A new dose of certainty for childhood cancer care in Mongolia

For children with cancer, having the right medicines available at the right time is essential to completing treatment. Yet in many countries with limited resources, access to quality-assured childhood cancer medicines can be inconsistent, with supply challenges, limited purchasing power and other barriers contributing to shortages or gaps in availability. 

For families in Mongolia, concerns about access to treatment can add another layer of fear to an already devastating diagnosis. When Dolgormaa’s son, Tuguldur, was diagnosed with leukemia, she feared the treatment he needed might not be available in Mongolia. “At the time we were first diagnosed, we were extremely panicked, thinking, ‘Should we go somewhere else? Should we go abroad for treatment?’” said Dolgormaa. 

Tögsöö faced similar concerns when her 5-year-old daughter, Nandinzaya, was diagnosed with leukemia. “When she was first diagnosed, people told us that blood cancer couldn’t be treated in Mongolia,” Tögsöö said. “Hearing that was devastating for our family.”

Tögsöö’s family began exploring care abroad, where the full course of treatment was estimated to cost between 200 million and 300 million Mongolian tugriks — approximately $56,000 to $83,000 in U.S. dollars, placing treatment abroad far beyond what many families can afford.

For both families, the uncertainty raised the same questions: Could they find the treatment their children needed? And if that treatment meant leaving Mongolia, could they afford it?

As these families faced the uncertainty of where their children could receive treatment, St. Jude Global was working with international and local partners to strengthen access to childhood cancer medicines in Mongolia and other countries around the world. Through the Global Platform for Access to Childhood Cancer Medicines (Global Platform), St. Jude and World Health Organization (WHO) are improving access to quality-assured childhood cancer medicines worldwide in collaboration with UNICEF and the Pan American Health Organization (PAHO) Strategic Fund.

Every dose matters  

At the heart of Mongolia’s pediatric cancer care infrastructure is the National Centre for Maternal and Child Health (NCMCH) in Ulaanbaatar, where children from across the country come for cancer diagnosis and treatment. “All children with cancer from across the whole country come here,” said S. Otgongerel, a pediatric hematology-oncology nurse at NCMCH. “Our main mission is treating them here in Mongolia.”

For NCMCH, fulfilling that mission has also meant navigating a challenge extending beyond the hospital: securing a reliable supply of the specialized medicines children need throughout treatment.

About 100 to 120 children are diagnosed with cancer in Mongolia each year. Because each type of childhood cancer requires different medicines, only a small number of children may need a particular drug. For suppliers, providing medicines in such small quantities may not be financially worthwhile, making some drugs difficult for hospitals to obtain.

For children undergoing cancer treatment, every dose matters. Missing or delaying therapy can disrupt a carefully timed treatment protocol. “When there was a medicine shortage, children sometimes couldn’t receive their treatment on schedule or complete part of their treatment cycle, which led to various complications,” said Otgongerel. 

When medicines were unavailable through the health system, families sometimes had to find and purchase them elsewhere, including outside of the country. That could mean substantial out-of-pocket costs as well as uncertainty about whether the medicines were transported and stored properly.

Building a foundation for reliable care  

The Global Platform was established to help address issues affecting pediatric cancer therapeutics through an innovative, multilateral collaboration among international partners and participating countries. The Global Platform goes beyond medicine supply, working alongside countries to strengthen the systems needed to store, prepare and administer these treatments safely.

In 2023, Mongolia was one of the first countries to participate in the Global Platform. St. Jude and WHO worked closely with Mongolia’s Ministry of Health and NCMCH to prepare the country to receive and safely use the medicines. Before the first shipment arrived, partners spent more than a year assessing Mongolia’s childhood cancer care system, identifying gaps in medicine access and strengthening the policies, clinical protocols and processes needed to deliver those medicines to children safely. 

“Medicine is only one part,” said B. Sukhbaatar, technical officer for non-communicable diseases, WHO Mongolia. “It also takes the right systems and standards to ensure those medicines are used safely and effectively.”

That meant assessing access to 35 essential childhood cancer medicines, updating clinical protocols and chemotherapy procedures, and training health care professionals in specialized care and early detection. In February 2025, that preparation reached a major milestone when Mongolia received its first shipment of childhood cancer medicines through the Global Platform. 

