Health in the steppes
Contributing to optimizing the healthcare system of a country undergoing epidemiological transition is the goal of the work carried out by Montpellier-based economist Marlène Guillon, who has made Mongolia her distant field of research.
It is a territory three times the size of France, populated by only 3 million inhabitants, half of whom live in the capital, Ulaanbaatar. With barely 2 inhabitants 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 inhabitants is nomadic or semi-nomadic.
Marlène Guillon has had the opportunity to explore these steppes on several occasions. Since 2018, the researcher from the Montpellier Research in Economics (MRE) laboratory has been conducting a project there on the efficiency of health centers in rural areas. "They are called Soum healthcenters , and they are primary care centers scattered across this vast territory, so that all rural residents can have access to care." Providing curative care, prevention, childbirth, vaccination, screening, and even minor hospitalization or surgery, these Soum health centers are small facilities with an average of fewer than three doctors, six nurses, midwives, and paramedical staff for about ten hospital beds.
A country undergoing epidemiological transition
But how did our economist end up in this distant country? "My post-doc supervisor had been working with Mongolia for a long time, but mainly on macroeconomic stability issues," explains Marlène Guillon. "However, given the context in the country, we thought it would be interesting to focus specifically on the allocation of healthcare resources." The context? A budgetary situation that is clearly unfavorable to increasing public health spending, despite the government's desire to expand universal health coverage. "Per capita health spending is 10 times lower than in France, and with no possibility of an increase in the health budget in the coming years, improving the efficiency of the health system becomes a top priority," the specialist points out.
This is a real necessity in a country that still has high maternal and infant mortality rates, "and which is also facing a sharp increase in chronic diseases such as diabetes and cardiovascular disease," says 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 themselves by looking at the efficiency of Soum health centers. "We are seeking to assess whether these centers could provide care that is as effective as it is currently, but with fewer resources. This is what we call efficiency," explains the researcher.
To measure this efficiency, researchers analyzed data from 260 Soum health centers across the country in 2017 and 2018. In particular, they looked at 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, then returned to her laboratory in Montpellier to process it. "We also trained doctors and public health workers on site to carry out these efficiency analyses," says the researcher.
Facilitating access to healthcare
These measures make it possible to identify 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 to pay for things like medication." The researcher also highlights the difficulty nomadic herders in these regions have in accessing healthcare: "If a herder has to travel to a center that may be a day's walk away to receive treatment, they have to leave their herd for several days, and many cannot afford to do so,"she laments.
This is one of the major challenges of these efficiency studies: optimizing the healthcare system as a whole so that everyone can benefit as much as possible. "If we find that a Soum health center could provide the same care, with the same quality but with fewer resources, we can save money on its operation, " Marlène Guillonpoints out . This money could then be reinvested elsewhere in the healthcare system, for example by covering transportation costs for herders who live too far away or compensating them for lost income due to time spent away from their herds."Or by covering the cost of medication when it is too high.
Minimizing waste of resources
"The idea is not at all to reduce healthcare spending at the risk of reducing the quality of care," reassures the economist. Quite the contrary: "The aim of our research is to propose a system that is better suited to the reality on the ground. By minimizing the waste of resources as much as possible, we can reallocate this budget to other healthcare projects."
The researcher would like to extend this approach to health centers in urban areas as well. "They are called Family Health Centers, and they are private healthcare centers under contract with the Ministry of Health."This new project, funded by the Asian Development Bank, has been delayed due to the pandemic."I haven't been able to set foot in Mongolia since February 2020," says Marlène Guillon, who makes no secret of her eagerness to return and hopes that the vaccine will reopen the country's borders. "Maybe in July or August"...