Mongolia’s tuberculosis response: building on strong foundations to accelerate progress

Mongolia has demonstrated strong commitment to tuberculosis (TB) control over the past decade, investing in systems, services and domestic financing to reduce the burden of the disease. A recent TB program review conducted in March 2026 highlights important best practices that have strengthened the national response while also identifying priority actions needed to close persistent gaps and accelerate progress toward ending TB.

Debriefing session at WHO office. © WHO Mongolia

What is working well

One of the strongest foundations of Mongolia’s TB response is national leadership and governance. The Ministry of Health and the National Center for Communicable Diseases (NCCD) provide a solid governance platform for TB prevention and care across the country. At subnational level, initiatives such as the TB‑free province approach demonstrate local leadership and innovation, showing how TB can be prioritized beyond the health sector.

Domestic financing for TB has increased substantially, with government resources now accounting for the majority of TB expenditure. This shift reflects reduced reliance on external funding and provides a critical base for sustainability. Payment mechanisms under the Health Insurance General Agency have also encouraged a gradual shift of TB services toward primary health care, increasing the volume of TB screening and follow‑up services delivered at family and soum health centres.

Mongolia has made significant progress in strengthening TB diagnosis. The expansion of rapid molecular testing has been substantial, with a large increase in Xpert testing sites nationwide. Most people with newly diagnosed or relapsed TB are now tested with Xpert and a hub‑and‑spoke specimen transport system allows samples collected at primary care level to reach diagnostic centres efficiently. This has improved bacteriological confirmation and drug‑resistance detection.

In TB treatment and care, Mongolia has adopted shorter, all‑oral regimens for drug‑resistant TB and maintains strong national laboratory capacity for drug‑susceptibility testing, including advanced methods at the national reference laboratory. Social welfare mechanisms, including food support and social assistance packages, are available to people affected by TB. Tripartite agreements between TB services, primary care facilities and patients reflect a commitment to shared responsibility for treatment completion.

Priority actions to accelerate impact

Reflecting on the review’s findings, Chakaya Muhwa, Team Lead, TB Programme Review, underscored the importance of clarity of ambition in shaping the national response: "Clarity of ambition is essential: whether the objective is TB control—often with limited focus on interrupting transmission—or the goal of ending the TB epidemic. Where ending TB is the stated objective, strategies must extend beyond biomedical interventions to address the social determinants of TB and prioritize effective case-finding and treatment retention, even when such interventions may not appear immediately efficient."

Debriefing session with Dr Chakaya Muhwa, Team Lead, TB Program Review. © WHO Mongolia

Despite these strengths, the review made clear that finding all people with TB remains the most urgent priority. A large gap persists between the estimated number of people with TB and those detected and notified, particularly among adult men aged 15–54 years. To close this gap, the review recommends being explicit about national ambition – whether the goal is TB control or ending TB – and aligning screening strategies accordingly. Expanding screening in high‑burden geographic areas, improving the use of data to better target populations at risk and addressing high drop‑off rates along the active case‑finding cascade are critical next steps.

The review calls for simplifying and decentralizing TB diagnosis. Priority recommendations include streamlining services, making better use of existing primary care laboratory infrastructure, deploying point‑of‑care diagnostic platforms at soum and family health centres and strengthening chest X‑ray services through renewed licensing and the use of artificial intelligence.

Improving treatment outcomes is another central priority. Treatment success rates for drug‑susceptible TB have declined in recent years, with men, older adults, unemployed individuals, and socially vulnerable groups experiencing poorer outcomes. The review strongly recommended ending the routine hospitalization of all people with TB and shifting toward community‑ and home‑based treatment support, reserving hospitalization only for those with clear clinical or social indications.

Visit to family health Center In Ulaanbaatar for TB program review. © WHO Mongolia

Addressing childhood TB is identified as a priority area requiring urgent action. The review recommended developing a dedicated action plan for childhood TB, expanding bacteriological confirmation using child‑friendly diagnostics such as stool testing, adopting WHO‑recommended shorter treatment regimens for non‑severe disease and integrating TB services with other child health platforms such as immunization and Integrated Management of Childhood Illness (IMCI).

Given the high and increasing burden of drug‑resistant TB, the review emphasized the need to move toward an integrated model of care for drug‑susceptible and drug‑resistant TB, decentralize treatment initiation for stable patients and phase out outdated diagnostic practices such as smear microscopy where molecular testing is available.

Finally, the review highlighted the importance of community engagement and data use. Expanding and professionalizing community health worker models, strengthening partnerships with civil society organizations and establishing community‑led monitoring would improve accountability and patient‑centred care. At the same time, making TB information systems interoperable and accessible to primary care providers would enable better tracking of patients across the care pathway and support data‑driven decision‑making.

Looking ahead

Mongolia has built strong foundations for TB control through leadership, financing, diagnostic expansion, and treatment innovation. By building on these best practices—and acting decisively on the review’s priority recommendations-the country has a clear opportunity to close detection gaps, improve treatment outcomes, and move closer to ending TB as a public health threat.