Can nationwide early screening achieve desired results?

The federal government of Mongolia plans to conduct a nationwide early screening, testing, and analysis of widespread communicable and non-communicable ailments primarily based on age, gender and well being dangers from Might 1. This has created expectations amongst residents that they are going to be coated by free medical examinations. The most important concern is whether or not this system shall be carried out effectively and convey huge socioeconomic advantages to society as anticipated.

This isn’t the primary time that an early screening program has been carried out in Mongolia. In 2018, the nation coated its residents with preventive medical examinations with funding from the Well being Insurance coverage Fund. Nonetheless, it failed to fulfill even 10 % of the goal. In different phrases, residents’ participation was very low. On this 12 months’s state price range, 60.8 billion MNT has been allotted from the Well being Insurance coverage Fund for the nationwide program.

The Ministry of Well being believes that early detection, screening, and analysis will scale back cancer-related deaths by 35 to 69 % primarily based on an estimate by the World Well being Group. Citing the group, Well being Minister S.Enkhbold said that 11.2 to 12.3 million MNT is estimated to deal with a really sick particular person however solely 150,000 MNT is required per particular person for early detection, testing and analysis.

After all, it’s good to goal for early detection and remedy earlier than a affected person’s situation worsens. Nonetheless, the truth that solely the first stage (screening and analysis) prices a big sum of cash signifies that the authorities should spend a lot more cash on the following stage (well being care and remedy).

Greater than 60 billion MNT is sufficient cash to construct a number of hospitals and faculties, and save many individuals and kids who’re significantly ailing and want medical remedy overseas. The public is nervous in regards to the danger that such an enormous sum of cash shall be “wasted” within the identify of early detection, testing and analysis. 

This isn’t a groundless concern. Mongolia took comparable measures a number of instances earlier than and wasted billions of tugrug. In 2006, as an illustration, when L.Gundalai was the minister of well being, the Nationwide Program for Wholesome Mongolians was authorised below a authorities decree. At the moment, extra than 3 billion MNT was spent on the program, which aimed toward offering immediate and high-quality medical examinations. If this system had been efficient and resumed, the variety of Mongolians dying from most cancers, heart problems and non-communicable ailments would have been decrease than it’s at current.

In 2012, the Wholesome Mongolians Program was additionally launched and a variety of actions have been organized to enhance public well being. Sadly, 10 years later, Mongolians are nonetheless not wholesome. Quite the opposite, the quantity of ailments among the many inhabitants is rising and the workload of hospitals is getting uncontrolled.

The federal government supplied early screening, testing, and analysis all through the nation in 2017. Inside this scope, the federal government signed contracts with personal laboratories and by means of them, offered three units of medical exams to insured individuals aged 40, 45, 50, 55, 60 and 65. There aren’t any information on how many individuals of this age have been screened and the way they managed to stop potential well being dangers.

In the identical 12 months, the Nationwide Wholesome Liver Program was carried out with a price range of 226.2 billion MNT. It may be mentioned that many individuals fell sufferer to it as a result of this system started with none preparation. In different phrases, substandard laboratories didn’t get correct outcomes from medical exams, diagnosing folks with out the hepatitis B virus with the virus and contaminated folks as wholesome. Usually, this system funded a quantity of personal organizations, but it surely didn’t profit residents as a lot as anticipated.

Following this, the federal government carried out the Wholesome Enamel — Wholesome Kids Program in 2018. This system was well-received by the general public, however was suspended as a result of inadequate funding. Additionally it is unclear whether or not the program achieved any outcomes. 

From this, we will see that the authorities initiated many formidable well being packages and actions, however failed to provide outcomes and wasted public cash.

QUALITY AND ACCESSIBLE TREATMENT IS ESSENTIAL

Just a few days in the past, one in every of my mates died of most cancers on the age of 35. Though he underwent surgical procedure, he was identified too late and his situation worsened quickly after. Greater than 4,000 folks with comparable diagnoses die every 12 months in Mongolia. Because of this 12 folks die of most cancers on daily basis. Our nation has one of many highest most cancers deaths on the planet. The primary cause for that is that the illness is detected at a late stage or when it can’t be cured.

