Economic components of the state program for the development of health care. Federal target programs

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Ministry of Health and Social Development of Russia

State budget educational institution
higher professional education

"Siberian State Medical University"

Ministry of Health and Social Development of the Russian Federation

(GBOU VPO Siberian State Medical University of the Ministry of Health and Social Development of Russia)

Faculty of Economics and Management in Health Care

Department of Health Organization and Public Health

Course work

in the discipline "Medical and social foundations of health"

FEDERAL TARGET PROGRAMS AIMED AT POPULATION HEALTH PROTECTION

Completed by: 2nd year student of group 7001

Baldandorzhieva N.A.

Checked: dr honey. sciences, professor

CM. Khlynin,

cand. honey. Sciences, Associate Professor O.V. Kudelina

Tomsk 2011

Introduction

At present, society and healthcare are faced with a very big problem - this is a decline in the health of the population, primarily the working-age population. In connection with this health care, a number of federal targeted programs have been developed aimed at reducing morbidity, improving the standard of living of patients suffering from socially significant diseases, as well as developing the medical literacy of the population.

So, the topic of my term paper "Federal targeted programs aimed at protecting public health" is relevant today, since federal targeted programs are designed to help in solving the strategic tasks of developing health care and the social sphere, especially in cases where it is necessary to concentrate resources to achieve specific goals within a given timeframe.

The aim of the course work is:

The study of federal targeted programs, its directions, activities.

Analysis of implementation, activities, program financing

To achieve this goal, it is necessary to solve the following tasks:

1. To reveal the essence of the federal target program.

2. To study financing, formation, approval of the target program.

3. Conduct an analysis of the implementation of federal target programs in the Russian Federation and their role in financing budget investments.

Chapter 1. Characteristics of federal target programs

1.1. Basic concepts of a targeted program aimed at protecting public health

In modern civilization, the human right to health protection ceases to be a purely individual property, it becomes the most important value for the state and civil society. The peculiarities of the right to health protection lie in the fact that it belongs to an inalienable right, belongs to a person even before his birth, is an indispensable condition for the life of society and is associated not only with the need to take care of his health of every citizen, but also with the responsibility of the state for the preservation and promotion of health. their citizens. Human life and health are the highest values for society, taking into account which all other values and benefits should be determined.

Public health protection is a set of political, economic, legal, social, scientific, medical, sanitary-hygienic and anti-epidemic measures aimed at preserving and strengthening the physical and mental health of each person, maintaining his long-term active life, providing him with medical and medicinal assistance. . At present, it is generally accepted that the program-target method serves as the most important tool for the implementation of the state social and economic development of the country and its individual regions, along with methods of forecasting and indicative planning.,

The federal target program is a complex of research, development, production, socio-economic, organizational, economic and other measures linked by tasks, resources and deadlines that provide an effective solution to systemic problems in the field of state, economic, environmental, social and cultural development of the Russian Federation.

Targeted programs are one of the most important means of implementing the structural policy of the state, actively influencing its socio-economic development and should be focused on the implementation of large-scale, most important investment and scientific and technical projects for the state, aimed at solving systemic problems that fall within the competence of federal executive authorities.

The target program may include several subprograms aimed at solving specific problems within the program. The division of the target program into subprograms is carried out on the basis of the scale and complexity of the problems being solved, as well as the need for a rational organization of their solution.

Budget financing can be divided into two parts - financing the volume of services and specific targeted programs. In the first case, funds go to a specific subject of budget expenditures; in the second case, funding can go to a number of industries. In this case, funding is sent either directly to the contractor or through the department.

The role of a customer of a long-term target program can be a state authority or a local government for municipal target programs. It is this body that acts on behalf of the state or municipality in the development of a long-term target program and its implementation.

Federal targeted programs are an effective tool for implementing the state economic and social policy, especially when solving long-term tasks and implementing large infrastructure projects. It is this program-project approach that is used in the countries of the European Union, in the USA, Canada, Japan and others to solve strategic problems of economic and social development, in cases where it is necessary to concentrate resources to achieve specific goals within a given time frame.

1.3. List of federal targeted programs aimed at protecting public health

Federal target program "Prevention and control of socially significant diseases (2007 - 2011)"

1) Subprogram "Diabetes mellitus"

2) Subprogram "Tuberculosis"

3) Subprogram "Vaccinal prophylaxis"

4) Subprogram "HIV-infection"

5) Subprogram "Oncology"

6) Subprogram "Sexually transmitted infections"

7) Subprogram "Viral hepatitis"

8) Sub-program "Mental disorders"

9) Subprogram "Arterial hypertension"

Federal target program "Children of Russia" for 2007 - 2010

Subprogram "Healthy Generation"

Subprogram "Children and family"

Federal target program "Improving road safety in 2006-2012".

1.3.1. Program "Prevention and control of socially significant diseases (2007 - 2012)"

The federal target program "Prevention and control of socially significant diseases (2007 - 2011)" (hereinafter referred to as the Program) was developed in accordance with the order of the Government of the Russian Federation of December 11, 2006 N 1706-r, the list of socially significant diseases approved by the Government Decree of the Russian Federation of December 1, 2004 N 715, the procedure for the development and implementation of federal target programs and interstate target programs in which the Russian Federation participates, approved by Decree of the Government of the Russian Federation of June 26, 1995 N 594.

The need to prepare and implement the Program is caused by a number of socio-economic factors that affect the decline in the quality of life of the population, including excessive stress, a decrease in the level of sanitary and hygienic culture, as well as still high rates of morbidity, disability and mortality, despite the implementation of the federal target program "Prevention and control of diseases of a social nature (2002-2006)".

The number of newly registered cases of HIV infection has reached 37.7 thousand cases, in correctional institutions Federal Service execution of sentences - 2 thousand cases, the proportion of HIV-infected pregnant women included in the program for the prevention of HIV infection in newborns was 75 percent.

