Opening remarks by Vladimir Putin:

Good afternoon, colleagues and friends.

Today I would like to talk about one the most important, pressing and challenging issues we face today – how to look after our population, and how to improve our demography.

In recent years we have proved, esteemed colleagues, that we can get results. If we focus on the key directions of our work then our demographic policies will work. The data for 2011 shows that the population of Russia has reached 143 million, and average life expectancy is now above 70 years (70.3). These figures exceeded even our own expectations, as well as those of experts both here in Russia and abroad. According to UN forecasts, the population of Russia was expected to reach 136.7 million by 2015. According to the Federal State Statistics Service, our previous data, this figure should be 142.2 million. And based on our demographic programmes, we were planning to bring life expectancy up to 70 years by 2015. I repeat, by 2015. But last year's results demonstrate that this milestone has already been reached. In the period 2005-2011 life expectancy jumped by five years.

I would like to point out that the increase in the population is not simply a result of immigration; it's due primarily to the falling death rate and the rising birth rate in Russia. Natural population loss, unfortunately, is still there, but it’s at its lowest level in 20 years, and almost a third of Russia's regions have registered a natural population increase. Almost one third of Russia's regions! Ms Golikova (Tatyana Golikova, Minister of Healthcare and Social Development) knows all about these figures, I would like to ask her to speak about them when her turn comes. This is due in large part to the work of the regional heads.

Since 2006, we have made great strides in reducing deaths from heart attacks, strokes, cancer and road accidents. We are developing high-tech healthcare and making it accessible to everyone, although admittedly we still have many problems to resolve in this area, insufficient funding being, I think, the main one. Our medical institutions could provide this high-tech care on a much larger scale if they had the necessary resources.

In the last six years more than 10 million children have been born in Russia. Our birth rate has already overtaken that of many European countries. For example, the birth rate per 1,000 of the population in Great Britain, Norway and France is 12.7, in Sweden 12.2, in Denmark 11.3, in Poland 11.2, Germany 7.9 and in Russia it stands at 12.6. In just six years we have managed to reduce infant mortality by one third. By one third! What this statistic means (it's easy to work it out) is that 11,000 children have been saved.

In 2011, the infant mortality rate was 33.6% lower than in 2005 (down from 11 to 7.3 per 1,000 babies born). In 2009, the infant mortality rate in Norway, for example, was 2.7 per 1,000 live births, in Germany 3.5, in France 3.6, and in Great Britain 4.7. And in 23 regions of the Russian Federation (only 23 for now but nevertheless that's already 23!), including Chuvashia, the Tambov Region and St Petersburg, the figures are already on a par with European levels, and even better. In Chuvashia, for example, it’s 3.5, in the Tambov Region it’s 4 and in St Petersburg it’s 4.3.

Without question, the positive trend in the birth rate is connected to the overall improvement of the situation in the country, the better quality of life for Russian families, and the wider planning horizon. Our support measures have also had an effect – in the form of federal subsidies for maternity capital, birth certificates, as well as the construction of regional perinatal centres and high-technology medical centres. You may have noticed that this week I visited Kurgan and saw the completing stage of the work to build one of these perinatal centres, the 22^nd one under a federal programme we are running. Experience shows that infant mortality declines substantially in those regions which have modern perinatal centres. Both infant mortality and maternal mortality go down. So I believe this work must continue. I have already issued the appropriate instructions. The Healthcare Ministry and Finance Ministry will have to work out how it can be done. There must be at least 20 to 25 more of these centres established across the country.

At the same time, we must understand that the demographic situation is still unstable. On average each mother still has between one and two children. Moreover, we are still feeling the effects of the demographic decline of the 1990s. The generation that was born in that period and that is now starting families is quite small. The country experienced a drastic drop in the birth rate between 1992 and 2002-2003. It was virtually a demographic chasm. Now this generation is at its reproductive age. It is starting families and having children. But this generation is very small in number.

You probably read my recent article in Komsomolskaya Pravda. If nothing changes (I mentioned this in my article) and if we do not take any measures to address the demographic problem, the population will shrink to 107 million people by 2050. If we work out new programmes and new support measures and manage to implement them successfully, the population will grow to 154 million by that time. What we need to do is not only to continue these programmes but expand them and put forward additional measures to boost the birth rate, which means supporting families with children as our top priority. Multi-child families should be the most valued, and families with two or three children the preferred social norm. We have to end the situation where the birth of a child causes a family financial difficulties or pushes it to the edge of poverty.  I will repeat again: we must introduce a special child benefit for families with three and more children in those regions which have a declining population. This benefit must be at least equivalent to the subsistence level for a child. Next year the subsistence level for a child is expected to be 7,000 roubles. When I talked to the staff of this medical facility today, I heard questions on this issue and I would like to return to it. What do I mean? It is important to provide support. Firstly, this programme must be targeted and support families with low incomes. That is the first point.

Second. I would like to stress that we must prioritise those regions where the experts record a negative demographic trend for several years in a row. Roughly speaking, these are regions in the European part of the country, the northwest and some regions in the Volga area and Russia’s Far East (additional expert research within the ministries and respective agencies is necessary, though). I would like to note – responding to a question I heard here today – that this approach does not have any ethnically-charged undertones but it will be specifically related to the situation in a particular region. People of any ethnicity who live in the demographically stagnant areas and need support from the government will receive this help regardless of their ethnic origin. But it is clear that the most problematic regions in this respect, for example, in the Far East (Ms Golikova told me about this this morning) are, say, Sakhalin and perhaps Kamchatka. We know that these areas are populated by indigenous people of the Far North that have been in decline for many years now. They also most likely include the Komi Republic in the north and definitely the Republic of Mari El in the Volga basin.

Tatyana Golikova: Mordovia.

Vladimir Putin: And Mordovia. Mari El is in a similar situation to Sakhalin. I will stress again: this programme will be implemented purely according to the needs of a particular region and there are no ethnic aspects to it. As a first stage, we will support the regions that need help. We will be looking for solutions to support families that want to have three and more children, which depends on success of the programme and the efficiency of the economy as well.

