Under the influence of the Soviet Union, in the years up to 1990, Mongolia established a health care system based on the Semashko model, characterized by strong central planning with the state being responsible for both financing and delivery of health care. Primary health care (PHC) at that time was characterized by the dominance of curative outpatient and inpatient services over preventive services. Despite many achievements, including universal access to health care, there were significant weaknesses, such as low efficiency—despite the high number of hospital beds and medical staff—and a lack of responsiveness to patient needs.

The collapse of the Soviet Union saw the withdrawal from Mongolia of its assistance in the beginning of the 1990s, resulting in an economic crisis. Under these circumstances, there was an urgent need for socioeconomic reforms, including substantial reform of the health sector.

The Government of Mongolia commenced reform of the health sector in the early 1990s and requested support from the Asian Development Bank (ADB). Since then, ADB has broadly supported health sector in Mongolia, including PHC reforms through health sector development programs and technical assistance that continue to date. Over the past 3 decades, these programs and technical assistance have contributed to the establishment of family health centers that provide PHC in urban areas. Significant support was provided for strengthening PHC provision in rural soum (subprovince administrative units) health centers. The PHC reforms in Mongolia consisted of a shift from hospital-based curative services toward PHC and preventive approaches in the provision of health care services at the primary level. The PHC reforms included restructuring the old system and introducing new management models based on public–private partnerships, increasing the range of services provided, introducing more effective financing methods, building human resources, and creating better infrastructure. Despite several challenges that persist, PHC has become the foundation and an increasingly important part of the provision of health care in the country.

This paper describes PHC in Mongolia and ADB support for its reform, including results achieved, challenges that remain, and the lessons drawn from experience. The experience gained from the support by ADB of PHC reforms in Mongolia and the lessons learned could be useful for similar future programs in Mongolia and other countries. The paper also outlines future directions for ADB support of PHC in Mongolia.