The proportion of patients with visual localizations of malignant neoplasms detected at stages I and II of the disease in the total number of patients with visual localizations of the tumor is 67.6 percent, the proportion of deaths from malignant neoplasms within a year from the date of diagnosis in the number of patients first registered in the previous year - 31.6 percent, mortality from malignant neoplasms per 100 thousand of the population is 233.1 cases for men, 170.3 cases for women. (As amended by Decree of the Government of the Russian Federation of 04/06/2011 N 254)

The incidence of syphilis is 72 cases per 100 thousand of the population, in correctional institutions of the Federal Penitentiary Service 176.6 cases per 100 thousand people, the incidence of syphilis in children is 21.2 cases, gonorrhea is 23.4 cases per 100 thousand of the child population. At the same time, the share of specialized medical institutions that monitor the variability of sexually transmitted infections in the total number of dermatovenereological institutions is 15 percent. The total number of specialized centers for the prevention and treatment of sexually transmitted infections for adolescents does not exceed 12 in the whole country.

The incidence of acute viral hepatitis B and C is currently 8.6 and 4.5 cases per 100 thousand of the population, respectively, chronic viral hepatitis B and C - 51.4 cases per 100 thousand of the population. The proportion of patients covered by brigade forms of psychiatric care in the total number of observed patients is 5 percent, the proportion of patients in need of inpatient psychiatric care in the total number of observed patients is 16 percent. At the same time, the average duration of treatment of a patient in a psychiatric hospital is 75.6 days, and the proportion of repeated hospitalizations in a psychiatric hospital during the year is 20 percent.

The incidence of cerebral vascular disorders (cerebrovascular diseases, including stroke) due to arterial hypertension is 5776 cases per 100,000 population, and the mortality from cerebral vascular disorders (cerebrovascular diseases, including stroke) due to arterial hypertension is 325 cases per 100,000 population.

95% coverage of children with preventive vaccinations is maintained. The incidence of diphtheria and measles is currently 0.25 and 1.6 cases per 100,000 population, respectively.

Main goals and objectives

The goals of the Program are to reduce the incidence, disability and mortality of the population in socially significant diseases, increase the duration and improve the quality of life of patients suffering from these diseases.

The objectives of the Program are:

Ø improvement of methods of prevention, diagnosis, treatment and rehabilitation of socially significant diseases;

Ø development and implementation of modern methods of prevention, diagnosis, treatment and rehabilitation of socially significant diseases based on advanced technologies;

Ø construction and reconstruction of specialized medical institutions.

The program is being implemented in 2007-2012. (As amended by Decree of the Government of the Russian Federation of 04/06/2011 N 254)

Within the framework of the Program, it is planned to carry out a set of interrelated measures for the prevention, diagnosis, treatment and rehabilitation of socially significant diseases throughout the entire period of the Program.

The program includes subroutines:

v "Diabetes mellitus",

v "Tuberculosis",

v "HIV infection",

v "Oncology",

v "Sexually transmitted infections",

v "Viral hepatitis",

v "Mental disorders",

v "Arterial hypertension",

v "Vaccination"

Subprogram "Diabetes Mellitus"

In patients with diabetes, the need for medical care increases as their condition worsens and complications occur. The prevalence of life-threatening and disabling vascular complications of diabetes mellitus, including diabetic retinopathy, diabetic nephropathy and cardiovascular complications, remains high.

The objectives of the subprogram "Diabetes mellitus" are:

Reducing the incidence of diabetes;

Improving measures to prevent its complications;

increase in the average life expectancy of patients with diabetes mellitus.

1) improvement of methods for the prevention and diagnosis of diabetes mellitus;

2) treatment and rehabilitation of patients with diabetes mellitus;

3) development and implementation of high-tech methods for treating the disease and its complications;

4) development and implementation of educational programs for patients with diabetes on the prevention and treatment of diabetes.

The proportion of complications in diabetes mellitus is currently 35 percent. Limb amputations were performed in 1 percent of patients. In total, for the first time during the year, 38.6 thousand people were recognized as disabled due to diabetes.

Subprogram "Tuberculosis"

In patients suffering from tuberculosis, a decisive factor of a socio-economic nature is a decrease in the level and quality of life.

Not all population groups are covered by preventive medical examinations for the purpose of early detection of tuberculosis. It is necessary to take additional measures to reduce the incidence, disability and mortality in tuberculosis, optimize the treatment of tuberculosis patients, ensure early diagnosis and prevent the development of severe complications in tuberculosis, increase the life expectancy and improve the quality of life of patients suffering from such a disease, including by strengthening financial -technical base of healthcare institutions.

The objectives of the Tuberculosis subprogram are to reduce the incidence of tuberculosis and reduce the death rate from tuberculosis.

The tasks of the subprogram are:

1) improvement of tuberculosis prevention methods, including

2) development of information programs for the population, educational

3) programs for TB patients and persons in contact with them;

4) improvement of tuberculosis infection control measures;

5) improvement of diagnostic methods, treatment and comprehensive programs of medical and social rehabilitation;

6) construction and reconstruction of anti-tuberculosis medical institutions.

The incidence of tuberculosis in correctional institutions of the Federal Penitentiary Service is currently 1515 cases per 100 thousand people, mortality - 153.4 cases per 100 thousand people, the proportion of cases of cessation of bacterial excretion - 73.5 percent, mortality from tuberculosis - 22.6 cases per 100 thousand population.

Subprogram "HIV-infection"

The continuing growth in the number of registered HIV-infected persons is largely due to socio-economic factors, the spread of drug addiction, and insufficient awareness of the population. It is necessary to increase the proportion of HIV-infected pregnant women included in the program for the prevention of HIV infection in newborns. It is required to study the drug resistance of the human immunodeficiency virus to antiretroviral drugs. Further development of safe technologies for the procurement of blood and its components is necessary in order to reduce the risk of HIV transmission when using donated blood and its products.

The objectives of the subprogram "HIV-infection" are:

Reducing the number of newly registered cases of HIV infection;

Implementation of methods for preventing HIV infection in newborns;

Ensuring the availability of antiretroviral drugs;

Decrease in the mortality rate of patients with HIV infection.

The tasks of the subprogram are:

1) improvement of methods for preventing the spread of HIV infection;

2) improving the methods of diagnosis, treatment and rehabilitation of HIV infection;

3) development and implementation of modern antiretroviral drugs;

4) construction and reconstruction of specialized medical institutions and equipping them with modern medical and technological equipment.

