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President of Russia Vladimir Putin: Good afternoon, friends and colleagues.

You know that today in Kaliningrad, we will be discussing with regional governors the development of primary healthcare. Therefore, I actually wanted to meet with you just before this event to talk about it as well, but if any other questions arise, feel free – we have no protocol or any preliminary plan here.

I asked the Governor and members of the Presidential Executive Office to invite mainly those people who are somehow connected with healthcare in general, who understand and feel what is happening, especially in primary healthcare: medical workers, representatives of public organisations working in this field, and administrators one way or another related to healthcare.

Look what has happened in recent years. We have addressed several times, at least twice, the issue of improving the primary healthcare sector, healthcare in general and primary healthcare in particular. We assumed we needed to provide federal support for regions and municipalities. So we did it and spent a significant amount on it. Some time passed, and it turned out that we have to go back to this issue, again at the federal level. So we provided financial support again. Another five years passed; we had hoped that the regions and municipalities would maintain the achieved level, but it did not work out, so again we have come to a situation where additional efforts and additional funds are required on the federal level. So this is a system-wide problem.

Judging by what we see here, this is happening, in part, because there is a gap between the municipal and state levels of government in our Fundamental Law, the Constitution, which sets out the state level as the regional and federal levels, but not the municipal level. What does this mean? It means that officials at the federal level, and often at the regional level as well, say that this is not their competence and that town and village authorities are free to act as they deem necessary. Town and village authorities respond that they would be happy to do this if not for the lack of funds and suggest redistributing the financing sources. And this goes on and on.

Of course, we will have to take system-wide decisions that imply a degree of coordination but should not come into conflict with our international commitments, because the municipal authorities must have a measure of independence. We cannot and will not violate this premise, yet there must be a connection between different levels of government.

Members of the public do not even distinguish between municipal and state responsibilities. They believe that the authorities in general must ensure quality services, in this case, medical services. Actually, the situation in education is almost identical. Anyway, this is the situation. Therefore, we should plan our actions based on modern realities and respond to whatever takes place.

Unfortunately, many bad things are taking place because primary care needs federal assistance again. But for the planned allocations to be used wisely and with the best possible effect, we must jointly formulate the rules, forms, methods and volumes – primarily volumes and only then methods – of spending these funds, so that the people see and feel improvements in the quality of medical services.

As you know, our national projects include a Healthcare project. Quite a large amount of money has been allocated until 2024: 1.3 trillion rubles. But this national project was developed in such a way that mainly… It envisages a bit for the primary healthcare sector, somewhere around 300 billion, if I am not mistaken. Well, not a little bit – 277, isn’t that right?

Healthcare Minister Veronika Skvortsova: 237.

Vladimir Putin: 237 billion. But this is not enough. This is for six years, until 2024, and given the situation that has developed in primary healthcare, this is clearly not enough.

Where does the main part of the funding go? To things that are quite necessary, one would say. They include first of all the fight against cancer – the main funds go there. This covers federal centres, interregional centres – these are large regional healthcare institutions. But fortunately, most people, 80 or 85 percent, do not need cancer treatment, but they do need a local outpatient clinic or some kind of inter-district institution to receive high-quality medical assistance on a regular basis. If that is the case, fewer people will need to receive treatment at hi-tech centres, because there will be fewer cases when the disease progresses to an advanced stage.

This is what I wanted to say at the beginning. The goal of our meeting and discussion today is to listen to you – the people who work with patients directly, and, having heard you, to take what you say into account when developing and implementing programmes for primary healthcare, which is the reason we have gathered here in Kaliningrad today.

That is all I wanted to say. Let us begin.

I want to repeat, if you have any non-health issues you want to raise, please go ahead. But I would very much like to talk about this topic, because today’s State Council Presidium meeting is devoted to it, and the professional community in this field has gathered here today.

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