Legislation and policy changes for Tuberculosis Surveillance in Mongolia: A qualitative analysis
Authors: Erdenee Oyunchimeg , Koyama Hiroshi 
Published: May 2019

ObjectiveIn 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.IntroductionMongolia 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.MethodsWe 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.ResultsResult 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.ConclusionsThere 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.