Subprogram "Oncology"

Disability rates due to malignant neoplasms remain extremely high. The proportion of patients who died from malignant neoplasms within a year from the moment of diagnosis is high. The organization of preventive medical examinations for the purpose of early detection of oncological diseases is insufficient. It is necessary to continue the study of substances, products, production processes, household and natural factors that are carcinogenic to humans.

The objectives of the subprogram "Oncology" are:

Ensuring early diagnosis of diseases;

Reducing disability and mortality in malignant neoplasms.

The tasks of the subprogram are:

1) improvement of methods for the prevention of cancer, early detection of tumor and precancerous diseases;

2) assessment of carcinogenic environmental factors;

3) monitoring of carcinogenic production factors and industries;

4) ensuring the diagnosis of tumor diseases of visual localization in the early stages;

Subprogram "Sexually transmitted infections"

The number of sexually transmitted infections (including cases of neurosyphilis) detected among adolescents is increasing every year. The resistance of pathogens of sexually transmitted infections to the drugs used is developing. In this regard, it is necessary to conduct health education activities and promote a healthy lifestyle. In addition, it is necessary to increase the number of specialized medical institutions that study the variability of sexually transmitted infections, organize research aimed at overcoming the therapeutic resistance of sexually transmitted infections and improving their diagnosis, taking into account the molecular characteristics of pathogens.

The purpose of the subprogram "Sexually transmitted infections" is to reduce the incidence of sexually transmitted infections.

1) improvement of methods for the prevention of sexually transmitted infections, including the development of information materials and educational programs for the population;

2) development and implementation of modern methods of diagnosis, treatment and rehabilitation of sexually transmitted infections;

3) improvement of the system for monitoring the resistance of sexually transmitted infection pathogens to the drugs used;

Subprogram "Viral hepatitis"

Every year, the incidence of chronic forms of viral hepatitis B and C, acute forms of viral hepatitis C, as well as disability and mortality in these diseases are increasing.

It is necessary to improve methods for investigating cases of epidemic outbreaks of viral hepatitis, molecular diagnostic methods, methods for preventing viral hepatitis, and further development of specialized medical care.

The tasks of the subprogram are:

1) improvement of methods for the prevention of viral hepatitis and epidemiological surveillance;

2) ensuring the quality of diagnosis, treatment and rehabilitation of acute and chronic viral hepatitis;

3) development and implementation of modern medicines and diagnostic kits;

4) construction and reconstruction of specialized medical institutions, equipping them with modern medical and technological equipment.

Sub-program "Mental disorders"

The incidence of mental and behavioral disorders in the population is growing. Every year about 60 thousand people die from suicides.

The purpose of the subprogram "Mental disorders" (hereinafter referred to as the subprogram) is to develop a comprehensive system for the prevention, diagnosis, treatment and rehabilitation of mental disorders.

The tasks of the subprogram are:

1) improvement of methods for the prevention of mental disorders, development and implementation of counseling assistance, training programs for the population on mental health and suicide prevention;

2) improving methods for diagnosing and treating mental disorders, introducing team forms of work in a psychiatric hospital, a day hospital, a neuropsychiatric dispensary and a rehabilitation hostel;

3) introduction of modern methods of psychosocial therapy and psychosocial rehabilitation;

Subprogram "Arterial hypertension"

The level of morbidity, disability and mortality of the population in diseases of the circulatory system, among which hypertension occupies a leading place, remains high. In this regard, it is necessary to take into account and prevent factors that contribute to a decrease in the quality of life of the population, including those caused by excessive stress loads.

It is necessary to develop and implement measures for the prevention of cardiovascular diseases, the implementation of programs for the organization of rehabilitation treatment for patients with stroke and acute myocardial infarction.

The goals of the subprogram "Arterial hypertension" are to reduce the number of diseases of vascular disorders of the brain (cerebrovascular diseases, including stroke) due to arterial hypertension and to reduce mortality from its complications.

The tasks of this subprogram are:

1) creation of an effective system for the prevention of arterial hypertension in risk groups;

2) development and implementation of modern methods of early diagnosis, treatment of arterial hypertension and rehabilitation of patients with its complications.

Subprogram "Vaccinal prophylaxis"

While maintaining a high level of coverage of children with preventive vaccinations, cases of diphtheria, measles and whooping cough, as well as outbreaks of mumps, continue to occur. It is necessary to create new vaccines for mass use and introduce modern technologies for their production. It is necessary to develop a system for informing the population about measures to prevent the spread of infections, controlled by means of specific prevention.

The purpose of the subprogram "Vaccinal prophylaxis" is to reduce the incidence of infections controlled by means of specific prophylaxis.

The tasks of the subprogram are:

1) improvement of infection prevention methods controlled by means of specific prevention;

2) improvement of methods for monitoring the implementation of preventive and anti-epidemic measures;

3) improvement of the vaccine transportation system.

1.3.2. Program "Children of Russia" for 2007 - 2010

There are 29 million children in the Russian Federation. The most vulnerable categories of children include orphans and children left without parental care (731 thousand children), disabled children (587 thousand children), children in a socially dangerous situation (676 thousand children). These groups of children need, first of all, social rehabilitation and adaptation, integration with society.

According to forecast data, by 2010 the number of children will decrease by 3.73 million compared to 2003, which determines the further trend of the country's population decline. The birth rate does not provide a simple reproduction of the population. Maternal and infant mortality rates remain high, and only 30 percent of newborns can be recognized as healthy. Over the past 10 years, the incidence rate of children in general has increased by more than 1.4 times.

Family troubles, antisocial behavior of parents and lack of control over the behavior of children leads the latter to early criminalization.

Statistics show a steady increase in juvenile delinquency (in 2003, 145.4 thousand crimes were committed, in 2004 - 154.4 thousand crimes, in 2005 - 154.7 thousand crimes).

The goals of the Program are to create favorable conditions for the integrated development and life of children, state support for children in difficult life situations.

