THE PROBLEM

Mongolia is a lower-middle-income-country (LMIC) in central Asia with a high TB burden (fourth highest in the Western Pacific Region, estimated prevalence of 757 per 100,000 population) and a smaller but persistent HIV epidemic that is concentrated in key populations, particularly men who have sex with men (MSM) and female sex workers (FSWs). Mongolia has achieved high TB treatment success rates but still struggles with lower case detection rates, especially among vulnerable groups such as migrants and the homeless. Efforts to reach key populations with HIV prevention, diagnosis, and treatment services are still incomplete.

Although Mongolia has made promising strides in increasing domestic resource allocation to its HIV and TB programs, the nation’s designation as an LMIC and its continued growth towards Upper-Middle-Income status suggest that the country may see declining Global Fund assistance in the coming years. As over 30% of both responses are financed by international donors, Mongolia recognizes that it needs to prepare early and systematically to ensure that national resources gradually replace external funds, even as the country expands and extends its HIV and TB programs, which will raise the future cost of these disease responses. To do so, the government, with backing from the Global Fund, has decided to conduct a comprehensive transition readiness assessment and develop a plan to assume increasing domestic responsibility for its national HIV and TB programs, setting the stage for a smooth transition from Global Fund support.

THE PHAROS SOLUTION

At the request of the Mongolian government and its HIV/TB Sustainability & Transition Technical Working Group (STWG) chaired by the Vice Minister of Health, a Pharos team consisting of international and national experts in public health, economics and financing has been recruited to help with the development of a Sustainability and Transition Readiness Assessment and an implementation plan. Building on its prior sustainability and transition projects in over a dozen countries, Pharos and the STWG have identified key bottlenecks and risks to the sustainability of the HIV and TB responses during the expected transition period, and will work with local stakeholders to formulate mitigating actions that Mongolia can take.

With the insight shared by national stakeholders and international experts, Pharos identified 13 key risks and recommended a set of 32 mitigation actions to address the risks. For each action, the Pharos team worked with the national stakeholders to produce detailed plans with the primary responsible agency, supporting agencies, timeline, funding source, and any existing plans related to the actions recommended. The numerous recommendations include a finance sub-committee to respond to the pressing demands of the fiscal tightened imparted by the Covid-19 pandemic, the employment of innovative social contracting between the government and civil society organizations to reach marginalized populations, and to explore all potential options for private-public partnerships in the country.

The engagement concluded in the end of 2020 with the endorsement of the STWG and Global Fund. The main findings, identified risks, and mitigation actions will help shape government policies and budgets in the coming years, and will be supported by the Global Fund’s new $13.3 million grant to Mongolia for 2021-23.

Status: Completed, December 2020

Team Members Involved: Robert Hecht, Miloud Kaddar, Naranchimeg Jamiyanjamts, Batzaya Gungaa, Moises Escobar, and Nathan Isaacs

For more information, contact us at [email protected].