Financing of Non-Communicable Diseases Prevention in Low- and Middle- Income Countries: Mongolia Case Study

Objective: Prevention programmes are increasingly seen as critical for tackling the rising burden of noncommunicablediseases (NCDs), but tend to be under-prioritised and under-funded, particularly in low- and middleincomecountries. The objective of this study is to estimate spending on NCD prevention in Mongolia and identifythe enablers, challenges and dynamics underpinning population-level NCD prevention spending, with particularfocus on tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity.Methods: Primary and secondary data collection was used to examine processes and organisational contexts thatshape the formulation of policy and financial frameworks for NCD prevention. The methodology was categorisedinto three tiers; an academic literature review, scrutiny and analysis of official policy documents and budgetary dataon health and NCDs, and in-depth stakeholder interviews with key government officials leading NCD programmes.Government and government-routed donor spending on population level prevention was gauged to estimate NCDprevention spending. Where possible, impact of prevention programmes on disease incidence and risk factors wasgauged through available outcome indicators.Results: Mongolia allocated an estimated MNT 10.5 billion on NCD prevention and health promotion in 2017, outof which population-level NCD spending accounted for MNT 5.1 billion (just over 1% of overall government healthspending). Enablers include tobacco taxation and regulation, earmarking unhealthy consumption through theHealth Promotion Fund and strengthened salt intake policies. Challenges include excess allocations towardsinpatient and specialist care, inadequate multi-sectoral action and stewardship for NCDs, food and beverageindustry interference in policy and limited alcohol regulation and tax.Conclusion: Mongolia has made considerable progress in formulating policies for NCD prevention, but spendingon NCD prevention still remains barely more than 1% of government health spending. Increased allocation ofresources towards population-level NCD prevention can both help address the growing NCD burden and bringsubstantial economic benefits.Keywords: Noncommunicable Diseases, Tobacco, Sodium Chloride, Dietary, Employees, Incidence, Inpatients,Behaviour, Risk Factors, Diet, Resource, Tobacco, Beverages, Taxes, Financial Management