepresentativeCountry RepresentativeWHO MongoliaWHO Mongolia


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PROBLEM STATEMENTPROBLEM STATEMENTIssuesIssues

NCD (Non-Communicable Diseases) Trend Lack of Primary Health Manpower

Healthy Lifestyle Promotion Training

Increase community awareness on

Healthy Lifestyle through Health

Professionals and Local Volunteers

Intensification and strengthening of Primary

Health Care services at FC level

Installation of Local Health Volunteers at

Family Clinic level

StrategiesStrategies

ImpactImpact

Increased awareness and healthy lifestyle-seeking behaviour of community thereby

increasing quality of life

Mainstreamed local health volunteers in the health care delivery system thereby

strengthening the current system

Reduction of incidence of non-communicable diseases

ProblemAnal sis:ProblemAnal sis:


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1.1. Streamline local health volunteering in the health careStreamline local health volunteering in the health caredelivery system;delivery system;

2.2. Improve health promotion among its population throughImprove health promotion among its population throughlocal health volunteers; andlocal health volunteers; and3.3. Improve access to quality primary health care servicesImprove access to quality primary health care services.

Project Objecti esProject Objecti es


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1.1.Community Diagnosis and Issue AnalysisCommunity Diagnosis and Issue Analysis

2.2. Consultative Meetings and Focus Group DiscussionsConsultative Meetings and Focus Group DiscussionsBoth service delivery and executive levelsBoth service delivery and executive levels

3.3. Participatory Strategic PlanningParticipatory Strategic PlanningFrom Bottom to Top ApproachFrom Bottom to Top Approach

4.4. Participatory National Volunteering Pilot Project DevelopmentParticipatory National Volunteering Pilot Project Development5.5. ResourceResource MobilisationMobilisation

Both Local and International SourcesBoth Local and International Sources

6.6. AdvocacyAdvocacyLocal Government Policy Development (e.g. volunteers monthly allowance)Local Government Policy Development (e.g. volunteers monthly allowance)

7.7.Continuing PartnershipsContinuing Partnerships

Both local and international partnersBoth local and international partners

ImplementationProcess:ImplementationProcess:


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Project esignProject esignBrandingBranding Family Clinic Health Worker (FCHW)Family Clinic Health Worker (FCHW)

Selection of Best 5 FCHWs for each 8 Family ClinicsSelection of Best 5 FCHWs for each 8 Family Clinics

Provision of essential training courses and study toursProvision of essential training courses and study tours

Popular Education using puppetryPopular Education using puppetry


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Provision of Official ID, Training Certificate, Vest and Utility bagProvision of Official ID, Training Certificate, Vest and Utility bagwith essential equipment and instrumentswith essential equipment and instruments

Provision of modest monthly allowance (approx. $5)Provision of modest monthly allowance (approx. $5)

Functional English and Computer Literacy ProgrammeFunctional English and Computer Literacy Programme

Provision of MicroProvision of Micro--Income Generating ProjectsIncome Generating ProjectsTriTri--media Exposuremedia Exposure


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At family clinic level, the project is seen successful in both valuingAt family clinic level, the project is seen successful in both valuingand refocusing the work of the volunteers and thereby releasing timeand refocusing the work of the volunteers and thereby releasing timefor clinic doctors and nursesfor clinic doctors and nurses

FCHWs are part of the communities. They serve as the link betweenFCHWs are part of the communities. They serve as the link betweenthe communities andthe communities and

the family clinics.the family clinics.

Findings and oncl sions:Findings and oncl sions:


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Improved healthImproved health--seeking behavior of the communities as evidencedseeking behavior of the communities as evidencedby increased clinic caseloads for medical consultations andby increased clinic caseloads for medical consultations andattendance in health sessions. Initial clinic and hospital recordsattendance in health sessions. Initial clinic and hospital recordsshowed that incidence of common illnesses has decreased to ashowed that incidence of common illnesses has decreased to acertain level.certain level.

Acceptance of FCHWs in theAcceptance of FCHWs in the

medical team. A significantmedical team. A significant

achievement in Mongoliaachievement in Mongolia

where the health system iswhere the health system is

extremely hierarchical.extremely hierarchical.


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Findings and oncl sions:Findings and oncl sions:The learning from study tour to the Philippines very successfullyThe learning from study tour to the Philippines very successfullyargued the case as to how community volunteers can be used andargued the case as to how community volunteers can be used andhow they can be better supported to undertake this role.how they can be better supported to undertake this role.

The project is practically replicable and could be used as a basis forThe project is practically replicable and could be used as a basis fora national scheme.a national scheme.


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Strong commitment from the government in a form of a legislationStrong commitment from the government in a form of a legislationwill ensure programme sustainability.will ensure programme sustainability.



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GLENN BEDEA. BENABLOGLENN BEDEA. BENABLOHealth Management AdviserHealth Management Adviser

Voluntary Services Overseas (VSO) Volunteer forVoluntary Services Overseas (VSO) Volunteer forDarkhan Health Department, MongoliaDarkhan Health Department, Mongolia

NV in Darkhan, Mongolia - Show Version

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