The objectives of the Program are:

Ensuring safe motherhood and the birth of healthy children, protecting the health of children and adolescents, including reproductive health;

Prevention and reduction of child and adolescent morbidity, disability and mortality;

Creation of a state system for the identification, development and targeted support of gifted children, preservation of the country's national gene pool, development of the intellectual and creative potential of Russia;

Prevention of social disadvantage of families with children, protection of the rights and interests of children;

As a result of the implementation of the federal target program "Children of Russia" for 2003-2006, a decrease in infant mortality was achieved (from 12.4 per 1,000 live births in 2003 to 11 per 1,000 live births in 2005), maternal mortality (from 31.9 to 100,000 live births in 2003 to 30.5 per 100,000 live births in 2005), reducing disability among children with chronic pathologies, improving the health of children and adolescents at all stages of development. Compared with 2003, in 2005 the number of homeless children decreased by 3.2 thousand people (4.27 thousand against 7.5 thousand), children in difficult life situations - by 274 thousand people (676 thousand). against 950 thousand). In 2005, more than 440,000 families with disabled children received assistance in social service institutions for families and children, which is 26 percent more than in 2003.

Within the framework of this federal targeted program, construction and reconstruction of 42 obstetric and childhood institutions, 77 institutions for orphans and children left without parental care, 60 orphanages for disabled children and rehabilitation centers for children with disabilities were carried out.

The implementation of the program made it possible to strengthen the material and technical base of more than 600 obstetric and childhood institutions, 1,200 specialized institutions for minors in need of social rehabilitation, including centers for helping families with children and crisis centers for helping women, more than 500 educational institutions, 92 temporary detention centers for minors offenders of the internal affairs bodies, more than 50 educational colonies of the penitentiary system of the Federal Penitentiary Service, more than 300 specialized institutions for disabled children, more than 400 institutions for orphans and children left without parental care (equipped with vehicles, agricultural machinery, modern medical - preventive, rehabilitation, computer, technological and household equipment).

It is proposed to allocate sub-programs "Healthy generation", "Gifted children", "Children and family" within the framework of the Program.

The goal of the "Healthy Generation" subprogram is to preserve, restore and improve the health of children and adolescents, to instill in them the skills of a healthy lifestyle.

The tasks of this subprogram are:

Ensuring safe motherhood, creating conditions for the birth of healthy children;

Introduction of high-tech methods for diagnosing and preventing hereditary diseases and congenital malformations in children;

Protection of the health of children and adolescents, including reproductive health;

Promotion of healthy lifestyles;

Prevention of morbidity, disability and mortality in childhood and adolescence;

The purpose of the subprogram "Gifted children" is to provide favorable conditions for the creation of a unified state system for the identification, development and targeted support of gifted children in various fields of intellectual and creative activity.

The tasks of the subprogram are:

Creation of a state system for identifying, developing and targeted support for gifted children, including on the basis of innovative technologies for identifying and supporting gifted children living in rural areas, settlements remote from major centers of culture, education, science;

Coordination of activities of basic centers for work with gifted children and their support;

Providing advice to parents and teachers working with gifted children;

The objectives of the subprogram "Children and Family" are to protect and improve the situation of children in difficult life situations, prevent social orphanhood and family problems, comprehensively solve the problems of families with disabled children, ensure their full life and integration with society, develop family forms of placement for children -orphans.

Due to the specifics of the problems of various categories of children, within the framework of this subprogram, such areas as "Prevention of neglect and juvenile delinquency", "Family with disabled children", "Orphans" are provided.

1.3.3. Program "Improving road safety in 2006 - 2012"

The problem of accidents associated with road transport (hereinafter referred to as accidents) has become particularly acute in the last decade due to the mismatch of the road transport infrastructure with the needs of society and the state in safe traffic, the insufficient efficiency of the road safety system and the extremely low discipline of participants road traffic.

In 2004, there were over 208 thousand traffic accidents, in which 34.5 thousand people died. Compared to 1997, the death toll has increased by 27.8 percent. Over the past 10 years, 312.5 thousand people have died as a result of traffic accidents, of which more than a quarter are people of the most active working age (26-40 years).

A radical change in the state of accidents occurred after 2000. The growth of the main indicators of accidents in 2001-2004 in relation to the 1 percent increase in the number of vehicles amounted to:

· for traffic accidents - 3.6 percent;

· in terms of the number of people who died as a result of traffic accidents - 2.7 percent;

· in terms of the number of persons injured as a result of traffic accidents - 4.5 percent.

Since 2000, such relative accident rates as the number of people killed in road traffic accidents per 10 thousand vehicles (transport risk) and the number of people killed in road traffic accidents per 100 thousand population have been steadily growing. (social risk). In 2004, they reached their maximum (more than 10 and more than 24 people died as a result of road traffic accidents, respectively).

Road traffic accidents cause significant damage to the Russian economy, amounting to 2.2 - 2.6 percent of the country's gross domestic product in the last 4 years (in 2004, the damage amounted to 369 billion rubles, including as a result of death and injury of people - 227.7 billion rubles).

The goal of the Program is to reduce the number of people killed in road traffic accidents by 1.5 times in 2012 compared to 2004. This will allow the Russian Federation to approach the level of road safety typical for countries with a developed motorization of the population, reduce accident rates and, consequently, reduce the social severity of the problem.

The conditions for achieving the goals of the Program are the solution of the following tasks:

prevention of dangerous behavior of road users;

development of a system for training drivers and their admission to participation in road traffic;

Reducing child road traffic injuries;

· Improving the organization of traffic and pedestrians in cities.

Chapter 2 Implementation Analysis

2.1. "Prevention and control of socially significant diseases (2007 - 2011)"

The solution to the problem of reducing the incidence, increasing the duration and improving the quality of life in socially significant diseases by software will be carried out by means of a reasonable choice of measures in all areas of the implementation of the federal target program "Prevention and control of socially significant diseases (2007-2011)".

Measures for implementation

When solving the problem of the incidence of socially significant diseases by the program-target method, there are 3 options for the implementation of the Program, which differ in the amount of funding.

The first option is financial support for the implementation of the Program in the declared volumes.

Approval of the Program under the first option will allow achieving the set goal.

Under this option, the implementation of the Program is associated with macroeconomic risks associated with the possibility of a decrease in economic growth rates and the level of investment activity, and the emergence of a budget deficit.

The second option is the adoption of the Program with the amount of funding from 50 to 80 percent of the declared volume.

