Mongolia’s healthcare system continues to face a critical challenge stemming from geographical disparities and the excessive concentration of medical services in the capital city. Provincial hospitals, in particular, still struggle with inadequate equipment and facilities, compounded by a shortage of specialized healthcare professionals. As a result, citizens often have no choice but to travel to Ulaanbaatar City to seek medical treatment, which is a troubling reality that persists today. The National Human Rights Commission of Mongolia (NHRCM) recently revealed that successive governments and the Ministry of Health have largely failed to implement policies aimed at reducing this centralization. Consequently, people continue to bear significant financial costs, spend considerable time traveling, suffer deteriorating health conditions, and, in some cases, even lose their lives while trying to access healthcare, an unacceptable situation in an era of advanced communication and technology.
The NHRCM further emphasized that herders, residents of remote areas, and other vulnerable groups are often unable to access even basic primary healthcare services, making them living examples of the inequalities that persist within the healthcare system. Even after traveling hundreds of kilometers to the capital, many rural residents are unable to secure appointments at public hospitals due to overwhelming patient loads, forcing them either to return home without treatment or wait for days on end. These challenges were highlighted in the NHRCM’s report on monitoring the implementation of citizens’ right to health protection and access to healthcare services, based on inspections and assessments conducted over the past three years.
Drawing on the current conditions of the healthcare sector and the violations and shortcomings identified during the inspections, the commission concluded that citizens’ right to health protection and access to medical services is far from being adequately guaranteed in Mongolia. Addressing the issue, S.Tungalagtamir, Head of the Research and Analysis Division of the NHRCM, stated “Over the past decade, the number of healthcare institutions in Mongolia has increased by 51.5 percent. The number of physicians per 1,000 people is also above the global average. Yet complaints about poor access to healthcare services and excessive workloads within the system continue unabated. The primary reason is the shortage of specialized medical professionals.”
S.Tungalagtamir then continued, “Most specialists live and work in Ulaanbaatar. In other words, rural areas lack advanced medical equipment, diagnostic tools, laboratory reagents, and skilled personnel. Many citizens assume that healthcare services in provincial and district hospitals have improved compared to the past. However, the reality is that conditions remain largely unchanged. According to a nationwide survey, 67 percent of respondents reported that they are unable to fully access healthcare services because of these challenges, while 33 percent said they had not received any medical assistance at all during the previous year. Therefore, it is essential to prioritize the procurement of medical equipment, improve the balance between doctors and nurses, deploy more specialized physicians to rural areas, and urgently reduce healthcare centralization and the burdens it places on citizens.”
As the head noted, although the number of physicians per 1,000 people has increased nationwide, the country is simultaneously experiencing a severe shortage of specialized medical personnel. The inspection found shortages of 638 general practitioners, 638 ophthalmologists, 439 pediatricians, 439 pathologists, 318 emergency medicine physicians, 260 psychiatrists, and 237 anesthesiologists. As a consequence, in many rural areas, public health services are being carried out by personnel from other disciplines in addition to their primary duties, while some healthcare services have been discontinued altogether. This has directly undermined the quality and accessibility of essential healthcare services and has significantly limited the ability of medical providers to reach and serve people living in remote and isolated regions.
NO DOCTORS AVAILABLE TO PROVIDE LIFE-SAVING EMERGENCY CARE
The number of healthcare institutions operating in Mongolia has increased from 3,244 in 2015 to 4,914 today, representing a 51.5 percent rise over the past decade. In addition, the number of hospital beds per 10,000 people stands at 88.1, which is approximately twice the international average. By both the number of healthcare facilities and hospital-bed density, Ulaanbaatar far exceeds many countries in the region.
Unfortunately, these figures actually represent a classic example of the imbalance between urban and rural healthcare services and the unequal territorial distribution of medical resources, a reality that the Ministry of Health and policymakers have largely failed to acknowledge. Rather than reflecting genuine improvements in healthcare accessibility, the statistics have instead become a factor inflating sectoral expenditures. In other words, the data indicate the urgent need to focus on the adequate provision of human resources, the strategic placement of healthcare infrastructure, and a more rational distribution of services across different levels of the healthcare system. They also highlight the necessity of strengthening primary healthcare services and implementing policies aimed at training, deploying, and retaining specialized physicians and healthcare professionals.
Several statistical studies reveal that the healthcare sector continues to suffer from widespread and uneven shortages of personnel across various specialties. Particularly alarming is the situation in emergency medicine, psychiatry, and anesthesiology, fields that provide life-saving and high-risk medical services. In these specialties, the patient load per physician is excessively high, while between 50 and 70 percent of the required positions remain vacant. These disciplines are commonly regarded within medicine as critical emergency-care specialties responsible for saving lives during the most precarious moments.
