Results
Epidemiological Transition and Disease Burden
From 1990 to 2019, Mongolia underwent an epidemiological transition similar to that observed in many emerging economies [
7]. By 2019, rates of several infectious and maternal-child health conditions, including lower respiratory infections, tuberculosis, diarrheal diseases, under-5 mortality, neonatal disorders, and maternal disorders, had substantially decreased from 1990 levels among both males and females. Some NCDs, such as chronic obstructive pulmonary disease and chronic kidney disease, also showed substantial declines. However, several NCDs, including ischemic heart disease, stroke, cirrhosis, stomach cancer, and lung cancer, remained leading causes of death from 1990 to 2019, while liver cancer and alcohol use disorder showed substantial increased rates [
8].
Mongolia continues to face major public health challenges, including tuberculosis incidence [
9]; mortality and morbidity from cardiovascular disease [
10], cancer [
11], diabetes [
12], and chronic respiratory disease [
13]; deaths attributable to household and ambient air pollution [
14]; amenable mortality [
15]; and low life expectancy at birth [
16].
According to WHO, the probability that Mongolians aged 30–70 years will die from 1 of the 4 major NCDs is 35%, which is substantially higher than the global average of 17.8%, the regional average of 17.2%, and the 19.4% average for middle-income countries [
17]. Rapid urbanization has concentrated more than 45% of the population in Ulaanbaatar, where more than 800,000 people live in unplanned ger districts, areas primarily composed of traditional Mongolian yurts, and face poor sanitation, air pollution, and social vulnerability [
18]. Mongolia has one of the highest NCD-related mortality rates in the WHO Western Pacific Region; in 2018, 59.0% of all deaths were attributed to cardiovascular disease (34.4%) and cancer (24.6%) [
19].
As Manaseki [
20] reported a major challenge for Mongolian health providers has been reaching scattered and mobile nomadic populations. Acute respiratory infections in winter and diarrheal diseases in summer were historically major causes of mortality and morbidity, especially among children. Other major contributors include diabetes and respiratory illnesses [
21]. In 2024, an estimated 27.9% of adults in Mongolia smoked daily, contributing to the respiratory disease burden [
22].
Infectious and Zoonotic Diseases in Mongolia
Overview of infectious and zoonotic diseases before 2020
Between 2011 and 2020, Mongolia recorded 31 infectious diseases nationwide, with an average incidence of 157.2 per 10,000 population. In 2019, 45,200 cases of 27 infectious diseases were reported, representing a 1.5% decrease from the 10-year average but a 7.5% increase from the previous year. That year, incidence was 143.2 per 10,000 population, 14.0 points lower than the decade average but 9 points higher than in 2018. Ulaanbaatar and the eastern region, particularly Dornod and Sukhbaatar Provinces, consistently reported higher incidence rates, ranging from 25 to 44 per 10,000 people above the national average [
23].
Zoonotic diseases such as brucellosis, plague, and tick-borne encephalitis (TBE) have persisted in Mongolia [
24]. Brucellosis, first identified in livestock in 1935 and in humans in 1949, had cattle seroprevalence rates as high as 35% before vaccination; these rates decreased to 5%–10% after vaccination, although some rural areas still reported rates of up to 50%. Chronic human brucellosis reached 8,000 cases by 2001, with 1,000–1,500 new cases reported annually since 1996 [
25]. Plague, caused by
Yersinia pestis, continued to affect about 40 people annually, mostly in rural areas, because of marmot hunting [
26]. TBE has been reported since 1969, with peaks between 1977 and 1986 and re-emergence in 2002. The disease was especially prevalent in the eastern and central regions from 2003 to 2005 and in Ulaanbaatar from 2006 to 2008 [
27]. Ticks and tick-borne pathogens pose a substantial threat to human and animal health in Mongolia because extensive pastoral lands and close interactions among wildlife, livestock, and humans facilitate zoonotic disease transmission [
28].
Infectious and zoonotic diseases in recent years (2019, 2021, and 2022), with significant shifts during the COVID-19 outbreak
In 2023, among confirmed infectious diseases other than COVID-19, sexually transmitted diseases accounted for 46.0% of all infectious diseases, representing a 17.1% decrease from the previous year; other infectious diseases decreased by 0.7%. Compared with the previous year, intestinal infectious diseases increased by 9.8%, respiratory infectious diseases by 7.9%, and zoonotic infectious diseases by 0.2% [
17].