Under this option, the funding of the Program will be focused on the most effective measures that ensure the stabilization of the main indicators of the incidence of socially significant diseases, as well as on activities that require relatively small amounts of funding.

The third option is to adopt a Program with less than 50 percent funding. Under this option, the funding of the Program is focused on the least expensive priority activities.

Financing

Funding for the preparation of drafts of the target program and concepts for the implementation of the program problem, the development of which is carried out by decision of the Government of the Russian Federation, is carried out at the expense of the funds provided for in the “Other Articles” section federal budget. The approved targeted programs are implemented at the expense of the federal budget funds attracted for the implementation of these programs from extrabudgetary sources, the budgets of the constituent entities of the Russian Federation.

Federation cannot be set below 5 percent in the current financial year, provided that the financing of the construction of facilities by the constituent entity of the Russian Federation remains at least 50 percent of the estimated cost of work during the period of the Program.

Financing of the activities of the Program is carried out at the expense of the federal budget, the budgets of the constituent entities of the Russian Federation and extra-budgetary sources.

The total costs for the implementation of the activities of the Program amount to 95820.8577 million rubles (in the prices of the corresponding years), of which 45453.4577 million rubles from the federal budget, 48763.2 million rubles from the budgets of the constituent entities of the Russian Federation, extrabudgetary sources - 1604.2 million rubles. (As amended by Decree of the Government of the Russian Federation of 04/06/2011 N 254)

Table 1.

Funding source for the federal target program “Prevention and control of socially significant diseases in 2007-2011”

Rice. 1 Source of funding for program activities

Financing of the Program at the expense of the federal budget is carried out in the following areas:

· capital investments - 23064.9064 million rubles;

· research and development work - 1238.7268 million rubles;

· other needs - 21149.8245 million rubles, including subsidies from the federal budget - 1593.716 million rubles.

Rice. 2 Directions for spending funds from the federal target program "Prevention and control of socially significant diseases 2007-2011"

Fulfillment at the expense of the federal budget of obligations on construction sites and facilities located in state property subjects of the Russian Federation and in municipal ownership, is carried out in the manner of interbudgetary relations in accordance with the provisions of the Budget Code of the Russian Federation.

Table 2. Financing of subprograms

subroutines	Million rub (plan)
Diabetes
Tuberculosis
Oncology
Sexually transmitted infections
arterial hypertension
Vaccination
Viral hepatitis
HIV infections
Mental disorders

Rice. 3 Funding for subprograms

Evaluation of the effectiveness of the Program implementation is carried out on the basis of comparison with the data for 2005 and taking into account the need to achieve the following indicators:

Increase in the average life expectancy of men with type I diabetes mellitus, up to 55.4 years, women - up to 59.2 years;

Increase in the average life expectancy of men with type II diabetes mellitus, up to 71.4 years, women - up to 73.2 years;

Reducing the incidence of tuberculosis in correctional institutions of the Federal Penitentiary Service to 1490 cases per 100 thousand people;

Increase in the rate of abacillation of tuberculosis patients registered at the end of the year to 36.1 percent;

Increase in the number of newly registered cases of HIV infection during the year up to 65 thousand cases;

Decrease in the number of newly registered cases of HIV infection during the year in correctional institutions of the Federal Penitentiary Service to 1.67 thousand cases;

Increasing the proportion of HIV-infected pregnant women included in the program for the prevention of HIV infection in newborns, up to 95 percent;

Improvement in indicators characterizing the early detection of malignant neoplasms, including an increase in the proportion of patients with visual tumor localizations detected at stages I and II of the disease, up to 72 percent;

Decrease in the proportion of patients who died from malignant neoplasms within a year from the date of diagnosis, in the total number of patients registered for the first time in the previous year, to 27.5 percent;

Decrease in mortality from malignant neoplasms in men to 231.2 cases per 100 thousand of the population, in women - up to 170 cases per 100 thousand of the population;

Reducing the incidence of syphilis in children to 7.1 cases per 100,000 children;

Reducing the incidence of gonorrhea in children to 7.7 cases per 100 thousand of the child population;

Increasing the share of specialized medical institutions that monitor the variability of sexually transmitted infections in the total number of dermatovenereological institutions up to 62 percent;

Increasing the number of specialized centers for the prevention and treatment of sexually transmitted infections for adolescents up to 60 units;

Decreased incidence of acute viral hepatitis B to 2.6 cases per 100,000 population;

Decreased incidence of acute viral hepatitis C to 3.7 cases per 100,000 population;

Increasing the proportion of patients covered by brigade forms of mental health care in the total number of observed patients up to 30 percent;

Exclusion of cases of poliomyelitis;

Reducing the incidence of measles to 0.99 cases per 1 million population.

2.2 Program "Children of Russia for 2007-2010"

The implementation of the Program activities will allow:

Improve the quality of life and health of children;

To improve the quality and accessibility of social services for families with children, especially for families with disabled children;

Improve the state system of social protection and support for minors in order to ensure the provision of emergency and prompt assistance to children in difficult life situations, as well as the implementation of long-term consistent work to support children in need of special state care.

The implementation of the activities of the subprogram "Healthy Generation" will allow to continue improving state support for the service of motherhood and childhood, to increase the availability and quality of medical care for women and children, to achieve by 2011:

Reducing the infant mortality rate to 9.8 per 1,000 live births;

Reducing the maternal mortality rate to 21 per 100,000 live births;

Reducing the mortality rate of children aged 0 to 4 years (inclusive) to 10.9 per 1000 newborns of the corresponding year of birth;

Increasing the proportion of children in the 1st health group to 37.5 percent of the total number of children;

Decrease in the rate of primary disability for children aged 0 to 17 years (inclusive) to 21.4 per 10 thousand children.

During the implementation of the Gifted Children subprogram, a state system will be created for identifying, developing and targeted support for gifted children, covering up to 40 percent of the school-age child population, aimed at preserving the country's national gene pool, forming a future highly professional elite in various fields of intellectual and creative activity.

The number of winners of all-Russian contests, competitions, olympiads, tournaments held within the framework of the subprogram will increase by 8 percent by 2011 compared to 2006 data.

