Vladimir Putin’s opening remarks:

Today we are meeting here in Smolensk in order to see how regional healthcare modernisation programmes are being implemented in the Central Federal District and, by extension, in other districts. This is a topic we return to so regularly it practically never falls from view. Today we shall consider how the final stages of the construction work on perinatal centres and high-tech medical centres is progressing. We have just visited the regional clinical hospital here in Smolensk, and seen the construction site for the Federal Centre of Traumatology, Orthopaedics and Endoprosthesis. I expect this work to be completed on schedule, and that by February 2012 – remember this construction work started in May this year – the new centre will be able to receive patients.     

Thanks to the Health national project we have managed to solve the most acute problems in healthcare. I repeat, only the most pressing problems. Now, under regional programmes, we must effect qualitative change in improving healthcare in the Russian regions. This is above all about upgrading the quality of medical help on offer, ensuring it is accessible and of course, it is about decent pay for medical professionals, medical workers. We have devoted serious sums to this. Before 2013, the federal budget and the Mandatory Medical Insurance Fund will allocate an additional trillion roubles to healthcare. We are all well aware that, for our country, this is a sizable sum. Regional modernisation programmes will be financed to the tune of 460 billion roubles. A further 490 billion roubles will be made available under the Health national project which we have decided to prolong.

As regards the regions in the Central Federal District, the most populous of all the districts in the Russian Federation, healthcare modernisation programmes will receive 113 billion roubles from the federal budget, and here I would like to identify several fundamental tasks.

The Ministry of Healthcare and Social Development and, of course, the regional administrations must review these programmes on a rolling basis. As part of these modernisation programmes, medical equipment must be procured and repair works must be carried out at hospitals and clinics. I would like to note that time is of the essence, we cannot afford to dawdle. Speaking of which, I’ll have more to say about that in a moment. I have seen how work is progressing in Smolensk: it is proceeding at a steady pace and largely according to schedule, which is heartening.

Russia’s constituent entities have received funding for these programmes. Now it all depends on the initiative, professionalism and promptness of the regions, as well as their ability to efficiently organise the work. The regions that are efficiently implementing programmes include the Belgorod, Lipetsk and Bryansk regions. Unfortunately, certain regions, such as the Vladimir, Kursk, Kostroma, Moscow and Tver regions, are having serious problems sticking to the schedule, even though all regions are working in the same conditions. I would like to emphasise that only 13% of the allocated funding has been put to use in the federal district so far.  

It is late August already, and yet only 13% has been spent. This is 4.7 billion roubles. The pace of work must be intensified. I ask the regions’ governors to strictly monitor equipment purchases and repair work. The money should be used to purchase up-to-date equipment on the basis of transparent procedures.   

Please don’t talk about the lack of regulation and fears regarding inspections by various supervisory organisations and law enforcement bodies. In Moscow, the criteria used during the bidding process were very good. Should any difficulties arise in the regions, I have made arrangements with Mr Sobyanin (Moscow Mayor Sergei Sobyanin) so that you can contact Moscow-based institutions to promptly resolve any issues.  

Another important point to mention – yesterday, I met with representatives of organisations for people with disabilities. We spoke about how the disabled cannot always get proper medical examinations due to the lack of a barrier-free physical environment and proper equipment. I would like you to pay attention to this issue. With new facilities under construction and old ones restored and repaired, you must not forget to make them accessible to people with disabilities. When purchasing equipment, you should pay attention to this, to ensure that people with disabilities have equal opportunity to use services at medical institutions and the equipment purchased for these institutions.  

Particular attention should be paid to how medical care is managed, including the introduction of up-to-date information technology, such as electronic document management, electronic medical records and electronic registration. This is convenient both for doctors, as they don’t have to do paperwork, and for patients, as they can make an appointment and see the specialist they need promptly, avoiding tiresome queuing. At the end of our meeting I would like you to view a video footage we have at our disposal so that you could see how people react to these queues.

In April, we sought to solve these problems by approving the strategy for the computerisation of healthcare. Funding for this totals 24 billion roubles, a considerable amount. It is necessary to spend these funds wisely and to introduce up-to-date technology.

Now, regarding perinatal centres and high-tech medical centres. We discussed the issue in March. Since then, another six perinatal centres have been opened in the cities of Krasnodar, Murmansk, Saransk, Tomsk, Yaroslavl and Voronezh.

