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President of Russia Vladimir Putin: Mr Murashko, I suggest we begin with the most important and challenging issue of all – the demographic situation. You wanted to start the meeting with this topic.

Minister of Healthcare Mikhail Murashko: Mr President,

I would like to begin by saying that the situation in healthcare and demographics has been improving as the number of Covid cases started to decline, which has been an additional factor in improving life expectancy.

Never before in the history of the Russian Federation has overall child mortality been as low as it is today.

As for the adult population, the results for cancer patients have been quite encouraging, and I will elaborate on this topic later. Here, the mortality rate declined by 4.5 percent over the past two years.

Unfortunately, the Covid pandemic exacerbated the situation with cardiovascular diseases, since its complications included thrombophilic disorders, or thrombosis. Covid has been receding, as we got better at treating and preventing it. Compared to 2019, mortality from cardiovascular diseases declined by 10 percent. However, this outcome is attributable to a whole range of initiatives.

I would like to note that regarding cancer patients, early diagnosis is essential. At the peak of the Covid-19 pandemic, we had to limit our preventive efforts, and offered people fewer check-ups and medical examinations in order to spare them the risk of catching Covid. However, as soon as the number of Covid cases dropped, we resumed appointments and ensured flexible schedules. To these efforts, we must add the large number of X-rays we performed for diagnosing lung diseases on time.

Almost all forms of cancer therapy are available today. The number of provided courses of chemotherapy has increased by almost 50 percent in the past three years alone, and the number of modern chemotherapy protocols has increased by almost 40 percent. Photon therapy has become more accessible: equipment that used to be available in a limited number of centres is now operated by regional cancer treatment centres. For the first time, we have proton therapy in the treatment arsenal. Four thousand patients have been treated in the past two years.

Vladimir Putin: Where is this equipment located?

Mikhail Murashko: There are three proton therapy centres, in Moscow, St Petersburg and the Ulyanovsk Region. Now we are working with Mikhail Kovalchuk to build additional radiation therapy capacities.

Radiopharmaceutical agents are also in active development. Our scientists have developed lutetium- and actinium-based drugs. What makes these drugs particularly interesting is that for certain types of cancer, they produce a good effect at the third and even fourth stage, when other forms of therapy no longer work.

This is an innovation that is already available in practical medicine. Two centres have opened in Moscow and St Petersburg, and we are ready to expand.

We have substantially changed regulation to ensure fast access to such medications. Today, Rosatom is helping us with production on an industrial scale. We plan to build a plant to produce radiopharmaceutical agents. Overall, we can see good prospects in this area.

Equipment has been supplied in great numbers, almost 12,000 units. More cancer treatment centres are under construction. Six have opened and I hope six more centres will soon be launched as well.

Regarding cardiovascular diseases, there are several key factors.

The first factor is medical observation. We have changed the approach to forming observation groups and now the compulsory healthcare insurance fund, insurance companies and medical organisations are involved. Our biggest objective is to form patient groups that require special attention. Some require therapy and others surgery.

A great number of X-ray units have been supplied to regions. The number of X-ray examinations has grown by 16 percent in the past year alone, which, of course, substantially impacts the survival and recovery rates.

There is also medication therapy where we are taking a strict approach to rational spending. We have received 10 billion rubles for the treatment of patients after vascular catastrophes, heart attacks and strokes. At the preliminary one-year stage, we planned to cover all patients in this category, but we decided to approach this job rationally, by using Russian medications and rational procurement. Essentially, we have extended the therapy to two years for the same amount of money. We ensure full compliance with all international and national recommendations. We also included eight more in the list of provided medications. And now, we are also introducing a group of patients with arrhythmia and a high risk of mortality to receive the same medications.

This means that the rational approach to using the resources is, of course, effective because medication therapy does reduce the likelihood of complications and repeated heart attacks and strokes in this group of patients.

Vladimir Putin: How do you assess the situation in primary care?

Mikhail Murashko: The situation in primary care is beginning to change, as our colleagues tell us and we see ourselves. First, we have developed – on your instructions – a satisfaction-based assessment system and there are also external assessments. We see that for the first time we have reached what is probably one of the highest satisfaction indicators in recent decades.

But it is perhaps too early to rejoice, because we see huge potential.

I would like to show you what has led to this state of affairs. When we began modernising primary care, people, naturally, were expecting something over and above the mere painting of walls and installation of equipment, although this aspect is also important. We collected data and ran polls on these expectations, with the regions helping us. Internal problems at medical organisations – personnel, drug provision, accessibility by transport and many others – were being addressed alongside infrastructure changes.

A case in point is the healthcare system in the countryside: we have put into operation about 3,500 urgent care stations and overhauled another…

Vladimir Putin: How many do we need overall?