Although zoonotic diseases accounted for a relatively small proportion of infectious diseases, they continued to show public health relevance and emerging patterns. In 2022, 2,355 cases of zoonotic tuberculosis were recorded, although specific data on
Mycobacterium bovis infections remain limited. Q fever had no confirmed human cases from 2017 to 2022, but 18.5% of tested ticks carried
Coxiella burnetii, indicating an environmental reservoir. In 2021,
Salmonella enteritidis was detected in imported and domestic poultry, with some strains exhibiting AMR. And , methicillin-resistant
Staphylococcus aureus was found in 17.1% of raw beef samples tested in Ulaanbaatar. Additional zoonotic threats included listeriosis, which caused livestock outbreaks in 2022 and human infections in 2017, and glanders, which remained enzootic among horses during 2018–2019. Tick-borne rickettsiosis also remained a concern, with incidence rates reaching up to 1.16 per 10,000 population between 2016 and 2018 [
29]. These patterns underscore the need for sustained surveillance and coordinated responses to zoonotic threats under the One Health framework.
As of 25 September 2023, Mongolia had recorded 1,011,388 COVID-19 cases and 2,284 related deaths [
30]. The pandemic substantially altered Mongolia’s public health response, surveillance capacity, and economy [
31]. Although COVID-19 dominated infectious disease reporting, it also revealed weaknesses in managing non-COVID-19 diseases, including delayed reporting and underdiagnosis of zoonoses and vector-borne illnesses [
32]. The pandemic further emphasized the importance of integrated, multisectoral approaches under the One Health framework, particularly for early warning systems, health infrastructure, and public education [
30].
Other infectious and zoonotic disease patterns
Ulaanbaatar and the eastern provinces, regularly reported above-average infectious disease rates. Plague remains endemic in western and southwestern Mongolia, with 216 human cases recorded between 1970 and 2022 and a mortality rate of 39.3% [
33]. Marmot meat is considered a delicacy in Mongolia, but its consumption carries a risk of
Y. pestis infection. Plague transmission primarily affects young men and boys, who become infected after contact with fleas from marmots or ground squirrels [
34]. Historical plague incidence has been loosely associated with annual rainfall, possibly because rainfall increases rodent populations and subsequent flea-human contact [
35].
Tick-borne diseases are widespread in central and eastern
aimags (provinces), where environmental conditions support tick activity [
36]. Between 2003 and 2008, the highest morbidity rates were observed in the eastern and central regions (2003–2005) and in Ulaanbaatar (2006–2008). However, monthly TBE morbidity was not correlated with meteorological factors such as average temperature and precipitation [
37].
One Health Approach in Mongolia
Drivers of One Health implementation: the role of nomadic life
The adoption of the One Health approach in Mongolia is shaped by several interacting drivers, including environmental change, livestock production practices, and socioeconomic factors. Together, these drivers influence the interconnected health of humans, animals, and the environment, creating both risks and opportunities for coordinated health interventions (
Figure 2).
A central driver is Mongolia’s traditional nomadic herding lifestyle, which is characterized by close and continuous interactions among humans, livestock, and the environment. This interdependence makes Mongolia a natural setting for the One Health approach because human, animal, and environmental health are closely linked. Mongolia has more than 10 times as many livestock as people, and herders rely heavily on livestock for their livelihoods. Seasonal movement patterns are determined by pasture and water availability, reflecting the ecological balance on which herding depends. However, these daily and seasonal interactions also expose herders to zoonotic diseases, often through close contact with livestock, particularly horses and camels, or through inadequate hygiene practices [
38].
Mongolian herders also recognize that climate-related environmental changes, including pasture degradation and water scarcity, directly affect both animal and human health. This recognition underscores the need for transdisciplinary policies that integrate ecological, veterinary, and public health perspectives. Mongolia remains one of the few countries where large-scale nomadic herding is still practiced. This way of life is deeply rooted in cultural heritage and is often passed down through generations. As of 2019, about 26% of the population maintained a pastoral lifestyle [
39], highlighting the continuing importance of herding traditions in Mongolian society [
40].
