World Journal of Surgery

, Volume 35, Issue 2, pp 272–279

Quantifying Surgical and Anesthetic Availability at Primary Health Facilities in Mongolia

  • David A. Spiegel
  • Shelly Choo
  • Meena Cherian
  • Sergelen Orgoi
  • Beat Kehrer
  • Raymond R. Price
  • Salik Govind

DOI: 10.1007/s00268-010-0904-7

Cite this article as:
Spiegel, D.A., Choo, S., Cherian, M. et al. World J Surg (2011) 35: 272. doi:10.1007/s00268-010-0904-7



Significant barriers limit the safe and timely provision of surgical and anaesthetic care in low- and middle-income countries. Nearly one-half of Mongolia’s population resides in rural areas where the austere geography makes travel for adequate surgical care very difficult. Our goal was to characterize the availability of surgical and anaesthetic services, in terms of infrastructure capability, physical resources (supplies and equipment), and human resources for health at primary level health facilities in Mongolia.


A situational analysis of the capacity to deliver emergency and essential surgical care (EESC) was performed in a nonrandom sample of 44 primary health facilities throughout Mongolia.


Significant shortfalls were noted in the capacity to deliver surgical and anesthetic services. Deficiencies in infrastructure and supplies were common, and there were no trained surgeons or anaesthesiologists at any of the health facilities sampled. Most procedures were performed by general doctors and paraprofessionals, and occasionally visiting surgeons from higher levels of the health system. While basic interventions such as suturing or abscess drainage were commonly performed, the availability of many essential interventions was absent at a significant number of facilities.


This situational analysis of the availability of essential surgical and anesthetic services identified significant deficiencies in infrastructure, supplies, and equipment, as well as a lack of human resources at the primary referral level facilities in Mongolia. Given the significant travel distances to secondary level facilities for the majority of the rural population, there is an urgent need to strengthen the delivery of essential surgical and anaesthetic services at the primary referral level (soum and intersoum). This will require a multidisciplinary, multi-sectoral effort aimed to improve infrastructure, procure and maintain essential equipment and supplies, and train appropriate health professionals.

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • David A. Spiegel
    • 1
  • Shelly Choo
    • 7
  • Meena Cherian
    • 5
  • Sergelen Orgoi
    • 2
  • Beat Kehrer
    • 6
  • Raymond R. Price
    • 3
  • Salik Govind
    • 4
  1. 1.Division of Orthopaedic SurgeryChildrens Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Department of Surgery S1Health Sciences UniversityUlaanbaatarMongolia
  3. 3.Swanson Family Foundation, Intermountain HealthcareSalt Lake CityUSA
  4. 4.Department of Public HealthWHO Representative OfficeUlaanbaatarMongolia
  5. 5.Emergency and Essential Surgical Care Project, Clinical Procedures Unit, Department of Essential Health TechnologiesWorld Health OrganizationGenevaSwitzerland
  6. 6.Swiss Surgical TeamInternational College of Surgeons (ICS)St. GallenSwitzerland
  7. 7.Johns Hopkins UniversityBaltimoreUSA