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Vladimir Putin had a working meeting with Deputy Prime Minister Tatyana Golikova.

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Excerpts from transcript of working meeting with Deputy Prime Minister Tatyana Golikova

President of Russia Vladimir Putin: Ms Golikova, today I wanted to talk to you about the progress in one of our major national projects, the Healthcare national project. We have allocated very substantial funds for it until 2024, namely 1,367 billion rubles, including 49 billion for primary care.

Overall, the programme is quite solid and aimed at achieving key results in the treatment of cardiovascular diseases, cancer and other conditions that, unfortunately, have a very negative effect on the mortality rate in the country.

All these measures are appropriate: they envisage the training of professionals with respective specialisations, the purchasing of necessary equipment, and construction of new and advanced medical centres. All of this is needs to be done.

As I said, we allocated 49 billion for primary care. However, I am still concerned. I know that construction of paramedic centres has started and will continue; that outpatient clinics are being brought in order and new clinics as well as mobile medical centres are under construction. But primary care is still of great concern to me.

In 2005–2007, we carried out the first major upgrade, if I may put it that way, of primary healthcare. Later, we did the same in 2010, 2011 and 2012.

My main concern is that there is some kind of disconnect between the efforts undertaken by the federal centre, which bring about a good and positive outcome, and what happens after that, a disconnect between different levels of government. This can be particularly felt in the social sphere, namely, education and healthcare. At lower levels, things tend to deteriorate.

Take a look at how things were in 2005–2007. Back then, we not only worked on upgrading healthcare, major repairs and equipment purchases, but we also paid attention to medical workers’ salaries. We were making additional payments in the amount of 10,000 rubles to doctors and primary care specialists, and 5,000 rubles to nurses. Where are these salaries now? Where did this primary care money go?

When I travel to the regions, people are talking about it. There were many questions about this during the Direct Line. I read them. Not everyone could make it onto TV, but there are questions and concerns, because their wages are at the subsistence level.

Thankfully, the law now stipulates that the minimum wage cannot be lower than the subsistence minimum (11,280 rubles), but they get paid less, which is surprising. This means that even the existing legislative statute is not enough.

I am aware of what the issue is. They work part-time and so on, but somehow the regional authorities manage to get around this. The disconnect between levels of government is the problem. The second problem is that the decisions are enshrined in laws, but are not implemented in real life.

Finally, in order to encourage more specialists in primary care – and we are experiencing shortages of specialists – we need to take a number of energetic steps to increase wages and to discuss ways to provide housing for medical workers, doctors and specialists, as well as mid-level care providers.

If we fail to resolve the entire range of issues here, we will certainly be unable to achieve the goals that I outlined in the executive order, namely, the national development goals in demographics.

We will not be able to achieve the life expectancy target we set, nor will we be able to increase natural population growth; we will not be able to improve the birth rate. That is, one of the main demographic goals in the executive order will not be achieved.

Therefore, today, I would like to discuss primary healthcare with you. And listen to what you have to say in terms of your assessments, recommendations and suggestions.

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Vladimir Putin: Let us discuss this entire set of issues again later. The goal was for doctors to receive 200 percent of the average wage in the regional economy, and this is the case in a number of medical institutions.

However, the bulk of medical workers do not feel the change, which causes our concern. In that case, we will not be able to achieve the goals we have discussed and you have just repeated.

Please submit your proposals for improving primary healthcare by early August.

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