Population migration, equity, and access in Mongolia’s rural health system
In 2020, Mongolia’s population reached 3,357,542, with 69.0% residing in Ulaanbaatar. Internal migration has continued to increase steadily, driven mainly by rural-to-urban movement [
41]. Some regions have limited access to clean water and adequate sanitation, contributing to the spread of waterborne diseases among humans and animals. The number of migrants was estimated at 748,000 in 2020, meaning that 1 in every 4 people in Mongolia was a migrant. Most migrants were internal migrants who moved mainly from rural to urban areas, contributing to intense urbanization and rural depopulation [
42].
Nutritional imbalance, poor living conditions, declining healthcare services, and limited implementation of targeted public health initiatives also adversely affect population health. Rapid urban migration has intensified disparities between urban and rural populations. Ulaanbaatar faces overcrowding and environmental health challenges, whereas rural areas remain underserved. These demographic shifts exacerbate inequities in access to safe water, sanitation, and healthcare, highlighting the dual burden of urban congestion and rural neglect [
43].
Strengthening rural healthcare and adopting a One Health approach are essential for addressing interconnected human, animal, and environmental health risks in Mongolia. Rural areas, which are home to much of the population, often lack adequate medical services, making integrated approaches particularly important. Since the 1990 transition to democracy and a neoliberal economy [
44], Mongolia has prioritized equitable healthcare. Rural healthcare is resource-intensive, and access is especially important in a large, sparsely populated country. To address this need, the government established family group practices, which provide free “essential” primary care nationwide, with additional services covered by social health insurance [
45].
Food safety
Foodborne diseases and contamination directly affect food safety and, although often underreported, are widely recognized as common threats to human health [
46]. These issues also have far-reaching consequences for productivity and economic development in Mongolia. Several major food safety challenges reflect the complexity of Mongolia’s human–animal interface, where endemic livestock diseases, including foot-and-mouth disease, brucellosis, and peste des petits ruminants, adversely affect animal health, livestock production, and food security [
47,
48].
A study of livestock and food security vulnerability, considering factors such as population growth and climate change, ranked Mongolia as the 6th most vulnerable country in the world. Mongolia also ranked 1st for high sensitivity to nutritional reliance on locally produced grazing-animal food products [
49]. Traditional livestock-herding practices, including consumption of raw meat, unpasteurized milk, and other animal byproducts, as well as hunting and handling wildlife, create pathways for disease transmission. These practices expose humans and animals to serious infections, including brucellosis, tuberculosis, anthrax, plague, influenza, and parasitic, rodent-borne, tick-borne, and other vector-borne diseases [
50].
Weak implementation and enforcement of food safety standards further contribute to foodborne disease. Common foodborne bacterial pathogens include
Salmonella,
Escherichia coli, and
Campylobacter, while
Brucella remains an important foodborne zoonotic pathogen associated primarily with consumption of unpasteurized dairy products [
51]. These implementation and enforcement gaps may increase the risk of foodborne infections and remain an ongoing challenge for public health protection. In addition, more than 98% of poultry and vegetables are imported [
52], creating challenges for consistent food safety oversight across complex international supply chains. Strengthening risk-based import control, food inspection, and surveillance systems is therefore essential to protect public health.
Environmental contamination further worsens food safety. Pollution from mining and other industrial activities often contaminates water sources and agricultural products, introducing harmful substances, including heavy metals and other environmental toxins, into the food chain. Food packaging, pesticide application, and antibiotic use in the food industry may also contribute to unwanted residues in foodstuffs, posing risks to both human and animal health [
49].
Climate change is expected to raise Mongolia’s average temperature by more than 5 °C by 2090, worsening droughts, pasture degradation, and extreme weather events. These changes have already reduced livestock productivity, increased disease risks, and lowered meat and milk quality. Vegetable production is similarly affected by heat stress, soil erosion, and limited irrigation, resulting in decreased yields and nutritional value [
48].
Antibiotic overuse in both human medicine and animal husbandry has also contributed to the growing threat of AMR. This overuse undermines the effectiveness of essential medicines and raises concerns about antimicrobial residues in meat and dairy products, further complicating food safety management in Mongolia [
50].
Together, these interconnected issues show the need for a comprehensive, multisectoral approach to food safety and public health in Mongolia.
