Table 2 Summary of the Kingdon framework’s three streams describing problem, policy and politics surrounding cardiovascular disease in Mongolia and outcomes directly or indirectly attributed to the urban population health initiative (bold/italic)

1992 Adoption of a new constitution accompanied by stepwise integration of free-market reforms and rapid urbanization, leading to a significant increase in the population of Ulaanbaatar (accounting for up to 50% of the total Mongolian population)

1997–2020 Multiple failures by different multilateral efforts to establish an integrated health information system

2006 STEPS survey in Mongolians aged 15–64

 • Hypertension prevalence of 28%

 • Diabetes prevalence of 8% (5% increase since 1999)

 • 91% of the surveyed population had ≥1 risk factor for developing NCDs and 21% had ≥3 risk factors

2009 STEPS survey

 • Hypertension control rates declined from 21% in 2006 to 12% in 2009

2011 First national baseline assessment on salt consumption

 • Average daily salt intake of 11.06 ± 5.99 g – more than double the WHO recommended 5 g daily

2013 STEPS survey

 • Hypertension prevalence persisted around 28% between 2006 and 2013

 • Hypertension control rates declined from 21% in 2006, to 7% in 2013*

 • An estimated 27% of individuals never had their BP measured

 • Of individuals previously diagnosed with hypertension, 72% were not treated by medication, 21% were treated but failed to achieve BP control and 7% achieved control

2019 STEPS survey

 • The prevalence of hypertension is 23.6%

2000 Alcohol control law adopted and updated in 2009

2005 Tobacco control law adopted and updated in 2012

2006 Introduction of the National Programme on Integrated Prevention and Control of NCDs

2011 Clinical guidelines for arterial hypertension

2012 Adoption of a food law and National Programme on Healthy City, District, Workplace and Schools

2012–2013 Pinch Salt intervention, associated with a reduction of 2.8 g of salt intake

2015–2025 National salt reduction strategy aiming to reduce salt intake by 30% by 2025

2016–2018 NHIF increases financial support to primary health clinics by 306% and raises reimbursements for hypertension medications, financed in part by a nationwide tobacco tax.

2016–2018 NHIF increases the number of subsidized antihypertensive medications from 12 to 24, including fixed combination drugs for the first time, and increases their average cost coverage by 5%.

2017–2019 MOH increases annual direct budget for primary healthcare by 19%

2018 New national hypertension guidelines and standard algorithm of care approved by MOH and implemented across all 142 primary health centres in Ulaanbaatar, including a lower hypertension diagnosis and control target (130/80 mmHg) and a lower age limit for screening (18 years)

2019 ‘Nutrition Education 1–6 grade’ student, teacher tools developed for schools, introduced on national level together with an annual check-up tailored to age and gender.

1997 Start of the World Bank & UN Development Programme collaboration with the Ministry of Finance on a 10-year poverty alleviation plan, investing and mobilizing over $470 million, including $20 M for eHealth software development with the MOH.

2007 US MCC programme and Mongolian Government sign a five-year contract including $42 million devoted to NCD (including a large scale hypertension initiative)

2010 WHO regional consultation on salt reduction in Singapore

2011–2016 Luxembourg Development Cooperation funds an €11-million project, to improve health services including for CV disease

2012–2016 Asian Development Bank funds a health sector development programme, providing loans totalling $29.9 million for hospital infrastructure, eight technical assistance operations and three grant projects for infrastructure, health policy development and other core clinical focus areas.

2017 Analysis by the UN Inter-Agency Taskforce demonstrating that, compared to interventions for tobacco control, alcohol abuse and CV disease healthcare services, limiting salt use offers highest return on investment

2019 New Bloomberg ‘Resolve to Save Lives’ grant agreement with the Onom Foundation, aimed at scaling the CARDIO interventions nationwide.

2019 MOH with support of WPRO starts Mon-PEN /HEARTS pilot initiative to improve prevention and early screening of NCD in one district of Ulaanbaatar and one province

2021 MOH starts rolling out Mon-PEN/HEARTS initiative in an additional seven provinces.