We also plan to support the regions that are going to introduce this additional child benefit.

During the first phase, co-financing could amount to 90%. By 2018 we will reach parity with the regions, fifty-fifty. I expect that the regions with strong budgets will assume a larger share of the cost or additionally increase assistance to families. I have to remind you that every constituent entity of the Federation must have coherent and tangible measures to support women who give birth to two or more children. These measures include regional maternity capital, free plots of land, including those for building individual homes, and the provision of housing. Let me stress that solving our demographic goals depends to a large extent on the activities of the regional governing teams, their commitment to creating improved conditions for people’s lives and for fulfilling their ambitions. Ultimately all economic achievements must have a tangible human dimension.

Let me note that the Russian Empress Catherine II, one of Russia’s most effective leaders, considered the growth of the population to be a priority for the governors. She was absolutely right. For us today that problem, that issue is highly relevant, without exaggeration it is at the top of the agenda. I am convinced that it should be the number one task for modern governors just like it was in her times. So I suggest that the regions take another hard look at their demographics in 2009 and in 2011 and pay special attention to the causes that bring down the birthrate and increase the mortality rate wherever there are such trends in the regions.

We should look at the entire situation: how effective are regional measures to stimulate the birthrate? Is the quality of medical service improving and how is it assessed by the patients themselves, by the citizens of our country? Finally, how effective are the programmes to cut the rate of road accidents, improve the environment and reduce occupational injuries. Most importantly, what is being done to support the institution of family? How is the birth assistance system working and is the system of assistance for young mothers effective? For example, have conditions been created to enable women to combine motherhood and their careers. Everything must be done to help them to preserve their skills and acquire some additional education.

As regards waiting lists for kindergartens, we should solve that problem in all the country’s regions in the next four years. I would like you to take note of the following: when you plan to build or renovate kindergarten facilities you should bear in mind that we will have a demographic slump connected with the dip in birthrates between 1992 and 2003. It would be best if today when planning preschool childcare that we combine these institutions with schools so that later, when things change, we could again convert them to other uses. I think we should develop a standard procedure on demographics for regional administrations. I ask the Ministry of Healthcare and Social Development, the Ministry of Economic Development and the Ministry of Regional Development to submit proposals for this.

Colleagues, it is obvious that we will not be able to solve ambitious demographic problems without high quality and easily accessible medical care, a modern healthcare system. I should remind you that we have concentrated the authority to administer healthcare at the regional level and dramatically increased the responsibility of the regions to provide accessible and high quality medical care.

You are currently implementing regional healthcare modernisation programmes. Some positive changes have taken place, especially at the primary level. But let’s face it, and you know this better than I do, there are still many problems. There are some unique and exceptional examples, but there are a lot of problems and I suggest that we discuss them.

In 2011 the federal budget transferred 190 billion roubles to the regions to finance regional healthcare programmes, healthcare modernisation. You have all the money. Some spend it better than others. Tatyana Golikova and I have discussed this again and she believes – and I agree with her – that it is not our aim to simply send and throw money around, but that we should not be slow in implementing these programmes.

What would I like to say in this connection? A quarter of the allocations for modernisation must go to your rural areas. We should repair and provide new equipment for feldsher-midwife stations and increase the number of general practitioner offices. I especially want you to keep the programme of attracting young doctors to rural areas under control. We have just seen that Rustam Minnikhanov (President of the Republic of Tatarstan) has very good modular primary medical and obstetric centres here, and they are cheap. I think it works out to 27,000 roubles per square metre, right?

Tatyana Golikova: 22.

Vladimir Putin: Yes, 22,000. This kind of production can be launched in every region or expanded where it already exists.

All the work, including creating the legal framework for additional benefits for rural residents, the allocation of housing, must be finished by March 1, 2012 to avoid a situation where a person comes to work in a rural community and has nowhere to live and has no financing. As a reminder, doctors under the age of 35 who wish to work in rural areas will receive 1 million roubles. That benefit will be available to those who arrived in 2011 or will arrive in 2012. For its part it is the duty of the region to help a young doctor solve his housing problem.

There is one point I would like to draw your attention to. For example, the Orel Region needs 97 more doctors in rural areas than it has now, but it has asked for the 1 million rouble subsidy for only one doctor! The Vologda Region needs 214 more doctors and it has applied for subsidies for just seven, the Saratov Region has a shortage of 116 doctors in rural areas but it has applied for subsidies for only nine. What does that tell you? It says to me that the heads of the regions are not paying enough attention to this. They are not ready to provide this housing and some of other things. At this rate we will move forward too slowly, my friends.

Second. We set very challenging objectives to modernise healthcare for the regions, which is why I think it’s necessary to stimulate those regions that have reported notable successes in modernising healthcare, the regions that are not just spending the money they are given but are truly improving the quality of medical care in rural areas. I have some good news for you: those who really do a good job and achieve results will receive additional funding. We have a reserve of 5 billion roubles and we are ready to direct it to those regions that achieve tangible positive results.

Let’s discuss the topics on our agenda. Tatyana Golikova, please, you have the floor.

Tatyana Golikova: Mr Putin, colleagues. You will now see a presentation. But to not repeat the indicators that you have already mentioned, Mr Putin, I will focus your attention on the problem areas in demographics in Russia. Just to remind you, our demographic concept envisages three stages. The first stage was to slow down the natural population decline, to ensure growth due to immigration, and indeed the results show that the natural population decline was cut by 2.9 times. Between 2011 and 2015 we are into the second stage of implementing the demographic policy. And I think I should draw your attention to the significant indicators that are essential for assessing the measures that we need to take and to introduce at the federal and the regional levels. Indeed all the demographers predicted a decline in the birthrate for 2010-2011, however, 2010 and 2011 had the highest birthrates. Even so, if you look at the estimated high forecast of Rosstat, in 2015 the birthrate should diminish for reasons that you all know. It could drop from 1,794,000 in 2011 to 1,784,000 in 2015. I will talk more about this later.

Vladimir Putin: This is why two children per family are not enough to maintain dynamic growth.

