Health and Social Welfare

Age groups of the population

By the end of 2002, Mongolia ’s population reached 2.475.400, an increase of 1.4 percent compared to the previous year. Currently, 49.6 percent of the population is male and 50.4 percent is female. In 2002, the percentage of population aged under 15 years was 32.6, aged 15-64 years 63.9 and aged 65 years and over was 3.5. Population in labor age reached 1.402.800. Due to the decrease in the birth rate, there were some considerable changes in age structure of the population.

The indication of the population sex ratio was much different in 2000, compared to 1999. For instance; the percentage of children between 0-14 in total population decreased, the percentage of 15-19 year olds increased, while the percentage of those aged 15-24 has no changes. In particular, the percentage of those aged 35-44 dramatically increased more than other groups.

Population growth considerably decreased during the last decade. Annual population growth stood at 3.6 percent in the 1970s; however, it was at 1.4 percent in 2000. Researchers worry that if the decrease continues in the next few years, it will be at 1.35 percent in 2010 and 0.91 percent in 2025, which may bring bad results for the reproductive ability of population.

The percentage of children between 0-14 in the population decreased by 13.8 points, while the percentage of elders tended to increase by two times. Ulaanbaatar city has a younger population, and the eastern part of Mongolia has an older population.

The growth of population in labor ages increases. Even if the increase reduces social burdens in population structure, it also affects Mongolia ’s current situation by increasing unemployment. The employment level is intending to be increased by means of promoting the economic growth in recent years.

Households and marital status

According to the population and housing census in 2000, Mongolia has over 550.000 households, which increased by 26.5 percent or 113.300 households against the previous decade. 54.8 percent of total households live in urban places, while 45.2 percent live in rural areas. During the current decade, t he number of rural households increased by 27.3 percent. The number of single people in marriage age is increased by 25.3-33 percent in 1989-2000. Specialists conclude that it is connected to the improvement in women’s educational achievements.

Young families in urban areas often have problems concerning dwellings, whereas, in rural areas they lack improvements in education, health service and information communications. In order to cope with these problems, the Government decided at its regular meeting on May 7, 2003 to announce 2004 as the Year of Promoting the Family.

Migration of the population

During the early years of Mongolia ’s market economy, migration from urban places to rural areas was dominant. However, due to dzud and drought natural disasters occurring frequently in the previous five years, migration from rural areas to urban places has increased, especially migration of herders who lost animals in the natural disasters, which dramatically increased. Along with the natural disasters, factors including insufficient quality of education and health services, and lack of work positions in rural areas, as well as others, led them to migrate. In the 2000 census, 491,806 people or 20.7 percent of the total population were covered in migration.

During the past five years, 65 percent of migrants have settled in Ulaanbaatar . The migrants make up 14 percent of Ulaanbaatar ’s population. Due to the centralization of population, 32.5 percent of the total Mongolian population lives in the capital city.

As Mongolian foreign relations and international cooperation have widened in recent years, Mongolians migrate abroad with the purpose of studying and working.

The country, that only 16 years ago used to screen anyone who was traveling abroad, today has the most traveled people in the world. Some 300,000 Mongolians or 12.5 percent of total population travel abroad each year.

Employment

Unemployment remains the Government’s main concern and a primary cause of poverty. The extreme severity of the last three winters revealed the vulnerability of the rural economy and accelerated the migration of people seeking better access to social services and employment opportunities from the remote aimags to urban areas, particularly to Ulaanbaatar .

Thanks to the laws on labor, the Law on exporting and importing of labor forces, passed in 2002, and the establishment of funds to support employment, the labor market is showing a good tendency to improve.

The National Program on Employment Promotion was passed in 2002 and the National Conference on Employment was held, which were significant steps in defining the outlook of labor market policy.

In addition, a law on vocational education was newly adopted. Because of experimental implementation of a program in collaboration with the United Nations Development Program (UNDP), preconditions for building of a structure of vocational training were set up.

Comparing 2002 to 2001, basic indication of Labor market showed a positive tendency. For instance, unemployment in 2000 had fallen to 3.6 percent in 2002.
At the end of 2002, there were 30,900 unemployed registered in employment offices, with a decrease of 23.5 points or 9,504 unemployed compared to 2001. 8.8 percent of the total unemployed are the higher educated, 11.9 percent are vocational, 31.3 percent are secondary school educational, 4.9 percent are primary educational and 0.7 percent are the non-educated and the rest are other categories.

