ISDS Annual Conference Proceedings 2019. This is an Open Access article distributed under the terms of the Creative Commons 

AttributionNoncommercial 4.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, 

distribution, and reproduction in any medium, provided the original work is properly cited. 

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 11(1): e395, 2019 

 

ISDS 2019 Conference Abstracts 

Legislation and policy changes for Tuberculosis Surveillance in 
Mongolia: A qualitative analysis 

Oyunchimeg Erdenee, Hiroshi Koyama 

Public Health, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan 

Objective 

In order to track progress towards TB goals, we investigated the legal framework for disease surveillance, specifically policy 

changes for TB surveillance in Mongolia during the MDGs and the SDGs era. 

Introduction 

Mongolia is one of countries in the WHO Western Pacific Region with a high TB burden. The National Stop TB Strategy 2010-

2015 implemented and developed strong surveillance and response system in the country. However, new TB incidence and deaths 

have not decreased significantly. Political commitment is critical for effective TB surveillance and that commitment can be 

demonstrated by a country’s legal framework, which governs the practice of prevention and control. Therefore, this study is aimed 

at investigating the legal underpinnings for disease surveillance to help identify what policy changes have occurred in Tuberculosis 

surveillance. 

Methods 

We conducted a literature review that included government strategy, programme guidelines and procedures, to examine the overall 

disease surveillance system in Mongolia, and used a framework analysis to investigate operation of the TB surveillance system 

(CDC 2001 guideline). First, nine of core functions and six of support functions for the TB surveillance system were placed on the 

Y axis, and the national TB strategies, programme, guidelines and procedures were placed on the X axis. Next, the strategies, 

programme, guidelines and procedures were unpacked and allocated to cells based on whether they were consistent with the 

essential functions of the surveillance system. These data points were then used to develop a matrix to enable understanding of 

correspondence and changes between the legal documents during MDGs to SDGs. 

Results 

Result 1. Mongolia has an Emerging Disease Surveillance and Response unit and A National Centre for Communicable Disease 

responsible for implementing the International Health Regulations in the country. The legal framework for the surveillance system 

was updated regularly and overall, 11 legal instruments were identified. 

Result 2. However, currently there is no specific national TB strategy since 2015. Recently, National Programme of Prevention 

and Control on Communicable disease 2017-2020 and Guidelines for TB Care 2017 were approved. The result of framework 

analysis shows that during MDGs era, the legal documents had weaknesses that were related to “feedback” from the core and 

“training and resources” from the support functions. On other hand, the weaknesses of the legal documents for SDGs were related 

to “outbreak preparedness and response” from the core and “training and supervision” from the support functions. 

Conclusions 

There is an urgency to update the legal framework to enable a comprehensive strategy specifically for TB surveillance nationwide. 

Also, additional studies should be done continuously and should incorporate other parts of the assessment, including co-ordination, 

laboratories,to help determine the factors that influence the overall structure of Tuberculosis surveillance in the country. Legal 

instruments for disease surveillance in Mongolia. 

  

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ISDS Annual Conference Proceedings 2019. This is an Open Access article distributed under the terms of the Creative Commons 

AttributionNoncommercial 4.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, 

distribution, and reproduction in any medium, provided the original work is properly cited. 

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 11(1): e395, 2019 

 

ISDS 2019 Conference Abstracts 

 

  

Number Focus Legal Instrument Type of 

document 

Year of 

document 

Purpose 

1 CD Strengthening 

prevention and control 

of hospital acquired 

infections 

Ministerial 

order #336 

1997 First complete legal document to control and reduce 

hospital acquired infection in Mongolia 

2 CD National Programme for 

Communicable Diseases 

Government 

resolution 

#129 

2002 Mid-term directions for hospital acquired infection prevention 

and control with estblishment of sentinel surveillance system 

with improved laboratory-based monitoring. 

3 CD National programme on 

prevention and control for 

Communicable Diseases 

(2017-2021) 

Government 

resolution 

#11 

2017 

(Updated 

version of 

2002) 

Reduce the spread of infectious diseases by strengthening the 

capacity of multi- sectors to strengthen surveillance, 

prevention and mitigation of epidemics, and to provide 

flexible, quality, accessible and prompt response to infectious 

diseases. 

