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Earlier on that day, the President met with public representatives of Kaliningrad Region.

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Opening remarks at expanded meeting of State Council Presidium

President of Russia Vladimir Putin: Good afternoon, colleagues.

Today, we have gathered in an expanded format: the governors of the majority of Russian regions are present here. Our task is to analyse the record of the regions in healthcare.

I know that you arrived here in advance and discussed these issues with the heads of the federal government bodies and the expert community. I also had the pleasure of meeting with a number of specialists who deal with these issues on behalf of public organisations and work in primary healthcare.

At the beginning of our meeting, I would like to say, and this is fair, that much has been achieved in the field of healthcare over the past few years. Steady growth of life expectancy is a very important indicator that shows positive changes in our healthcare system. Thus, in 2014, it was 70.9 years and in August of this year, it was 73.6 years. The World Health Organisation has confirmed these figures and the growth rates.

Of course, this is a result of strenuous efforts, productive work of doctors, medical organisations, scientists and talented teams in many regions. They have made an enormous contribution to the development of high technology and specialised medical assistance, and to the resolution of very complicated tasks in maternal and child health.

I would like to emphasise once again, all our achievements confirm that we are able and at the same time obliged to do more, moreover, to consider the high and constantly growing needs of society. Actually, it is clear to everyone – I am referring now not just to healthcare but to any area in general – that we assess today’s conditions not by how bad it was yesterday but based on today’s needs and depending on what we must and would like to achieve tomorrow. Yesterday’s achievements are often seen as normal today; this is only fair.

Today over 60 percent of our citizens have a low opinion of the quality of healthcare, mostly primary healthcare.

I would like to repeat that for us this demand means we need to seriously improve our performance in this area.

You know that since August we have held a series of meetings on this subject and discussed the problems that are vital to people, including the limited quality of primary healthcare institutions, that is, medical and obstetrical stations, infirmaries, outpatient clinics and district hospitals. Many buildings were built in the middle of the past century and have not been repaired for many, many years. Diagnostic equipment is often scarce, and practically all of them are short on personnel.

Following these meetings and in accordance with the instructions I gave to the Government, the plans for upgrading primary healthcare have been endorsed. Based on these, the regions must draft their regional programmes before January 10 and adopt them before July 1.

You know how things are in your regions. Primary healthcare is primarily the responsibility of the regional authorities, and you certainly have your own views on resolving these accumulated problems. I would like today’s discussion to be to the point and absolutely sincere.

Essentially, primary care is closest to the patients and is crucial for them. Most of the patients’ claims are fair and justified. In cases where little has changed for the better, this has become particularly clear. When the local authorities rush into optimisation and often do so in a perfunctory manner making access to medical care more complicated, it only makes the situation worse.

Take, for example, an outpatient clinic with therapists conveniently located not far from a person’s home. But then, the specialist doctors and diagnostic equipment are often located either at the other end of town, or even in a neighbouring district. No doubt, such logistics are good for cutting costs, but they ignores patient needs and interests and do not make medical services readily available.

Given these circumstances, some patients might take their time and wait, others will have patience and wait in line, but still others will get frustrated and put it off. As a result, this could lead to a serious illness or serious complications.

A lot depends on the primary care physicians’ experience, knowledge and skills, and their focus on patients. However, often a doctor may have to see up to 30 patients in one shift and – doctors know this better than anyone else does – fill out a stack of papers as well. We touched on this in our conversation earlier.

Doctors and paramedical staff are the ones who bear the brunt of responsibility for the health of every patient, and thereby, of our nation. Creating the proper environment for them to be able to properly perform their medical duties is our common and most important task.

Also, we must finally figure out how effective the current pay system is. I will not go into detail now, but I think you will cover this in our discussion today. Some things, well, are just surprising. As soon as we equated nurses to the middle-level staff in terms of salary growth rates, they began to demote them to janitorial staff. Why? Their salary is not that high to begin with. What are you trying to save?

As much as 150 billion rubles in additional funds – 50 billion a year – were set aside to finance the modernisation of primary care over three years starting in 2020. This amount is so far believed to be sufficient for the initial phase of modernisation in the second half of 2020. I believe the amount of funding can be adjusted following an expert analysis of regional programmes.

The Government came up with its own approaches to distributing funds by region. This is a fairly complicated matter involving budget-to-budget transfers and we need to sit down and discuss it. Colleagues, I am here to listen to your proposals. Most importantly, we must see specific and visible results from the allocated appropriations.

There are many issues on our agenda. You looked into them carefully during the roundtable discussions and had the opportunity to exchange views.

Now, what matters is to reach mutually agreed upon decisions. Primary care is the foundation of the entire healthcare system. The word “primary” implies priority, not some obscure spot on the periphery of the healthcare system. In order to take primary care to the high level it deserves, the authorities at all levels must act in a coordinated manner and efficiently.

To reiterate, the regions must do the bulk of the work. I want the Government, the Ministry of Healthcare and other departments to provide comprehensive assistance and support to the regions.

Let us get to work.

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