Health policy evaluation during Covid-19
Researchers from the University of Eastern Finland, Dr.Javklanbayar.D, Dr.Ekhjargal.B, and Professor Jussi Kauhanen, conducted research on the effectiveness of certain health policies implemented in Mongolia during the COVID-19 pandemic. It was published in The Lancet Regional Health – Western Pacific, Asia Pacific Journal of Public Health in 2021 and 2022, respectively.
In their first research, they explained several reasons why the “One door-one test” approach was implemented inefficiently and not optimally in terms of design. In the second study, it was concluded that despite the successful implementation of vaccination measures against the COVID-19 pandemic in Mongolia, the early lifting of the restriction in reliance on it has created negative consequences such as violating child rights, weakening public trust, and increasing social inequality.
To reduce the outbreak of the COVID-19 epidemic, the government imposed a restriction from February 11 to 23, 2021 during the Lunar New Year holiday, and implemented the "One door - one test" approach during this period. Researcher Javkhlanbayar and other researchers believe that the measure was implemented inefficiently and inefficiently based on the following reasons. Those include:
Mass testing can provide a snapshot of the COVID-19 situation at that time. As of February 9, 2021, there were an average of 41 COVID-19 new cases per day in Ulaanbaatar and no deaths. There was little need for mass testing and the public may have been lulled into a false sense of security too soon. Furthermore, at the time, all patients with COVID-19, regardless of the severity of the case, were hospitalized, and most cases were traceable. However, on February 24, 2021, the Ministry of Health reported that 131 cases (including 59 new cases) were detected as a result of the "One door - one test" approach implemented for 18.4 billion MNT. This shows how ineffective the approach was. Consequently, the COVID-19 cases skyrocketed just after the intervention (see Figure).
New cases of COVID-19 infection in Ulaanbaatar - by day. Source: Ministry of Health Update on the situation of the coronavirus (COVID-19), 2021.
“The “One door - one test” approach was not implemented optimally in terms of design. The test was conducted regardless of the size and structure of the family, thus the person who was tested on behalf of the family could not fully represent the infection situation of the family. To prevent such a situation from occurring, it was necessary to establish more precise criteria for the person who would be tested on behalf of a household. However, due to the lack of such criteria in the "One door-one test", male members of the household and those with a low risk of infection tended to participate more in the test. As a result, the researchers concluded that by failing to test the infected population truthfully, the reality of the epidemic was distorted.
In addition, at the time of the implementation of this approach, the rate of transmission of COVID-19 infection by family members to each other was 4.6%-49.5%, and research results showed that elderly family members and couples were more likely to get infected within the family. Therefore, when implementing the approach, it was possible to implement it more optimally based on the results of these studies.
The “One door-one test” approach has overburdened healthcare workers, increasing their risk of burnout and exposure to the COVID-19 virus.
The inefficient use of resources risks creating resource shortages during a later spike in the spread of COVID-19.
In the future, the researchers recommended reviewing the "One door-one test" approach and conducting a cost-effectiveness analysis of the measures to be taken in the fight against the COVID-19 pandemic. In the paper published in 2022, the research team found that the curfew and some movement restrictions in Mongolia in 2021 were not coordinated with the situation of the epidemic, which reduced the effectiveness of the vaccination implemented in March 2021.
If you want to get more information about the research and have any questions related to the research to ask the researcher Javkhlanbayar.D, you can participate in the NRCC research seminar on June 7, 2023, at 6:00 p.m. Click here for more information about the workshop.
A detailed version of the research paper is mentioned in the article below:
Mass testing for COVID-19 in Ulaanbaatar, Mongolia: “One door-one test“ approach
Click here for more information on D. Javkhlanbayar, Associate Professor of Public Health Policy and Economics at the University of Eastern Finland.