Transparent Procurement Process for Healthcare (MN0035)

Main objective:
To receive high quality healthcare service fitting with citizens' needs through the clients/service providers and enable information transparency.

Brief description of commitment:
- Convert the contract that health insurance agency makes with health service providers to performance and outcome based active contracting;
- Renew healthcare service standards, guidelines and instructions in line with healthcare technology,citizens needs and scientificevidences
- Involve CSOs to take part in procurement process and tender evaluation as well as reporting procurement results
- Improve information transparency related with health insurance fund generation and spending and fully transform healthcare financing system to citizen oriented digital information system

Ambition:
High quality, affordable and demand driven healthcare service provided and mortality and morbidity decreased by improving and strengthening strategic procurement

Milestones:
1. Convert the contract that health insurance agency makes with health service providers to performance and outcome based active contracting
2. Renew healthcare service standards, guidelines and instructions in line with healthcare technology,citizens needs and scientific evidences
3. Involve CSOs to take part in procurement process and tender evaluation as well as reporting procurement results
4. Improve information transparency related with health insurance fund generation and spending and fully transform healthcare financing system to citizen oriented digital information system

1. Improve the strategic procurement process for healthcare service, make quality monitoring transparent

Main Objective

To receive high quality healthcare service fitting with citizen’s needs through the clients/service providers and enable information transparency.

Milestones

1. Convert the contract that health insurance agency makes with health service providers to performance and outcome based active contracting.
2. Renew healthcare service standards, guidelines and instructions in line with healthcare technology, citizens’ needs, and scientific evidence.
3. Involve CSOs to take part in procurement process and tender evaluation as well as reporting procurement results.
4. Improve information transparency related with health insurance fund generation and spending and fully transform healthcare financing system to citizen-oriented digital information system.

Editorial Note: For the complete text of this commitment, please see Mongolia’s action plan at https://www.opengovpartnership.org/wp-content/uploads/2019/12/Mongolia_Action-Plan_2019-2021.pdf.

Commitment analysis

This commitment aims to reform Mongolia’s health insurance financing and improve citizen access to high quality healthcare services. It aims to do this by increasing transparency and involving civil society in healthcare-related procurement and financing processes. The Ministry of Health and Ministry of Finance are responsible for the implementation of this commitment, in collaboration with relevant professional associations, healthcare-related CSOs, and the Mainstreaming Social Accountability in Mongolia (MASAM) project.

The action plan notes that the existing healthcare procurement and financing process is unsatisfactory due to a lack of transparency. ^[1] Specifically, at the time the action plan was developed, citizens did not have access to critical information on how healthcare institutions allocate and spend their budgets, even though such institutions are funded by public funds, through health insurance premiums and taxes. In 2018, the government allocated around 5.2 billion Mongolian Tugrik (MNT) (i.e. around USD 1.8 million) for primary healthcare. In 2019, the budget was increased threefold to 15.6 billion MNT (around USD 5.5 million). ^[2]

A review of Mongolia’s healthcare system published by the World Health Organization (WHO), ^[3] found that despite sustained funding, legal mandates, ^[4] the introduction of healthcare reforms, ^[5] and consistent improvements in health-related indicators, there remains a multitude of problems with the overall quality of care and efficiency. According to these reports, healthcare suffers from deficiencies in several areas, such as diagnostic capacity, essential medicines supply, and equipment availability. ^[6] The reports confirm that the lack of transparency and citizen involvement in healthcare financing contribute to these deficiencies. ^[7]

This commitment is relevant to the OGP value of access to information as it proposes to improve the transparency of information related to health insurance budget allocation and spending by developing a digital information system. It is relevant to the OGP value of civic participation as it aims to involve civil society in the healthcare procurement and financing process.

This commitment is generally verifiable with measurable activities and milestones, such as the revised standards and guidelines, and information uploaded on a digital information system. However, the commitment does not specify the extent of information that will be made available on the proposed system, or the mechanisms of civil society participation in the procurement and tender process.

If fully implemented as written, this commitment stands to have moderate potential impact on the transparency and effectiveness of healthcare financing. Prior to this commitment, citizens and civil society could not influence healthcare financing, procurement, or tender decisions, or even access information related to health insurance budget allocation. This commitment would thus represent a significant improvement from the status quo.

The success of this commitment, however, depends on citizens and civil society being empowered to contribute meaningfully to decision making, and sufficient and relevant information being made easily accessible to inform this process. As the commitment does not outline clear measures to ensure this, the full scope of this commitment is difficult to assess. The commitment also proposes to renew healthcare service standards, guidelines, and instructions. While this may serve to institutionalize and sustain civil society participation in healthcare financing, key legislation, such as the Law on Citizens’ Health Insurance 1994 would also have to be amended to reflect and give full effect to these changes.

Going forward, the Ministry of Health could consider broadening the spectrum of citizen participation and taking a more customized approach in safeguarding participation of vulnerable groups, such as people with disabilities, people in rural areas and in poverty, and gender and sexual minorities. Additionally, the mechanism for involving CSOs in the procurement process and tender evaluation needs to be clearly formulated and operationalized.

1.Improve the strategic procurement process for healthcare service, make quality monitoring transparent

Limited:

The Health Ministry approved a total of 16 standards and 15 instructions on care and services in 2019. [1] Parliament also passed amendments to the Health Insurance Law of Mongolia, the Health Law of Mongolia, and the Medicine and Medical Devices Law of Mongolia in August 2020, creating a legal framework to increase public funding for government-backed health insurance. [2] However, the government self-assessment report does not report any progress on converting contracts between health insurance and providers to performance and outcome-based active contracting. It also does not mention involving CSOs in procurement monitoring. [3] The commitment was in collaboration with the World Bank-funded Mainstreaming Social Accountability in Mongolia (MASAM) project, which did not record any progress beyond early 2019. [4] World Vision, the initial developer of the commitment, phased out involvement during implementation, but the Health Ministry did not subsequently take ownership.