Is the Mongolian Health Sector Ready for a Sector‐Wide Approach?

Mongolia has experienced major social and economic changes since the early 1990s. Large-scale reforms have been introduced in all sectors over the last 10 years. Implementing health reforms requires a more coordinated approach and the Mongolian health sector has been exploring an option of implementing a Sector-Wide Approach (SWAp) to the health sector. This article aims to develop and apply an analytical framework for assessing the feasibility of implementing SWAp in the Mongolian health sector. Review of published and unpublished evidence at the national and international levels is undertaken and complemented by semi-structured interviews with key respondents from Mongolian Ministry of Health. A framework for assessing the feasibility of SWAp in Mongolia has been developed which comprises the key elements and stages of development of SWAp in a particular context. This framework has been then applied to assess the feasibility of implementing SWAp in the Mongolian health sector. The main SWAp elements are in place. Emerging central level capacity, increasing donor confidence and willingness to move towards sector-wide management is now becoming more evident in Mongolia. It looks like Mongolia is ready for a national level government-led SWAp with the potential to implement a fully-fledged SWAp in the health sector. The essential ground-work for starting a SWAp is in place, but further capacity strengthening is needed. A framework for implementing health SWAp in Mongolia is suggested. It is important to consider the improvement of existing government systems in future SWAp arrangements to ensure local ownership.     

Negotiating Compliance: The Case of Autonomous Hospitals in Vietnam

Maternal death is one of the highest causes of global mortality. Governments have long used regulation to improve maternal health but concurrent fiscal‐decentralisation reforms can undermine clinical performance. This article focuses on public Vietnamese hospitals to explore how regulatory compliance is pursued in decentralised health facilities, since Vietnam has seen increasing autonomisation of public hospitals in the last decade while simultaneously experiencing marked reductions in the maternal mortality ratio. Our analysis suggests that autonomisation has allowed regional regulatory regimes to emerge and that regulatory compliance must compete with other priorities. Compliance can therefore be rethought as a negotiation having implications for how government and maternal health advocates persuade self‐sufficient hospitals to take on wider health‐system goals.