120 Voices, One Fight

Mongolians plan their next steps to end TB

By The Global Fund

January 23^rd, 2020

In the world’s least densely populated country, finding people who are sick from tuberculosis is a challenge. 70% of TB cases are missed by Mongolia’s health system. They’re not diagnosed, treated or even reported.

To help tackle this challenge, in late 2019 the Global Fund increased funds available to fight TB in Mongolia by 48% – amounting to US$10.7 million over three years. In January 2020, Mongolians gathered in the capital, Ulaanbaatar, to discuss how best to invest that money to achieve their TB targets.

“Country dialogue,” a process built into the Global Fund funding cycle, brings together different groups of people who respond to and are affected by the diseases in a country. It is a conversation – an opportunity for people to share their experiences to help decide how and where to invest Global Fund grants for maximum impact.

In Mongolia, with the fourth highest TB burden in the region, this dialogue is also a way to renew the country’s commitment and roadmap to a TB-free future.

More than 120 people at the country dialogue meeting represented nongovernmental organizations, health care providers, the Global Fund Country Coordinating Mechanism (the committee of local community, government and health experts that develop and guide Global Fund-supported programs in a country), the national government, international organizations and – critical to the response in Mongolia – the mining sector, other industries, the military and prisons. Some traveled as far as 1,500 km to attend.

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After a briefing on the state of TB in the country, discussion groups delved into specific challenges such as improving the treatment success rate and strengthening human resources. A plenary discussion then brought them closer to agreeing on a plan. After another meeting in February, the country will finalize its plan for tackling TB in Mongolia and send its funding request to the Global Fund in March.

Finding Missing Cases

70%

Percentage of TB cases missed by Mongolia’s health system in 2018

(Source: World Health Organization)

With 70% of TB cases missed in Mongolia in 2018, one discussion group focused on how to innovate to find the missing cases. With government clinics leading detection, one attendee suggested using private clinics to expand reach nationwide. Military recruits are currently screened for TB, another pointed out; what about continuing the screening throughout service members’ careers?

Why is Country Dialogue Important?

“This is important to reach the very ambitious Sustainable Development Goal for the end of TB – including the elimination, prevention and control of TB in Mongolia.”

Dr. Anuzaya Purevdagva , Technical Officer, Expanded Program on Immunization and Communicable Diseases, WHO Mongolia Country Office

“We hope for new, practical ideas and strategies to implement TB services.”

Tsolmon Boldoo, Epidemiologist, TB Department, National Center for Communicable Disease

Quoting a Mongolian proverb, “If we decide together we can’t go wrong.”

Dr. N. Naranbat, President, Mongolian TB Coalition

“We need to shift the paradigm – not to do the same as we have done for many, many years. Hopefully there will be new things.”

Bazarragchaa, STREAM Clinical Trial Coordinator, National Center for Communicable Disease

Community Response

Dr. D. Adija says community volunteer programs are key to ending TB. A retired children’s TB doctor in Darkhan-Uul province, Dr. Adija served as a community representative at the meeting.

“Volunteers do important work,” says Dr. Adija, speaking in Mongolian. “They work from the beginning through the end of a TB patient’s history.”

She says volunteer support groups enable patients and families to rely on each other to overcome the disease together. She also cites the high treatment success rates of the Global Fund-supported Mongolian Anti-Tuberculosis Association, whose home-visit volunteers work in the eight high-TB burden provinces and Ulaanbaatar.

Mongolian Anti-Tuberculosis Association volunteer A. Tsendhkuu (left) delivers TB medicines to patients like Uranchimeg (right) every day in Songino Khairkhan District, Ulaanbaatar. Uranchimeg completed treatment in 2019.

In addition to delivering and tracking medicines, the volunteers complete early screening questionnaires with those who come into contact with patients, including family members and neighbors. They also transport samples to testing sites.