www.blackwellpublishing.com/journals/afm 65 REGIONAL ROUNDUP Asia Pacific Family Medicine 2003; 2: 65–70 Blackwell Science, LtdOxford, UKAFMAsia Pacific Family Medicine1444-1683© 2003 Blackwell Publishing Asia and WoncaJune 2003226570Original ArticleDeveloping family medicine in MongoliaM O’Rourke et al. Correspondence: Michael O’Rourke, 46 Knowles Avenue, North Bondi, New South Wales, 2026, Australia. Email: morourke@nbondi.wow.aust.com Accepted for publication 14 February 2003. REG I ONAL ROUNDUP Developing family medicine in Mongolia Michael O’ROURKE, Michael MIRA, Bunijav ORGIL and Jacques JEUGMANS Mongolia Ministry of Health, Government Building VIII, Ulaanbaatar, Mongolia Abstract Background: Mongolia previously had no tradition of Family Medicine. As part of overall health sec- tor reform, a general practice model has now been established with a primary care system of family doctors in group practices covering all population centers in the country. Methods: The present article describes the family doctor implementation process, including capita- tion payment arrangements, registration, retraining programs and community education. Results: The Mongolian experience – targeted and focused primary care reform with investment of resources and government commitment to change and innovation – offers lessons to other countries in central Asia developing Family Medicine models. Conclusions: The challenges for Mongolia and for other transitional central Asian countries remain reorienting the health system from hospital based services to primary care and to raising quality and standards. © 2003 Blackwell Publishing Asia and Wonca Key words: capitation, central Asia, clinical training, Family Medicine, health reform, quality improvement. Mongolian health care Mongolia is a large landlocked country in the north- ern part of central Asia, located between Russia and China. A relatively small number of people – 2.4 mil- lion – live in a large geographic territory of 1.56 mil- lion sq km, 2400 km long from east to west and 1260 km from north to south, giving a population density of 1.5 inhabitants per sq km. However, approx- imately 50% of the population lives in urban centers – 700 000 people in the capital Ulaanbaatar alone. As in Australia and Canada, other countries with vast terri- tories, ensuring appropriate health services in a coun- try with urban and sparsely populated rural areas like Mongolia, presents significant organizational and logistical challenges. In common with other countries influenced by the Soviet model of health care, the Mongolian health sys- tem was centrally planned; dominated by the hospital sector with no tradition of general practice; and exclu- sive of community involvement or participation. 1 Patients were regarded as passive consumers of services prescribed and organized by largely anonymous bureaucrats. Since the transition to a market economy in the early 1990s, health reform is now firmly on the Mon- golia agenda and one of the major vehicles for health service reform in the country is the Health Sector Development Program (HSDP), an initiative funded from Asian Development Bank loans to the Mongolian Government. The HDSP has been underway since mid 1998 and according to a recent review, 2 has already impacted on the structure and delivery of Mongolian health care. The HSDP is directed towards structural and organizational reform by moving the Mongolian system from the inefficiencies and poor standards of the old model towards a modern customer focused approach emphasizing quality and patient care. The reform program is aimed at developing primary health care via the family doctor initiative (doctors working in groups as general practitioners separate from hospit- al based services); improving quality (through quality assurance processes to focus on continuous improve- ment practices); improving services (through equip- ment provision and hospital refurbishment and