Tatyana Golikova: I was just going to say that. These indicators which we planned at a time when the demographic situation was dire, did not permit us to make far-reaching plans and set ourselves ambitious targets. Still, as regards the mortality rate, I would like to say that while in the first five years of the first stage of the policy we reduced the mortality rate by 6.4 percentage points, the tentative data for 2011 show that the mortality rate has fallen by 5.2 points, practically to the same extent. This shows that whatever criticism may be directed at the healthcare system, it is working. It is also important that the natural population decline decreased 1.8 times within a year, but the target for 2015 is to achieve a natural growth and obviously when we set the target for the number of children per woman we said 1.68. Now, according to 2011 data, it is 1.6. If we don’t want to revert to the situation we had a few years ago we will have to adjust our medium-term demographic plans in Russia. To meet the ambitious objectives that we set in terms of preserving the population and ensuring a natural growth we must approach the indicator 2 by 2015. As for immigration, immigration in 2011 was nearly 300,000, the indicator that we included in the demographic policy concept for 2025. If we maintain these numbers then the indicators we wanted to achieve at the second stage, the size of the population – 142-143 million – have already been achieved in 2011 and we will have them in 2015 as well.

I would now like to draw your attention to the statistics in various regions. But before I move on to statistics I would like to say that the indicator of children per woman was 1.296 in 2006, a fairly low number because until 2003 the birthrate in the Russian Federation stood at 1.2 million a year and the population had been declining seriously since 1996. The worst of it was that 2.3 million people a year died. At that time it became the rule. Now the indicators are much better. Clearly these numbers were possible thanks to the demographic efforts at the federal level and at the regional level in Russia. The most popular measure was probably the maternity capital (I have to say that 3.4 million people have applied for maternity capital as of February 1)… Two other measures have been very popular. The first is housing, 98.7% of the allocations go to finance various ways of providing housing. And another very popular measure, introduced during the crisis, was paying 12,000 roubles in cash from the maternity capital benefit, something 3.3 million people have taken advantage of during the last two years.

I will now move on to the summary birthrate coefficient. So far the figure is available only for 2010: Rosstat has yet to sum up the results of 2011. We only have data for the entire country for 2011. While the summary birthrate coefficient in 2010 in the Russian Federation was 1.569, four federal districts (Northwestern, Central, Southern and the Volga District) had a lower indicator although certainly…

Vladimir Putin: Less than 1.6?

Tatyana Golikova: Less than the average for Russia.

Vladimir Putin: 1.6?

Tatyana Golikova: Yes. Clearly, in three regions – one in the Northwestern District, three in the Southern Federal District and five in the Volga Federal District -- have indicators above the Russian average. But the overall situation in these districts is not comforting.

As for the Far Eastern, Siberian, Urals and North Caucasus Federal Districts the indicators vary but on the whole the birthrate is higher than the Russian average. Speaking of individual regions, 10 of them have the best summary birth rate coefficients.

I would like to draw your attention to one more indicator. Traditionally a woman’s best reproductive age is between 20 and 29. But based on the experience we have from our demographic policy, we see that women here have a reproductive age between 20 and 39. The average age of women in Russia in that bracket is 29.8. The regions on the left side of the slide are those where the figures for the summary birthrate coefficient and the share of women in the 20-39 age bracket look good. And those on the right side – the Bryansk, Ulyanovsk, Penza, Belgorod, Ivanovo, Saratov, Tula and Tambov Regions, the Republic of Mordovia and the Leningrad Region – there the situation is alarming in terms of birthrate and in terms of the number of children per woman. If we look at the changes that took place regarding the birth of a second child when we introduced maternity capital, we see that the number of two or more children per family increased by 16.3 p.points compared with 2006. That is a very good indicator, but I would like you to note that between 1982 and 1989 the summary birth coefficient in the Russian Federation exceeded 2 and in 1987 it was at an all-time high: 2.19 children per woman. In fact these are the indicators that…

Vladimir Putin: What was it? 2?

Tatyana Golikova: 2.19, practically 2.2, so these are the targets we should meet by 2015-2016.

Regarding life expectancy. As you have mentioned, we see some positive change here. Next slide, please.

Life expectancy has increased substantially in recent years, but I must note that the lifespan of men is increasing faster because naturally, a woman’s life expectancy is higher. The gap between the life expectancy of men and women narrowed by 1.1 year between 2006 and 2011, from 12.9 to 11.8. As regards the dynamics of natural growth, 28 regions showed natural population growth in 2011, compared with 16 regions in 2006. I won’t list them; you see them on the left side of the slide. As for birthrate dynamics, I would like to dwell on it in more detail. In 2011 the birth rate was 0.2%. The number of regions where the birthrate is falling is increasing year in and year out. There were 14 such regions in 2009 and 44 in 2011, and the most critical areas in terms of falling birthrate, as we have mentioned, are Sakhalin Region and the Republic of Mordovia where the demographic situation is very difficult. But we have fairly good numbers for the mortality rate.

Vladimir Putin: You should add Mari El. Mari El and Mordovia are about the same.

Tatyana Golikova: Yes, about the same. As for the mortality rate, those indicators are good in practically every region.

Vladimir Putin: Meaning that the mortality rate is falling?

Tatyana Golikova: Yes of course. I should just note that the Chechen Republic, Kabardino-Balkaria, the Republic of Altai and the Krasnodar Territory report a slight increase. It is not a significant increase but still I would like to draw the attention of the heads of these regions to the fact that in the current situation even that cannot be tolerated because we must reduce the mortality rate; that’s the main way we can preserve the population of the Russian Federation.

Vladimir Putin: What are the main causes?

Tatyana Golikova: Cardiovascular, road accidents and cancer, it’s the same as always. We still lead the world in terms of deaths from stroke although we have been working on this, but still…

Vladimir Putin: Cardiovascular diseases.

