Vladimir Putin's opening remarks:
Good afternoon, colleagues,
Yesterday, we studied residential construction using the example of a new housing development in the Moscow Region. Today, here in Tver, we will use this excellent example of a new perinatal centre to talk about high-tech medical centres and the construction of perinatal centres.
You know, we have planned an entire programme for these endeavours. Just recently, at a meeting of the Presidium for National Projects in Tambov in July, we discussed progress made in the construction of both perinatal centres and high-tech medical centres.
A number of high-tech medical centres are already up and running, receiving patients, performing operations, but for some there are problems. Let us talk about that today.
Regarding perinatal centres, I don't need to tell you how important this programme is for sustainable demographic development, improving people's quality of life, as well as providing accessible and truly modern medical care.
Let me remind you that in 2005, no more than 60,000 people had access to high-tech medical care at state funded healthcare institutions. In 2009, the figure went up to 254,000; in 2011, there will be 294,000; for 2012, the forecast is 335,000; in 2013, there will be 369,000 such people. And by 2015, our task will be to fully meet the needs of the nation for high-tech medical care.
We are giving our utmost attention to motherhood and childhood. We launched the Birth Certificate programme and we have begun introducing modern systems in the diagnosis and care of newborns. As a result, infant mortality has been reduced considerably. I particularly want to point out that, for the first time, infant mortality in 17 regions of the Russian Federation has decreased to the level of developed EU countries. More recently, there was a dramatic lag behind these countries. The infant mortality rate in Russia used to be twice as high as figures in the developed countries of the EU.
In essence, we took up the formation of a national infrastructure of high-tech healthcare services for the first time in earnest as part of the Healthcare priority national project, and our principled position was to primarily build new clinical centres in the country's regions and thus bring modern high-quality medical care to the people who need it, so that they do not have to get on a train or a plane to receive treatment at Moscow hospitals, spend money on travel, accommodation and incur other expenses that are not directly related to healthcare, or be placed on a waiting list for months or even years to get the operation or tests they need.
We planned the construction of 14 national high-tech medical centres and a one-of-a-kind research and clinical centre for paediatric haematology, oncology and immunology, which we intend to commission, as planned, in 2011. Three high-tech medical centres have already been commissioned in 2008 and 2009, and this year, four new centres will open in Khabarovsk, Krasnoyarsk, Chelyabinsk, and Tyumen. The programme should be fully implemented by the end of 2011, when all the new centres should be operational and receiving patients.
We also planned to build 22 regional perinatal centres, and provided for the establishment of two more special national perinatal centres, which will develop innovative technologies and techniques and then transfer them to the regions. Four regional perinatal centres are already operating: in Irkutsk, St Petersburg, Kaliningrad and here, in Tver, where we are today. We are currently finishing equipping the fifth centre - in Murmansk.
That being said, the work is not always done on schedule and not always properly organised. In this regard, I draw your attention to the regions that have extensive delays with the installation of equipment, construction of foundations and conduits for furnishing the centres to accommodate advanced healthcare technology. This applies first of all to the Primorye Territory and the Kaliningrad Region. In essence, the construction of the so-called underground part - the foundation - is the responsibility of the constituent entities of the Russian Federation, as we have agreed. You must take comprehensive measures for the land plots for the prospective centres to be ready in time so as to avoid what happened in one region: because of inconsistencies among the various agencies, equipment and components were transported, stored, and then contaminated by a fungus, and now they simply have to be destroyed.
I also ask the Finance Ministry, Healthcare Ministry and State Corporation Russian Technologies to provide calculations for additional financial resources required to complete the construction of high-tech medical centres. These funds should be allocated in the federal budget for 2010 and 2011.
Now, a word about our joint work with the regions on perinatal centres. We agreed that we would build them on the principles of 50-50 co-funding. The federal budget has almost completely fulfilled its funding obligations: 11.5 billion roubles have been transferred to the regions, and the remaining 2.5 billion will be available, as agreed, by the end of the year.
Unfortunately, I cannot say that the regions are doing their part as well. There is a whole array of problems and failures.
Let me remind you that a standard design for a medical centre was approved at a value of 1.5 billion roubles. I reiterate that this standard design was implemented at the centre where we are now. However, based on the decision of virtually all the constituent entities of the Russian Federation, the cost estimate for perinatal centres has been increased, by somewhere in the range of 13% to 20%, but also by 100% in some places, and even by 139% in the Krasnoyarsk Territory. As a result, the general lack of regional funding for the construction of perinatal centres in now upwards of 17 billion roubles.
I know very well that appreciation sometimes occurs for objective reasons, such as the inflation, price increases - it's all clear. But when the increase is 139%, I think you'll agree that it is just too much. This means either the calculations in the beginning were faulty or we haven't been keeping track of prices.
It is clear that managers, especially those managing healthcare facilities, influence regional leaders to refine and improve the perinatal centre design, to increase its capabilities. But if you make such decisions, you should understand what stands behind them. We must fully take responsibility for this performance, including financial responsibility, since good intentions, as we know, if they are not backed by real resources, become plain populism and discredit an inherently important and useful idea.
