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Meeting of the State Council Presidium and the Commission for the Implementation of Priority National Projects

May 30, 2011, Gorki, Moscow Region

Dmitry Medvedev chaired a joint meeting of the State Council Presidium and the Presidential Commission for the Implementation of Priority National Projects and Demographic Policy on children’s health protection issues.

Earlier in the day, the President visited one of Moscow’s children’s medical centres, inspected its operation, and spoke with staff and visitors.

Mr Medvedev has held a series of meetings over the last month on developing the healthcare system for children, has visited a number of medical institutions.

* * *

Opening remarks at a joint meeting of the State Council Presidium and the Commission for the Implementation of Priority National Projects and Demographic Policy

President of Russia Dmitry Medvedev: Colleagues,

We are here today for this joint meeting of the State Council Presidium and the Commission for the Implementation of Priority National Projects and Demographic Policy, which deals with a matter of absolutely crucial importance: our children’s health. We all know that there are more than enough problems in this area. I want to round up the results of the work that we have been doing over the last month and finalise the instructions for the Government and the other organisations able to influence the situation in this area.

As you know, we have invested considerably in the country’s medical system over recent years. A total of 786 billion rubles [$28 billion] has been invested through the Healthcare National Project over the period between 2006 and 2010. This is a lot of money by any standards, a lot of money for our country, and indeed for any big developed country.

Many of the programmes implemented have proved effective, in particular the maternity certificate programme and the perinatal centres development programme. I recently visited a maternity hospital in Kostroma and discussed this subject with the doctors there. They say that the maternity certificate programme has filled a great need and is working quite well, and this is confirmed by the regional governors too. The national project has already helped to reduce deaths from pregnancy-related complications and infant mortality. Over 2006–2010, infant mortality dropped by 30 percent, and pregnancy-related deaths by almost 15 percent. Of course, we will have to move over to new criteria, and I will speak about this, and this will also help to further reduce these figures.

I remind you that in 2011 and 2012 more than 618 billion rubles will be allocated for carrying out regional healthcare modernisation programmes. More than a quarter of this money – around 163 billion rubles — will be spent on children’s healthcare. We have also earmarked a further 120 billion rubles for improving professional training and education. The financial situation today is thus quite good overall, especially when contrasted with the financial difficulties we had over recent years. We therefore are to use these funds as effectively as possible and do our utmost to achieve real quality change in the children’s healthcare system.

This requires us to set a clear list of objectives and have a clear picture of the final results we want to achieve over these coming years. In other words, we should set the specific targets we want to reach in children’s healthcare. We also need to improve the various mechanisms involved – the legal, organisational, and financial mechanisms. I think that, concerning the priorities that we are to take into account in drawing up the state healthcare and education programmes, there are several key points that stand out today.

First, prevention is the best way to protect our health and constitutes the foundation of any healthcare system. Its effectiveness depends greatly on timely prevention efforts in our kindergartens and schools, and on our ability to promote and inculcate a healthy lifestyle. You all know that we have long had big problems with this, and in this respect the human resources policy in our medical and education systems also has a big part to play.

”In 2011 and 2012 more than 618 billion rubles will be allocated for carrying out regional healthcare modernisation programmes. We therefore are to use these funds as effectively as possible and do our utmost to achieve real quality change in the children’s healthcare system.“

I want to note in particular the necessity to develop the system for providing psychological help. Children are in need of this, as are their parents, and indeed everyone involved in educating our young people. We must work on straightforward things such as further training for the specialists working with children, and increasing the number of young professionals coming into the system. We can use all possible incentives in these efforts, including the obvious but very important incentive of better pay. This has been the subject of much discussion of late, discussion about what we can and cannot do. But there are some categories of health sector workers on which we absolutely have to make urgent decisions, given the current state of affairs. I have spoken about this already.

Working together with the regions, the Government has until September 1 to present proposals on increasing wages by at least 50 percent for healthcare professionals working in the preschool and general school systems. We know what state preschool and school healthcare is in today. It’s simply non-existent. At best a nurse turns up from time to time, and gets paid a pittance for the job. Even taking into account the current wage payment system and organisation in the regions, these people are earning only 3,000–5,000 rubles a month, and this is unacceptable.

Coming to another point: I just visited an ordinary Moscow children’s medical centre before this meeting. The centre was nothing special, housed in a building built in 1964, and now in need of complete overhaul, even though everything is neat and clean inside. The people using the centre seem happy with the healthcare it provides. At least, the parents at the centre at the moment I was there said they were happy enough, and given that we turned up there out of the blue, they were probably expressing their honest thoughts.

But there is something that all of the big regions such as Moscow and the Moscow Region, and all other regions are to always remember. We are all busy building new housing at the moment, and this is very good. Apartments are being built for public sector workers, or sold on the market, and we are helping various groups of people to buy their own homes. But what often happens is that the new housing goes up, but not in tandem with the accompanying infrastructure such as local medical centres and kindergartens. These facilities arrive only a year or more, sometimes five years later, but people need to live their lives right here and now. It is absolutely essential therefore that housing and infrastructure development go hand in hand everywhere. Even in the Moscow Region there are problems with this. First housing gets built, and then a few years later kindergartens and medical centres start to open.