Tatyana Golikova: As regards the infant mortality rate, we have very positive trends there. But I would remind you that beginning in 2012 we are adopting new criteria and the new criteria may greatly change the indicators of infant mortality. We expected that the infant mortality rate would increase to 8.1 by 2015, but that was part of the demographic policy when the modernization programmes had not yet been launched. I would like the regions to pay attention to this important matter. What you have mentioned – the creation of perinatal centres, the introduction of a three-tier system of medical assistance for women during the reproductive years – that is an important factor that may change the situation and prevent that indicator from growing worse. Even so, I would like to say that the leaders in terms of reducing mortality are the ones that you have mentioned: the Republic of Chuvashia, Tambov Region, St Petersburg, Sakhalin Region, the Republic of Komi, Kaliningrad Region, and the Republic of Tatarstan. So far there has been no improvement in the Chechen Republic, the Republic of Dagestan, the Republic of North Ossetia-Alania and the Jewish Autonomous Area. We are very worried about the infant mortality indicators in the Republic of Tuva, the Republic of Altai, the Khabarovsk Territory, the Nenets Autonomous Area and the Kamchatka Territory. Our colleagues there have a lot of work to do.

As you said, Mr Putin, in your article, you propose a measure to encourage the births of three or more children. I would like to appeal to my colleagues: we did the calculations yesterday, and as I said, we must achieve a coefficient of 2. What does that imply? It means that about 17-20% of newborns must be third children or more. Now, the figure for 2010 is 13.1% (the figures for 2011 are not in yet). So, you see that we have a lot of work to do. The number of three or more children should be increased to 30% in the near future. But if we are to implement that measure effectively (I won’t repeat what you said in your opening remarks) we believe that assessment of the effectiveness of current programmes must be considered to be one stage in implementing the programme, and that the work must be done now. Secondly, we must introduce allowances in the regions where the negative demographic trends continue and perhaps, at the final stage, spreading these measures to these regions.

What needs to be done? We believe that we should promptly introduce amendments to legislation to introduce a special benefit similar to the way we introduced the maternity capital benefit, but it is of a somewhat different character.

Second. We must specify the Russian regions which need to introduce that allowance during the first stage, identify the categories of families entitled to that benefit, develop the procedure of financial support of these benefits, the procedure of means testing of families; naturally determine the amounts of financing at the regional and federal levels to be directed to solve these problems. Obviously that work must be done jointly with the regions because there should be an equal playing field in legal terms.

And three more points I would like to briefly mention. You also mention them in your article. It is about helping women who are raising children. It is about professional rehabilitation and increasing the competitiveness of women who are on childcare leave. That measure was introduced at the federal level last year. But because in 2012 we delegated this authority to the regions, I would like to draw your attention to the need to continue this work because only 73 regions have been planning this so far, whereas regions like Smolensk, Leningrad, Sverdlovsk, Kemerovo, the Republic of Ingushetia, the Karachayevo-Circassian Republic, the Chechen Republic, the Udmurtian Republic and the Republic of Sakha (Yakutia) have yet to include this measure in their programmes. And one more point is assisting the employment of disabled people, parents with disabled children and parents with many children. These measures are implemented at the federal level. The corresponding funds are included in the federal budget and they are used as part of the regional programmes and within the quotas that we allocate to the  regions.

Finally, I must say a word about the immigration policy. As I said, the target for 2025 is 300,000, although we did in practice reach that indicator in 2011. But I would like you to look at the quality of immigration, the qualitative indicators. We see four areas here, they are on this slide. They include bringing foreign workers to jobs that cannot be occupied by Russian workers, encouraging foreign citizens to sign long-term employment contracts, simplifying the procedures for obtaining temporary residence permits and work permits, and citizenship for foreign citizens who have been working on the territory of the Russian Federation for a long time, who pay insurance, who have graduated from Russian higher education institutions and work in the field they have been trained in. Finally, we must look into providing access to foreign citizens and members of their families to social and medical services, depending on their legal status. That is a problem that needs to be addressed now. The Federal Migration Service is preparing a concept for our immigration policy and we hope that it will yield a tangible result. Thank you.     

* * *

Tatyana Golikova: Mr Putin, colleagues. I will briefly go over the modernisation programmes because what I am going to present to you is a summary of the data found in the materials based on your reports. To begin with, the implementation rate for all three sources – in 2011 there were three sources worth 298.3 billion roubles – was 59.3%. We divided the regions into three groups: the first comprising the 29 regions that implemented the spending targets by up to 70%, the next group, between 70 and 50% and the last group under 50% (below 50% because the average implementation is somewhere between 50 and 60%).

The following are the main areas of implementation of healthcare modernisation. The first encompasses four subdivisions: completing the construction of the facilities already started, capital and routine repairs, and the procurement of medical equipment. For all these indicators, with the exception of completing the construction of projects already in progress, the implementation was above 50% (except for exclusive items such as completing the construction of projects that were more than 80% finished). Nevertheless for five healthcare institutions in three regions of the Russian Federation state contracts were not signed in 2011 and there is a high probability that they may not be fulfilled.

In the 4^th quarter of 2011 the country’s regions embarked on informatisation efforts as part of the integrated concept of informatisation that we have adopted in the Russian Federation. We are currently carrying out a pilot project on accessing federal services. Taking part in this pilot project are the Belgorod and Volgograd Regions, the Trans-Baikal Territory, the Ivanovo and Omsk Regions, the Republic of Sakha (Yakutia), the Sverdlovsk Region and the Stavropol Territory. The first stage will be in March, when we will review the early results of modernisation in the regions and at the federal level.