Evaluation of the implementation of the direction "Prevention of neglect and juvenile delinquency" by 2011 will be carried out according to the following indicators:

· the proportion of street children in the total number of child population - 2.17 percent;

· The proportion of children who received social rehabilitation in specialized institutions for minors in the total number of neglected and homeless children is 83.3 percent.

Evaluation of the implementation of the direction "Family with disabled children" by 2011 will be carried out according to the following indicators:

The proportion of children with disabilities who received rehabilitation services in specialized institutions for children with disabilities in the total number of children with disabilities - 43.1 percent;

The proportion of families with disabled children who received services in specialized institutions for children with disabilities in the total number of families with disabled children in need of services is 25.2 percent.

The implementation of the activities of this subprogram will reduce the number of orphans and children left without parental care transferred to institutions for full state support, increase the number of orphans and children left without parental care transferred to the upbringing of families of citizens, ensure effective socialization of children who found themselves in a difficult life situation, and their integration with society.

The evaluation of the implementation of the direction "Orphans" by 2011 will be carried out according to the indicator reflecting the share of orphans and children left without parental care, transferred to the families of citizens, in the total number of orphans and children left without parental care, which should reach 72 percent.

Financing

The total amount of financing of the Program is 47,845.9 million rubles (in the prices of the corresponding years), including:

At the expense of the federal budget - 10101.7 million rubles;

At the expense of the budgets of the constituent entities of the Russian Federation - 36315.1 million rubles;

At the expense of extrabudgetary sources - 1429.1 million rubles.

Table 3. Source of funding for the activities of the FTP "Children of Russia 2007-2010"

The allocation of funds to spending areas is as follows:

Capital investments - 25899.3 million rubles, including:

At the expense of the federal budget - 6917 million rubles;

At the expense of the budgets of the subjects of the Russian Federation - 18812.3 million rubles;

At the expense of extrabudgetary sources - 170 million rubles;

Research and development work - 37.7 million rubles at the expense of the federal budget;

Other needs -21908.9 million rubles, including:

At the expense of the federal budget - 3147 million rubles;

At the expense of the budgets of the constituent entities of the Russian Federation -17502.8 million rubles;

At the expense of extrabudgetary sources - 1259.1 million rubles.

Rice. 4 Program funding sources

2.3 Program "Improving road safety in 2006 - 2012"

health population targeted investment

The executors of the Program activities are determined in accordance with the procedure established by the legislation of the Russian Federation.

The Program is supposed to be implemented within 7 years (2006-2012) in 2 stages.

At the first stage (2006-2007), the main activities were identified for implementation:

· creation of a system of propaganda influence on the population in order to form a negative attitude towards offenses in the field of traffic;

· Ensuring the involvement of civil society institutions in preventive work;

· Improving the licensing system in the field of driver training, developing a legal framework for monitoring the implementation of self-training by citizens to obtain the right to drive vehicles of categories "A" and "B";

· preparation of proposals for the introduction of mechanisms in relation to driving schools to improve the quality of driver training;

Strengthening control over the availability, serviceability and use of security equipment;

· increasing the prevention of child road traffic injuries, the active introduction of child restraints;

· Implementation of pilot projects to replace traffic police posts with technical automatic systems for monitoring road users' compliance with the Rules of the Russian Federation Road Traffic and the use of helicopters to speed up the arrival at the scene of a traffic accident;

Prevention of traffic congestion, optimization of high-speed traffic on sections of the road network;

· Monitoring the dynamics of road traffic injuries, public opinion on road safety issues and the implementation of the Program activities.

Stage II (2008-2012) provides for the implementation of the following activities:

· further increase in the volume of work on the organization of traffic and pedestrians, including the introduction of integrated schemes and projects for the organization of traffic, traffic management of main, district and citywide significance;

· Expansion of the scope of work on the construction of underground and elevated pedestrian crossings;

· increasing the role of public associations and organizations in carrying out preventive measures;

Improving work on the prevention of children's road traffic injuries;

· improvement of forms and methods of control and supervision over the observance by road users of the established norms and rules;

· improvement of forms and methods of international cooperation in the field of road safety;

· continued monitoring of the dynamics of road traffic injuries, public opinion on road safety issues and the implementation of the Program activities.

The transfer to the constituent entities of the Russian Federation of material and technical resources (equipment that does not require installation, special vehicles), purchased at the expense of the federal budget, is carried out by state customers of the Program in the manner established by the Government of the Russian Federation.

Financing

The total amount of financing of the Program is 47,755.51 million rubles, including:

At the expense of the federal budget - 21049.01 million rubles (of which - for research and development work - 2446.23 million rubles, capital investments - 15247.58 million rubles and other needs - 3355.21 million rubles);

At the expense of the budgets of the subjects of the Russian Federation - 26245.4 million rubles (of which for capital investments - 21805.9 million rubles and other needs - 4439.5 million rubles);

At the expense of extrabudgetary sources - 461.1 million rubles (of which for capital investments - 359.9 million rubles and other needs - 101.2 million rubles) N 528, dated 15.07.2008 N 538, dated 14.02.2009 N 132, dated 02.08.2011 N 642) reduction by 2012 in the number of people who died as a result of traffic accidents,

Table 4. Funding sources of the FTP "Improving road safety in 2006-2012"

Rice. 5 Program funding sources

Conclusion

Upon completion of the work, it can be concluded that today federal targeted programs aimed at protecting the health of the population are one of the most important means of implementing the social policy of the state and actively influencing socio-economic development.

Evaluation of the effectiveness of the implementation of the programs under consideration is carried out on the basis of a comparison with the data for 2005.

The results of the effectiveness of the program "Prevention and control of socially significant diseases for 2007-2011"

Reducing the proportion of complications in diabetes mellitus to 28.5 percent;

Reducing the incidence of tuberculosis in correctional institutions of the Federal Penitentiary Service to 1490 cases per 100 thousand people;

Decrease in mortality from tuberculosis to 15.2 cases per 100 thousand people, including in correctional institutions of the Federal Penitentiary Service - up to 104.9 cases per 100 thousand people;

Reducing the incidence of syphilis to 49.2 cases per 100 thousand people, including in correctional institutions of the Federal Penitentiary Service - up to 148 cases per 100 thousand people;

Decreased incidence of chronic viral hepatitis B and C to 54 cases per 100,000 population;

Program objectives

The tasks of turning Russia into a global leader in the world economy, reaching the level of developed countries in terms of social welfare indicators dictate new requirements for the healthcare system.