54.3 percent of unemployed are women. According to the age groups of unemployed, 25.4 percent of them are between 16-24, 34.3 percent are between 25-34, 30.1 percent are between 35-44 and 10.3 percent are above 45 5.0 percent of the registered unemployed are poor, 38.3 percent are the extremely poor, 26.9 percent have 3 or more children and 0.8 percent are the disabled. The Fund for supporting employment accumulated 1850.9 million tugrugs in 2002.

78.8 percent of the accumulated money came form payments of organizations, importing employment forces from abroad, 13 percent from the state budget, 5.4 percent from local budgets and 2.8 percent from other incomes.

Local governors accumulated money of about 100 million tugrugs in the sub funds for supporting employment in aimags and districts.

Money from the funds is spent commonly on building work positions, vocational training and supporting employment granting small loans.

By the end of 2002, 8.075 foreigners from 66 countries were allowed to work in 481 foreign organizations in Mongolia . About 33.7% of the foreigners work in mining, 24.5% in construction and communications, 12.6% in refining, and 5.2% in the educational sector.

The State often supports the labor of disabled people and takes many kinds of measures.

In 2002, 328 disabled people were involved in vocational training; bakery, and sewers as well as others and 771 disabled were provided with work positions.

Social Welfare

An extensive system of social protection existed in pre-reform Mongolia , characterized by features typical to a centrally planned economy, including price subsidies; generous pension benefits and family allowances; universal free health care etc.

The structure of social welfare reformed in recent years. On January 1, 1995 , Laws that reformed the social insurance system came in to effect. As outlined in the Social Insurance Law, fund-comprising pensions, benefits, compensation for job-related accidents, and unemployment funds was established, as well as a new State Social Insurance Agency consisting of representative of the Government, employers, and employees.
Today about 14.00 employers, 545.900 individuals (83.500 of which are volunteers) pay insurance fees. Along with this 91.4 percent of the Mongolian population has been involved in health insurance. Insurance fees for 1.4 million of the population are granted by the government, which spends annually 90.3 million tugrugs on pensions and treatment of insurance fee payers.

Prior the recent reforms, pensions were paid by the state budget of Mongolia . However, the Parliament passed fundamental guidelines on the reforms for pension to be followed until 2021. In this context, measures to introduce the pension insurance’ accounts as the first stage of reform for pensions is now undertaken.

A social welfare service, apart of social security, has tow basic directions; social welfare and care services for social vulnerable groups. There were five laws on the social welfare pensions and care services in Mongolia . Those were renewed, amended and passed by the parliament of Mongolia in 1998 and came in to affect of January1, 1999. The state social welfare organization has had today’s joint structure; State Social Welfare Office, Social Welfare Centers in districts, social welfare and care service center in aimags and social workers in soums, with 830 employees.

Social welfare centers serve 115.400 people. Along with the services, Social Safety Funds supports relief centers that provide free lunches for the poor and centers for homeless people. Money being spent by the social welfare fund reached 17.5 billion tugrugs by the end of 2002.

A project Social Welfare Sector Development Program will be implemented for five years. The project will be financed with loan worth at $16 million. $8 million of hat is intended to spend for making policy reforms in social welfare sector and another $8 million has been projected for modification of structure and services of social welfare organizations.

The Government intends to make the protection of the poor consistent with the market economy through promoting such employment of local enterprise promotion centers; the creation of income-generating and employment opportunities for women; development of small-and medium-sized enterprises for processing and marketing of agricultural products; restocking the herds of poor families, who do not have an adequate number of livestock etc.,

Under existing legislation, the minimal subsistence level of the population should e determined at least once a year. According to information release at the end of April 2003, the lowest subsistence level was established at 19.500 tugrugs for the western region, at 20.500 tugrugs for eastern, at 29.800 tugrugs for the central regions and at 25.300 tugrugs for Ulaanbaatar.

Health sector

The population health status was dramatically improved in Mongolia in the 20th century. Within this period of time infant mortality had decreased by 16 times, while maternal mortality had experienced almost a 100-fold decline, and such communicable diseases as louse-born epidemic typhus, genital lymphgranulomatosis, smallpox and poliomyelitis were eradicated, predetermining an almost four-fold increase in population number, and improvement in population health. Although such profound changes have been associated with a number of socioeconomic factors, they have been unbreakably bound to the contemporary science-based health sector development in Mongolia , while the first hospital was established only in 1924 with 3 health workers and 15 beds.