A total of 24 perinatal centres are planned to be build – two federal and 22 regional. From 2008 through 2010, a total of 19 billion roubles was allocated from the federal budget for building and equipping these centres, while another 15 billion roubles was allotted from regional budgets. Seventeen centres have been opened and are now operating. Some 60,000 high-risk female patients have received consultations in these centres from January of this year through August, and almost 22,000 babies have been born.

I am pleased to say that the majority of young moms are satisfied overall with the quality of medical care provided at the perinatal centres. Currently, 95% of the respondents say they are satisfied with how they are treated by the staff as opposed to 90% of those polled in February, 2011. The number of patients complaining about rude staff members has fallen threefold, from 54.5% in February to 17.9% in July. These are just figures, but they reflect people’s attitudes and the quality of services being provided. Yet, the poll has revealed that, for instance, a third of the respondents in the Tver Region are dissatisfied with how they are treated by medical staff. As compared to February, the survey has shown an increase in the number of patients who are dissatisfied with the quality of the food, from 8% to 14%. In Irkutsk, as many as 50% of those polled said they were dissatisfied with the quality of food at the centres, which is particularly sad and alarming. Mr Mezentsev, (addressing the governor of the Irkutsk Region) I’d like you personally to address this problem.

Let me emphasise once again that along with modern medical technology and qualified personnel, these centres should also maintain a respectful attitude toward their patients and provide access to all basic services, including pharmaceuticals, cafeterias and communications services. We need to consider every detail here. I therefore suggest that we think about establishing modern basic requirements for the conditions of patient treatment in perinatal and high-tech medical centres, drawing on the experience of the best of these clinics.

 This year we need to complete six more perinatal centres – in Krasnoyarsk, Saratov, Chita, Perm, Blagoveshchensk and Kurgan. But there are delays with almost all of these construction projects. Perm and Kurgan are lagging 3 months behind schedule, while Blagoveshchenk and Chita are operating on a two-month delay.

But in the Saratov Region, the situation is absolutely outrageous... Regional authorities reported last December that their centre had been commissioned. Then it became clear that construction was still underway, and they promised to complete the project by May 1. But earlier this month, we received a revised construction schedule, setting the launch date for December 31. What is going on here? What kind of attitude is this towards their work? I thought this attitude was a thing of the past in Russia, but it seems I was wrong.

I’d like our regional leaders to keep in mind that ensuring compliance with schedules, estimated costs and the quality of construction work is among their personal responsibilities.

There are also problems involved with the construction of high-tech medical centres, which are lagging behind as well. For instance, there is a 10-month delay in the project that is under construction in Perm and an 8-month delay in the project in Barnaul. We’ll talk about this in further detail later on.

Let me just remind you that thousands of patients are waiting for these new centres to open. To them, this is a matter of vital importance. Yet in some cases their hopes are being shattered by sluggishness and irresponsibility. We cannot possibly attribute this to underfunding, because enough money has certainly been channeled toward these projects.  Our task is to increase the availability of high-tech medical services and to reduce the current shortages, so that people will be able to receive the treatment they need. We are well aware of the substantial need for high-tech surgery, as well as our actual capacities. We should work to improve this situation as fast as we can.

I was speaking earlier about queuing; it would appear that Russia will have no chance of ever resolving this problem (or the problem of roads, for that matter). But the situation is not as desperate as it may seem. The number of problematic regions, which just recently stood at 42, has now decreased by half.

Now let’s hear what the public thinks about us.  

(A documentary is shown in which members of the public complain about the shortage of medical specialists, as well as long queues and poor waiting conditions in outpatient clinics.)

You see? Mr Korolyov (Addressing the governor of the Lipetsk Region), I hope that you and your fellow governors will deal with this problem. Let me emphasise once again that there is a sizable amount of funding set aside for IT and we should be sure to use this money to introduce more high-tech equipment to our healthcare sector.

If there is a shortage of doctors specialising in any particular branch of medicine, we won’t be able to fill this gap overnight. But we can do something right away to reduce the waiting time for patients. About 30% of clinics in the country have already introduced online registration systems. So let’s speed things up.

Please Ms Golikova, go ahead.

Tatyana Golikova: Mr Putin, ladies and gentlemen. Today we are discussing the implementation of our programme to modernise healthcare in the Central Federal District. The district includes 18 regions, whose combined population accounts for 30% of the total population of the country. And its rural communities make up 18.5% of the total.