The third area is the introduction of medical service standards. In 2013 we must effect a civilised transition to new, modern standards. We will spend two years in modernising the institutions to ensure the proper quality of medical assistance and medical equipment. In 2011 we were planning to introduce 77 new federal standards, but because of the delay in the adoption of the law on the basic principles of healthcare we proposed to the regions that they update their standards on the basis of our projects. They managed to introduce 89 standards at 3,178 institutions across Russia which naturally resulted – which I will get into later – in the growth of the average salaries of doctors and mid-level medical personnel. In addition, as you will remember, we had decided that part of the resources would be used to increase pay to specialists in narrow fields in outpatient clinics, and the indicators there are fairly good because the regions have exceeded the targets for the number of personnel involved in this programme. As part of the modernisation, 14-year-old teenagers received a full medical checkup, which began on September 1, the start of the new school year. Nevertheless we covered 94.1% of the target group within four months. But I would like to draw your attention to the fact that the modernisation of healthcare is not only about equipment and repairs, it is about fundamentally changing the approach to the way medical assistance is organised, and upgrading accessibility by taking into account all the regional characteristics that were included when we designed these programmes. By this I mean geographical, environmental, demographic factors, the morbidity rate, etc. As a result we agreed with the regions that we would create an integrated system of controlling the flow of patients at all the stages in the provision of medical services. We have introduced uniform standards of availability of paramedic assistance centres, primary medical and birth assistance centres, general practitioners’ offices and outpatient centres for a corresponding amount of the population. However, though we have these standards, we have yet to reach the planned targets. We hope that 2012 will be the year in which the indicators that have been planned by the regions will be achieved, because this is an organisational challenge and a lot of time was taken up by preparatory activities.

I would like to note that the number of mobile medical teams has increased by 313. This was partly shown in the video presented by one of the doctors. But that of course depends on infrastructure: roads, communications, telephones, etc.

Vladimir Putin: Why is there such a big difference? In 2010 the target for primary medical and birth assistance centres, for example, was 4,800…

Tatyana Golikova: It’s because of optimisation. That normative target… (off mike) was 3,118.

Vladimir Putin: Yes. So, that is not so bad. A decent performance. Just a second.

Tatyana Golikova: That's the differenсу -- this is our target. This is how many we should have in the country and this is what we had in 2010. The target for 2011 was 158, but we created just 38, and it is the same picture for each case. In other words, the target is in the first column, that’s to ensure accessibility.

Vladimir Putin: It's a big lag.

Tatyana Golikova: Yes it is.

Vladimir Putin: Especially in small communities.

Tatyana Golikova: Yes. But this is precisely what characterises accessibility, which is the main subject of complaints from the community.

For communities with less than 100 residents -- according to law, we are supposed to have first-aid homes. All the relevant regulations have been issued. I must say that the regions did a fairly good job. They opened 4,028 of these first-aid home centres.

Vladimir Putin: Hang on. Who did this?

Tatyana Golikova: The regions. These are the targets that were set in the programmes for 2011.

Vladimir Putin: Listen, colleagues, look at what is happening here. We were planning to open primary medical and birth assistance centres in rural areas… In communities with populations between 100 and 300 people we planned to open 158 such centres, and actually opened 38. We should have a look at the original data.

Tatyana Golikova: We’ve got everything.

Vladimir Putin: You’ve got it here?

Tatyana Golikova: Yes, but I have to dig up these materials from the pile in front of me, I’ll give them to you later.

Vladimir Putin: Okay, I’ll look at them in Moscow. But we must seek to meet the targets. I am addressing everyone present in this room: please follow this progress. I understand that you can make all kinds of wonderful plans, but if nobody looks at them what is the point of making them in the first place? This is part of the modernisation programme, isn’t it?

Tatyana Golikova: Absolutely.

Vladimir Putin: When we launched the modernisation programme I called everyone’s attention to the need to focus on rural areas. Everybody said: “Yes, yes, we will.” They cheerfully planned to open 158 medical and birth assistance centres, but in reality opened just 38. In communities with populations between 300 and 700 people we planned 156 and actually opened 75. In communities of 1500 residents we planned 655 and opened a little over 200; in communities with 3000 people we planned 226 and opened 169. If we go on fulfilling our plans in this manner, where will this leave us? I would like to hear your proposals on how we will monitor the results of the implementation of these plans, otherwise we won’t be able to implement any of our plans.

Tatyana Golikova: Very well. In general, all the regions have included a timeline for opening these structures in their modernisation programmes.

Vladimir Putin: In the Primorye Territory they fell short by 30 centres, in the Pskov Region by 15 and in Yamalo-Nenets Autonomous Area they were 13 short. But give me a more complete picture please.

Tatyana Golikova: All right, Mr Putin. I have already spoken about first aid.

Vladimir Putin: For what period? Over the course of the year?

Tatyana Golikova: The year 2011.

Vladimir Putin: Listen, guys, that’s not the way to work. What sort of work is that? Is this the first time we are discussing the results?

Tatyana Golikova: No, naturally we are just reviewing the results from 2011 because…

Vladimir Putin: Let us agree to have quarterly reports in the future.

Tatyana Golikova: We have a quarterly report, but we proceeded based on the schedules that were in the regional modernisation programmes. We are reporting these indicators, but for the most part they will all be opening towards the end of the year.

Vladimir Putin: Well, they were shifted towards the end of the year and you see the result. You can go on pushing back the deadlines. Okay, you may have moved them back but then you should have at least done what you planned. It’s agreed, let us have quarterly reports.

Tatyana Golikova: All right. Seventh slide, please. We have a similar situation for consultative diagnostic centres, and interregional outpatient clinics. Here too the regions have failed to meet the targets set for 2011. The indicators are shown here for different levels. But I must say that the rate of referrals to outpatient clinic centres has improved. The load is gradually being taken off stationary healthcare facilities and moved to the primary level, the day patient facilities. The number of outpatient visits increased by 2.75% compared with 2010, and in-home medical services (home nursing) increased by 4.1%.

Vladimir Putin: Wait a second, who is in charge of this, your deputies for medical matters or the corresponding ministers?

Tatyana Golikova: Vice governors are responsible.

Vladimir Putin: Vice governors. Then I have a request for you: we will hear reports each quarter and I will ask you to check the corresponding reports every month. This matter should be established under serious control, otherwise we will constantly have disruptions and we will fail to fulfill any of our plans.

Tatyana Golikova: As regards the infrastructure of health centres, the situation is more encouraging. Slide 8.

Vladimir Putin: I can understand the situation during the first year, it was necessary to get the project off the ground: to launch all the necessary mechanisms, to hold tenders and so on.

Tatyana Golikova: Yes, that was the most difficult part.

