Board Governance for Sustainable Development: A Swot-Ahp Evaluation of Strategic Leadership in Mongolia's Specialized Hospitals

Sustainable Development Goal 3 (SDG-3) commits countries to ensuring healthy lives and well-being, a commitment that depends squarely on the strength of health system governance, including at the level of the individual hospital board. In Mongolia's specialized hospitals, effective governance by the Board of Trustees is central to strategic leadership, yet the Board's own role has been largely untouched by prior structural equation modeling of hospital governance. This paper addresses that gap using pairwise-comparison questionnaires completed by executives and governance experts at three anonymized state hospitals, identified here as Hospital A, Hospital B, and Hospital C. A SWOT-based Analytic Hierarchy Process (SWOT-AHP) quantified how internal and external factors shape Board governance, and the resulting priority weights informed a Threats-Opportunities-Weaknesses-Strengths (TOWS) strategy together with a forecast running through 2030. Among internal factors, the strongest were the Board's commitment to fair compensation and service quality for medical staff (0.218), its consistent representation of staff interests (0.213), and its oversight of executive management (0.159); the weakest were an unclear development strategy and vision (0.135) and limited use of annual reports for risk assessment (0.152). Among external factors, the chief executive's greater authority relative to the Board (0.224) exerted the strongest influence. Overall, strategic leadership in these hospitals is constrained chiefly by an unresolved division of authority between the Board and executive management; SO, WO, ST, and WT strategies are proposed to strengthen Board effectiveness by 2030 and, in doing so, to support progress toward SDG-3 targets on health-system governance and universal health coverage.