Furthermore, the ongoing shortages of general practitioners, psychiatrists, anesthesiologists, and pediatricians are adversely affecting the quality and accessibility of primary healthcare, preventive screenings, diagnostic services, and treatment. Although the overall number of physicians has increased, only about one-third of the country’s healthcare workforce is employed in rural areas. Human resource statistics show that rural regions have approximately 30 physicians and 38 nurses per 10,000 residents, whereas the corresponding figures in the capital are two to three times higher.
The disparity is particularly pronounced among specialists. Compared with rural areas, Ulaanbaatar has 3.4 times more specialized surgeons, 2.9 times more orthopedic and trauma surgeons, and between 2.3 and 3.6 times more professionals in diagnostic imaging and dentistry. Moreover, only 15 percent of the limited number of physicians working in rural areas are engaged in primary healthcare services.
According to inspections conducted by the Ministry of Health, family health centers and soum health centers face severe staffing shortages. The assessments found deficits of 36 percent among nurses, 46 percent among physicians, and 53 percent among other healthcare personnel. In addition, the utilization rate of medical equipment at these facilities was assessed at less than 40 percent. These figures speak volumes about the challenges facing the continuity and quality of healthcare services.
Internationally, primary healthcare providers are generally required to be located within a distance that allows residents to reach them on foot within 15 minutes. However, inspections conducted by the NHRCM between 2023 and 2025 found that staffing levels and professional qualifications among rural doctors and nurses averaged only slightly above 30 percent of the required standard. Specifically, 43 percent of soum health centers operated without a physician, while 56 percent lacked other healthcare specialists altogether. As a result, many rural hospitals have effectively become empty buildings with little or no medical personnel.
Globally, primary healthcare services account for approximately 58 percent of all healthcare delivery. In Mongolia, however, primary care constitutes only 19.6 percent of healthcare services, illustrating the structural imbalance within the country’s healthcare system. International experience shows that excessive reliance on referral-level and centralized healthcare systems tends to be more expensive, less efficient, and less patient-friendly. Consequently, many countries have shifted their healthcare strategies toward strengthening and expanding comprehensive services at the primary-care level.
RIGHT TO HEALTHCARE EXISTS ONLY ‘ON PAPER’
Officials have also pointed out that many healthcare facilities in Mongolia’s provinces and soums suffer from aging infrastructure. A large number of hospital buildings have exceeded their intended lifespan, no longer meet modern standards, and, in many cases, have never undergone major renovation since they were first commissioned. In addition, shortages of essential medical equipment, including MRI and CT scanners, centralized sterilization and laundry systems, rigid endoscopic surgical equipment, stationary ultrasound machines, blood centrifuges, flexible endoscopes for gastric, colon, and rectal examinations, bacteriological laboratory equipment, panoramic dental X-ray machines, and CR/DR X-ray systems, continue to hamper the delivery of specialized healthcare services in rural areas.
The Chief Commissioner of the NHRCM, D.Sunjid stated that “In Mongolia, the right to health protection, the right to life, and the right to receive healthcare services are fundamental rights guaranteed by the Constitution and various international treaties and conventions. Therefore, we conducted a comprehensive assessment to determine the extent to which these fundamental rights are being realized in practice.”
She continued, “This report, which spans nearly 200 pages, identifies numerous barriers, including the crisis within the healthcare financing system, excessive workloads in hospitals, over-centralization of services, shortages of healthcare personnel, deficiencies in professional skills, disparities between urban and rural healthcare services, interruptions in the supply of medicines and medical equipment, the lack of a human rights-based approach to healthcare delivery, discrimination and inequality, weak preventive healthcare policies, and inadequate oversight and accountability mechanisms.”
“Most importantly, these issues do not exist one by one. Rather, failures across multiple levels of the healthcare system have become interconnected, creating serious violations of citizens’ right to health protection. Even today, many people cannot access treatment at public hospitals when they need it. At the same time, although some may wish to seek care at private hospitals by paying out of pocket, they often lack the financial means to do so. As a result, countless citizens are left waiting for appointment slots to become available at state hospitals or for medical reagents, medicines, and injections to be supplied. This reality demonstrates that Mongolians’ right to life and access to healthcare remains ‘guaranteed’ largely on paper rather than in practice,” D.Sunjid concluded.
The findings paint a troubling picture of a healthcare system in which constitutional and internationally recognized rights are not being fully realized. While legal guarantees formally exist, persistent structural deficiencies, resource shortages, and unequal access to services continue to prevent many citizens from receiving timely and adequate medical care. As a result, the gap between the legal promise of healthcare rights and the everyday experiences of patients remains substantial.
