Early-age mortality, socio-economic development and the health system in Mongolia.

Since the 1920s Mongolia has developed an extensive and well-staffed health care system that has made modern health technologies accessible to most of its population. In addition, the country experienced rapid economic and social development whose benefits were equitably distributed among the population. In spite of this progress, infant and child mortality levels are high by contemporary standards and during the past 20 years these rates have remained virtually constant. The modern health care delivery system, externally imposed, failed to take into account the specific characteristics of the Mongolian culture; this fact is identified as one of the major determinants of the unexpected levels of early-age mortality. The excessive orientation toward curative medicine, the lack of health prevention and promotion activities and the lack of community participation have resulted in the people continuing to believe in traditional therapeutic patterns and self-care. They perceive the modern system exclusively in curative terms and not with regard to health preservation and disease prevention. Most Mongolians do not fully understand the health care system, and use its services mainly because they have no alternative, or because of coercion rather than conviction based on the learning and internalization of its basic principles. In practices and ideas of child care, preservation of health and disease prevention, people seem to identify more with the traditional health care system. Like other former socialist countries, Mongolia is experiencing deep economic and social transformations, whose implications for the health care system are discussed. An economic crisis whose end is nowhere in sight, emergent social inequalities, a vague health insurance model with unclear financing sources, and lack of concern by most policy-makers in strengthening the preventive component of the health system, are not positive factors for substantial infant and child mortality decline in the near future. A clear advantage is, however, the fact that there is a wide space for major improvements with existing internal and external resources.