Hill Peter S, Dodd Rebecca, Dashdorj Khurelmaa
International Health, School of Population Health, University of Queensland, Australia.
Reprod Health Matters. 2006 May;14(27):91-100. doi: 10.1016/S0968-8080(06)27226-4.
Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.
自向民主制度转型以来，蒙古在国家层面和卫生部门都经历了一系列改革。本文审视了这些改革的速度和范围、它们对性健康和生殖健康服务产生影响的方式以及对卫生人力的影响。蒙古以前是鼓励生育的，如今在避孕药具使用、妇女教育以及降低孕产妇死亡率方面取得了重大进展。然而，青少年怀孕率和性传播感染率不断上升，以及堕胎率居高不下，仍然是挑战。《国家生殖健康方案》的实施以技能发展、外展服务和资源提供为目标。创新的青少年友好型卫生服务吸引了城市青年，而家庭小组医疗模式的发展为向包括性健康和生殖健康服务在内的边缘化社区提供初级医疗保健创造了激励机制。《卫生部门战略总体规划》为卫生领域的协调发展提供了一个平台，但受到政府和捐助界缺乏共识、相互竞争的卫生优先事项以及关于生育和堕胎的新辩论政治化的威胁。由于以前在性健康和生殖健康方面取得的成果容易受到政治变革的影响，这些紧张关系有可能加剧现有的差距，并默认形成两级医疗保健系统。