Climate change
Climate change, especially rising temperatures and shifting rainfall patterns, is altering infectious disease patterns globally, yet awareness remains low. Health professionals need to raise awareness and strengthen preparedness through climate-informed risk assessments and community-level surveillance for early response. Additional research is needed, particularly in low- and middle-income countries [
53].
Mongolia has already experienced substantial warming and drying and is expected to continue experiencing these changes. Temperatures are rising faster than the global average, and communities across Mongolia are already feeling the effects, which challenge traditional pastoralist-herder lifestyles and contribute to rural-to-urban migration. Higher temperatures are likely to increase the frequency and severity of heatwaves and droughts, especially in the south and southwest. Seasonal extremes are also expected to become more pronounced, and dzud, a distinct Mongolian phenomenon characterized by drought-like summer conditions followed by extremely cold, harsh winters, is likely to become more frequent and severe [
54].
Climate change may trigger wide-ranging negative feedback loops between livelihoods and health. It also alters the spread of vector-borne, waterborne, and foodborne diseases; for example, floods and droughts can shift cholera seasonality, underscoring the need for strong surveillance for early detection and response [
55]. Chandipwisa et al. [
56] also described climate change as a growing public health threat that increases zoonotic and foodborne disease risks and requires a One Health approach, stronger surveillance and food safety systems, and urgent global cooperation.
Pasture degradation has increased in recent years, following worsening droughts, higher temperatures, and the drying of water sources. Because much of the population depends heavily on livestock, climate shocks have reduced incomes by decreasing animal weight and wool and cashmere yields. The close proximity of pastoralist-herders to livestock as they move across pasturelands, including areas that host natural reservoirs of serious diseases such as plague, further supports the importance of One Health approaches [
57].
Environmental health challenges
Air pollution
Air pollution has increased substantially during the past decade in major Mongolian cities, especially Ulaanbaatar, because of rapid urbanization, poor urban planning, rural-to-urban migration, poverty, unemployment, economic crises, reliance on coal for heating and cooking, increasing motor vehicle use, and other pollution sources. These factors have contributed to worsening population health [
58]. The mean December particulate matter with an aerodynamic diameter of ≤10 μm (PM
10) concentration at 3 local sites, Erdenet, Darkhan, and Murun, exceeded the national permissible daily mean level of 100 µg/m³ during 2015–2019. Monthly average winter concentrations ranged from 89 µg/m³ in Erdenet in 2015 to 230 µg/m³ in Murun in 2019 [
59].
Since 1990, Mongolia has conducted more than 60 studies assessing the health effects of air pollution. Early studies focused on respiratory diseases linked to NOx and SOx, whereas later research from 1990 to 2007 expanded to immune-system effects and began monitoring PM
2.5 and PM
10. More recent assessments have shown associations between air pollution and cardiovascular disease, fetal development, disease burden, and indoor air quality. Findings suggest that air pollution contributes to 20% of cardiovascular disease cases and 9.2% of all deaths in Ulaanbaatar. Researchers have concluded that worsening air pollution is a major driver of poor physical development, respiratory and cardiovascular conditions, immune disorders, and cancer, especially among children, and have provided evidence-based recommendations for policy and prevention [
60,
61].
A systematic review by Soyol-Erdene et al. [
59] found that particulate pollution is the most severe and primary pollutant in Mongolian cities. Studies have adequately described the sources and composition of particulate matter in Ulaanbaatar. Most have focused on mass concentration and the chemical composition of total suspended particulates, PM
10, and PM
2.5, including ions, metals, elemental carbon, and organic carbon; however, frequent updates remain necessary. Increased NO
2 is closely associated with the growing number of vehicles, whereas SO
2 emissions are mainly associated with coal combustion and, to a lesser extent, transport activities. Compared with the growing number of air-quality studies in Ulaanbaatar, studies in other provinces remain limited. Findings from urban air-quality studies in Mongolia suggest several directions for future research.
