Can nationwide early screening achieve desired results?

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The government of Mongolia plans to conduct a nationwide early screening, testing, and diagnosis of common communicable and non-communicable diseases based on age, gender and health risks from May 1. This has created expectations among citizens that they will be covered by free medical examinations. The biggest concern is whether the program will be implemented efficiently and bring enormous socioeconomic benefits to society as anticipated.

This is not the first time that an early screening program has been implemented in Mongolia. In 2018, the country covered its citizens with preventive medical examinations with funding from the Health Insurance Fund. However, it failed to meet even 10 percent of the target. In other words, citizens’ participation was very low. In this year’s state budget, 60.8 billion MNT has been allocated from the Health Insurance Fund for the nationwide program.

The Ministry of Health believes that early detection, screening, and diagnosis will reduce cancer-related deaths by 35 to 69 percent based on an estimate by the World Health Organization. Citing the organization, Health Minister S.Enkhbold stated that 11.2 to 12.3 million MNT is estimated to treat a very sick person but only 150,000 MNT is required per person for early detection, testing and diagnosis.

Of course, it is good to aim for early detection and treatment before a patient’s condition worsens. However, the fact that only the primary stage (screening and diagnosis) costs a large sum of money means that the government will have to spend much more money on the next stage (health care and treatment).

More than 60 billion MNT is enough money to build several hospitals and schools, and save many people and children who are seriously ill and need medical treatment abroad. The public is worried about the risk that such a huge sum of money will be “wasted” in the name of early detection, testing and diagnosis. 

This is not a groundless concern. Mongolia took similar measures several times before and wasted billions of tugrug. In 2006, for instance, when L.Gundalai was the minister of health, the National Program for Healthy Mongolians was approved under a government decree. At that time, more than 3 billion MNT was spent on the program, which aimed at providing prompt and high-quality medical examinations. If the program had been effective and resumed, the number of Mongolians dying from cancer, cardiovascular disease and non-communicable diseases would have been lower than it is at present.

In 2012, the Healthy Mongolians Program was also launched and a number of activities were organized to improve public health. Unfortunately, 10 years later, Mongolians are still not healthy. On the contrary, the number of diseases among the population is growing and the workload of hospitals is getting out of control.

The government offered early screening, testing, and diagnosis throughout the country in 2017. Within this scope, the government signed contracts with private laboratories and through them, provided three sets of medical tests to insured persons aged 40, 45, 50, 55, 60 and 65. There are no data on how many people of this age were screened and how they managed to prevent potential health risks.

In the same year, the National Healthy Liver Program was implemented with a budget of 226.2 billion MNT. It can be said that many people fell victim to it because the program began without any preparation. In other words, substandard laboratories failed to get accurate results from medical tests, diagnosing people without the hepatitis B virus with the virus and infected people as healthy. In general, the program funded a number of private organizations, but it did not benefit citizens as much as anticipated.

Following this, the government carried out the Healthy Teeth -- Healthy Children Program in 2018. The program was well-received by the public, but was suspended due to insufficient funding. It is also unclear whether the program achieved any results. 

From this, we can see that the government initiated many ambitious health programs and activities, but failed to produce results and wasted public money.

QUALITY AND ACCESSIBLE TREATMENT IS ESSENTIAL

A few days ago, one of my friends died of cancer at the age of 35. Although he underwent surgery, he was diagnosed too late and his condition worsened soon after. More than 4,000 people with similar diagnoses die each year in Mongolia. This means that 12 people die of cancer every day. Our country has one of the highest cancer deaths in the world. The main reason for this is that the disease is detected at a late stage or when it cannot be cured.

In the last six years, cancer killed about 26,000 people locally, proving that it is more dangerous than the COVID-19 pandemic. Therefore, experts say that if a campaign is to be organized, special attention should be paid to detecting, treating and stopping the spread of cancer, which is one of the leading causes of death in the country.

In particular, Director of Policy, Planning and Development Department of the National Cancer Center L.Bayarsaikhan said, “A person who is diagnosed as healthy today may get sick tomorrow. Therefore, in order to save our citizens, it is important not only to offer a one-time medical examination but also to conduct regular early screening of cancer in each province and district. Officials will probably want to talk about the results only after a certain number of citizens are involved in the early testing. It remains to be seen whether they will talk about the number of people covered or provide information on those who have been treated under the initiative.”

He noted that early screening is based on three basic principles around the world.

• First, the diagnosis must be clear, not general. For instance, the detection of liver cancer should be clearly indicated. If the prevalence of a disease affects a country’s society or economy, public early screening is required.

• Second, the disease must be efficiently detected at a low cost

• Third, quality treatment must be available to everyone once it is detected.

 L.Bayarsaikhan also said, “Any early screening should be conducted in an efficient way and at a low cost. If it is expensive, it will become doubtful whether treatment can be equitable and accessible for everyone. In Taiwan, for example, lung cancer is the leading cause of death. However, there is no national population-based lung cancer screening program. Its people are voluntarily involved in diagnosis because it does not have an early screening program that meets the above mentioned three criteria. Every year, 4,000 people die of cancer in Mongolia. It would be better to have a policy on cancer, which is one of the leading causes of death in the population.”

UNPREPARED FOR EARLY SCREENING

Under the program, adults will be involved in 19 types of medical checkups, the minister informed. For example, they will undergo screenings for cardiovascular diseases, diabetes and tuberculosis, mental and physical health assessment, blood pressure measurement, biochemistry test, general blood and urine tests, tests for glucose, Hepatitis B and C, syphilis and HIV, electrocardiogram, esophagus, gastroscopy, chest X-ray, breast checkup, and abdominal and thyroid ultrasound. Children under the age of 18 will be offered six types of medical checkups, including screenings for non-communicable diseases, mental health assessments and clinical medical checkups such as eye and oral health examinations, and TB tests.

It is a huge task to involve all citizens in these medical examinations. Of course, the burden will fall on doctors and health care workers. They are already overworked due to the global COVID-19 pandemic and people have to wait over a month to get treated at public hospitals. This begs the question: Are the staff of large public hospitals ready for this large-scale work? At the moment, it looks unlikely as it is not clear whether preparations for the nationwide program have been made.

Provincial and district general hospitals are expected to conduct early screening and testing. There is a lot of work to be done for the health sector over the next month, starting from preparing specialized doctors and staff for the nationwide health checkups. However, when asked about the readiness for the program and the organization of its activities, the line ministry said, “We will provide information on this at the end of April.” Judging by this situation, the ministry may not have made the necessary preparations and arrangements, which could cause confusion among the public and make hospital staff become panicked when the program launches in May.

In addition, it does not seem appropriate to include blood, urine, and diabetes tests in the early screening program as these checkups are performed by family health clinics. On the other hand, the Ministry of Health has instructed doctors and staff of public hospitals to train specialists for early screening and testing. It is difficult to quickly and efficiently train these specialists with high responsibilities over patients’ well-being when so little time is left. I hope that the Ministry of Health understands that people need reliable and accurate diagnoses, as well as quality treatment, to stay healthy.

Misheel Lkhasuren

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