Healthcare services in the region are provided by 2,442 institutions, or a little more than 30% of the nation’s total.

I mention these figures to demonstrate that 30% of Russia’s population is concentrated in the Central Federal District and the percentage of medical institutions here is roughly equivalent. As for the availability of medical personnel – an issue to which the documentary we just saw was devoted – there are, on average, 48.2 doctors per 10,000 residents in the Central Federal District. For the Tula Region, this figure is 29.1 while in Moscow, it stands at 71.9. The national average is 44.1.

Further we will talk about the average availability on territories that make up the Central Federal District. As to the demographic situation (something these programmes are designed to address) and the figures on the decline in the mortality rate (both overall and infant mortality rates), I would like to say that the Central Federal District has seen a decline in both overall and infant mortality rates for several years in a row. Nevertheless, the overall mortality rate in the Central Federal District is still higher than in the Russian Federation in general. With the infant mortality rate, the trend is reversed: the situation in the Central Federal District is much better. With the overall mortality rate, the situation in the Central Federal District is best in the Belgorod Region, the Moscow Region and in Moscow; for infant mortality, the Smolensk, Belgorod and Tambov regions are best.

Regarding the prevalence of various diseases in the Central Federal District, first place belongs to respiratory diseases, followed by circulatory diseases, external causes and tumours. Here I would like to speak about the disease rates in general and in individual territories. The best rates (although they are higher, and this can be seen) are in the Belgorod, Tula and Vladimir regions. This means that they give priority to regular medical check-ups and early diagnosing; this means that primary care here works better than in other regions of the Central Federal District.

I want to draw your attention to the next slide. When we worked on these federal programmes, each region created its own map. The thing is that the availability of primary care depends not only on healthcare factors, but also on the infrastructure that is being created. For primary care, it depends on the state of the roads and the availability of transport, and this may limit the access to healthcare, cause a shortage of medical personnel, and so on. As a consequence, there may be problems with delayed medical aid. Unfortunately, in a significant number of communities, not only in the Central Federal District, but also in other territories – these are communities with less than 100 residents or with 100-300 residents – people do not have adequate medical care and have to seek it in bigger towns and to get there somehow. In light of this, access to medical care and developing primary care were included as criteria for almost all regional healthcare modernisation programmes. Later I will speak about the current situation here.

As to the demographic data for the first six months, I should say that in some regions of the Russian Federation (including nine in the Central Federal District) the overall mortality rates were even lower than expected for this year. It does not mean that these figures were artificially lowered; it means that these regions actively carried out the initial stages of some parts of the Healthcare National Project, which had a significant positive impact on mortality rates. Here I have to single out as the Belgorod, Vladimir, Voronezh and Kostroma regions, which in the first six months achieved a significant positive result in reducing infant mortality rates. There are 11 such regions in the Central Federal District, which means that they are a majority.

For a significant number of regions that have shown these results, the reason – as you, Mr Putin, have correctly noted in your introductory remarks – is that perinatal centres have opened there and they use new technology for treating pregnant women and women suffering from diseases.

As for budget execution, the problems should perhaps be divided into two categories. Overall, allocations for the Central Federal District’s programmes from all sources (these are subsidies of the Federal Mandatory Medical Insurance Fund, regional budgets and the territorial funds) total 202.7 billion roubles. The Federal Mandatory Medical Insurance Fund allocates 29.5%, almost 30%, of the total sum of subsidies for the healthcare modernisation programme. You have already said that actual cash execution is fairly low now. There are objective and subjective reasons for this, and I’ll now talk about them. But first I would like to draw your attention to individual parameters that characterise the natural parameters for the implementation of programmes in the three areas we are talking about.

The first area is improvement of material and technical resources. This, as you remember, includes minor and capital repairs and the purchase of medical equipment. As to capital repairs, it is planned for 849 healthcare facilities in the Central Federal District in 2008. By August 1, work was to begin in 634 facilities, but has begun only in 374. I would like to add that work is progressing as scheduled in the Belgorod, Bryansk, Ivanovo, Smolensk and Tambov regions. In the Vladimir, Yaroslavl, Kostroma and Moscow regions, implementation is under 10%. In the Kursk and Tver regions, capital repairs were not planned for the first six months of 2011. They are scheduled for the second half of the year.