Water quality
Mongolia is experiencing substantial water stress [
62] because of insufficient and unreliable rainfall, changing precipitation patterns, and flooding. Water scarcity is particularly evident in areas where populations rely on open water sources (streams and springs), many of which are disappearing. In recent years, groundwater mineralization and salinization have increased and are expected to worsen with climate change. These changes pose serious health risks, particularly through increased incidence of waterborne diseases. Climatic and water-quality indices are expected to fluctuate in the future, influencing disease prevalence. In developing countries, for example, a 1 °C increase in temperature has been estimated to be associated with a 5% increase in diarrheal diseases [
63].
Several studies have identified a range of waterborne diseases, including gastrointestinal infections such as dysentery, salmonellosis, and epidemic typhus [
64]. Globally, diarrheal disease ranks as the fourth leading cause of morbidity among all registered disease cases.
During winter, 36% of household storage containers were contaminated with
E. coli (mean, 12.5/100 mL), increasing to 56% in summer (mean, 50/100 mL). KAP surveys among the general population indicated that common practices among
ger residents, such as discharging greywater into pit latrines, soak pits, yards, and streets, contribute to environmental pollution and health risks. Household water supplies also showed high levels of bacterial contamination in drinking water [
65].
According to Mongolian National Standard 900:2005, drinking water must contain fewer than 100 microorganisms per 100 mL and no
E. coli or other pathogens. However, groundwater samples from household wells showed a 1.1-fold increase in microorganisms during summer, with
E. coli and
Proteus confirming contamination.
E. coli titers were correlated with total microorganism counts and
Salmonella levels, linking soil contamination to groundwater safety. Proximity to pit latrines was also strongly associated with elevated
E. coli and
Proteus concentrations in soil [
66].
AMR
Rising AMR threat
Mongolia has high rates of antibiotic overuse and self-medication, which contribute to the growing problem of AMR. Several studies have examined the key drivers of high antibiotic consumption in Mongolia. Dorj et al. [
67] reported very high consumption rates and large differences among the hospitals investigated. Inappropriate and excessive antibiotic use increases healthcare costs and may contribute to higher rates of nosocomial infections caused by potentially resistant species. Antibiotic consumption in acute hospital settings was significantly higher than in other countries, with a high prevalence of inappropriate use and overuse [
68]. To date, however, no concrete actions have been taken to effectively address AMR in human health.
During the Bridge Workshop organized by FAO, WHO, and WOAH from 15 to 17 June 2022, participants emphasized the need for stronger cross-sectoral collaboration across 15 key areas, including national and local regulations, technical-level policies, risk assessment, laboratory capacity, and AMR response. Widespread concern about AMR was reflected visually, as nearly all participants marked these areas in red to indicate critical gaps. One major challenge is that, AMR remains a relatively new issue within the human–animal–environment interface in Mongolia. Addressing this threat requires coordinated action to close gaps in policy, regulation, and surveillance [
69].
National action plan on AMR
In late 2022, Mongolia established the Multi-Sectoral Coordination Committee (MSCC) to lead national AMR control efforts. The MOH and the Ministry of Food, Agriculture, and Light Industry (MOFALI) serve as the main responsible agencies. The MSCC was formalized under Joint Order A/521 and A/331, which outlines its key functions, including funding allocation, policy development, and regulatory oversight. The committee also serves as an advisory body to government ministers and oversees relevant governmental and nongovernmental entities. On 2 May 2022, the MOH and MOFALI approved Joint Order No. A/255 and A/137 to implement the Multisectoral National Action Plan on Antimicrobial Resistance for 2022–2025. However, the MSCC lacks a clear legal basis, raising concerns about its sustainability and effectiveness. Following its first WHO-supported meeting in November 2022, a national technical working group was established to guide implementation, with regular MSCC operation and monitoring planned under the national action plan [
70].
Funding challenges and budget allocation for AMR
The estimated budget for the 4-year implementation of the national AMR action plan is approximately 4.6 million US dollars, according to WHO. However, financial constraints resulting from the COVID-19 pandemic, together with ongoing global political and economic challenges, may limit the Mongolian government’s ability to fully fund the initiative. Given these constraints, the MSCC is expected to play a leading role in securing funding and integrating AMR interventions into Mongolia’s broader national development agenda. Nevertheless, the committee continues to face challenges in coordinating and monitoring all aspects of AMR control. Because the national AMR action plan remains in the early stage of implementation, detailed work plans, clearly defined sectoral roles, and coordination policies remain underdeveloped. Clear guidelines and coordination mechanisms will be essential for the long-term success and sustainability of AMR control efforts [
71].
