In Ulaanbaatar City, which is home to over half of the country’s population, there is a significant and growing demand for healthcare services. Yet, the capital city faces an ongoing crisis in its healthcare infrastructure. Despite the substantial concentration of people, the available medical facilities are sorely inadequate in meeting the needs of the population. The capital city, with its expanding population, is home to only a handful of specialized healthcare institutions, including three hospitals focusing on specialized medical services, 13 providing more focused specialties, one emergency medical center, four district general hospitals, 10 health centers, and just three maternity hospitals. However, the severity of the situation lies not in the quantity but in the quality and infrastructure of these healthcare facilities. The country, with all its resources, has yet to address the fundamental issues that plague its healthcare system, despite its citizens relying on these limited institutions for their medical needs.
The state of these hospitals and clinics is a sad reflection of the country’s lack of attention to healthcare infrastructure. In many cases, the buildings are dilapidated, with some structures now infested by mold and mildew, rendering them not only unsafe but also unsanitary. Basic hygiene standards are not met, and modern medical equipment cannot be installed due to outdated and underdeveloped facilities. The situation goes beyond the internal conditions of these hospitals; the external environment surrounding the hospitals is equally neglected. Many hospitals have signs that are barely visible, the surrounding areas are poorly maintained, and there are no adequate spaces for parking or safe access for patients. In some cases, the hospital's accessibility is so poor that patients and their families have to struggle to even find the entrances.
Moreover, in certain areas, the land originally allotted to the hospitals has been encroached upon. For example, a notorious case involves the National Center for Maternal and Child Health, where the National University of Mongolia attempted to demolish the hospital’s fence and claim the land in broad daylight. The dispute over this land is ongoing, illustrating the complex issues regarding land ownership and usage around healthcare institutions. Similarly, the National Cancer Center faced a situation where private entities blocked access points to the facility, leaving both medical staff and patients in a difficult situation. The State Central Third Hospital experienced a similar fate, where the land around the hospital was sold to private businesses, causing a severe degradation of the hospital’s environment. In addition, the First Central Hospital has also struggled with access points, as has the National Trauma and Orthopaedic Research Center, which has seen its surroundings increasingly overrun by private clinics and diagnostic centers.
These developments raise a critical issue: the government’s inability to adequately maintain or upgrade state-run healthcare facilities, despite increasing demands for healthcare services. This situation creates a two-fold crisis: the lack of modern infrastructure makes it difficult to provide quality healthcare, and the encroachment of private entities further reduces the space and resources available to public hospitals. As these private businesses thrive, profiting off the gaps in the public healthcare system, the government continues to funnel large sums of public health insurance funds into the private sector, further exacerbating the disparity between public and private healthcare services.
The problems extend to district-level healthcare centers as well. In areas like the Baganuur District Health Center, the entrances and exits of the facility are so poorly designed and positioned that they lead directly onto busy automobile roads. Patients arriving by car face difficulties finding parking, while those relying on public transportation are forced to navigate poorly designed roads just to access the center. The Songinokhairkhan District’s “Tsambagarav” Health Center faces similar challenges, with its access points again being compromised by its proximity to the road. The Chingeltei District Health Center faces comparable issues. As these district centers struggle to provide basic healthcare services, the situation only worsens due to the lack of proper planning, infrastructure, and resources to improve the external conditions of the facilities.
The situation with maternity hospitals is especially concerning. The external environments of these hospitals are in such a state of disrepair that they resemble areas of low economic activity, almost as if they have transformed into a “black market” for other businesses. This lack of care for the surroundings not only negatively impacts the aesthetic and safety of the facility but also decreases the overall health and safety standards of the hospital. Among the second-tier healthcare institutions in Ulaanbaatar, the Sukhbaatar District Health Center stands out as one of the oldest and most difficult to upgrade. Despite serving a population of 142,000 people, this hospital’s infrastructure is outdated, and it lacks the capacity to accommodate modern medical equipment or offer the specialized services that are required by law. It was built in 1987 and is one of the most poorly maintained facilities, surrounded by construction materials, stores, and other structures that block the hospital’s access points.
Sukhbaatar’s Health Center illustrates the broader issue that many of Mongolia’s healthcare institutions face. While the Health Law of Mongolia mandates that district hospitals must provide at least seven specialized services, the Sukhbaatar District Health Center’s lack of proper infrastructure makes it impossible to fulfill these requirements. The surrounding area is so congested that it is increasingly difficult for patients and medical staff to navigate through it. The lack of modern medical equipment, coupled with the absence of specialized treatment rooms, means that this center cannot adequately meet the needs of the population it serves.
