RESUMO
INTRODUCTION: In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. METHODS: Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. FINDINGS: The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. CONCLUSIONS: Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor.
RESUMO
Hepatitis B virus infection is a serious public health problem. Mongolia is one of the countries with the highest rates of hepatitis B virus infection in the world. The routine immunization with the hepatitis B vaccine began nationwide in 1991. The purpose of this study was to determine the persistence of seroprotection (anti-HBs >or= 10 mlU/mL) in children 5-10 years old that were immunized with the hepatitis B vaccine as infants. In total, 438 children were selected from six health facilities in Ulaanbaatar through a multistage random sampling method. Vaccination information was confirmed by checking the vaccination records kept in the health facilities. A blood sample was obtained from each child for anti-HBs, HBsAg and anti-HBc. Of 438 children, five (1.1%) were HBsAg positive and 58 (13.2%) were anti-HBc positive. Sixty infected children were excluded and a total of 378 (86.3%) sera were evaluated. The seroprotective antibodies were detected in only one-fourth of the children at the age of ten. Titres of anti-HBs decreased significantly with age (Linear regression p = 0.01). This decrease is primarily due to the rapid decrease in children living in ger areas (p < 0.001) compared to children living in apartment areas (p = 0.152). On the other hand, children living with higher socio-economic status had more exposure to blood-borne pathogens, probably due to inappropriate health-seeking behaviors.