Challenges in AMR management
AMR is a cross-cutting issue that requires coordinated action across multiple sectors. Implementation of the national AMR action plan faces numerous challenges, including regulatory gaps, limited public awareness, weak surveillance systems, and laboratory-capacity gaps in the animal health, human health, and agricultural sectors [
72]. WHO governance recommendations emphasize that a dedicated secretariat or national focal point is essential for coordinating AMR-related activities between national and subnational levels. However, Mongolia has not yet established such a secretariat [
73], which may lead to inefficient information sharing, weakened partnerships, and poor coordination of national AMR initiatives. Byakharjav et al. [
74] also reported limited understanding among livestock stakeholders and inadequate surveillance systems, both of which continue to impede effective AMR control. Strengthening One Health collaboration, education, and monitoring systems is essential to reduce AMR risks in the agricultural and food sectors.
Policy and Governance Frameworks of One Health
Mongolia has established key institutions to address public health threats, including the MSCC for AMR and the NCZD. Gaps remain in governance, funding, and coordination. Stronger data sharing, digital surveillance, and evidence-based prescribing are needed to improve health outcomes and antimicrobial use. The MOH has a coordination mechanism for AMR reporting [
71] and has joined the WHO antimicrobial resistance network (WHONET). By 2022, efforts to strengthen national capacity included technical support to enhance the use of WHONET and the Global Antimicrobial Resistance Surveillance System. Despite this progress, laboratory capacity remains limited, with only 46 state laboratories able to conduct AMR testing [
75,
76].
Zoonotic disease priorities include brucellosis, echinococcosis, rabies, anthrax, and bovine brucellosis (
Figure 3). These priorities align with long-standing national research priorities. Sustainability is critical for Mongolia’s zoonotic disease surveillance system, and long-term success depends on adequate funding, human resources, and effective intersectoral coordination. The NCZD collaborates with the human and animal health sectors to conduct joint outbreak investigations and develop response plans. However, inadequate communication and coordination between sectors remain persistent challenges [
77].
Animal diseases continue to pose risks to public health and economic development, particularly in the livestock sector. Despite ongoing control programs and the revised Animal Health Law (2017), veterinary services face capacity constraints in managing transboundary and trade-sensitive diseases [
78,
79]. Several strategic control programs for transboundary animal diseases and zoonoses have also been implemented [
80,
81].
Overview of National Strategies Promoting One Health
Mongolia has increasingly incorporated One Health principles into key national strategies, including the Health Sector Strategic Plan, the Zoonotic Disease Control Program, and the National Action Plan on AMR (2022–2025). Sectoral country profiles were jointly developed with support from WHO, FAO, WOAH, and UNEP to assess Mongolia’s readiness and identify priority actions under the One Health Joint Plan of Action (2022–2026) [
2].
Policies on Human–Animal–Environment Interfaces and One Health Framework Adoption
Although Mongolia’s Law on Food Safety (2012) and Animal Health Law (2017) provide regulatory oversight of zoonoses and food safety, policies addressing the broader human–animal–environment interface remain fragmented. A critical gap is the absence of a dedicated legal framework for wildlife health, because the Ministry of Environment and Tourism does not have jurisdiction over wildlife diseases [
82]. Mongolia has adopted or engaged with global frameworks such as the International Health Regulations (IHR 2005), WHO’s JEE, and WOAH’s PVS Pathway. In 2022, Mongolia also conducted a National Bridging Workshop to identify operational gaps in multisectoral coordination [
83]. These efforts reflect a growing commitment to harmonization with the Quadripartite One Health Joint Plan of Action (2022–2026).
Legislative and Regulatory Frameworks
The Asia Pacific Strategy for Emerging Diseases also supports the advancement and maintenance of core capacities under the IHR 2005 [
84]. In line with this framework, Mongolia participated in the voluntary JEE assessment in 2025. The Law on Disaster Protection (2003) and the Law on Health (2011) establish Mongolia’s legal framework for disaster and public health emergency response, defining roles, responsibilities, and resource allocation at national and local levels. In 2024, Mongolia adopted a new public health law to strengthen service delivery and system resilience, reflecting ongoing efforts to align with the IHRs [
85,
86].