From uncertainty to reliability

The impact of the Global Platform extends beyond simply having medicines on hospital shelves. For clinicians, it has brought greater certainty that the medicines a child needs will be available when it is time to administer them.

That reliability has changed the experience of treatment for families and health care teams. Instead of worrying about where they might find the next medicine or whether treatment could proceed as planned, families can focus more fully on their child’s care. For Otgongerel, that shift is felt throughout the hospital. “Families have greater peace of mind, and so do we,” she said. “We can feel more at ease knowing the medicines children need will be available throughout treatment.”

The change extends across NCMCH. “Since receiving our first shipment in February 2025, we no longer face medicine shortages or treatment interruptions, and we have access to quality-assured medicines,” explained J. Otonbaatar, general director at NCMCH. 

Strengthened systems beyond supply 

The availability of medicines created the need for enhanced protocols and processes inside the hospital pharmacy at NCMCH. In the past, nurses in the hematology-oncology unit prepared chemotherapy medicines while also providing bedside care. With guidance such as the Standard Operating Procedure for Safe Delivery of Chemotherapy provided by the Global Platform, NCMCH has since established a dedicated chemotherapy-compounding service, where a trained pharmacy technician prepares each dose under a pharmacist’s oversight before it is delivered to the clinical unit for administration.

“This isn’t something you can just store and hand out,” said G. Chimedtseren, a NCMCH pharmacist in the chemotherapy-compounding unit. “I especially care about children’s safety and making sure the correct dose is used, and the right medicine is given to each child.”

Moving chemotherapy preparation into the pharmacy has also created a more controlled process for handling medicines that can pose risks to the people preparing them. The compounding unit was equipped with specialized equipment, while pharmacy staff received training and developed procedures for properly preparing the medicines. 

“Chemotherapy medicines are substances that require specialized facilities, equipment and trained staff to handle them safely,” said V. Oyungerel, head of the Department of Clinical Pharmacy, NCMCH. “Through this effort, we’ve strengthened those systems to protect children and ensure each medicine is properly prepared at the right dose.”

The systems established through the Global Platform are also intended to support Mongolia’s ability to maintain reliable medicine access over the long term. NCMCH and its partners are strengthening medicine forecasting, financing and procurement while continuing to build the health care workforce needed to sustain childhood cancer care.

“Mongolia itself needs to be capable of taking this over independently,” said B. Batdulam, head of the Department of Pediatric Hematology-Oncology, NCMCH. “That capacity won’t appear overnight; it has to be built up in stages.”

Treatment at home, hope for the future 

For Dolgormaa and Tögsöö, one of the greatest impacts of the Global Platform is simple: their children received the medicines they needed without leaving Mongolia. Both Tuguldur and Nandinzaya received treatment at NCMCH and have since entered maintenance therapy, which requires continued access to medicine after the most intensive phase of treatment ends. Before the Global Platform, NCMCH could not routinely provide outpatient maintenance medicines, leaving families to find them elsewhere. Today, clinicians calculate and prescribe each child’s maintenance dose, and the hospital pharmacy dispenses the medicine directly to families.

For Dolgormaa, that change has provided a sense of security throughout Tuguldur’s treatment. “Our doctor told us that our center had brought in all these medicines, meaning our son could be fully treated right here in his own country, in his own language, alongside fellow Mongolians,” she said. “We started treatment here, and we haven’t had to source any medicine from outside — not a single dose.”

Nandinzaya spent about eight months receiving intensive treatment and will continue maintenance therapy. “The medicine arrived, and we no longer had to worry about whether it would be available,” Tögsöö recalled. “We could focus on following our doctor’s guidance and getting Nandinzaya through treatment.”

Now, the two families who once wondered whether their children would have to leave Mongolia for lifesaving care can look beyond the next medicine or treatment cycle and toward what comes after. 

“We have so much hope for the future,” Tögsöö said. “We imagine our daughter growing up, becoming a student, and our family living happily together. We have so many dreams for her, it’s hard to know which one to mention first.”