Ulaanbaatar’s healthcare system is still based on a Soviet-era model, which divides healthcare facilities into different tiers based on the complexity of the services they offer. Third-tier hospitals, such as the specialized centers, provide high-level services, while second-tier hospitals are supposed to focus on more basic, general healthcare services. However, this division has led to an overwhelming burden on the third-tier hospitals, which are forced to handle a disproportionate share of medical cases due to the inefficiency and underdevelopment of second-tier hospitals. As a result, patients are often forced to wait for long periods to receive the necessary medical attention, adding to the stress and strain on the already overburdened healthcare system.
The Sukhbaatar District Health Center, along with many other second-tier hospitals in the capital city, is unable to cope with the high demand for healthcare services. The outdated infrastructure and lack of modern equipment severely limit the hospital’s capacity to provide timely care. Despite the demand for 40,000 beds annually in the district, the hospital struggles to meet even the most basic medical needs. The Law on Health’s requirement that district hospitals must provide specialized services is simply not achievable in these conditions.
The development of Mongolia’s healthcare system has progressed through three distinct phases: the early period (1921-1940), socialist healthcare (1941-1990), and the post-1991 period of modernization and reform. Throughout these periods, the focus of the healthcare system has largely been on improving the quality of medical services, with much less attention paid to the physical infrastructure of the hospitals and clinics. The lack of focus on upgrading the external conditions of healthcare facilities has left public hospitals with decaying buildings, poor accessibility, and inadequate spaces for patients and staff alike. The government has failed to invest in the physical infrastructure required to create a truly effective and modern healthcare system.
Hospitals are not merely places for administering medical treatments—they are environments that should ensure the safety, comfort, and well-being of both patients and healthcare professionals. In addition to providing proper medical care, healthcare facilities must create an environment conducive to recovery, safety, and quality service. The Constitution of Mongolia guarantees every citizen the right to live in a healthy and safe environment, protect their health, and access medical care. However, many of the public hospitals in Ulaanbaatar are far from meeting these basic requirements. Patients and healthcare staff face significant risks due to the deteriorating conditions of the hospitals, and the government’s failure to address these issues undermines the fundamental rights of citizens.
Despite having over 30 laws and regulations governing healthcare standards in the country, many of the standards related to the physical environment of hospitals are not adequately enforced. These include critical standards such as those related to sanitation, accessibility, and the overall safety of hospital buildings. Second-tier hospitals, for example, are required to adhere to numerous guidelines regarding hospital building codes, sanitation requirements, and operational standards. In 2022, the government issued updated guidelines for healthcare facilities, specifying the necessary criteria for hospital access roads, parking spaces, waste management, and environmental sustainability. These guidelines emphasize the need for three main access points to be available for patients, medical staff, and emergency services. Despite these requirements, many hospitals continue to fall short of these standards due to inadequate enforcement and oversight.
The situation in Ulaanbaatar highlights the growing disparity between public and private healthcare services. While the number of private clinics and hospitals continues to increase, the public healthcare system remains trapped in a cycle of underinvestment, overcrowding, and neglect. As private healthcare providers thrive, profiting from the gaps in the public system, the government continues to allocate substantial amounts of public health insurance funds to private healthcare providers, further widening the gap between the two sectors.
Ulaanbaatar, with its population of nearly two million, requires a well-functioning, accessible, and modern healthcare system that can meet the needs of its diverse population. However, the current state of the public healthcare system is inadequate, with many hospitals operating in outdated, overcrowded, and unsafe conditions. The government must urgently prioritize investment in healthcare infrastructure and the enforcement of standards to ensure that all citizens have access to quality healthcare services in a safe and healthy environment.
In conclusion, the healthcare system in Ulaanbaatar is in dire need of reform. The capital city’s public hospitals are plagued by outdated infrastructure, inadequate resources, and a lack of regulatory oversight. Meanwhile, private clinics continue to flourish, profiting from the deficiencies in the public sector. The government must take immediate action to address the gaps in the healthcare system, invest in the modernization of public hospitals, and ensure that all citizens have access to safe, high-quality healthcare services. Only through these efforts can Mongolia begin to close the growing gap.
By D.CHANTSALMAA