Before the 1990s, the health system was state owned, and centrally run with financing from general government revenues. Health care was free of charge at the point of delivery. The system was very much reliant on curative services, very resources intensive, based upon high bed numbers and large numbers of medical personnel. Despite many achievements, including improved equity and access to health care and control of communicable diseases, there were weaknesses, including low efficiency and a lack of sensitivity to consumers’ rights.

The acute economic distress associated with the transition after 1990 severely affected the health sector. The system experienced a major loss of resources, which led to some inevitable deterioration of health services. However, the Mongolian government has not reduced its policy commitment to the equitable provision of services and it has re-assessed its strategies in the light of experiences of transition. Therefore, the health sector ownership and financing has been diversified, a health insurance scheme and a policy shift toward greater emphasis on primary health care has been introduced in the early 1990s. In accordance with the recent amendment in the Health insurance Law, the Scheme covers some outpatient services and hospital services however, the insured make co-payments from 5-15 percent depending on the level of hospitals. The family group practice (FGP) model was introduced since 1998 by the Health Sector Development Program with the support of ADB to provide primary health services free of charge to the population. Family doctors were reorganized in to private group practices, with guarantees of income through risk-adjusted capitation payments form the government. In 2002, the FGPs covered 940 family doctors. The National Public Health Policy was adopted in 2001, establishing a long-term framework for public health.

The health status of the people in Mongolia is relatively better than that of an average low-income country. There have been improvements in child mortality in spite of the difficulties of transition. Infant mortality decreased form 63.4 to30.4 per thousand live births between 1992 and 2002. Maternal mortality has been relatively stable at about 161 per 100.000 live births over the last decade and it reached the lowest rate of 124 in 2002. Mongolia historically has a strong commitment to immunization, which is evident from the high coverage rates (over 90 percent for tuberculosis, DPT, measles, hepatitis B, and polio). The country is undergoing an epidemiological transition characterized by a decline in communicable diseases and a rise in non-communicable diseases in total mortality. The leading causes of mortality form 1995 up to the present are disease of the circulatory system, cancer, accident and injuries.

Despite successful efforts, the health sector is facing problems related to the deepened marginalization of some of the population, internal migration and the number of homeless people as well as poor living conditions, which are causing the increase of poverty-related diseases such as TB and STDs. In addition, there are problems of unequal health status and access to health services between the rural and urban populations, and between different income groups, high maternal and child mortality, despite recent improvements.

The health sector comprises of 17 specialized hospitals and centers, 4 regional diagnostic and treatment centers, 12 district and 21 aimag general hospitals, 323 soum hospitals, 18 veterinary posts, 233 family group practices, and 536 private hospitals and 57 drug supply companies/pharmacies. In 2002, the total number of health workers was 33273, of which 6823 were doctors, 788 pharmacists, 7802-nurses and 14091 mid-level personnel. At present, there are 27.7 physicians and 75.7 hospital beds per 10.000 population overall.

A large portion of the health budget is still spent on curative services. There are weaknesses in hospital services: inefficiency, patient dissatisfaction, outdated treatment protocols and equipment. Since January 2002, the government started to implement the Public Sector Management and Finance Act, a new phase of health system organization and financing with output based funding. The successful implementation of the new regulations is an immediate challenge to increase cost-effectiveness and greater responsibility of health organizations in the country.

Housing and Community Service

The urbanization process intensified from the 1960s in Mongolia and today, 57 percent of the population or 1.34500 citizens live in Ulaanbaatar and 43 percent live in rural areas. 49.1 percent of the population lives in ger districts. The square per capita living in apartment is 6.7 quadrate meters in Ulaanbaatar and 56 quadrate meters in rural areas, which are lower than the international standard by twice.

81.6 percent of households with apartments live in private houses and 16.6 percent live in state-owned apartments.

67.3 percent of the total Mongolian households, comprising 94.5 percent of Ulaanbaatar households and 34.3 percent of rural households, have been linked to the energy source. 44.4 percent of total households live in an apartment with centralized heating. 54.8 percent of Ulaanbaatar citizens live in apartments with centralized heating, while 2.5 percent of rural citizens live in apartments with centralized heating and 39.8 percent with cold and hot water. As of the population and housing census in 2000, about 18.000 households live in apartment sharing with others, as they have no apartments. Every year about 10.00 couples got married, which increases the number of households without apartments.