4 CD Strengthening 

prevention and control 

of hospital acquired 

infections 

Ministerial 

order #85 

2008 Ministry of Health replaced the previous infection control 

guidelines with intention of moving closer towards 

international standards 

5 CD Emerging Diseases and 

Public Health 

Emergencies (2012- 

2016) 

Ministerial 

order # 

2012 Aim is designed to strenghten preparedness planning, 

prevention, early detection and rapid response to 

emerging diseases and other public health emergencies 

6 NCD National Programme for 

Non-Communicable 

Diseases 

Government 

resolution # 

2005 Strengthen NCD prevention, screening and risk 

management by population-based prevention systems and 

participation and cooperation of organizations, 

communities, the international community 

7 NCD National Programme for 

Non-Communicable 

Diseases 

Government 

resolution # 

2013 

(Updated 

version of 

2005) 

Strengthen NCD prevention, screening and risk 

management by population-based prevention systems and 

participation and cooperation of organizations, 

communities, the international community, 

8 NCD National Programme for 

Non-Communicable 

Diseases 

Government 

resolution 

#289 

2017 

(Updated 

version of 

2013) 

Strengthen NCD prevention, screening and risk 

management by population-based prevention systems and 

participation and cooperation of organizations, 

communities, the international community, 

9 NCD Cancer registration and 

surveillance 

Ministerial 

order #431 

2014 National programme for cancer prevention, control, and 

intervention through gathering analyzing, sharing, 

informing about new incidence or deaths of cancer 

10 Gener

al 

State Policy on Public 

Health 

Parliament 

Statement 

#81 

2001 The state policy on public health is to protect and promote the 

health of the population by ensuring the harmony of nature, 

human beings and society, to create favorable conditions for 

living and working in healthy and safe environment. 

11 Gener

al 

Health Law Law 2011 The purpose of this law is to define the state 

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ISDS Annual Conference Proceedings 2019. This is an Open Access article distributed under the terms of the Creative Commons 

AttributionNoncommercial 4.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, 

distribution, and reproduction in any medium, provided the original work is properly cited. 

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 11(1): e395, 2019 

 

ISDS 2019 Conference Abstracts 

Framework analysis for TB surveillance 

Surveillance system 

functions (CDC 2001) 

Indicator of 

the 

government 

documents 

MDG era 

Reflectio

n of the 

functions 

for 

MDGs 

SDG era 

Reflection 

of 

functions 

for SDGs 

6. Combat HIV/AIDS, malaria 

and other diseases- Halt and 

begin to reverse the incidence of 

malaria and other major 

diseases. 

Goal 3.3 By 2030, end the epidemics of 

AIDS, tuberculosis, malaria and 

neglected tropical diseases and combat 

hepatitis, water-borne diseases and other 

communicable diseases 

(2000-2015) (2015-2030) 

I.Core functions 

National 

Programm

e for 

combating 

Communi

cable 

disease 

National Strategy 

on TB (2010-2015) 

Criteria 

results 

National 

Programme of 

Prevention and 

Control on 

Communicable 

disease 

Guideline for TB 

care / Minister 

order A/306 
Criteria 

results 

(2002-

2010) 
(2017-2020) (2017)) 

1.Case detection 

Purpose 

To reduce 

the 

prevalence 

and 

mortality 

of 

tuberculosi

s by 2010 

by 

introducing 

a direct 

short-term 

treatment 

at all levels 

of health 

services 

Eliminate TB in 

Mongolia defined as 

an incidence rate of 

fewer than 1 case 

per 1,000,000 

population 

yes 

Combat the spread 

of communicable 

disease prevention 

and response, to 

strengthen inter-

sectoral cooperation 

and cooperation, 

and to establish a 

healthy behavior for 

infectious diseases. 

1.Management and 

organization of 

tuberculosis care 

2.Detection, 

diagnosis and 

treatment for drug 

sensitive TB 

3.Detection, 

diagnosis and 

treatment for drug 

resistant TB 

4.Detection, 

diagnosis and 

treatment for co-

infection of TB and 

HIV 5.Routine 

detection and 

control of TB 

contacts 

6.Guidelines for TB 

control and 

prevention 

7.Management 

guideline for supply 

of essential 

products for TB 

care 

yes 

2.Case confirmation yes 

8.Procedures for 

registration and 

reporting of 

tuberculosis 

yes 

3.Case registration yes   yes 

4.Case reporting yes   yes 

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ISDS Annual Conference Proceedings 2019. This is an Open Access article distributed under the terms of the Creative Commons 

AttributionNoncommercial 4.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, 

distribution, and reproduction in any medium, provided the original work is properly cited. 

