World Journal of Surgery

, Volume 36, Issue 10, pp 2359–2370 | Cite as

Strengthening Surgical Services at the Soum (First-referral) Hospital: The WHO Emergency and Essential Surgical Care (EESC) Program in Mongolia

  • Jaymie A. HenryEmail author
  • Sergelen Orgoi
  • Salik Govind
  • Raymond R. Price
  • Ganbold Lundeg
  • Beat Kehrer



Provision of surgical care continues to receive little attention and funding despite the growing burden of surgical disease worldwide. In 2004, The World Health Organization (WHO) established the Emergency and Essential Surgical Care (EESC) program, which was designed to strengthen surgical services at the first-referral hospital. There are limited data documenting the implementation and scale-up of such services. We describe the nationwide implementation of the EESC program in Mongolia over a 6 year period.


Surgical services were increased in rural areas of Mongolia using the WHO Integrated Management of Emergency and Essential Surgical Care (IMEESC) toolkit from 2004 to 2010. Fund of knowledge tests and program evaluation was done to measure uptake, response, and perceived importance of the program. Two years after the pilot sites were launched, programmatic impact on short-term process measures was evaluated using the WHO Monitoring and Evaluation form.


The program was implemented in 14 aimags/provinces (66.67 %) and 178 soum hospitals (52.66 %). Fund of knowledge scores increased from 47.72 % (95 % confidence interval (CI) 40.7–54.7) to 77.9 % (95 % CI 70.1–85.7, p = 0.0001) after the training program. 1 year post-training, there was a 57.1 % increase in the availability of emergency rooms, 59.1 % increase in the supply of emergency kits, a 73.64 % increase in the recording of emergency care cases, and a 46.66 % increase in the provision of facility and instrument usage instructions at the pilot sites.


The EESC program was successfully implemented and scaled up at a national level with improvements in short-term process measures.


Surgical Care Surgical Service Pilot Site Surgical Capacity Nationwide Implementation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors acknowledge the work of international partners other than mentioned in the text and staff at the WHO country office in Mongolia who have furthered the cause of increasing surgical care in Mongolia.


The authors include staff members of the WHO. They are responsible for the views expressed in this publication and do not necessarily represent the decisions or stated policy of the WHO.

Conflicts of interest



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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Jaymie A. Henry
    • 1
    • 2
    Email author
  • Sergelen Orgoi
    • 3
  • Salik Govind
    • 4
  • Raymond R. Price
    • 5
  • Ganbold Lundeg
    • 6
  • Beat Kehrer
    • 7
  1. 1.University of California, Berkeley, School of Public HealthBerkeleyUSA
  2. 2.San FranciscoUSA
  3. 3.Department of Surgery S1Health Sciences UniversityUlaanbaatarMongolia
  4. 4.Department of Public HealthWorld Health Organization Representative OfficeUlaanbaatarMongolia
  5. 5.Swanson Family FoundationIntermountain HealthcareSalt Lake CityUSA
  6. 6.Department of Anesthesiology and Intensive Care MedicineCentral University HospitalUlaanbaatarMongolia
  7. 7.Swiss Surgical Team, International College of Surgeons (ICS)St. GallenSwitzerland

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