Within the final six years, most cancers killed about 26,000 folks domestically, proving that it’s extra harmful than the COVID-19 pandemic. Due to this fact, consultants say that if a marketing campaign is to be organized, particular consideration must be paid to detecting, treating and stopping the unfold of most cancers, which is without doubt one of the main causes of loss of life within the nation.

Specifically, Director of Coverage, Planning and Growth Division of the Nationwide Most cancers Heart L.Bayarsaikhan mentioned, “An individual who is identified as wholesome at present could get sick tomorrow. Due to this fact, with a view to save our residents, it is necessary not solely to supply a one-time medical examination but in addition to conduct common early screening of most cancers in every province and district. Officers will most likely wish to speak in regards to the outcomes solely after a sure variety of residents are concerned within the early testing. It stays to be seen whether or not they’ll speak about the variety of folks coated or present info on those that have been handled below the initiative.”

He famous that early screening is primarily based on three primary rules round the world.

• First, the analysis should be clear, not common. For example, the detection of liver most cancers must be clearly indicated. If the prevalence of a illness impacts a rustic’s society or financial system, public early screening is required.

• Second, the illness should be effectively detected at a low price

• Third, high quality remedy should be accessible to everybody as soon as it’s detected.

 L.Bayarsaikhan additionally mentioned, “Any early screening must be performed in an environment friendly approach and at a low price. Whether it is costly, it should grow to be uncertain whether or not remedy could be equitable and accessible for everybody. In Taiwan, for instance, lung most cancers is the main reason behind loss of life. Nonetheless, there isn’t a nationwide population-based lung most cancers screening program. Its individuals are voluntarily concerned in analysis as a result of it doesn’t have an early screening program that meets the above talked about three standards. Yearly, 4,000 folks die of most cancers in Mongolia. It will be higher to have a coverage on most cancers, which is without doubt one of the main causes of loss of life within the inhabitants.”

UNPREPARED FOR EARLY SCREENING

Beneath this system, adults shall be concerned in 19 varieties of medical checkups, the minister knowledgeable. For instance, they’ll endure screenings for cardiovascular ailments, diabetes and tuberculosis, psychological and bodily well being evaluation, blood strain measurement, biochemistry take a look at, common blood and urine exams, exams for glucose, Hepatitis B and C, syphilis and HIV, electrocardiogram, esophagus, gastroscopy, chest X-ray, breast checkup, and stomach and thyroid ultrasound. Kids below the age of 18 shall be supplied six varieties of medical checkups, together with screenings for non-communicable ailments, psychological well being assessments and scientific medical checkups comparable to eye and oral well being examinations, and TB exams.

It’s a big activity to contain all residents in these medical examinations. After all, the burden will fall on medical doctors and well being care employees. They’re already overworked because of the international COVID-19 pandemic and folks have to attend over a month to get handled at public hospitals. This begs the query: Are the employees of enormous public hospitals prepared for this large-scale work? In the mean time, it appears unlikely as it’s not clear whether or not preparations for the nationwide program have been made.

Provincial and district common hospitals are anticipated to conduct early screening and testing. There’s numerous work to be completed for the well being sector over the following month, ranging from making ready specialised medical doctors and employees for the nationwide well being checkups. Nonetheless, when requested in regards to the readiness for this system and the group of its actions, the road ministry mentioned, “We will present info on this on the finish of April.” Judging by this example, the ministry could not have made the mandatory preparations and preparations, which might trigger confusion among the many public and make hospital employees grow to be panicked when this system launches in Might.

As well as, it doesn’t appear applicable to incorporate blood, urine, and diabetes exams within the early screening program as these checkups are carried out by household well being clinics. On the different hand, the Ministry of Well being has instructed medical doctors and employees of public hospitals to coach specialists for early screening and testing. It’s tough to rapidly and effectively practice these specialists with excessive obligations over sufferers’ well-being when so little time is left. I hope that the Ministry of Well being understands that folks want dependable and correct diagnoses, in addition to high quality remedy, to remain wholesome.