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 11(1): e395, 2019 

 

ISDS 2019 Conference Abstracts 

5.Data management 

Goal 

To increase 

the level of 

verification 

of 

diagnosis 

of 

pulmonary 

TB up to 

75 percent; 
By 2015, reduce TB 

prevalence to 154 

per 100,000 By 

2015, reduce TB 

mortality to 15 per 

100,000 

yes 

By 2020, reduce TB 

prevalence to 158.9 

per 100,000 By 

2020, reduce TB 

mortality to 6.5 per 

100,000 

  

yes 

6.Data analysis 

To increase 

level of 

recovery 

for 

pulmonary 

TB 

incidence 

up to 90 

percent 

yes 

  

yes 

7.Outbreak preparedness   yes   no 

8.Outbreak response 
  

yes 
  

no 

9.Feedback   no   yes 
II.Support functions   

1.Guidelines 

Objectives 

Sub-

program on 

Tuberculos

is Control 

and 

Prevention 

1.Strengthen human 

resources, 

organization, and 

management of the 

Mongolia TB 

programme 2.Early 

detection and 

improve quality of 

DOTS services. 

3.Early detection 

and timely, 

appropriate 

treatment of 

multidrug resistant 

TB (MDR-TB). 

4.Overcome stigma 

and discrimination 

5.Ensure equitable 

access to quality TB 

services for all 

people 

yes 

1.Stabilize active 

screening of 

tuberculosis in the 

community; 

2.Introduce new 

techniques and 

technologies for TB 

diagnosis and 

treatment; 3.Provide 

diagnosis and 

treatment of 

tuberculosis with 

continuous 

medicines, reagents 

and test kits; 

4.Increase the 

capacity of doctors, 

specialists, and 

human resources to 

provide health care 

services in 

  

yes 

2.Laboratory capacity yes yes 

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ISDS Annual Conference Proceedings 2019. This is an Open Access article distributed under the terms of the Creative Commons 

AttributionNoncommercial 4.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, 

distribution, and reproduction in any medium, provided the original work is properly cited. 

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 11(1): e395, 2019 

 

ISDS 2019 Conference Abstracts 

3.Supervision 

Strategies and 

activities 

1.1 Advocacy to 

improve political 

commitment and 

development of 

supportive policy 

environment, 1.2 

Strengthening 

information, 

monitoring and 

evaluation system, 

1.3 Strengthening 

human capacity, 

yes 

tuberculosis, and 

create conditions 

for them to 

maintain their 

employment; 

5.Strengthen TB 

surveillance system 

and expand research 

and research. 

6.Organize 

advocacy work for 

policy makers and 

decision makers at 

the national and 

local levels to 

reduce 

tuberculosis;Involve 

governmental and 

non-governmental 

organizations in 

social and 

psychological 

support for clients; 

7.Increase access to 

TB services through 

expanding 

community-based 

activities; 

Improving the 

prevention and 

control of infectious 

diseases of the 

health organization 

and creating a 

client-friendly 

environment; 

8.Collaborate with 

the media to 

intensify the 

activities of 

providing health 

education to 

citizens and 

strengthening the 

right knowledge 

and attitudes. 

no 

4.Training 

2.1 Early detection 

and treatment 

through 

strengthening 

laboratory services 

and other means 2.2 

Support patients 

through treatment 

2.3 Strengthening 

TB drug 

management 2.4 

Engagement of non-

NTP providers in 

TB control (Public-

Private Mix DOTS) 

2.5 Improving 

coordination of 

TB/HIV 

collaborative 

activities 3.1 

Expand 

programmatic 

management of 

MDR-TB 4.1 

Behavior change 

communication 5.1 

Improve access to 

DOTS in peripheral 

areas 5.2 Expansion 

of services for 

vulnerable 

populations 

no no 

5.Resources   no yes 

 

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