Minor repairs are being done; they are planned at 61 facilities, and are mainly financed from the funds of territories and are being carried out in the Kaluga and Orel regions. As to medical equipment, 1,298 healthcare facilities in the Central Federal District plan to purchase 67,669 items in 2011; by August 1, 792 facilities were to buy 43,957 items, but so far, contracts have been signed only for 2,020 items. Budget execution in the Kaluga, Smolensk and Belgorod regions has by now exceeded 25%; in the Lipetsk Region and in Moscow, it is under 10%. Unfortunately, the Voronezh, Ivanovo, Kostroma, Kursk, Moscow, Orel, Ryazan, Tambov, Tver and Tula regions have still not begun purchasing equipment. All the figures given are dated August 1, 2011 and taken from the reports of the regions.

Now to the objective and subjective reasons. What do we see as the objective reasons for cash execution? The thing is that cash execution on material and technical resources is done upon completion of the work. Major repairs and routine cosmetic touch ups will not be funded before the jobs are finished and projects commissioned. The majority of commissioning schedules have set deadlines for the fourth quarter of 2011.

As for equipment purchases, they are usually funded 10% or 30% in advance, the rest being paid after installation, so final payments are also scheduled for this year’s fourth quarter.

What sort of subjective reasons could there be for this? Well, for one, lengthy contract placement for equipment supplies and maintenance is an issue, and, secondly, regional executives have procrastinated in drawing up auction papers.  I would like to turn my attention to typical complaints from regional healthcare departments that when papers are submitted to government contract agencies these latter are all too often shelved instead of being promptly taken care of. Moreover, in many Russian regions – take, for instance, the Yaroslavl Region (shown on slide) – branches of the Federal Antimonopoly Service cancel auctions and postpone others as a result. And, naturally, the deadlines for the design and estimate projects are being moved.

As for other factors – the opening of rural health posts, dispensaries, and GP offices, the situation here is more or less normal. We have figures for the year’s first half but none for the year’s first seven months because we report quarterly statistics. By looking at particular regions, we can get an idea about the country as a whole. I would like also to mention the progress made by treatment centres substituting hospitals and day hospitals, and the increase of the number of rural general practitioners in the Oryol, Ivanovo, and Yaroslavl regions.

As for the organisation of first aid in small villages, I mentioned – with up to 100 inhabitants or 100 to 300, we are focused on first-aid stations and health posts. Improving roads and transport will go a long way in accelerating patient delivery to hospitals. We intend to increase the medical personnel by 12.5%, a hike which all regions are preparing for. The purchase of upgraded equipment will naturally also expedite medical aid.

I will not discuss the introduction of IT in detail as you have already done. I would like to add only that all Russian regions had submitted additional contracts by August in compliance with the approved documents, and a contract has been signed with the Bryansk Region.

The third problem involves two sub-directives– improving the access to outpatient clinics – in particular, aid by specialists, who, naturally, will receive a pay increase for it – and upgrading hospital treatment.

The improvement of access to outpatient clinics has been planned for this year in 1,642 clinics of the Central Federal District, 774 of which are already working on this rpogramme. Even more clinics — 796 to be exact, are increasing salaries for their 71,696 doctors. More than one-half of doctors and nurses are receiving bonuses in these regions.

Let’s take the region where we are at this very moment, for example. Here, in the Smolensk region, we envisage bonuses for 71 categories of doctors and 31 categories of nurses, and already 2,420 specialists out of a total 2,490 received them.

With regard to wage increases and the improvement of drug and consumables supply to hospitals, new standards are being introduced at 901 healthcare institutions, and as of August 1 — in 823. These new standards have been introduced in 375 institutions so far. I would also like to mention a meeting we held with regional authorities on August 9, in which we analysed the upgrading of healthcare in sufficient detail. We planned to introduce unified federal standards this year. However, outline legislation for healthcare is still in its second reading at the State Duma, and therefore regions continue to abide by current medical and economic standards. We are in the process of upgrading regional standards, and this by nature necessitates wage increases.

As I said in the beginning, the Belgorod Region looks the most promising in this respect. It has coped 100% with the programme in all aspects. The region has submitted a relevant schedule shown on this slide. I am calling your attention to it because presently, hospital doctors’ salaries are increased in the regions which have been following the basic standards.