Therefore, it is a necessary to build apartment covering over 80.000 square meters in order to provide for households without apartments. It requires investment worth 150-220 billion tugrugs. In 2002, the housing stock reached 6663.0 thousand square meters, and increased by 1.6 percent compared with the previous year, that is 103.2 thousand square meters housing were put into operation in the fiscal year /by living areas/, 89.9 percent of newly constructed buildings were private houses and apartments. In the same year, number of pumps and transport means for distribution of the water supply were increased by 85 and 17.003, and reached 883 and 232.037 respectively. The Asian Development Bank funded Loan Project for housing, now being implemented, supports the building of stable housing structures in Mongolia . The project is implemented by Golomt Bank and it has been authorized to issue loans worth 31 million tugrugs in the first stage of the project.

The Citizen’s Representatives Meeting of Ulaanbaatar launched 2003 as the Year of Investment and Construction. Construction worth 94 billion tugrugs will be carried out throughout the city during the year with a focus on building apartments. The Kyokushuzan development foundation will build 1000 apartments and Tsast Impex Company will build the “New Morning” apartment complex. In additional, 1400 flats will be built in the Moscow district. The joint Mongolian-Chinese Bogda Holding company is planning a model residential district in the Rail Road area, where three apartment blocks for 186 families will be finished soon.

Care for Children and Youth

As of the population census 2000, 46.6 percent of Mongolian population consists of children under the age of 18. Mongolia has joined international legal documents regarding the protection of children’s rights. A law on the protection of children’s rights was passed in 1996. During the current decade, educational programs have been implemented which have substantial effects and improvements for educational services and protection of children’s right to education. School age children cover 21 percent of Mongolia ’s population.

There are many organizations for children, including Mongolian Scout Union, Mongolian Youth Union, “One World-Adolescents” and Red Cross of Youth, International Children’s Camp “Nairamdal” as well as other local organizations. The Children” Book Palace is inaugurated in Ulaanbaatar in May, 2003

The Scout Association of Mongolia is the biggest youth NGO in the country. At the present, there are 9000 scout members and more than 56.000 young people have gone through the scout ranks. Over the last eight years, about 1.500 Mongolian youths have participated to the several international scout activities, such as international camps, Jamborees, Youth Forums, exchange programs and scout gatherings in 22 different countries. Beginning in 2002, National Program to Improve Development and Protection of Children is being implemented, which runs until 2002-2010 with three stages.

Youth. About 40 percent of Mongolia population is between 16-35. In forthcoming 25-30 years, Mongolia is expected to be in the first 15 countries, with its percentage of youth in the population. Almost 93 percent of total youth are literate, 33.5 percent secondary school education, and 16.8 percent are vocational and tertiary. Every year 50.000-60.000 youth transfer to the labor market, but 60 percent of them have now jobs and schools.

Over 15.00 youth, who just graduated from the secondary schools, are registered in the labor markets. According to the Ministry for Education, Culture and Science, 35 percent of youth age 18-22 attend the tertiary education and a total of 56.906 students study at state-owned and private universities, institutes and colleges. 34.706 or 60.9 percent of those are female students are the rest 22.200 or 39.1 percent are male. 12.177 students study in vocational or technical schools. Mongolian youth commonly marry at 20-24.

The role of Women in Mongolia society

The 50.5 percent or 1.232.800 of Mongolia population is women. About 61.300 women of those head the family. The educational achievement of women is improving year by year. To date, 11.8 percent of Mongolian parliament members, 9.1 percent of deputy ministers, 16.9 percent of chiefs of agencies and organizations, 4.5 percent of presidiums of Citizens Representative Meetings of city and aimags and 3.3 percent of governors of aimag and districts are women. In recent years, the percentage of tertiary women has increased from 55 percent to 65.4 percent.

The National Program for Advancement of Mongolian Women (NPAW) adopted by the Government in 1996 represented progress in advancing women’s status in Mongolia . In addition, a National Program to Satisfy Gender Equity will be implemented from 2003 until 2020 to build a comfortable environment so tat women can equally participate in social development and equally receive the fruits of social growth.

As for employment, 64.5 percent of workers in educational sector, 71.3 percent of workers in the social welfare sector and 63 percent of judges are women. The unemployment level of women stood at 18.2 percent as of the 20000 population census. Mongolia has joined around 20 international agreements on Human Rights and one is the UN Convention on eliminating all forms of discrimination towards women.