An Ethnographic Evaluation of Post-Alma Ata Health System Reforms in Mongolia: Lessons for Addressing Health Inequities in Poor Communities

Abstract

Abstract Globally, post-Alma Ata health care system reforms have included reorganization of government health agencies, establishment of rationalized, evidence-based systems of care, implementation of user charges for public services, and experiments with third party financing. Drawing on materials collected in the context of long-term ethnographic research in Mongolia, this chapter reveals that there is a mismatch between the economic rationality that underlies current health reform programs and the realities of the lived experiences of illness in poor communities. Coupled with decentralization and poor regulatory oversight, current health reform efforts can result in fragmentation of the health system, increasing opportunity costs for health care seeking by poor households, reduced access to essential drugs, and an overall increased risk for health-cost related impoverishment. The chapter concludes by arguing that ethnographic information on health care seeking in poor communities can inform health reform efforts through explaining how features of health reform produce health inequities.