1. Current situation and policy directions on Infrastructure and equipment of the Health sector Ya.Buyanjargal, Director, Policy Coordination and Implementation Department, MOH 2014-06-07 Ulaanbaatar city

2. Content 1.Current situation 2.Challenges 3.Needs and demand - Facility - Equipment 4.Legal environment 5.Proposed project proposal 6.Outcome, Output

3. 1. 1. CURRENT SITUATION OF INFRASTRUCTURE AND EQUIPMENT OF THE HEALTH SECTOR

4. Health expenditure by source of financing (by percent) In 2014, total budget -584.4 billion General government budget -422,8 billion Health insurance fund -123.4 billion Other revenue -13.2 billion Foreign donation -25.0 billion

5. Health expenditure by source of financing (2011-2014)

6. Health expenditure by source of financing, 2011-2014, by last 3 years

7. MEDICAL FACILITY

8. NEWLY BUILT FACILITIES First maternity hospital Third maternity hospital State first central hospital extension Bayangol district hospital with 100 beds

9. NEW BUILT CONSTRUCTION Soum health centers -5 aimags National mental health center extensions Health Promotion centers- Govi-Altai, Оrkhon aimag’s soum Regional Diagnostic and Treatment Center, maternal hospital, trauma hospital extensions -Uvurkhangai Maternity hospital with 50 beds – Zavkhan, Khuvsgul

10. 2014-2015, 5.5 million $ 2012-2016, 9.0 million $ 2012-2016, 4.2 million $ 2014, 61337 $ FOREIGN INVESTMENT 2011-2016, 42.0 million $

11. Foreign investment 2 Foreign investment 2012-2014 CountryProposal activitiesEquipmentConstruction LuxemburgHeart center, maternal child health, e-health expand 2,0 billion To using distance telemedicine for improving maternal and new born health 1.0 billion JapanTo provide with fully equipped ambulances200 million Equipment for maternal hospitals1.0 million $ Modern medical equipments 4,0 million KoreaNational diagnostic and Treatment center25,0 million $18.0сая $ FrenchTrauma5.0 сая eвро- ChinaE-health18.9 million $ AustriaCancer center7.0 сая евро- Maternal and child health center7.0 сая евро- Central hospital 17.0 сая евро-

12. 2. CHALLENGES Зураг тавих

13. FACILITY NEEDS (CONSTRUCTION) Medical serviceBuildMaintenanceExtension Soum health centers638- Family health centers2-- Hospital217- Central hospital-122 Specialized centers1-- Establish (Oxygen manufacture, isotop, supply of single use medical devices..etc) 1-3--

14. CHALLENGES OF CONSTRUCTION Insufficient health facilities compared to population health needs and demands, growth of population Rapidly increased burden of maternal hospitals District hospitals don’t have standardized facility to provide hospital care services in districts Family and soum health centers facilities do not meet water and sanitation requirements

15. CHALLENGES EQUIPMENT AND SUPPLY 60% of all facilities need to be re-equipped with medical equipment (Assessment of public hospitals in Ulaanbaatar, 2013-2014) Absence of fully equipped ambulances, renovation is slow None specialized helicopter for emergency and disaster medical care Insufficient supply of single use medical devices Introduction of new technology is slow No unit for maintenance of equipment and configuration control

16. 3. NEEDS AND DEMAND - FACILITY - EQUIPMENT

17. Needs and demand Need to improve infrastructure and facility of health organizations Supply essential equipment for introduction of new health care technologies Provide with fully equipped ambulances and renovate car park Use a specialized helicopter for emergency care Expand use of telemedicine

18. LEGAL ENVIRONMENT

19. Legal environment Government action plan for 2012-2016: – “To create an opportunity to receive quality diagnostics and treatment services in the country” - Develop modern national pharmaceutical industry and expand production of traditional medicines Ministerial order # 176, 2013 “Integrated policy on health technology”. - To introduce new advanced technology and equipment in phases - To establish a manufacture of medical devices -To establish diagnostic centers and reference laboratories - Set up the unit of maintenance equipment and configuration control

20. LEGAL ENVIRONMENT Law on license for business entity Procurement law Law on Concession Public and private partnership (PPP): - Support PPP in order to improve investment efficiency - Effectively use of PPP to introduce high cost diagnostics and treatment methods and technologies

21. Legal environment State policy on medicine: To encourage foreign and domestic investments for introduction new technology -To support manufacturing of essential drugs -To support export of national drug products -To introduce Good Manufacturing Practice (GMP) in phases

22. Standard – Standard for central hospital function and structure – Standard for specialized center function and structure – Standard for general hospital function and structure – Standard for soum, inter soum hospitals function nad structure – Standard for family health center function and structure – Standard for sanatorium function and structure – Common requirements for drug medical devices supplier organization – Common requirements for biological active products supplier organization – Standard for the environment hygiene requirements of health organization

23. SUGGESTED PROJECT PROPOSAL

24. Suggested infrastructure project Emerging needs for facility construction Chingeltei district hospital extension Second block of National trauma orthopedic research center Center of nursing and palliative care Clinical pathology center Future needs for facility construction … Soum health centers Public health centers

25. SUGGESTED ESSENTIAL EQUIPMENTS Establish additional Diagnostic centers in the remaining aimags Manufacture for oxygen generator system for medical care Essential equipment and devices in areas with high incidence of trauma Essential equipment for Neonatology intensive care Manufacture for syringe and needles

26. IMPACT For the Health sector - Renovation of medical equipment - Improvement of infrastructure - Working environment of health facilities becomes safe and comfortable - Improve professional capacity of health professionals - Increased health care accessibility - Improved diagnostics and treatment quality For the Investor - Opportunity to effectively work in the health sector - Opportunity to provide government services on contractual basis - Opportunity to have tax exemption, - Opportunity to access to loans and financial supports within legal environment - Opportunity to introduce own products in the health market - Opportunity to raise reputation and corporate responsibility and positive public image For the citizen - Will have access to quality, safe and accessible care - Will be reduced health related financial risks - Will be improved quality of life and life expectancy

27. THANK YOU FOR YOUR KIND ATTENTION