Mongolia needs more pediatricians

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About 37 percent of the population is under 18 years of age in Mongolia. Specifically, 31.2 percent of the population are children aged zero to 15, with the majority being children up to nine years of age, according to a study by the Health Development Center. The number of children is expected to increase steadily until 2045, according to the National Statistics Office of Mongolia. Even though fertility rates have fluctuated in the last 15 years, researchers also predict that the number of births will also rise. In 1990, the birth rate was 35.3 per 1,000 people, but it decreased to 17.8 by 2005. The figure has been growing steadily since 2006 and reached 24.5 in 2018. The rising number of children in Mongolia highlights the need to improve and increase the quality and accessibility of future child medical services more than ever. Unfortunately, there are only 741 professional pediatricians in the nation can provide medical care to infants, children, adolescents. The government is still talking about reducing child mortality and meeting the Sustainable Development Goals, even though nothing has been done about training more pediatricians. For instance, one of the goals of the Mongolia Sustainable Development Vision 2030 is to reduce infant mortality by the age of five to 15 per 1,000 live births. Also, officials highlighted that deaths per 1,000 live births will be reduced to eight or nine by 2030. 

Let's look at international data. About 26 percent of the world's population is children, 23 percent of the US population is children and approximately 16 percent of most countries of the European Union are children. Mongolia’s neighboring countries China and Russia prepare professional pediatricians for their children through policy. The child mortality rate is less than 5.5 per 1000 live births in Russia and eight in China. This means they pay special attention to raise their children in healthy and safe. These countries employ the most qualified physicians for children’s health care and don’t lack in professional pediatricians.

In 2018, the mortality rate for children under five years old was 16.9 per 1,000 live births, and the death of an infant was 13.4 per 1,000 in Mongolia. Compared to 2010, these figures decreased significantly. But Mongolia has to work harder to achieve international standards. According to a study by the National Center for Maternal and Child Health, about 771 infants, 1,315 children aged one to eleven months and over 1,500 children aged between one to five years died between 2013 and 2017.
In other words, Mongolia lets more than 3,000 children under five years of age die each year. What’s worse is the knowledge that more than half died of treatable diseases. Specifically, 400 to 500 children die from pneumonia each year. Joint research of Mongolia's National Center for Public Health and the United Nations Children's Fund Mongolia Country Office shows that child illnesses and mortality will increase and medical costs are predicted to increase by 33 percent by 2025 if we fail to take action. Hundreds of children die of influenza and similar diseases, but the only government response is increasing beds at hospitals. 

Nationwide, about 70 percent of all patients of family clinics and soum hospitals are children and infants, but these health organizations lack specialized pediatricians. There are only one or two specialized doctors for children in district hospitals. The only advice they give out is, “Support your baby's immunity and give them curds and sea buckthorn.” Associate professor and geneticist at the National University of Mongolia J.Khulan said, “Most pediatricians seem to find no reason for a cold or flu. For example, when people ask how to protect themselves from the flu virus, many doctors recommend improving their immunity. But supporting immunity alone cannot prevent colds and flu.” J.Khulan highlighted that everyone's immune system is different. “Many doctors advise using some kinds of medicine to support the immune system. But I wonder if they know that such medicines should only be used when a child is sick.”

A pediatrician must study the anatomical and features of a child's body because the stages and standards of treatment for children are different from adults. Even when using antibiotics, the dosage is calculated individually, accounting for the age and body weight of the child. With the slightest mistake, the treatment can fail and the child will suffer more. The National University of Medical Science started preparing pediatricians in 1946, but the program stopped in 1996 due to unclear reasons. 

Heads of the medical sector explained that pediatricians can be prepared after university graduation within two years. Between 1946 and 1996, 2,000 pediatricians were prepared, but there are only 741 professional pediatricians working in
hospitals nationwide. Only 200 pediatricians were prepared since 2008. The National University of Medical Science reported that they started classes for pediatricians in 2019, but no one has taken the class as of yet.

In Mongolia, the main reason for a high child mortality rate is the lack of professional pediatrician and poor quality of medical service. Mongolia’s the health sector hasn’t been preparing pediatricians for 24 years, which is appalling. A serious look and care for the health of the future generations of our nation are needed to prevent further child deaths.

Enkhnaranjav Tumurbaatar