Contributions of surgery for building sustainable healthcare in rural Mongolia

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.