So far the impression has been that the priority status of the perinatal centres construction is empty words to some of our colleagues in the regions. Their budget policy testifies to this. However, healthcare as a whole and particularly the demographic programme are among the pivotal fields of government activities. I have said so before, and you all know it quite well, those of you present here and our colleagues in the regions, who are listening to us. It is one of our critical goals. Any progress we have made in the demographic situation will vanish in no time unless we pay due attention to this issue.
Let us turn to rising costs and to the fulfilment of our mutual obligations. I see the Trans-Baikal Territory governor on the screen. The territory has received all the federal allocations we had agreed on, while you, distinguished colleagues, have funded just 3% of construction, according to the information that has reached me. Mordovia has funded only 6%, the Kurgan Region 7.6%, and the Kirov Region 25%. This is a bit more but still not enough.
Requests are coming from the regions to postpone the commissioning of centres. I want to call your attention to the fact that it is better in such instances not to lag behind or amend schedules but to do everything possible to meet the set deadlines and follow the plans we have made in every detail. The pace of the job should pick up dramatically. All our colleagues in the regions should submit explicit and thoroughly verified schedules of construction and equipment assembly. The Ministry of Healthcare and Social Development must closely cooperate with the regions and monitor the situation continuously. I ask Deputy Prime Minister Alexander Zhukov to coordinate the entire process and pay personal attention to every instance when the deadlines are not met.
I would like to discuss another issue today. The federal healthcare modernisation programmes will be launched in 2011. I think that the regions should pay special attention to improving mother and child healthcare in drawing up these programmes. It really is a critical field that demands the utmost concentration of our energy and resources. Let us get down to business. Minister of Healthcare Tatyana Golikova has the floor. Go ahead, please.
Tatyana Golikova: Thank you, Mr Putin.
Mr Prime Minister, ladies and gentlemen,
The Strategy for the Demographic Policy until 2025 is the essential document on which our decisions are based in the sphere of the Healthcare National Project and demographic policy. The key goals of this strategy are to stop the population decrease, to increase birth rates and at least halve death rates, including maternal and infant mortality.
Mr Putin, the efforts you have mentioned in your opening remarks are certainly bearing fruit. The birth rate increased by 21.6% in the Russian Federation in 2005-2009; infant mortality decreased by 26.4% and maternal mortality by 13.4%. No doubt, we should not rest on our laurels because our main goal concerns not the natural decline in the population but stabilising the population and its natural increase. The two aspects of the national project we are discussing today - high-tech healthcare and medical aid to mothers and children - are certainly the principal factors that help us reach the goals set out in the Strategy of the Demographic Policy until 2025.
I would like to speak in detail about high technology we are implementing in the perinatal centres under construction and within the framework of what we have seen today. No doubt, the organisation of mother and child healthcare we have seen here and in all newly opened centres and which, I hope, we will see in the centres to be built in the future, includes the treatment of pregnant women with severe pathologies. Such treatment is impossible unless particular requirements are met. It is, as I have said, treatment of life-threatening disorders affecting the mother and the baby, aid to weak babies, high-tech first aid, the availability of mobile obstetrical units for anaesthesia and life support and of neonatal consultation and life support centres for emergency aid to mothers and newborns and, certainly, special care nurseries for premature babies. I want to remind you that Russia has announced a shift to the world standards of birth in 2012 as part of implementing its Strategy of Demographic Policy until 2025. The construction and opening of perinatal centres is timed to this deadline, among others, because we need the latest technology for such medical aid.
As you said in your opening remarks, we have opened perinatal centres in Irkutsk and Kaliningrad. The federal funding for them was channeled not so much into construction as into equipping the centres. Indicatively, the high-tech equipment we are discussing is available at the Tver centre we have visited today and at the national perinatal centre, which has been licensed a few days ago and is affiliated to the Almazov Federal Centre of Cardiology, Blood Disorders and Endocrinology in St Petersburg. Regional centres are ready to open in Murmansk, Rostov-on-Don, Kirov, Voronezh, Krasnodar, Yaroslavl, Ryazan, Kemerovo, Yekaterinburg, and Tomsk. Regrettably, we cannot be sure that sufficient progress has been made on similar centres in Kursk, Volgograd, Saransk, Perm, Saratov, Blagoveshchensk, Chita, Kurgan, and Krasnoyarsk. We are finalising all the details in decisions made on the national perinatal centre in Moscow.
Perinatal centres equipped with cutting-edge medical equipment pool the efforts of specialists in various fields and implement effective therapeutic and diagnostic know-how to offer the entire range of healthcare, including consultations, diagnostics, inpatient treatment, online consultations, and the establishment of mobile obstetrical and neonatal units for anaesthesia and life support.
The principal difference between a usual maternity ward and a perinatal centre lies in high-tech aid to mothers and babies with pathologies. As this slide shows, normal pregnancies, which ordinary maternity wards at city and district hospitals can cope with, make only 24% of the total number of pregnancies. All the others run medium and even high risks. All high-tech equipment which, I stress once again, we have seen here and will see in other centres is meant for pathological deliveries and the care of babies with congenital conditions.
