MON/006
Consolidating cardiovascular services and National Cardiovascular Centre in Mongolia

The MON/006 project, as formulated at the beginning of 2017, foresaw an implementation period of three years for a budget of 3 000 000 EUR (considering the Luxembourg contribution alone). In 2018, the project benefited from a budget extension of 1.5 MEUR to finance the development of architectural plans for the National Cardiovascular Centre. Given the scope and the relatively short implementation period, only one so-called “anticipated” final evaluation was planned, the conclusions of which were to guide decision-makers and the donor in deciding on a possible follow-up to this project or a definitive withdrawal of the Luxembourg Cooperation's support to the cardiology sector, after nearly twenty years of support. This evaluation was therefore planned six months before the project's initial end date (May 2020) to allow time to formulate a possible new phase if such were the conclusions of the evaluation. The evaluation mission took place in November 2019 and resulted in a report written and validated in December, two months before Mongolia's borders were closed by the national authorities due to the Covid-19 pandemic.

The conclusions of the evaluation report being very positive, the recommendations were to extend Luxembourg's support for the cardiology sector into a new project phase. However, due to the Covid-19 pandemic and heavy travel constraints, it was not possible to consider the formulation of a new phase in 2020 or 2021. In addition, the closure of the borders made it impossible to carry out many of the tasks and activities of the MON/006 project that were planned in the last months of the implementation period. Also, it was decided to extend the duration of the project until a return to normalcy - from a health point of view - allows the project to be completed correctly with the dedicated budget. This situation has led to the duration of the project being extended three times (with no financial extension) until September 2022.

The main achievements of the project have led to significant progress in the following technical areas:

• prevention of cardiovascular diseases;
• capacity strengthening;
• cardio surgery, interventional cardiology and electro-physiology;
• cardiology and cardiovascular telemedicine at Provincial, District levels and Shastin Central Hospital (SCH).

External surgical teams from Luxembourg (INCCI), as well as French (ASF) and Asian partners played a key role in capacity strengthening in cardiac surgery and interventional cardiology. The project invested in capacity strengthening, mainly on secondary and tertiary levels of the health care pyramid with many different actions, making the quality and access to cardiology services constantly improving.

Telemedicine has become an essential tool to ensure adequate professional support in clinical decision-making and management of patients in peripheral doctors by specialists in SCH.

Finally, all these converging actions have contributed to better health for all in Mongolia, in line with the overall objective of the project.

Although this project was supposed to be the last phase of Luxembourg's support to the cardiology sector in Mongolia, the results it demonstrated during its implementation - and despite the context of the pandemic, which significantly slowed down planned activities - led the Luxembourg Ministry of Foreign and European Affairs to reconsider its position:

• during MON/006, the impact of strengthening quality of care at various levels became apparent. At the province (aimag) and district (Ulaanbaatar) levels, cardiologists gained diagnostic skills (e.g. echography) and at SCH level there was a significant improvement in sophisticated diagnostic and therapeutic (surgical) skills;
• the number of unnecessary medical transfers decreased significantly over the period, while the number of necessary transfers increased from 30% to 60%, ensuring better management of health care from a medical and financial point of view;
• the number of complex cardiac surgeries and interventional treatments performed at SCH increased, while at the same time, mortality from cardiovascular disease decreased;
• telemedicine has been extended to primary care, including cardiovascular risk assessment;
• online training, congresses and webinars organised during the pandemic increased the participation of medical staff and reached the most remote physicians;
• all preparatory work for the construction of the National Cardiovascular Centre has been completed, including detailed architectural design and cost estimates, land allocation within the SCH building approved by the relevant authorities, as well as approval of all technical requirements.

Following the recommendations of the final evaluation, a formulation mandate was issued in early 2022, just before the closure of MON/006, allowing the development of a new intervention: MON/007 - Cardiology, Cardio-surgery and Telemedicine in Mongolia.