Hepatitis Free Mongolia
“Hepatitis Free Mongolia” evolved from FIRE’s “Love the Liver” program which began in 2009 under a Memorandum of Understanding with the Ministry of Health (MoH). Ever since, FIRE has been supporting MoH and the World Health Organization’s (WHO) guidelines and goals in preventing, diagnosing, and eliminating viral hepatitis and liver cancer across Mongolia. It is designed to be replicated in communities around the world, empowering individuals and health care systems with the training and tools to end the hepatitis epidemic
In 2016, this project was one of five international programs recognized for “Innovative Hepatitis Screening b the WHO and the European Association for the Study of the Liver (EASL). In 2017 it was featured in the Economist Intelligence Unit three times.
“Hepatitis Free Mongolia, Phase 1” was implemented in 2017-2019 screening 5,017 people with blood tests, FibroScan, ultrasound, and physical examinations by specialists at all 14 clinics across Dornod province. 1,966 people were vaccinated against hepatitis B, 36 health care workers were trained, 20 computers were delivered, 50,000 information pamphlets were distributed and 20 community leaders were part of an advocacy meeting. For more information please view Phase 1 final report.
“Hepatitis Free Mongolia, Phase 2” began in Summer 2021 with the goal of eliminating hepatitis C in Sukhbaatar province by 2022. This will be FIRE’s with mobile screening in rural Mongolia, please visit our Rotary Global Grant webpage for more information.
At each new implementation, services are added and adjustments made based on community needs, input, and lessons learned. The key aspects of Hepatitis Free Mongolia include the following activities
Quick Facts
(since 2011)
- 8,526 people screened in six provinces and Ulaanbaatar
- 12.6% of people were positive for hepatitis B
- 12.1% of people were positive for hepatitis C
- 1.2% of people were positive for liver or other abdominal cancer
- 3,814 UltraSound examinations given
- 3,017 exams provided by specialists
- 1,419 FibroScan examinations given
Mongolia’s national Healthy Liver Program currently requires several tests to begin hepatitis treatment that are not available in rural Mongolia where half of Mongolia’s population. Some required tests are not available at the primary care clinic, meaning people can have to travel for up to one day to reach the provincial capital for the testing. Other tests are simply not available at all outside of Ulaanbaatar, Mongolia’s capital, such as FibroScan.
A team of Mongolian specialists consisting of an oncologist, hepatologists, and ultrasound and FibroScan specialists, travel from Mongolia’s capital city, visiting every health clinic in the province to provide the following free services:
Step 1: Rapid serum tests for viral hepatitis B and C are given.
Step 2: Those positive for HBV or HCV have an ultrasound examination.
Step 3: Those with liver lesions are tested for AFP and are seen by an oncologist.
Step 4:Those with signs of cirrhosis during the ultrasound exam are given a FibroScan and seen by a hepatologist.
Step 5: Those who test positive for HBV or HCV but have no indication of current cancer or cirrhosis are seen by a hepatologist.
Step 6: Hepatologists and oncologists physically examine and counsel participants on their medical condition, follow-up treatment, physician referrals, and necessary lifestyle changes.
Hepatitis Coordinators are trained government social workers and health care workers who work directly with the community, visiting families and homes. They are essential to reach the most remote, hard-to-find individuals as they know the community better than anyone else. The Hepatitis Coordinators distribute and share information about the healthy liver program, viral hepatitis testing, and educate community members one-on-one, person-to-person, directing them to receive the necessary testing and treatments while they are conducting their everyday duties. A key element to successfully accomplish the national “Healthy Liver Program” goals is to share basic information about viral hepatitis with the general population and ensure people get tested and treated.
FIRE and the Ulaanbaator Rotary Club worked with the Health Center of Saga University, Japan to organize a training for the nation’s first “Hepatitis Coordinators” in Töv province. A visiting specialist from Saga University trained 108 participants including health care workers, social workers, and health insurance inspectors from across Töv province. This was a pilot training program aimed at creating awareness and increasing participation in the national “Healthy Liver” program.
The Government of Mongolia launched the national “Healthy Liver” program in May 2017. Since its launch, only 47% of those eligible for free testing have voluntarily participated. Of those who have been screened, less than 35% of those who tested positive for hepatitis C have followed through on getting treatment.
This Hepatitis Coordinator program has been specifically designed for immediate disease prevention and management. This system could also be used to quickly disseminate information, testing, treatment, and vaccinations throughout a community for other health issues including Covid-19.
The hepatitis B vaccine also protects against liver cancer. FIRE continues to vaccinate health care workers who test negative for hepatitis B and have not previously been vaccinated. Vaccinations are also given to participants of FIRE’s Viral Hepatitis and Liver Cancer Screening Project who test negative for hepatitis B.