Vladimir Putin: But now we need to get back on schedule.

Tatyana Golikova: Perhaps we could make use of Rustam Minnikhanov's proposal concerning the primary medical and birth assistance centres or feldsher-midwife stations that we were shown when we were here at the exhibition, because a lot of the work that the regions are doing to modernise existing centres fails to deliver results. And these…

Vladimir Putin: Modern.

Tatyana Golikova: Easy-to-build modern centres could be more effective. We have discussed this, and in principle the factory that produces these centres can meet the high demand that exists in Russia today.

Vladimir Putin: We can use this factory and some others. There are many enterprises now in the regions that can make…

Remark: We too.

Vladimir Putin: Yes, of course. They exist almost everywhere, all that is needed is to organise it properly. Please continue.

Tatyana Golikova: Slide nine please. Another element of the modernisation programme is the development of child healthcare. The two-year programme allocates 169.2 billion roubles for these purposes, which is 27.2% of the total funding. In the first year, the amount of financing totalled 53.9%, but the bulk of the money is used to repair premises and to acquire equipment. The definitive leaders in terms of using the money that has been allocated and putting children’s medical facilities in order are the territories shown in this slide. I won't list them.

The next slide shows the statistics of completed construction and capital repairs.

Vladimir Putin: These are the regions that…

Tatyana Golikova: These are the regions that have done well.

Vladimir Putin: … A high level of performance, yes?

Tatyana Golikova: … A high level of performance in the field of child healthcare.

Vladimir Putin: We have just mentioned those that are performing poorly, let's go through some of those that are doing well. The Ivanovo Region, 93%, the Kursk Region, 91%, Altai, 85%, Buryatiya, 86%, Dagestan, 81%, Karachayevo-Circassia, 85%, the Bryansk Region, 86%.

Tatyana Golikova: The Lipetsk Region, 81%.

Vladimir Putin: The Lipetsk Region, 81%. Well done.

Tatyana Golikova: Next slide, please.

I would like to draw your attention to the targets that are in the 2012 programme, but began to be implemented in 2011. This is what you have focused your attention on. In 2010 the deficit of beds for newborn intensive care stood at 3,332, and the deficit of pathology beds for newborns and premature babies was almost 10,000. Some regions started implementing this programme in 2011. You are able to see a positive shift although it may not be occurring at a very high rate. Still, we reduced the deficit in the first case by 30%, and in the second case the results are less impressive, but they are still tangible. And 15 regions have opened wards or beds for palliative care, hospice assistance to children who are seriously ill.

Based on the findings of medical checkups, we have determined the following. Unfortunately the findings are not comforting. In terms of the structure of the diseases that have been identified, 12.6% of newly identified diseases are connected with disorders of the reproductive function of 14-year-olds. During the course of in-depth medical examinations 57% of 14-year-olds were diagnosed with conditions that previously went unnoticed. That means that preventative work at an earlier age was not properly done. Most importantly, 14 is the age at which a teenager has to register with the military conscription committee. And we have found that 57% of all those who have had a medical checkup are diagnosed with various diseases for the first time. Of course they are working with this group of people, but I would like to say that the regions should pay particular attention to this, not to wait for the mandatory medical checkup at age of 14 but to have annual medical checkups of children, which is required under the laws and regulations, and in fact the regions are doing this, but apparently not enough. This latest medical checkup campaign has revealed these problems.

And now about wages. We had planned that the wages would be raised by 35% on average over two years under the modernisation programme. The average doctor’s salary in Russia is 28,000 roubles, up 16% on 2010. Mid-level medical workers’ salaries stand at 15,500 roubles, which is 14.7% higher than in 2010. At present we only have data on wages in the economy at large for 2011. Regarding the average for Russia (no regional breakdown has arrived as of yet, we only have data for 11 months and they are positive), in 12 months the salaries of our doctors were 19.3% higher than the average wage in the economy.

Vladimir Putin: In the country as a whole?  

Tatyana Golikova: Yes, exactly. Unfortunately the salaries of mid-level medical professionals are lagging by 34.1%. This is a very big gap and we should put our minds together to determine how to raise the salaries of mid-level medical workers. When you look at and compare with the 11 months in the economy the situation is more or less acceptable, but because the 12^th month is the month when all the bonuses and incentives are paid, the situation may change, but we will only see that when Rosstat provides the corresponding data.

As regards personnel, this is the key issue today. We increased enrollment at medical schools and additional professional education institutions in 2011 by 33%. We increased retraining programmes by 3%. In 2011, as part of the modernisation programme and our current activities, 212,000 medical workers have completed retraining courses. The deficit of doctors became 30% less than the healthcare modernisation programme’s target.

Vladimir Putin: In other words, you thought there would be a greater deficit?

Tatyana Golikova: Yes, according to the regional plans. And you mentioned this 1 million roubles Allowance.  I would like to say that together with the regions and Vladislav Surkov, and with the plenipotentiary representatives in the regions, we have done some serious work in the past few days. Let me elaborate. We have stimulated the regions to dramatically step up their work to pass legislation regarding this 1 million rouble allowance. Unfortunately as of today 72 regions have reported the adoption of regulatory acts (this was as of 6 p.m. today), and nine regions reported that approvals of regulatory acts have not yet been completed. I am sorry to have to list these regions because we have tried our best, but so far there have been no results. They are the Republic of Ingushetia, the Kaliningrad, Kursk, Moscow, Novgorod, Tambov, Tula and Yaroslavl Regions and the Nenets Autonomous Area. As of yesterday information, we remitted 62 million to the Tyumen Region because it was the first to meet all its commitments. As of 6 p.m. today we have transferred 534 million roubles to a fair number of regions. But unfortunately, as you have noted, the occupational guidance work and the educational work that needs to be conducted has not yet been properly organised, even in the regions that have provided the relevant information. We have made note of this and we ask the regions to pay attention to this in order to speed up this work.

In conclusion I would like to speak about the tasks for 2012. The first thing I would like to ask the regions to do is meet the timeframe for 2011-2012. Obviously, 2011 was a difficult year because we were beginning the programme. The programmes are now up and running, but nevertheless we want you to stick to these schedules.