Ensuring the priority of prevention in the field of health protection and the development of primary health care

In the direction of solving this problem, it is necessary to increase the efficiency of primary health care, optimize the total number of beds, increase the efficiency inpatient care. The practical implementation of the transition to a healthy lifestyle is impossible without bringing preventive medicine closer to the person. In this regard, the priority is to provide the population, primarily healthy people and people with chronic diseases without exacerbation, with preventive care within walking distance. It is necessary to develop and implement mechanisms to stimulate the polyclinic level for the earliest possible detection of diseases and to prevent the development of diseases to the stage leading to hospitalization. The implementation of these measures is aimed at improving the indicators of temporary disability of the working population.

Formation of a responsible attitude towards their health among the population, refusal of smoking, alcohol and drug abuse, provision of conditions for a healthy lifestyle, correction and regular monitoring of behavioral and biological risk factors for non-communicable diseases at the population, group and individual levels should become the most important direction of policy in the field of health protection.

Non-communicable diseases (diseases of the circulatory system, oncological diseases, respiratory diseases and diabetes mellitus) cause more than 80% of all deaths in the population of the Russian Federation, with 56% of all deaths due to cardiovascular diseases. The development of non-communicable diseases is based on a single group of risk factors associated with an unhealthy lifestyle (smoking, physical inactivity, poor diet, alcohol abuse).

The World Health Organization has identified 7 leading risk factors that make the main contribution to premature mortality in Russia, including:

high blood pressure (35.5%), hypercholesterolemia (23%),
smoking (17.1%),
unhealthy diet, insufficient consumption of fruits and vegetables (12.9%),
obesity (12.5%),
alcohol abuse (11.9%), low physical activity (9%).

Risk factors can accumulate in individuals and interact with each other, creating a multiple effect: the presence of several risk factors in one person increases the risk of death from diseases of the circulatory system by 5-7 times.

Based on the experience of many countries (Finland, USA, Great Britain, New Zealand, etc.), it has been proven that lifestyle modification and reduction in the level of risk factors can slow down the development of circulatory system diseases both before and after the onset of clinical symptoms.

Systematic analysis shows that lifestyle and nutritional changes can reduce the risk of death from coronary heart disease both in the population and among patients with this disease. Thus, stopping smoking reduces the risk by 35% and 50%, respectively, increasing physical activity by 25% and 20–30%, moderate alcohol consumption by 25% and 15%, changing at least 2 factors in nutrition by 45%. % and 15–40%.

Another systematic analysis shows that the treatment of patients with coronary heart disease and other diseases of the circulatory system with drugs from the group of antiplatelet agents reduces the risk of complications in such patients by 20-30%, beta-blockers - by 20-35%, ACE inhibitors - by 22-30%. 25%, statins - by 25-42%.

An analysis of the reasons for the significant reduction in mortality from diseases of the circulatory system in many countries showed that the contribution of recovery (lifestyle changes) and the reduction of risk factors in reducing such mortality ranges from 44% to 60%.

Factor analysis of the causes leading to high rates of cancer incidence and mortality showed that the influence of group A factors (tobacco smoking, excessive alcohol consumption, overweight, nutritional imbalance, other factors (production, natural environment, housing, the impact of infectious carcinogenic factors, etc.) .) is 65%, and group B factors (delayed detection and treatment of precancerous diseases, late diagnosis of cancer, lack of screening, lack of formation and monitoring of risk groups, irregular preventive examinations of the population, lack of medical examination of risk groups, lack of oncological alertness of doctors in the primary network, lack of educational work among the population, insufficient work to motivate the population for active and conscious participation in screening activities, the absence of unified screening programs at the federal level, the absence of a register of persons included in screening programs) is 35%.

The basis for promoting a healthy lifestyle, along with informing the population about the dangers of tobacco consumption, irrational and unbalanced nutrition, low physical activity, abuse of alcohol, drugs and toxic substances, should be training in hygiene, work and study rules. At the same time, increasing the motivation of the population to maintain a healthy lifestyle should be accompanied by the creation of appropriate conditions for this. In addition, priority should be given to measures not only for the timely detection of risk factors and non-communicable diseases, but also for their timely correction.

When reforming the system of primary health care for the population, the tasks of changing the system of providing assistance to the rural population come to the fore; modernization of existing institutions and their divisions; alignment of patient flows with the formation of uniform routing principles; development of new forms of medical care - hospital replacement and outreach methods of work; development of emergency care on the basis of outpatient departments; improving the principles of interaction with hospitals and ambulance units.

Building a modern system of providing primary health care to the population should include both the smallest settlements and large cities.

Improving the efficiency of providing specialized, including high-tech, medical care, ambulance, including emergency specialized, medical care, medical evacuation

High-tech medical care is part of specialized medical care and includes the use of new, complex and (or) unique, as well as resource-intensive methods of treatment with scientifically proven effectiveness, including cellular technologies, robotic technology, information technology and genetic engineering methods developed on the basis of achievements medical science and related branches of science and technology.

To improve the availability and quality of medical care, measures will be taken to improve the organizational system for providing specialized, including high-tech, medical care, to improve the provision of medical care for socially significant diseases, including patients with diseases of the circulatory system, tuberculosis, oncological, endocrine and some other diseases, the introduction of innovative methods of treatment into practice, the development of infrastructure and resource support for healthcare, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization.

The Federal Law "On Compulsory Medical Insurance" provides for the inclusion of high-tech medical care in the system of compulsory medical insurance from 2015. One of the conditions for such inclusion is the development of the possibility of providing high-tech medical care in medical institutions of the constituent entities of the Russian Federation.

The main tasks of providing emergency, including emergency specialized, medical care, medical evacuation at the present stage should be to provide patients and injured with pre-hospital medical care aimed at preserving and maintaining the vital functions of the body, and delivering them as soon as possible to a hospital to provide qualified specialized medical care. This work should be carried out mainly by feldsher teams.

It is necessary to increase the role and effectiveness of the use of emergency medical teams as intensive care teams and, if necessary, highly specialized teams.

