Mongolia: a health system in transition.

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Abstract
70% of the 2.2 million population of Mongolia are younger than 35 years old. More than 75% of the population live in urban areas, but many adopt the traditional nomadic lifestyle for at least a few weeks each year. 95% of the population is literate. Winters produce extremely cold temperatures and shortages. Mongolia has a well structured and staffed health care system. 3.9 physicians serve 1000 people. Women comprise more than 80% of physicians. Leading causes of mortality and morbidity are acute respiratory infections (ARIs) in the winter and diarrhea in the summer, particularly among children. Hypertension and ischemic heart disease are common. Mongolians are the greatest consumers of red meat in Asia and perhaps the world. The health system is in the process of switching from a centralized system of specialist clinics to a family doctor system. Family doctors usually are general physicians, pediatricians, and gynecologists who have undergone family doctor training. They have not received adequate training in treating ARIs, however. Family doctor clinics have 3-6 physicians, each physician with his/her own nurse. Each physician cares for 200-350 families (350-600 children younger than 16). Family doctors must visit each newborn every 2 weeks for the first 3 months and then once a month until age 1. They must also visit each elderly and homebound chronically ill patient at least once a month. Their nurses either come with them or visit patients alone to administer injections, change dressings, take infants' measurements, and encourage persons to come for vaccinations. The small district and county hospitals face shortages of drugs, raw materials, and functional equipment. The few national hospitals provide tertiary care. Treatment without medicine and traditional treatments of herbal remedies and Buddhist rituals and prayers are resurging in popularity. Harmful practices include swaddling babies, which contributes to rickets and pneumonia, and giving ill children their mother's early morning urine. Immunization coverage is high. Supplementary ration cards provide milk, flour, meat, rice, and sugar to pregnant women and mothers of children under 1 year old. Milk centers in major towns provide milk to children with a doctor's prescription. Even though malnutrition is rare, vitamin deficiencies are common.

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