Financing of Non-Communicable Diseases Prevention in Low- and Middle- Income Countries: Mongolia Case Study

Abstract

Objective: Prevention programmes are increasingly seen as critical for tackling the rising burden of noncommunicable
diseases (NCDs), but tend to be under-prioritised and under-funded, particularly in low- and middleincome
countries. The objective of this study is to estimate spending on NCD prevention in Mongolia and identify
the enablers, challenges and dynamics underpinning population-level NCD prevention spending, with particular
focus on tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity.
Methods: Primary and secondary data collection was used to examine processes and organisational contexts that
shape the formulation of policy and financial frameworks for NCD prevention. The methodology was categorised
into three tiers; an academic literature review, scrutiny and analysis of official policy documents and budgetary data
on health and NCDs, and in-depth stakeholder interviews with key government officials leading NCD programmes.
Government and government-routed donor spending on population level prevention was gauged to estimate NCD
prevention spending. Where possible, impact of prevention programmes on disease incidence and risk factors was
gauged through available outcome indicators.
Results: Mongolia allocated an estimated MNT 10.5 billion on NCD prevention and health promotion in 2017, out
of which population-level NCD spending accounted for MNT 5.1 billion (just over 1% of overall government health
spending). Enablers include tobacco taxation and regulation, earmarking unhealthy consumption through the
Health Promotion Fund and strengthened salt intake policies. Challenges include excess allocations towards
inpatient and specialist care, inadequate multi-sectoral action and stewardship for NCDs, food and beverage
industry interference in policy and limited alcohol regulation and tax.
Conclusion: Mongolia has made considerable progress in formulating policies for NCD prevention, but spending
on NCD prevention still remains barely more than 1% of government health spending. Increased allocation of
resources towards population-level NCD prevention can both help address the growing NCD burden and bring
substantial economic benefits.
Keywords: Noncommunicable Diseases, Tobacco, Sodium Chloride, Dietary, Employees, Incidence, Inpatients,
Behaviour, Risk Factors, Diet, Resource, Tobacco, Beverages, Taxes, Financial Management