Colleagues, we have the possibilities we need today to allocate funds, place obligations on the developers, and put in place the conditions for ensuring that along with new housing, kindergartens, medical centres, and even hospitals if necessary, are built at the same time. Otherwise we will find ourselves facing big imbalances.

To give an example, in the medical centre I visited just before, the head doctor said that the centre has around 10,000 children from Moscow registered there for treatment, and another 3,000 from the Moscow Region. But the Moscow Region is very big and has considerable possibilities at its disposal. If the children are going to centres in Moscow itself, this suggests that there are not enough centres in the Moscow Region. This is true not just of the Moscow Region, but is the case in most parts of the country. You should pay attention to this problem. Housing development must go hand in hand with development of medical centres and kindergartens. There is no alternative. Maybe this should be made part of the set standards. It is something we have to think about.

Second, I remind you that at the meeting of the Commission for Modernisation and Technological Development of Russia’s Economy in May I gave an instruction on provision of medicines for children and adjustments to the national timetable for preventive vaccinations. Of course, we need not just children’s medicines, but also new Russian-made vaccines and Russian-made medicines that measure up to international standards.

I remind our regional governor colleagues and everyone interested in the subject that as from 2012, newborn babies will be registered in Russia following the criteria set by the World Health Organisation. I know that premature babies, babies born with a low body weight, were always cared for in specialised clinics. Today we are to make sure that maternity centres everywhere can provide such care. I have instructed that money from the presidential reserve fund amounting to 350 million rubles, as I stated earlier, should be allocated for buying specialised medical equipment for caring for these categories of newborns. These efforts should certainly result in the improvement in statistics and in the performance of our healthcare facilities.

Third, we must do more to support children in difficult circumstances, children with disabilities and their parents. This is one of the duties of the state. We are working at the moment on programmes to prevent disabilities and efforts to treat and rehabilitate children with disabilities and integrate them into normal life. We are developing inclusive education. But there are still important areas that require our attention, things such as programmes to educate and provide psychological support to parents of children with serious health problems. We have to raise parents’ knowledge and skills with regard to caring for their children in the home environment. I think that this is an area in which non-profit organisations, charity organisations working with children, especially children in difficult circumstances, can make a big contribution, and we should support them in developing their activities in this area.

I met not so long ago in St Petersburg with NGOs working with children with illnesses and disabilities. This is a very difficult job, very noble, and a great responsibility. As is so often the case, there are many organisational problems and problems with the laws that these organisations encounter in their operation. In short, along with the list of presidential instructions that I will sign following today’s meeting, I also want to sign a list of instructions on improving the legislation regarding NGOs. The State Duma is currently putting one of the draft laws through its second reading, and it will be passed soon it seems. There are a number of proposals that we should include on the short-list of instructions that require our attention and are to be approved by the federal bodies.

”Working together with the regions, the Government has until September 1 to present proposals on increasing wages by at least 50 percent for healthcare professionals working in the preschool and general school systems.“

The fourth issue is that of schools. I spoke about this when I visited a therapeutic facility on the Caucasus Black Sea coast at the start of May. We held meetings in several other places too, where this subject came up. I am referring to the work to develop and equip school canteens, at reasonable cost of course. Many of the regions represented here today are working on this and we are starting to see modern kitchens and canteens in their schools. This programme’s implementation must continue. We began it as a pilot project in 2007, if I recall correctly, and now we are to implement it nationwide.

Another big area of concern is the school medical rooms, which are in a dreadful state in most schools, except at the most elite and well-off schools. There is nothing there in most cases, and often not even a nurse. These school medical rooms should be properly equipped, and I think the regions are up to this task. School gyms need to be modern too of course. The regional authorities are doing a lot in this area. You can build school sports facilities shared by more than one school too, this is also a possibility, but whatever the case, school sports facilities in general also play a big part in children’s health.

* * *

All of the modest but nevertheless visible successes, which we have achieved in recent years in the development of medicine and healthcare for children, are certainly even more modest in rural areas. The meetings like this one are precisely intended to promote a broadest variety of advanced educational technologies, improve children’s healthcare and medical assistance availability in the countryside.

Thus, I would agree we should give specific attention to healthcare in rural areas. True, people who live in the countryside may be basically healthier, but the problem is that when any medical treatment is required, they sometimes have to travel dozens of kilometres to get it, and when it comes to ambulances or various sophisticated surgeries their availability for rural residents is even more questionable than for city dwellers. That is an issue to certainly be addressed.

As I mentioned, healthcare has been in the focus of our attention over the last month so I will summarise the points addressed at the meeting on organisation of children's healthcare and summer holidays I chaired in Sochi on the Black Sea shore, at my meeting with St Petersburg NGO representatives involved in assistance to children with limited abilities, during my visits to various medical facilities in Kostroma, Moscow and other places, as well as at the meeting of the Commission for Modernisation [and Technological Development of Russia’s Economy] on pharmaceuticals. The decisions and suggestions of all of these meetings should be summed up and submitted to myself by the Government and the Presidential Executive Office as a general list of instructions to be issued.

I wish all of you, particularly the pediatricians, success in your work.

May 30, 2011, Gorki, Moscow Region