Adapting policies and interventions to new contexts – Hypertension, Mongolia
Why this case study?
This case illustrates the importance of adapting interventions to the local context and piloting them prior to scale up.
The case study also highlights some of the barriers and facilitators to the adaption and piloting process and proposes ways in which to address these.
Adapting policies and interventions to new contexts
The George Institute for Global Health, Sydney, Australia
Hypertension and comorbidities
General population of Ulaanbaatar (Mongolia’s capital city)
Population-wide salt reduction programmes are widely viewed as one of the most cost-effective interventions for the prevention of hypertension and associated NCDs.
The number of such national programmes has almost doubled between 2010 and 2014 and programmes are now being implemented in most regions of the world. However, to date, most of those that have demonstrated an impact are from HICs. There is some way to go to translate the lessons from these countries to low and medium income countries (LMICs).
Description of policy or intervention
Successful salt reduction programmes identify the main sources of salt in the diet and then develop a strategy to reduce them.
The Ministry of Health in Mongolia (MMoH) implemented a pilot intervention to reduce population salt intake in Ulaanbaatar during 2012–2013. The results of this pilot, combined with a series of other initiatives, informed the development of a National Salt Reduction Strategy.
What took place?
The MMoH established an intersectoral working party and organized a two-week national consultation and training programme on salt reduction. Actions arising included implementation of a pilot salt reduction intervention.
The main objective of the pilot intervention was to reduce salt intake of the employees of three factories, based on the notion that simply telling people what they should/should not eat does not work – the food environment also needs to change. Adapting this to the Mongolian context, implementation strategies included training employees on the negative health impact of salt and on consuming a healthy diet, as well as actually reducing salt levels in the food served in company canteens/kitchens.
Pre- and post-intervention monitoring showed that salt intake reduced between 2011 and 2013. The number of people that did not know which foods were high in salt also declined substantially during the same period.
These activities demonstrated the potential for action and helped to convince policy-makers to scale up the policy to national level, resulting in the Mongolian National Salt Reduction Strategy being endorsed by the government in 2015 – with the ultimate goal to reduce population salt intake in Mongolia by 30%.
What have we learnt?
Success of the pilot intervention and scaling up of the policy to national level was possible for a number of reasons:
- The importance of multisectoral action was recognized from the outset.
- The project emerged from consultation and training on salt reduction and raised awareness of the health impacts of salt.
- The approach started by trying to understand the main sources of salt in the diet and how best to reduce them (rather than simply replicating salt reduction initiatives from other countries).
Lessons for other countries:
- Do not just replicate other programmes. A good understanding of how consumption patterns are contributing to salt intake in the country of interest is also needed.
- Do ensure that your strategy is multifaceted, combining a change of the food environment together with programmes to change consumer behaviour.
- Do continue with advocacy programmes to ensure strong government support and adequate financing.
- Do establish effective multisectoral stakeholder engagement, community participation and training procedures from the outset.
- Do, where possible, implement pilot interventions.
- Do not leave evaluation until the end of the programme. Regular monitoring ensures programmes are on track to achieve targets.