Prevention and Control of Major Non-Communicable Diseases and Injuries

Country: 
Mongolia
Region: 
Area of competence: 
Integrated Primary Health Care
Donor organization: 
MCC (Millennium Challenge Corporation)
Start of Project: 
07/2009
End of Project: 
09/2013
Staff-month: 
720
Value of service: 
€ 5,984,522
Partner Organisations: 
THL
Description of Project: 

Project background
Mongolia has rapidly increasing rates of NCDIs, including cardiovascular disease, diabetes, cancers and injury-induced trauma. Mongolia’s mortality and morbidity rates from cardiovascular disease and cancers greatly exceed those of Western countries and now represent the major cause of death and disability, particularly in younger age groups (i.e., 35 to 55 years of age). Trauma response and emergency medicine are under-developed. At the same time, current NCDI programs in Mongolia are treatment based, with inadequate attention to cost-effective NCDI prevention, early detection, where relevant, and disease management. The project aimed to achieve its objectives over 51 months in 21 aimags and all districts of Ulaanbaatar, Erdenet and Darkhan targeting 95% of the Mongolian population aged 15 – 64 years of age.
The priorities identified for the project were cardiovascular diseases (CVD), diabetes type II, breast and cervical cancer, hypertension, smoking and drinking amongst youth, and injuries related to road traffic accidents.

Overall objective of the project
The project’s short term objective was to increase access to information and services about NCDIs, which enabled Mongolians to guard their health. The project’s long term objective was to increase the productive lives of Mongolians.

Specific objectives of the project
Assist the National NCDI programme in setting priorities, developing programmes, and monitoring and evaluating NCDI efforts.
Promote prevention and early detection and appropriate treatment of hypertension, Type II diabetes and elevated blood sugar and cervical and breast cancer.
Provide youth, adults and those at high risk of NCD in 95% of the population with information and motivation and services they need to change their behaviour and decrease risky practices such as smoking and consuming a high fat diet.
Increase national efforts to reduce the risk of road traffic accidents to pedestrians in Ulaanbaatar and perhaps one other secondary city and Increase access to effective low cost NCDI interventions.

Purpose of the TA
To contribute to decrease mortality and morbidity due to non-communicable diseases and injuries and to support the Government of Mongolia’s work to refine and accelerate ist NCDI program.

Description of Services: 

TA service results
Outputs related to objective 1
Rapid needs assessment conducted in 2009.
KAP survey for teachers and Global Health School Based Survey (support WHO, CDC) conducted in 2009 and follow up in 2013.
KAP for pedestrians, drivers and policemen in Ulaanbaatar conducted in 2009 and follow up in 2013.
M&E plan developed in 2009-2010.
Facility Based Impact Study conducted in 2011 (baseline) and follow up in 2012.
STEPs survey conducted in 2009 and follow up in 2013.
KAP for general public conducted in 2010 (baseline) and follow up in 2013.
Health seeking behaviour study on breast and cervical cancer conducted in 2009 (under RNA).

Outputs related to objective 2
Six study tours organized.
Attendance of up to 20 Mongolian professionals to international conferences.
2 international and 1 national conference organized.
Training needs assessment conducted in 2009.
5 years training plan developed in 2009.
Newly developed or revised curricula, modules and training materials on NCDI prevention and case management in 2010.
ToT program and training materials pre-tested (1,000 training days) in 2010.
ToT conducted (3000 training-person days) in 2010-2011.
Training program and materials for 34 regional training (for medical and non-medical staff) developed and local training and logistical contractor supported.
Mechanisms for the implementation of the NCDI health project developed.
Different communication campaigns on prevention and early detection conducted.
Law on Tobacco, Law against Alcohol revised, Road Traffic Safety Law revised.

Outputs related to objective 3
Information and dissemination plan developed.
National NCD Communication strategy approved by the MoH.
Tested messages for NCDI prevention and branding of project.
Knowledge hub for information and communication (web-based) developed.
Regular NCDI newsletters (updates).
School health curricula and health standard revised.
Health promoting school concept supported from grants.
Educational materials for general public, schools and health professionals designed and tested.
TA in designing of 15 national awareness campaigns provided to local contractor in 2011-2013.
WHP concept disseminated and WHP network with more than 450 members established.

Outputs related to objective 4
Revised NCDI service package: clinical guidelines, clinical standards and procedure protocols on Hypertension, Diabetes type II, Breast and Cervical Cancer, BLS, Palliative care.
TA in implementation of revised NCDI service package.
TA to NCC in implementation of cervical cancer recall system and cancer registry system 5 is provided.
National road traffic safety strategy supported.
Safe school routes survey conducted in 2011.
Black spot survey conducted and black spot interventions defined in 2011.
Road traffic accidents & crimes survey conducted in 2011.
Traffic law and regulation reviewed.
Traffic law enforcement improved.
Safety standards for road engineering improvements developed.
Grants Manual, GMIS and system documents established
Organize four grant calls for proposal.
Potential grantees trained in proposal writing.
TA for grantees by international and local staff provided.
Monitor the implementation of grant projects.

Technical activities
The specific measures being implemented under the project included training and assistance in improving public education campaigns, enhancing and extending screening measures to include a significant proportion of the target population, introducing modern treatment protocols, providing intensive in-service  training in modern prevention, detection, and disease management to physicians and general medical personnel, and providing limited but critical  modern equipment required to achieve the proposed interventions to an appropriate international standard. The intention was to support evidence-based, cost-effective interventions at the primary health care or accident prevention level that can be sustained after the project ends in September 2013.
Through a competitive small grants program the project also supported short-term applied research and community initiatives to provide decision makers and program implementers with information on the most effective, affordable and sustainable approaches to the major NCDIs.
All activities were in line and in support of the “National Program on Prevention and Control of Non-communicable Disease” which was approved by the Government of Mongolia.

Project Volume: 
€ 7,480,653