The birthplace of Genghis “Chinggis” Khan, modern Mongolian is steeped in nomadic tradition, warrior ancestry, and Tibetan Buddhist influence. With an intriguing past and complex present, Mongolia is a unique country where the landscape, history, and people intertwine to create a place unlike any other on earth.
Mongolia is a landlocked, upper middle-income country located in the heart of Central Asia, between Russia and China. With 3 million people it has one of the world’s lowest population density iat an average of 1.5 square kilometers per person, making access to health care and other amenities very difficult. An estimated 30% of the population maintains a traditional pastoral nomadic lifestyle, spreading themselves over the 1.62 million square kilometers of land with livestock outnumbering people 17 to one.
Approximately 1.5 million Mongolians live in the capital city of Ulaanbaatar, 58% of which are under the age of 30. Almost 27% of the population lives under the national poverty line, and 27% live on less than $1.25 a day. The average life expectancy is 69 years old. Mongolia has a literacy rate of 97%. Mongolia’s capital, Ulaanbaatar, is the coldest capital city in the world, and the most polluted city in the world according to a 2011 World Health Organization (WHO) study.
During winter, temperatures can reach -40ºF for days at a time. The sustained severe cold causes massive loss to livestock herds almost every year. The harsh winter conditions and loss of livestock often result in swells of citizens migrating to areas surrounding the city, living in gers or yurts (felt tents). These areas are called “ger districts”. It is estimated that 70% of the Ulaanbaatar population live in the ger districts. According to the municipal government, up to 40,000 rural people arrive in Ulaanbaatar every year.
Starting in the late 20th century, mining became central to Mongolia’s economy. Copper, gold and coal, are the primary mineral resources in Mongolia. Until 1990, one third of the country’s gross domestic product (GDP) was dependent on the Soviet Union. That economic paradigm ended abruptly in 1990 with the imminent breakup of the Soviet Union.
Rapid development from foreign investment peaked in 2011 to 2013. In 2011 Mongolia was the fastest growing economy in the world. Since then, foreign investment has dropped by more than 75%, and the local currency has devalued against the dollar by 70%. Mongolia is currently in a deep recession.
Health Care System
Established by the Soviet Union, the healthcare system is a tertiary system. Every citizen is assigned to a primary care facility that are located in every administrative division, urban and rural, across Mongolia. There are a total of 508 primary care facilities across Mongolia.
Secondary facilities are located in every provincial center and all nine districts of Ulaanbaatar. They provide a substantially greater level of care and diagnostics from the primary care facilities. There are 73 secondary facilities in Mongolia. Tertiary hospitals are located in Ulaanbaatar. There are 27 specialized hospitals. These include the National Center for Communicable Diseases, the National Cancer Center, etc. The health care system in Mongolia is overseen by the Ministry of Health nationally and locally supervised by provincial and district health departments. The infrastructure of the healthcare system is very well organized. However, it is also underfunded, under supplied and under educated.
Liver Health in Mongolia
Mongolia has one of the highest rates of viral hepatitis, the highest rate of liver cancer (six times the international average) and the highest rate of hepatitis superinfection (hepatitis B and D co-infection), in the world. 67% of patients with hepatitis B (HBV) are reported to also have hepatitis D. More than 77% of Mongolians are estimated to have been infected with hepatitis B virus (HBV) at some time during their life. Between 10% and 22% of the general population is chronically infected with either hepatitis B or C.
93% of liver cancer patients in Mongolia are also infected with hepatitis. Chronic viral hepatitis infections are responsible for 57% of liver cirrhosis and 78% of primary liver cancer. One in 10 deaths in Mongolia is caused by liver cancer. 78% of liver cancer is not diagnosed until stage III or IV. 85% of liver cancer patients die within one year of receiving the diagnosis. The majority of treatment for liver cancer in Mongolia is currently palliative care.
The high rate of liver cancer in Mongolia is due largely to the late diagnosis of hepatitis. Viral hepatitis infections can be prevented through administering vaccines (hepatitis A, B, and E), improvement of hospital infection prevention and control procedures and education of the general population. Hepatitis B virus vaccine is the only vaccine known to prevent liver cancer. Mongolia was one of the first countries to introduce hepatitis B vaccine into routine immunization schedules for newborns and children under 1 year old in 1991. Despite Mongolia’s large nomadic population, an estimated 99% of newborns receive the first dose of the vaccine within 24 hours of birth. The incidence of viral hepatitis B has decreased substantially since the vaccination was introduced. However, viral hepatitis B and C are still high among populations over 40 years old.
Chronic viral hepatitis C can be cured with a 3-6 month drug treatment. There are also treatments, but not yet a cure, for hepatitis B. While Mongolia has the cure for hepatitis C at one of the lowest prices in the world, due to logistical and diagnostic issues, hepatitis C treatment is still inaccessible in rural Mongolia where half the population lives.
The combined factors of a small population (3 million people), 97% literacy rate, and excellent infrastructure of the healthcare system places Mongolia in a unique position to comprehensively combat viral hepatitis, setting an example for the world on how to eliminate a viral epidemic. The high literacy rate and small population makes awareness campaigns extremely effective. The small population also makes screening, testing, vaccination, and intervention campaigns manageable. The well-designed health care system infrastructure ensures that policy changes and training can be well-disseminated throughout the national system.
Since 2009, FIRE has been supporting the Mongolian Ministry of Health (MoHS) to prevent and diagnose viral hepatitis and liver cancer across Mongolia. FIRE’s strategic, multi-layered programs are implemented with various stakeholders at every level. These programs are designed to be replicated not only across Mongolia, but anywhere, empowering individuals and health care systems to end this epidemic. Read about some of these initiatives on or What We Do page.
FIRE Projects maintains an office in Ulaanbaatar, led by Dr. Munkhnasan Myagmarjav.