Figure 4 illustrates Mongolia’s key public health priorities under the new law. These priorities identify areas requiring cross-sectoral action and show how Mongolia’s One Health framework integrates human, animal, and environmental health to address zoonoses, AMR, and EIDs.
Surveillance and Early Warning Systems for Infectious Diseases
Public health surveillance in Mongolia involves the systematic collection, analysis, and dissemination of health data to guide timely interventions and reduce disease burden. Its primary goals are early outbreak detection, rapid response, and evidence-based decision-making. The NCCD leads infectious disease surveillance across all levels of the health system [
87].
Mongolia operates a comprehensive surveillance system that includes indicator-based, syndromic, event-based, and disease-specific components managed jointly by the NCCD and NCZD. Syndromic surveillance, implemented since the 1990s, is a key mechanism for early detection of public health threats [
88]. At the primary level, they are collect and report data on infectious disease syndromes, with weekly reports submitted to subnational surveillance units [
89].
Surveillance System for Zoonotic Diseases and Its Sustainability
The NCZD leads zoonotic disease surveillance in Mongolia, including brucellosis, anthrax, plague, and influenza. Monitoring, laboratory testing, outbreak investigations, and strengthened data systems support timely response and public health decision-making, although managing a broad range of zoonotic threats remains challenging [
17]. The legal framework, aligned with the IHRs (2005), defines roles across sectors and supports intersectoral coordination between human and animal health systems [
90].
National Priorities, Legislation, Policies, and Programs in the Animal Health Sector
Livestock plays a central role in Mongolia’s pastoral economy, accounting for about 90% of agricultural production and totaling 64.7 million animals in 2023. National priorities include livestock development, export growth, veterinary services, food safety, and compliance with international standards [
91]. The General Authority for Veterinary Services leads national programs on disease prevention, zoonoses control, and trade certification [
92]. Given Mongolia’s borders with Russia and China, cross-border disease risks remain substantial. Border inspection and quarantine systems play a critical role in preventing transboundary animal diseases [
93].
Multisectoral Actions
Multisectoral coordination is mandated under Decrees No. 08 (2017) and No. 28 (2023), with the MOH’s Emergency Operations Center facilitating regular information exchange across sectors, including zoonoses, food safety, and environmental health. During the COVID-19 pandemic, the State Emergency Commission served as the central coordinating body, bringing together multiple ministries and agencies to oversee response efforts and strengthen intersectoral collaboration [
30].
Figure 5 illustrates the timeline of key regulatory documents related to the One Health approach in Mongolia and presents a conceptual framework for multisectoral collaboration within the national public health landscape. This framework was developed by synthesizing policy documents, surveillance reports, and interviews with key stakeholders in all 3 sectors. The diagram highlights formal coordination structures, such as intersectoral committees and councils, as well as informal mechanisms that enable cross-sector communication and joint action.
The framework depicts multisectoral collaboration across policy, operational, and stakeholder levels, including national strategies and regulations, joint surveillance and outbreak response, defined actor roles, and mechanisms for communication and data sharing.
Overall,
Figure 5 visually synthesizes Mongolia’s integrated public health approaches, showing how policies, operational activities, and stakeholder interactions converge to support coordinated, evidence-informed responses to zoonotic diseases, AMR, and emerging public health threats under the One Health framework.
Prioritized Recommendations and Directions for Future Research
This study identified key drivers influencing implementation of the One Health approach in Mongolia, reflecting the country’s distinctive sociocultural, environmental, and health contexts. These drivers include nomadic lifestyles, urbanization and migration, climate change, and environmental health risks.
These findings can inform policy, risk assessment, and research to strengthen integration across human, animal, and environmental health. A structured One Health index could also track Mongolia’s progress in addressing zoonoses, environmental risks, and AMR.
Drawing on global One Health frameworks, key recommendations for Mongolia are to: (1) strengthen surveillance of zoonotic diseases and climate-related health risks; (2) improve coordination across health, agriculture, and environmental sectors; (3) establish monitoring frameworks for zoonoses, AMR, and environmental health; (4) increase public awareness, particularly among herders and urban populations; and (5) strengthen governance through comprehensive policies, sustainable financing, and integration of traditional knowledge.
, Suvd Batbaatar1
