Assessing needs for systematic non-communicable disease prevention efforts in urban Mongolia

Noncommunicable diseases (NCDs) are an emerging health problem and result in considerable economic burdens at national, regional, and global levels. Mongolia, as is the case in many other developing and developed countries, has experienced a shift in the burden of disease from infectious to NCDs. The prevention and management of NCDs are now an essential responsibility of the health care system in Mongolia. Improved and a better performing primary health care system is one of the important aspects of NCD prevention and management in Mongolia. The goals of the study were to: 1) measure the relationship between the characteristics of the physicians and the residential populations they serve, and the NCD prevention practices (i.e. risk factor assessment, behaviour modification recommendation, treatment plan, and follow-up practice) of health care providers; 2) explore the reasons/underlying the determinants of current NCD prevention practices; and 3) identify areas for possible improvement of NCD prevention practices at the primary health care level through the collection and analysis of both quantitative and qualitative data from the six main urban districts of Ulaanbaatar. 200 surveys were completed by family doctors and 21 key informant interviews, 4 focus group discussions, and 6 participant observation sessions were conducted. The results showed that physicians’ medical specialties, experiences working in primary care, year of graduation from university, number of family doctors working in a family clinic, and the relative poverty level of the community were predictive of elements of NCD prevention practice among family doctors. Doctors specialized in family medicine, who worked with four or five colleagues, and had more experience in primary health care offer better prevention activities. Several significant barriers (e.g. doctors’ inadequate practice skills, workload at family clinics, and poor health-seeking behavior of patients) and facilitators (e.g. prevention activity and policy toward NCD prevention) of NCD prevention practices were identified at physician, family clinic, population, and policy/health system levels. Improvements to organizational activities, and resources and services such as increasing funding and reorienting primary health care, were recommended to develop the practice of NCD prevention and management at the primary health care level in urban areas of Mongolia.