Eliminating hepatitis in Mongolia
By Meredith Potts, FIRE Executive Director
FIRE – Flagstaff International Relief Effort is a non-profit, non-government organisation (NGO) which began its work in 1999 in the devastated economy of post-Soviet Mongolia. FIRE’s mission is to place aid directly in the hands of the people within the country. FIRE has been working in Mongolia since 1999 and specifically with the Ulaanbaatar Rotary Club, representing Rotary International, on hepatitis and health safety programmes since 2009. Recently they have partnered with Rotary International to lead “Hepatitis Free Mongolia, Phase 1,” with support from Saga University in Japan and Gilead Sciences.
In the “Hepatitis Free Mongolia, Phase 1” we worked to support Mongolia’s national “Healthy Liver Program” by expanding Saga University’s Hepatitis Coordinator programme, organising Mongolia’s first training for Hepatitis Coordinators in Töv and Dornod provinces. Saga University’s Hepatitis Coordinator programme was previously adopted by the Japanese Ministry of Health in its successful hepatitis elimination campaign. The Hepatitis Coordinators distribute and share information about the healthy liver programme, viral hepatitis testing, and educate community members one-on-one, person-to-person, directing them to receive the necessary testing and treatments while they are conducting their everyday duties. Together with Rotary International, we partnered with Saga University to modify and adapt the programme to be culturally relevant to Mongolian customs and language. The training was expanded to include social workers and specifically adapted to utilise Mongolia’s comprehensive governmental social service and health care networks and systems.
In both provinces, we worked closely with the Governor’s office and the provincial health department to organise the training and identify the best candidates for participation. We choose to focus primarily on government social workers and health care workers because they work directly with the community, visiting families and homes. They are essential to reach the most remote, hard to find individuals and they know the community better than anyone else. To successfully accomplish the national “Healthy Liver” programme goals it is essential that we share basic information about viral hepatitis with the general population, and encourage people to get tested and treated. The new Hepatitis Coordinator programme will help accomplish this sharing of information.
Visiting specialists from Saga University trained 108 participants in Töv province on December 5 and 6 2018. Participants included health care workers, social workers and health insurance inspectors from all 26 counties and the province centre in Töv. After evaluating the training in Töv province, the training was expanded to include a more interactive approach which includes videos, photos, group work and group discussions as well as pre- and post- tests to evaluate the effectiveness of the training.
We created a new training manual, pamphlets and posters for distribution to community members and community facilities. The Coordinators were given bags, vests and badges to help identify them. On June 25, 2019 in Dornod Province, 60 participants were trained to become Hepatitis Coordinators. Participants included health care workers, social workers and community volunteers from all 13 counties and the province center.
Together with Rotary International we partnered once again with Saga University to kick off “Hepatitis Free Mongolia, Phase 2” in Sukhbaatar province. We expanded the Hepatitis Coordinator programme to include the development of a mobile app that allows the Hepatitis Coordinators to manage their patients, and for us to manage the Hepatitis Coordinators. We are also supplementing the salary for the Hepatitis Coordinators, providing more extensive training and educational materials and detailed job expectations. We expect these modifications to help us successfully eliminate hepatitis C virus in Sukhbaatar province in 2022.
Top tips for success
- Our continuous community assessments over the years has led to partnerships with organisations from around the world and across all sectors. These partners have brought their expertise, new concepts and in-kind donations that have leveraged resources, saved money and allowed us to expand the programmes.
- Implementing projects within existing government systems and WHO guidelines is essential for sustainability and replicability.
- We seek comprehensive solutions to solve the problem. We almost never implement a programme the same way twice. We constantly evaluate and review our projects and make necessary adjustments to improve the impact and efficiency with new, innovative approaches for the next implementation.
Achievements to date
- Distributed 78,500 pieces of community awareness materials
- Vaccinated 3,022 persons
- Trained 3,571 health care workers
- Developed a new Hepatitis Coordinator position, training programme and a mobile app.
Leadership: The leadership in Mongolia changes frequently. Since the launch of the “Healthy Liver Program” in 2017, there have been four Ministers of Health. This makes continuity and consistency challenging. It also makes it difficult for international partners to work in Mongolia.
Funding: COVID-19 pandemic has delayed the start of our Phase 2 project and made it challenging to secure funding for non-COVID work. Mongolia has also presented to be a difficult location to fund given some of the mentioned challenges.
- Pay attention to the customs and education level of the population, as well their medical services capacity. This will inform how to most effectively reach the public.
- Never stop learning and adapting. Keep listening to the community, evaluating your programmes and adjusting the activities to improve the outcomes and reach.
- Work within the existing public, private and government programmes and systems. This leverages both time and resources of all programmes and networks, maximising efficiency and reach.