Second. Many regions said they wanted to adjust the qualitative indicators. We will not adjust qualitative indicators because if we do, the programmes will always be considered to be fulfilled. We should keep track of the dynamics of indicators that you have planned.

The third point I would like to mention is the increase of financial support for the programme of state guarantees which are territorial programmes, including out of the money earmarked for raising the standards of medical care. I have already spoken about the one million roubles Allowance.

And the very last thing, Mr Putin. It’s about the totality of the measures taken by the regions under modernisation programmes, in terms of cash flows and qualitative as well as demographic indicators. From the preliminary data that is available we can single out the six or seven best performing regions of the Russian Federation. They are the Trans-Baikal Territory, the Omsk, Ryazan and Voronezh Regions, the Republic of Mordovia, the city of St Petersburg and the Republic of Tatarstan. This is an open-ended list because we only have preliminary data so far, especially on regional demographic indicators. Because you have issued permission and a directive to pay a bonus of 5 billion roubles so far to the foremost territories by a certain deadline, I believe it is May 1, we will have another look at Rosstat data for March. As a result the list may remain as it is or some more regions will be added that show good performance indicators on the two components of the programme. Thank you. 

Vladimir Putin: How much more will need to be added? Just approximately, on average?

Tatyana Golikova: If you recall, we reserved a more substantial sum, 35 billion roubles, for two years. Why 5 billion, then? Because we do not consider…

Vladimir Putin: No, how much on average for one region?

Tatyana Golikova: As of right now, there are seven regions. Of course the breakdown will be different considering the different sizes of the population.

Vladimir Putin: About half a billion?

Tatyana Golikova: Half a billion roubles, yes.

* * *

Vladimir Putin’s comments:

On Sakhalin Governor Alexander Khoroshavin’s report

Vladimir Putin: Mr Khoroshavin, the demographic indicators in your region are lower that the average figures for the rest of the country. The overall birthrate in Russia is 12.6 % per 1,000 people, while in Sakhalin it is 11.8%. The mortality rate in Russia is 13.5%, while in your region it is 14.1%. This is evidence of insufficient attention being paid to healthcare, motherhood and childhood issues, medical equipment supplies, skill levels of medical staff, traffic problems, industrial injury rates, and so on. It requires a set of measures. So, let me draw your attention to this, and I ask all the other speakers today to focus on the main items of our current agenda.

On Smolensk Governor Sergei Antufyev’s report

Vladimir Putin: Mr Antufyev, you’ve covered a lot of ground; I know that what you’ve said exists in reality and that much is being done. I visited your region not so long ago and I saw for myself how you and your colleagues are working. In fact, you have started large-scale programmes, but their results have so far been modest. That’s the crux of the matter.

Where the housing programme for families with many children is concerned, we will consider it together, because it is our common responsibility. But the results in the areas of demography and healthcare indicate that these issues have been attracting insufficient attention. The birthrate in your region is 17.5% lower than the national figure: 10.4% against 12.6% on average across Russia. The mortality rate is higher by 19.6%; the natural decline in population numbers in Russia as a whole is 0.9%, whereas yours is 6.4%. This is a dramatic difference, if you compare it with the average national indices. Child mortality has grown as well. In terms of absolute values, these figures are insignificant; they amount to isolated cases, but still you have a 26.8% growth. Mr Antufyev, you should pay more attention to healthcare and to concrete work with medical institutions: who is in the field and how, what pay they receive, what equipment and other supplies are delivered. How are healthcare modernisation programmes faring in the Smolensk Region? How much money has the Smolensk Region received under this programme?

Tatyana Golikova: The Smolensk Region has received 1.5 billion roubles under the general programme.

Vladimir Putin: No, it was 4.4 billion.

Tatyana Golikova: That’s the total. I am speaking about 2011. The performance figure is 75%.

Vladimir Putin: Well, the performance figure is reasonably good. Let me repeat once again: you should not spend the money for the sake of using it up; you must think it through carefully. For the Smolensk Region, 4.4 billion roubles over two years is a large amount of funding. Look into it once again, whether it is being channeled where it needs to go and whether it will be spent efficiently. More than half of the sum is yet to be spent. I ask the Ministry of Healthcare and the Region authorities to analyse once again what is to be done in this respect.

Tatyana Golikova: Very well.

On Pskov Governor Andrei Turchak’s report

Vladimir Putin: Mr Turchak, you know well that you have very poor results across all of the main indicators. All of them, including the most sensitive ones. You are exonerated by the fact that the situation has been improving since you took over as governor. That is true. There are some positive trends. But, while keeping that in mind, I wouldn’t like you to forget about these acute problems. They are number one in your region. The figures are so abysmal that I don’t even want to cite them. I am not blaming you personally. As I said, the situation has been improving since you took office. The Ministry of Healthcare is assuring me that the development trends are positive. We should continue this work with more perseverance. For Pskov, it truly is one of the most acute and important problems. There are many problems, of course, but this one is a priority. We also would like to draw your attention to the traffic situation. I understand that there is much transit traffic, but these problems must nevertheless be addressed by you in cooperation with the road authorities. All medical services involved in aiding victims of road accidents must be developed at an accelerated rate.

Оn Head of the Republic of Tatarstan Rustam Minnikhanov's report

Vladimir Putin: You have done very well indeed. You report good figures for the basic indicators: the birth rate is 6% higher than the national average, the mortality rate is 8% lower than the national average and the rate of natural increase is 1%.

Rustam Minnikhanov: Our population has been increasing for 20 years due to migration; I consider this one of our biggest achievements. We need to maintain this trend to ensure further growth.

Vladimir Putin: Yes, we must ensure the population keeps growing. Thank you, Mr Minnikhanov.

