Enkhtuya B, Badamusuren T, Dondog N, Khandsuren L, Elbegtuya N, Jargal G, Surenchimeg V, Grundy J
FlindersNational Centre for Communicable Diseases, Ministry of Health, Mongolia.
Rural Remote Health. 2009 Apr-Jun;9(2):1045. Epub 2009 Apr 15.
Since the 1990s, Mongolia has undergone a rapid social and economic transition with migration to the urban areas of the national capital Ulaanbaatar. The main reasons for the migration are social sector decline in rural areas and the potential for employment opportunities in urban areas. There are also new internal patterns of migration in rural and remote areas relating to recent developments in the economic sector. Despite recent innovations in health system management in Mongolia, in some urban and rural and remote locations health services are not sufficiently accessed by the most socially and economically disadvantaged populations. These concerns provided the motivation for the Ministry of Health of Mongolia and development partners to attempt to access the most difficult to reach populations through the development of a micro-planning process referred to as the 'Reaching Every District strategy' (RED). This article describes and analyses RED micro-planning processes and content, and highlights the lessons learned. The main source of data for this planning system development was in the development and testing of the micro-planning process in Byanzurkh District, Ulaanbaatar in June 2008.
The principal intervention developed and trialed was a health micro-planning strategy for improved access to immunization and maternal and child health services for difficult to reach populations. The planning methodology was a problem-solving approach progressing from health mapping to barrier analysis, to activity planning and costing and finally to monitoring and evaluation.
Main success factors in the development of the planning methodology were the use of barrier analysis and mapping approaches for data analysis and problem solving at the local level, and re-orientation of management approaches from 'inspection' to supportive supervision. Additionally, although the RED strategy is intended to be an immunization-specific intervention internationally, evidence from the development and trial of the process in Mongolia indicates its potential for wider health systems applications. This is particularly so for detecting and responding to the maternal and child health service needs of the more difficult to reach sub-populations.
自20世纪90年代以来，蒙古经历了快速的社会和经济转型，人口向首都乌兰巴托的城市地区迁移。迁移的主要原因是农村地区社会部门衰落以及城市地区存在就业机会。农村和偏远地区也出现了与经济部门近期发展相关的新的内部迁移模式。尽管蒙古近期在卫生系统管理方面有所创新，但在一些城乡及偏远地区，社会和经济上最弱势的人群仍无法充分获得卫生服务。这些问题促使蒙古卫生部和发展伙伴试图通过制定一种称为“覆盖每个区战略”（RED）的微观规划流程，来接触最难触及的人群。本文描述并分析了RED微观规划流程及内容，并突出了所吸取的经验教训。该规划系统开发的数据主要来源是2008年6月在乌兰巴托的Byanzurkh区开展和测试微观规划流程。
所开发和试验的主要干预措施是一项卫生微观规划战略，旨在改善难以触及人群获得免疫接种及母婴保健服务的机会。规划方法是一种解决问题的方法，从卫生绘图到障碍分析，再到活动规划与成本核算，最后到监测与评价。
规划方法开发的主要成功因素包括在地方层面使用障碍分析和绘图方法进行数据分析及问题解决，以及将管理方法从“检查”重新定位为支持性监督。此外，尽管RED战略在国际上旨在作为一项特定于免疫接种的干预措施，但蒙古在该流程开发和试验中获得的证据表明其在更广泛的卫生系统应用方面具有潜力。对于发现和应对更难触及的亚人群的母婴保健服务需求而言尤其如此。
