At the 5th Wonca World Rural Conference in Melbourne in May 2002, I had the opportunity to meet Dr Sodov Sonin, the Project Executive Secretary of the Health Sector Development Programme in Mongolia. This national project is sponsored by the Asian Development Bank ( ADB ). During that short meeting, Dr Sonin briefed me on the aims of the project and his view of the important roles the family doctors of Mongolia had to play for the project to succeed. We then discussed the need for close cooperation between the FPs/GPs , the Ministry of Health of Mongolia and the office of the project headed by Dr Sonin. He then extended me the kind invitation to visit Mongolia and to attend the first ever National Seminar of Family Doctors of Mongolia during which the aims and objectives of the project would be discussed in detail..

I accepted Dr Sonin's invitation with interest given the promise of family medicine in Central Asia. I had recently visited Khazakstan and Kyrgyzstan in Central Asia and left with a good sense of the health care situation in those countries. During that visit, we discussed the possibility of Wonca having a separate region in Central Asia. In an earlier conversation with Dr Sonin and Dr Yonbontsoo, President of the Mongolian Association of Family Doctors, they also had indicated their preference that Mongolian Association join the Central Asia Region of Wonca when the new region is formed. They expressed this preference in view of the common modern history, language and somewhat similar health system (inherited from the earlier Soviet era.) that they shared with the other Central Asian Countries.

My 6-day visit to Ulaan Baatar , the capital of Mongolia, to attend the national seminar and meet the various officials in the government, required me to fly via Beijing. I therefore took the opportunity to make a short stop-over to meet with the Host Organising Committee of the next Asia-Pacific Regional Conference in Beijing in November 2003. A short report of the developments of that conference will be given in the next issue of Wonca News.

The Health Sector Development Programme of Mongolia has, as its core, the establishment of numerous Family Group Practices ( FGPs ) throughout Mongolia. Each of these FGPs would be staffed by 4 - 6 well trained family doctors managing a fixed register of patients, very much like the National Health Service of the United Kingdom. The family doctors would be centrally financed with very little co-payment by the patients. The Family Group Practices are to be located in the communities and villages throughout the numerous provinces of Mongolia.

This project when successfully implemented would mean cost-effective, easily accessible and comprehensive healthcare for all of Mongolia, both in the urban and rural context. This move in restructuring the healthcare delivery system, however, requires a paradigm shift in the thinking of the policy makers, the population, the medical profession and especially the individual doctor - both FPs/GPs and specialist alike. As is the case in the other former Soviet satellite states of Khazakstan and Kyrgyzstan, medical care in Mongolia is strongly specialist based and the concept of the family doctor is hardly known or practiced. Up to recently, doctors that are brave and adventurous enough to call themselves family doctors find little understanding by their patients of what a family doctor actually is or does. There is also the constant problem of low morale and low self-esteem on the part of the FP/GP.

This First National Seminar of FP/GPs in Ulaan Baatar, was held to address these problems and to gather feedback from all the FPs/GPs throughout Mongolia on their views of the Health Sector Development Programme. Some family doctors had to travel for almost two full days on the roads to attend the event in Ulaan Battar. My impressions from translated conversations with attendees at the seminar were generally hopeful. Despite the initial difficulties they were experiencing, the FPs/GPs were very positive and willing to cooperate with the Ministry of Health and work together to ensure the success of the Programme. It was generally agreed that the upgrading of professional skills of the FGP doctors was of prime importance. This was felt by most of the attendees of the Mongolian Association of Family Doctors.

I was given the privilege of addressing the whole seminar on one afternoon. I took the opportunity to explain Wonca, its structure, mission, objectives and ties with the WHO and other medical NGOs to the attendees. The newly published Wonca -WHO Guidebook, Improving Health Systems: The Contribution of Family Medicine, was also introduced to the doctors present. I was given the honour of personally handing out about 30 copies of the Guidebook to the main FP/GP representatives from each province. There were immediate requests for a Mongolian translation of the Guidebook.

I had a better understanding of the Health Sector Development Programme and the day-to-day problems of the Mongolian family doctors when I was taken on visits to 2 urban FP/GP premises within Ulaan Baatar and 2 rural ones about 40 km outside the city. In all these centers there was strong emphasis on patient education and preventive medicine by way of posters and information leaflets offered to patients. I was particularly impressed by the over 95% coverage for childhood immunization achieved by the combined efforts of the family doctors and nurses. Many a time the errant child had to be personally traced by the home-visiting doctor or nurse. These health centers had very little equipment and simple medical instruments like the ophthalmoscopes and otoscopes were shared if available. Examining couches were improvised beds and furnishings were very basic and functional.

Despite the paucity of adequate equipments and support services, the doctors in these health centers were obviously proud of their work and the way they were looking after the health of their patients. It was a real eye-opener for me to see what doctors in developing nations like Mongolia could do with despite their modest equipment and financial resources by concentrating on primary prevention and patient-education.
In all the 4 health centers that I visited, the one common reply to my question of what the doctors there felt was most needed, was a desk-top computer for patient registration, data collection and analysis, local information net-working and especially Continuing Professional Development. In this regard, I would urge Member Organisations of Wonca to consider a special scheme of assistance to these colleagues of ours whereby still functioning desktop computers that are being replaced at home or in the office could be reconditioned and shipped to them rather than being thrown away.

In my meetings with Dr TS Sodnompil, the State Secretary of Mongolia and Dr Udval Natsag, the Vice Minister of Health , it was made very clear to me that the authorities in Mongolia strongly supported the Health Sector Development Programme and see the successful implementation of the Programme as very important in the future progress of healthcare delivery in Mongolia.

Finally, I had the priviledge of meeting the President of the National Medical University of Mongolia, Dr T. Lkhagwasuren. During the discussion, Dr Lkhagwasuren spoke of the difficult and immediate task he had of re-organizing the curriculum of the undergraduate medical course in line with the changes taking place in medical colleges of more advanced countries. He requested Wonca's assistance to help him network with some of the more advanced medical colleges in the member countries of Wonca as he was looking for possible means of information exchanges and expert assistance. Member Organisations that are able to help could contact me at the Wonca Secretariat for details of how to reach Dr Lhhagwasuren.

The final 2 days of my stay there were more relaxed as Dr Sonin and later Drs Yondontsoo and Orgil of the Association, took me out to the hills and open steppes to enjoy the scenery and witness the traditional life of the herdsmen of Mongolia famous for their horses and riding skills.

From what has been mentioned above it is very evident that Wonca , as an international organization representing the interest of FPs/GPs worldwide, can play an important role in helping developing countries realize their goal of establishing national healthcare systems based on the principles of family medicine and access to the family doctor. There are vast human resources and skills available in the worldwide 'Wonca Family". What is needed is for some Member Organisation to take the lead.