On Governor and Chairman of the Government of the Khabarovsk Territory Vyacheslav Shport's report 

Vladimir Putin: Mr Shport, overall, you reported positive results for the main indicators. You said that your birth and mortality rates have stabilised. This is good for the birth rate, which is higher than the national average, but not good in terms of the mortality rate, which is also higher than the national average. This kind of stabilisation will not help improve the demographic situation, because at 7.5% the mortality rate is considerably higher [than the average], which is why the natural decline in the population is much higher in your territory than across the country as a whole. This kind of stability is of no use. As I have said, objectively speaking you have done a great deal – I have the relevant figures here. You are obviously not standing still, but moving forward with confidence. But there are also problems that you need to address. According to your plans, you intended to renovate nearly 50 health care facilities, 49 to be precise, but you have in fact repaired less than 50% of these. Can you explain why? Why haven’t you fulfilled your own plans?

Vyacheslav Shport: Mr Putin, we will complete the renovations this year and reach our target figures. The trouble was that the tenders were held too late, because we did not launch this programme at the beginning of last year.

Vladimir Putin: Carry on.

Vyacheslav Shport: I want to say that there are no problems.

Vladimir Putin: Good.

Vyacheslav Shport: We are working according to our plans and will complete all the projects this year.

Vladimir Putin: All right, but just make sure that quality is not compromised. I hope that you will catch up with your schedule and fulfil all your plans.

You said at the beginning of your report that the medical community is quite satisfied with your healthcare modernisation efforts. On the whole, we of course … We need to know the views of the experts, but the opinions of the consumers of your medical services are even more important. I recommend that you conduct these types of surveys more often. After all, your ultimate goal is to ensure that the people are satisfied with the medical services they receive. But, as I said, you seem to be doing quite well, on the whole. Thank you.

On Head of the Republic of Dagestan Magomedsalam Magomedov's report

Vladimir Putin: You spoke about traditions and so on… Traditions are all very well, but I am looking at the figures now and can see that you have been working well, on the whole. Judging by what I have seen on the screen, the situation at your healthcare facilities is very good, at least in Makhachkala. Of course, you need to pay more attention to rural community health centres, which is a problem everywhere across the country, including Dagestan. This is obvious to everyone – I know this because I have been there more than once and know what things look like. But you have made great strides in this area in Makhachkala – I can assure you that this is so because I visit healthcare establishments very often. Everything looks good, very modern, and it appears that you are paying proper attention to this issue. You have implemented nearly all your healthcare plans. This is good. Of course, regions like yours need assistance, and we will certainly continue to provide it. What I have noticed is that salaries in the republic’s healthcare system remain modest. Judging by the figures, such as the declining mortality rate and the  natural increase in the population, your doctors work hard but their salaries remain very modest. This issue needs attention from you, from the Healthcare Ministry and from all of us. Thank you very much.

On Governor of the Orel Region Alexander Kozlov's report

Vladimir Putin: Mr Kozlov, I’d like to say, just as I have said in several previous cases, that you have been working on practically all fronts: you are allocating the regional mothers’ capital and families with three and more children are entitled to receive a plot of land free of charge. I can see that you are implementing renovation projects, although they are not always on schedule, and also building new facilities, introducing standards and increasing salaries. Everything seems to be as it should. It is clear that it has not been possible to reverse all the negative trends in the slightly more than three years you have been governor. However, the fact that not all of the negative trends have been reversed means that you should pay more attention to these issues. You said that the birth rate is rising, but the increase is recognised as very insignificant. The birth rate in your region is among the lowest in Russia, at 16.7%. You said that the mortality rate has decreased and is now 16.3%. But according to my information it was 17.3% and is now 17.2%. Maybe we should check the data to know where the figure of 16.3% came from. And so the natural decline in the population... It is clear that the mortality rate is decreasing, but on the other hand, infant mortality has gone up in your region for some reason. I think that in absolute figures it is probably insignificant, but it is still the case that the rate has grown. I want to know why.

We are introducing new equipment, changing standards and streamlining the operation of our medical establishments, yet the infant mortality rate has gone up. Why is that? Mr Kozlov, I would like you to address these problems very carefully. You have considerable experience, and I know that if you focus your attention on a problem it will get resolved. And this is one of the key issues. I said this at the beginning of our meeting, but I want to repeat it: I hope very much that not only in the Orel Region but also all the Russian regions… Do you know how financiers refer to inflation? They speak about inflation targeting, which means that they set a target of consistently lowering all the indicators. Likewise, you should set a target of increasing all the indicators, the mortality rate of course has to go down, but the birth rate must go up and the provision of healthcare services to the people must be improved. Your region has the right conditions for achieving these goals. You simply have to work consistently towards achieving the desired outcome.

On Governor of the Kirov Region Nikita Belykh's report

Vladimir Putin: As for IVF, this method should definitely be used more widely across the country, that goes without saying. We must also try to bring down the number of abortions, which are a major problem. The healthcare modernisation programmes in all regions have a provision to make sure that psychological assistance centres are established for all women who need it. However, we have to be honest and recognise that no matter how well counsellors do their job, when a family does not earn enough money to feed and bring up a child then even a dozen counsellors will be of little help. That is why, first of all, it has been proposed that special one-off allowances are paid for having a third child in demographically depressed regions, aimed at helping families raise their children. And secondly, regional programmes should also take this element into account and identify those women who have the courage to have a third child in the current difficult economic climate. This is especially important for single mothers, as Mr Belov has said. We must work to change people’s attitudes to such situations and to help these women.

* * *

Vladimir Putin’s closing remarks:

I’d like to thank you for today’s work and to emphasise once again that the problem we have dealt with is one of the most urgent and important ones and we all understand this very well. The future of this country will largely depend on how effectively and professionally we tackle it.

I’d like to draw your attention to the critical remarks made today, to some drawbacks, the persistent problems and the unresolved issues. I’d like to say it again: we have the necessary resources and they are all programmed into the budgets – your budgets and the federal one, and now the task is to organise the work properly.

I’d like to repeat that we just started this work last year and there were problems linked with the time schedule of tenders and how work was organised. We have resolved all of these issues. I expect you to fully implement not only all programmes and plans for 2012, but also those for 2011. Everything that has not been done in full must be completed by all means.

Thank you very much for your attention.