We have no grounds to reproach the regions for entitling only a portion of doctors to raises because they are addressing a number of issues "in a parallel way", and therefore their resources have to be distributed accordingly. Many healthcare institutions cannot meet all standards for now because they still need to order equipment and retrain specialists. That’s what I mean by parallel arrangement: we introduce more standards as healthcare services are getting ready to comply with them and as more and more new specialists are getting involved in the rpogramme    .

However, during the meeting on August 9, we called on all regions of Russia to be as quick and efficient with the job as possible. I will again conveniently mention the Smolensk Region as an example, because we are here now. By the end of the year, the region intends to increase the average healthcare wage to 16,000 rubles per month compared to 13,500 rubles last year. The average monthly wage in the Central Federal District was 15,000 rubles, as of August 1 – 21,000 rubles for doctors and 12,700 for nurses.

Please look at the slide illustrating the situation in the regions represented here – the Vladimir, Kaluga, Kursk, Moscow and Oryol regions, and the city of Moscow. We are also showing the situation in the Volgograd Region, the Republic of Tatarstan, the Kamchatka Territory, and the Novosibirsk and Sakhalin regions (they are not on the line) though they do not belong to the Central Federal District. Please take into consideration these regions’ reports, because statistics have been cited there on decreasing salaries. It might be just a mistake, but I ask regional governors to take a closer look. If it’s merely an issue of incorrect figures, then please correct this error.

Practically all Russian regions are asking us how to use funds saved in programme     implementation where maintenance contract and equipment auctions are concerned.

Mr. Putin, I would like to inform you that on August 23 we forwarded a letter to all region governors on how to do it. Major changes of grant distribution between institutions and industries require the programme to be duly changed. Relevant amendments and supplements must be made to the agreement signed with the regions today. As for changes within one particular institution due to economic reasons, it is up to regions themselves to make these changes through local legislation. They should inform us as we monitor the programme’s implementation.

This is what the situation looks like now in the Central Federal District. Mr. Putin, and I’m not saying this to absolve local governors, but major changes are still to occur in July and August – that is, immediately after the first half-year – because principal tenders and their summarisation fall in July and August. I expect more in September. Later, final settlements will follow because, as I said, payments are made for projects already implemented. Thank you.

Vladimir Putin: Thank you very much. Ms Golikova, I would like you and your colleagues to pay attention to the following: we are talking about the improvement of an established healthcare network in the framework of our modernisation programme. Some healthcare institutions are inefficient and have few patients. They should be replaced by good hospitals and clinics with cutting-edge equipment and highly professional personnel. When we visited a hospital today, a young woman came up and complained that a railway company hospital was closing down, even though it was the only hospital to treat multiple sclerosis patients. True, it’s a hospital primarily for railway employees, but it’s one of a kind. I don’t know whether the woman was correctly informed and the hospital was really closing down without a substitute, or maybe she got her facts wrong, but she has the right to know—the public must be kept informed. Moreover, no network should be streamlined to lose any element. Mr. Antufyev (Smolensk Region governor), please pay attention to this, and talk to Russian Railways. I will join in the discussion if necessary. Please be more attentive to such things, or modernisation might take an ugly form.

Tatyana Golikova: I would like to say that the establishment of inter-municipal centers is part and parcel of the modernisation rpogramme in almost all parts of the Central Federal District. Such centres will ease access to healthcare in urban conglomerations. As new general practitioner offices and rural health posts are opening one by one in many regions of the Central Federal District, healthcare becomes much more accessible. Some regions get rid of the less efficient institutions, but I hope this trend won’t be carried too far. As for the hospital mentioned, we will certainly talk about it with Russian Railways, the company the hospital belongs to.

Vladimir Putin: Possibly, it might be substituted. As the modernisation rpogramme continues, multiple sclerosis patients might be transferred to other hospitals, but the public must be duly informed about it. It’s settled.

* * *

Vladimir Putin’s closing remarks:

Ladies and gentlemen. I won't go into any more long speeches. We’ve worked out a detailed resolution at our meeting today. So let’s just add some of the points that we made during the discussions.

I’d like to point out once more that all three areas that we considered – regional healthcare modernisation, the construction of perinatal centres and the creation of high-tech medical centres – are among the top priorities of the state’s social policy.

With the massive quantity of public funds that has been channeled into these areas, our efforts should produce tangible results for the people. So please make sure that this work is of the highest quality and is carried out on time. Thank you.