Health in the Steppes
The goal of the research conducted by Montpellier-based economist Marlène Guillon—who has made Mongolia her distant field of study—is to help optimize the healthcare system of a country undergoing an epidemiological transition.
It is a country three times the size of France, with a population of just 3 million, half of whom live in the capital, Ulaanbaatar. With barely 2 people per square kilometer, this country has the lowest population density in the world. Welcome to Mongolia, a land of mountains, steppes, and deserts, where nearly one in three people is nomadic or semi-nomadic.
Marlène Guillon has had the opportunity to explore these steppes on several occasions. Since 2018, the researcher at the Montpellier Research Laboratory in Economics (MRE) has been leading a project there focused on the efficiency of health centers in rural areas.“They’re called Soum healthcenters ; they’re primary care facilities scattered across this vast territory, so that all residents of rural areas can have access to care.” Whether for curative care, preventive care, childbirth, vaccinations, screenings, or even minor hospitalizations or small surgical procedures, these Soum health centers are small facilities that, on average, have fewer than 3 doctors, 6 nurses, midwives, and paramedical staff for about ten hospital beds.
A country undergoing epidemiological transition
But how did our economist end up in such a distant country?“My postdoc supervisor had been working with Mongolia for a long time, but mainly on issues of macroeconomic stability,” explains Marlène Guillon. “However, given the situation in the country, we thought it would be interesting to focus specifically on the allocation of healthcare resources.” The context? A fiscal situation clearly unfavorable to increasing public health spending, despite the government’s desire to expand universal health coverage.“Per capita health spending there is 10 times lower than in France, and with no possibility of increasing the health budget in the coming years, improving the efficiency of the health system becomes a top priority under these circumstances,” the specialist emphasizes.
This is a real necessity in a country that still has high maternal and infant mortality rates,“and which is simultaneously facing a sharp rise in chronic diseases such as diabetes and cardiovascular disease,” notes Marlène Guillon. In this context of“epidemiological transition,” every tugrik invested in the healthcare system must be put to good use. This is the mission our researchers have set for themselves as they examine the efficiency of the Soum health centers.“We are seeking to assess whether these centers could provide care that is just as effective as they do now, but with fewer resources—that is what we call efficiency,” explains the researcher.
To measure this efficiency, the researchers analyzed data from 260 Soum health centers across the country in 2017 and 2018. In particular, they focused on what economists refer to as “inputs” and “outputs.”“Inputs are all the resources invested in the center, such as staff and equipment. Outputs are all the care provided to patients,”explains Marlène Guillon. The economist collected this data in the field from the Mongolian Ministry of Health and then processed it in her laboratory in Montpellier.“We also trained doctors and public health professionals on-site to conduct these efficiency analyses,” says the researcher.
Improving access to healthcare
These measures make it possible, in particular, to identify health centers that are not functioning very well.“For example, we found that the Soum health centers in the poorest regions were the least efficient, because even though care is free, patients still have out-of-pocket expenses—they have to pay for medications, for instance.” The researcher also highlights the difficulty nomadic herders in these regions face in accessing care:“If a herder has to go to a health center that may be a day’s walk away, they must leave their herd unattended for several days, and many cannot afford to do so,”she laments.
This is one of the key challenges of these efficiency studies: to optimize the healthcare system as a whole, so that everyone benefits as much as possible.“If we find that a Soum health center could provide the same care, with the same quality but using fewer resources, we can save money on its operations, ”Marlène Guillonpoints out . “That’s money we could reinvest elsewhere in the healthcare system—for example, by covering transportation costs for herders who live too far away, or by compensating them for lost income due to time spent away from their herds.”Or by covering the cost of medications when it becomes too high.
Minimize waste of resources
“The idea is certainly not to cut healthcare spending at the risk of compromising the quality of care,” the economist reassures us. Quite the contrary:“The goal of our research is to propose a system that is better suited to the realities on the ground. By minimizing waste of resources as much as possible, we can reallocate that budget to other healthcare initiatives.”
The researcher hopes to extend this initiative to health centers in urban areas as well.“They’re called Family Health Centers; they’re private healthcare facilities contracted by the Ministry of Health.”This new project, funded by the Asian Development Bank, has had its launch postponed due to the pandemic.“I haven’t been able to set foot in Mongolia since February 2020,” laments Marlène Guillon, who makes no secret of her eagerness to return and hopes that the vaccine will reopen the country’s borders to her. “Maybe in July or August”…