Online Program

Contributions of surgery for building sustainable healthcare in rural Mongolia

Monday, November 4, 2013 : 10:45 a.m. - 11:00 a.m.

Raymond Price, MD, Intermountain Surgical Specialists, Intermountain Healthcare, Salt Lake City, UT
The 2012 Copenhagen Consensus identified strengthening surgical capacity as one of the top ten priorities for allocating money to respond to the world's biggest challenges. Improving capacity for surgical care through collaboration among organizations, agencies and institutions can pave the way for improved quality of medical care. The World Health Organization (WHO) needs assessment of first level healthcare facilities in Mongolia identified severe deficiencies in infrastructure, human and physical resource capabilities, and limited supplies. In response, the Mongolian Ministry of health, in collaboration with the WHO, local surgical and anesthesia societies, and international non-governmental organizations instituted countrywide programs that aimed to: a) build capacity for emergency and essential surgical care at the rural facilities and b) develop improved surgical capability at the regional diagnostic and treatment centers by training surgeons, general practitioners, and health workers both in basic and laparoscopic surgical procedures. A six-year assessment of the program using the WHO Monitoring and Process form (from 2004-2010) showed dramatic improvements in short-term process measures with a 57.1% increase in the availability of emergency rooms, a 59.1% increase in the supply of emergency tool kits and a 73.6% increase in the recording of emergency cases. The laparoscopic training program was sustained by the participants, who later occupied leadership positions. The number of gallbladders removed doubled with a rapidly growing percentage of them being removed through less invasive laparoscopic techniques. More importantly, countrywide surgical morbidity and mortality dropped significantly with the community exhibiting increased trust in the healthcare system.

Learning Areas:

Administer health education strategies, interventions and programs
Chronic disease management and prevention
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
Describe the countrywide program in Mongolia to improve access to surgical care combining the World Health Organizations Global Initiative for Emergency and Essential Surgical Care for rural facilities with laparoscopic and emergency surgical training at the regional referral hospitals. Explain how the program has led to increased access to basic and emergency surgical care in rural sites, improved surgical capabilities at the regional referral hospitals, and the resultant decrease in surgical morbidity and mortality throughout Mongolia. Discuss the effect of increasing capacity for surgical care on improving medical and healthcare in general in Mongolia.

Keyword(s): Developing Countries, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am co-author of book "Global Surgery and Public Health: A New Paradigm". Co-author of many articles on emergency and essential surgical care and laparoscopic training development in Mongolia. Member of WHO GIEESC program/ co-organizer of 3rd world biennial meeting 2011. Award from Minister of Health, "visiting" professor Health Science University of Mongolia, Honorary member Mongolian Surgical Society. Associate director Center for Global Surgery U of U.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.