Mongolia 10605 SPH 2 midterm evaluation 2015

Background

NLM has been working in Mongolia since 1994 in several areas of development. The Strengthening Primary Health Care Project (SPH) was based on an initiative from the Ministry of Health and previous experience from the successful implementation of “Health Development Project” in Darkhan and Selenge provinces from 1998-2008.

A “Memorandum of Understanding” with the Ministry of Health and Governor’s Offices and Aimag Health Departments of Khovd, Govi-Altai and Bayan-Ulgii aimags was established during the first project period in 2008-2012.

Since 2013, the project is implementing its second five-year period in all the aforementioned provinces. The project addresses the weak primary health care in Mongolia with special focus on low management capacity of province health administrations, provider centered and low quality primary health care services, as well as little health knowledge and unhealthy attitudes among the community.

Purpose/objective

The purpose of the mid-term evaluation was to assess the implementation process so far; analyze the accomplishments against project documents; identify issues and recommend further corrections; and present lessons to be learned.

Methodology

Semi structured interviews were done with pupils and parents in schools. Observation was used both in schools and kindergartens. Key informant interview were done with health, education and governor officials, and face-to-face interviews were done with
school pupils, parents and key partners.

Sixteen focus group discussions with a total of 160 participants were held with representatives from steering committees members, Aimag health department officers and heads and doctors of family health centers, officials from Education and Culture Department and directors and teachers of schools and kindergartens, and representatives from model streets.

Desk review was used to review the project documents and health indicators in order to substantiate the survey findings. The survey covered all 7 units from Bayan-Ulgii, Khovd and Gobi-Altai Aimags including 4 soums chosen with multiple stage sampling techniques.

Key findings

The most effective intervention is regional forums and experience sharing. During the intervention, entities got the following benefits: Unit initiates a lot of activities, maintain its activities and improve; Learning by doing; Get proud by its achievements.

Model projects have been implemented successfully with its mobilization by experience sharing and regional forums: Management teams on high levels are actively involved and contribute financially; Activities expanded and disseminated to others; Citizens and families are promoted and mobilized; Living and work environment has improved; Healthy behavior and attitude is gradually changed and improved.

Effective interventions for particular target groups: Healthy organization and model center for organizations; Model street for families; Behavior change communication, peer education, health campaigns and Olympiads for school pupils.

Recommendations

• To provide sustainability of good practices and disseminate to others, including nationwide.
• To consider continuously cooperation of stakeholders and partners.
• To reach pupils effectively via schoolteachers and doctors, peer education, health campaigns and Olympiads, parents via soum and family health centers, mobile phone and internet.
• To improve job description of school doctors and develop criteria of workstations and their continuous education.
• To create supportive environment for the best practices like healthy street, school and centres with its budget and guidelines.
• To develop and implement strategies for appropriate use of medicine for adults and vision protection for pupils.