The regions with perinatal centres providing postnatal care and national research institutes established in 29 regions exemplify healthcare. The Ryazan Region is among them. Infant mortality rates in such regions are 5% to 7% below the national average and 10% to 13% below the average in the regions that have no perinatal centres and do not provide postnatal care.
We can conclude even now that perinatal centres with cutting-edge equipment and innovative treatment rescue about 650 babies in their first year annually nationwide. When every constituent entity receives such a centre, the number of rescued babies will reach 1,700 a year.
After reaching entire capacity, 22 perinatal centres will treat more than 90,000 patients.
As I have said, two perinatal centres opened last year: in Kaliningrad and Irkutsk. Federal aid was channeled not so much into their construction as into medical equipment. The slides here show that infant mortality has come down 40% in the Kaliningrad Region and 30% in the Irkutsk Region.
This is certainly due not only to the presence of the centres alone but to the entire prenatal and infant healthcare system.
As we see in this slide, the 29 Russian regions that have perinatal centres have far better figures than the other 54 regions that have no such centres in terms of the number of liveborn babies, maternal mortality and other established indices of comparative monitoring.
I must also mention that infant and maternal mortality has also dropped dramatically in this region in the past few years.
In 2005 to 2009, the birth rate rose by 19.4% and infant mortality decreased by 32.1% in the Tver Region, and maternal mortality rates dropped from 75.1% in 2005 to 13.3% in 2009. These spectacular figures show what can be achieved when top authorities consider it a priority and promote it.
I want to say that the construction of perinatal centres and the development of high technology is not all we are doing. We are certainly making progress within the framework of proposals you approved in Tambov. Our objective in the regions is to create a three-tier system of medical aid to pregnant women and newborns, the establishment and development of medical consultations and life support services, the improvement of diagnosing fetal pathologies, and so on.
We expect the regions to pay special attention to this aspect as they draft standard healthcare modernisation programmes. At any rate, we have set out relevant objectives for them.
As for the other component, connected with the construction of cutting-edge centres and high-tech healthcare, we have certainly come a long way from the 60,000 patients you mentioned in the beginning of your address.
I must say that disease prevention envisaged by the national project, health screening in particular, aims at diagnosing disorders at their initial stage. As a result, the number of patients in need of high-tech and other treatment has been growing.
But when the decision was made at the start of the national project on the geography of high-tech medical centres and on making high-tech treatment more widely available, it was certainly based on the structure of mortality and morbidity in Russia.
As we all know today, incidence leadership belongs to cardiovascular diseases, injuries and orthopaedic disorders. We have also chosen neurosurgical centres, of which there are two. We have made the choice not because these disorders have the greatest occurrence but because neurosurgery was available only in Moscow and St Petersburg until recently. Our colleagues have achieved good results there but the current goal in this field is the dissemination of their skill and experience to the rest of the country. Neurosurgical centres will open in Tyumen and Novosibirsk. The Tyumen centre will be commissioned this year according to a schedule we have agreed with State Corporation Russian Technologies.
What have we gained with the centres opened in 2008 and 2009? These are the three centres you have mentioned: two cardiovascular centres, in Penza and Astrakhan, and one in Cheboksary for traumatology, orthopaedics and prosthetics. The Penza centre has performed 6,410 high-tech operations, 52% of them on patients from the Penza Region and the rest for people from the neighbouring regions. The Astrakhan centre has operated on 4,906 patients, 62% of them from the Astrakhan Region, and the Cheboksary traumatology and orthopaedic centre on 4,180 patients, 71% of them residents of Chuvashia.
What do we expect from the centres to open this year? The majority of them will open in the fourth quarter. Even now, the present budget stipulates at least 200 high-tech operations in each centre. Funds are available, and we expect a government contract for about 10,000 instances of high-tech treatment in all four centres as early as next year. As a rule, it takes two to two and a half years for a high-tech medical centre to achieve estimated capacity envisaged by project documents and targets set as the project was launched. Another group of centres will open next year. The work on them is also going on despite a certain lag you mentioned in your opening remarks.
I also want to call attention to our planned specialist training for high-tech medical centres. We have trained about 800 specialists in various fields of medicine since the national project was launched. As you see in the slides, the training and retraining takes place at leading medical institutes in Moscow, St Petersburg and Novosibirsk. We should not, however, ignore the opportunity you approved in Tambov. I mean specialist training in the latest innovation technology at foreign and other medical institutions. I cannot say that this is not happening already, but it is financed by medical institutions and regions. However, we have included it in the national project as of next year, though its funding will be limited, roughly 50 million roubles.
In conclusion, I would like to say that the statutes of the four centres to open this year have been approved. They have obtained Federal Tax Service certificates on their government registration as legal entities, and registration with the tax authorities. Their managers have been appointed, and payrolls and budget estimates approved. Specialists have been trained for their staff, as I have said. We are already launching new telemedicine technology at all perinatal and other high-tech centres. We had no time today to call your attention to another detail, which might appear of small importance though it really is not: the Tver perinatal centre is switching to electronic records covering the entire life of mother and child from birth through adulthood. Thank you.
Vladimir Putin: Thank you very much.