Mikhail Murashko: There are a total of 43,000-odd urgent care stations functioning in this country.

Vladimir Putin: How many of them did we plan to refurbish or build from scratch?

Mikhail Murashko: We planned to open a total of 6,500 new urgent care stations.

Vladimir Putin: This means almost half has been done.

Mikhail Murashko: Yes. And we planned to revamp almost as many: 2,700 urgent care stations and outpatient clinics.

If we consider a ten-year period, one in every two urgent care stations in Russia will be modernised at the expense of regional or federal funds by 2025. This is an absolutely good thing, and people see it. In addition, we are buying equipment for these urgent care stations: we planned to buy about 26,000 units of equipment but expanded the list based on a rational approach with a focus on purchasing Russian-made equipment. As a result, we saved funds and could supply 58,000 units of connection-capable equipment to urgent care stations: they are connected to the internet, with electrocardiograms and other things transmitted online. Information systems are used.

There were no pharmaceutical activities at 35,000 urgent care stations all over the country. This means that a village lacks a pharmacy and the local station had no opportunity to sell medicines. Today, all urgent care stations in villages lacking a pharmacy have been issued licenses. We did this within three months, trained personnel…

Vladimir Putin: So, they have the right to sell [medicines] then and there…

Mikhail Murashko: Both sell and dispense free of charge, if necessary, to benefit-entitled citizens.

Vladimir Putin: With a prescription.

Mikhail Murashko: In addition, another serious issue with the rural first aid stations is accessibility. I would like to use this occasion to say that the governors have a responsible approach to this matter, paving the roads where necessary and moving bus stations, including closer to outpatient clinics, which is a good form of interaction.

Furthermore, 11,000 vehicles have been supplied to the healthcare sector over the past two years, and another 9,000 are to be supplied by 2025. It is the largest figure ever. Next, we have provided 5,000 ambulance vehicles over these years jointly with the Ministry of Industry and Trade. It is a significant breakthrough.

Next, regarding medical aviation. I would like to thank you for supporting the Far Eastern regions, because we have increased their funding by 2 billion rubles. Medical aviation is extremely important for these regions, which is why an additional 2 billion rubles will be allocated to them from the budget this year.

In other words, this comprehensive approach allows us to deal with nearly all issues.

And one more issue concerns personnel, of course. We are extremely grateful to you for approving additional incentive payments in primary care, which has had a great deal to do in the past few years. The staff have been working hard to help people during the Covid and flu periods. They faced monumental challenges. It is important for us to provide additional incentive payments to those who work very hard to save lives.

Vladimir Putin: This is also an element of society’s appreciation of their work.

Mikhail Murashko: All of us appreciate this, and I am very grateful to you for this. Thank you very much.

Vladimir Putin: Thank you.

Mikhail Murashko: And a few words about the new territories.

Today, repairs are being done in 138 medical organisations. They are also receiving equipment – practically every third clinic is undergoing repairs or receiving equipment. There is a large number of tasks. It is necessary to modernise the healthcare system. The human resources component is also very important.

Today, our scientific, research medical centres and federal clinics are curating everything and already visiting the regions. First, they are providing methodological support, teaching and consulting specialists and rendering medical aid. Plus, they have already started selecting patients for federal clinics and the first patients are already arriving there.

Following your instructions, we are conducting medical examinations of children.

Vladimir Putin: The next step after the examination is key.

Mikhail Murashko: Everything is well planned in this respect as well. Doctors have sent thousands of children for medical treatment after examinations that revealed pathologies. The entire package of services that must be organised for medical aid is based on the individual needs of each child.

I am very grateful to the doctors, the pediatricians that have been very active in this respect.

For the first time, we tried this option that has earned a very good reputation. In cooperation with the Ministry of Industry and Trade, we bought vehicles and filled them with equipment that is installed in a school or kindergarten. It is very convenient. For instance, a team comes and sets up its equipment in a school or office. Children undergo medical exams on the spot, which is very effective. Doctors prepare all the medical documents. Many parents are also present. They receive consultations and recommendations from doctors. This option is very efficient. We tried it for the first time, and I think other regions should follow suit.

Vladimir Putin: We did the same with rural health posts in villages.

Obviously, it is necessary to build new facilities and repair old ones – they were not repaired for decades. They require equipment, personnel training and medications. People from these territories who need assistance from federal clinics should be sent there for treatment.

Mikhail Murashko: Today, roughly 700 specialists are working full-time in these territories. They are sharing their knowledge with their colleagues which helps standardise practices. We have already conducted the first round of training for the heads of medical facilities. They should know all our standards of medical treatment and referral. They should have access to everything and understand everything. Doctor-to-doctor interaction is always the best way to work.

Vladimir Putin: I agree.

All right, thank you.

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