A successful solution to the problems of organizing and providing emergency medical care to the population is possible only in close connection with the improvement of the work of the outpatient service, including the transition to the organization of primary medical care on the principle of a general practitioner (family doctor), day hospitals, hospitals for home.

Development and implementation of innovative diagnostic and treatment methods

In the next decade, developed countries will move to the formation of a new technological base for economic systems based on the use of the latest achievements in the field of biotechnology, informatics and nanotechnology, including in healthcare. Development information technologies and the advent of advanced technologies for computing and processing information will allow the use of predictive approaches based on modeling in the field of health care. First of all, interest is the possibility of creating epidemiological models that will allow us to analyze and predict the prevalence of various diseases in the population, thereby increasing the effectiveness of preventive measures.

There is an obvious need for the formation of targeted scientific programs in priority areas in order to maintain the health of the population and promote a healthy lifestyle, the development and implementation of new effective technologies for early diagnosis in the practice of the healthcare system.

Taking into account the forecasts of the intensive introduction of biomedical technologies into the advanced healthcare practices of developed countries, an important task is to create the necessary conditions for the development and implementation of such products and technologies in the domestic healthcare system.

Improving the efficiency of obstetrics and childhood services

The issues of protecting the health of mother and child are named as priorities in all fundamental documents on the development of health care, the goals of reducing maternal, infant and child mortality are proclaimed among the UN Millennium Development Goals. Reducing maternal, infant and child mortality is very difficult due to the presence of numerous factors, mostly difficult to manage, that affect these indicators. The indicator of maternal mortality depends on the socio-economic state of the country, geographical features, the development of medical care, the cultural and educational level of the population.

In Russia in 2011, the maternal mortality rate was 16.2 per 100,000 live births. At this level of the indicator, 320-350 working-age women die every year, which places a heavy burden on families, reduces the number of children that could be born in the future, and increases the underproduced contribution to GDP. According to the WHO, the average European maternal mortality rate in 2010 was 20 per 100,000 live births and decreased by only 9.1% between 2005 and 2010. The lowest maternal mortality is in countries with developed economies, high population density, and developed transport infrastructure. For example, in Germany in 2010 the maternal mortality rate was 7.0 per 100 thousand live births, in France - 8.0, in the UK - 12.0. At the same time, maternal mortality is much higher in Eastern European countries. In particular, in the Republic of Moldova, the maternal mortality rate in 2010 was 41.0 per 100 thousand live births, in Latvia - 34.0, in Ukraine - 32.0, in Romania - 27.0, in Hungary - 21, 0.

In countries with a larger area, with other equal conditions, it is usually higher than in smaller countries - in the USA, the maternal mortality rate was 21.0 in 2010, in Canada -12.

Infant mortality has similar patterns - low rates of infant mortality are typical for countries with a high standard of living of the population, a small area and a high population density. For example, in Germany in 2010 the infant mortality rate was 3.5 per 1,000 live births, in France - 4.1, in the UK - 5.0, in Belgium - 3.5, in Austria - 3.9. In countries with a high standard of living of the population, but a large extent of the territory, the presence of regions with a low population density, the infant mortality rate is slightly higher. For example, in the United States, the infant mortality rate in 2010 was 6.0 per 1,000 live births, in Canada it was 5.0, and in Australia it was 5.0.

At the same time, in some European countries, the infant mortality rate is higher than in the Russian Federation. In particular, in the Republic of Moldova, the infant mortality rate in 2010 was 11.8 per 1,000 live births, in Ukraine - 9.1, in Romania - 9.8, in Montenegro - 10.0, in Macedonia - 7.7 .

Low rates of maternal and infant mortality correlate to some extent with health care costs (in % of GDP), which are - in the USA - 15.2%, in Germany - 11.1%, in France - 10.1%. In Russia, the growth in health spending from 3.1% to 3.7% of GDP was accompanied by a decline in maternal and infant mortality rates. The infant mortality rate is affected by whole line factors requiring an interdisciplinary approach.

First of all, this is the state of the material and technical base of obstetric and childhood institutions. Until now, most regions are not fully provided with resuscitation and intensive care beds for newborns, which have modern high-tech equipment. There is no network of perinatal centers that provide medical assistance to the most severe contingent of pregnant women, women in childbirth, puerperas and newborns. In developed countries, perinatal centers are organized at the rate of 1 center per 1 million population in countries with high population density, and per 500 thousand population in countries with low density. With this calculation, the number of perinatal centers in Russia requires a significant increase.

The presence of highly qualified specialists in maternity and childhood institutions plays a huge role in reducing the infant mortality rate. In Russia, there is a huge staff shortage of both neonatologists and nurses, which is primarily due to low salary. As a rule, in the Russian Federation, there are from 4 to 10 critically ill newborns per 1 nurse in the intensive care unit for newborns. In the US and Europe, there are 1 extremely sick newborn, or 2 seriously ill newborns, or 3 stable children per 1 nurse.

The level of financing of medical organizations has a great influence on the quality of medical care for newborns born with pathology and the result of their treatment. In the Russian Federation, the cost of treating one child in the intensive care unit is about 200–300 US dollars per day. In the UK, the cost of treatment per day is 1600-2000 pounds. In the USA, depending on the severity of the condition of the newborn, it ranges from 2,000 to 5,000 US dollars, in Europe - from 1,500 to 4,000 euros per day. At the same time, a significant share of the funds falls on the salaries of medical workers.

Other factors also have a significant impact on the level of maternal and infant mortality - the quality of road communication, sufficient availability of automobile and air ambulance transport, a healthy lifestyle of the population, control of migration processes.

Reducing infant and child mortality from injuries, violent actions, neglect by parents from socially disadvantaged families of the health and well-being of their children is the responsibility of not only and not so much medical workers, but social protection authorities, the Ministry of Internal Affairs of Russia, the Ministry of Emergency Situations of Russia, etc.

Thus, by improving the availability, quality and organization of medical care for mothers and children, reducing the number of abortions, it is possible to reduce maternal and infant mortality by 2020 to the level of 6.5–6.0%, maternal mortality to the level of 15.5–15, 0 per 100,000 live births. Reducing infant mortality to 3–4%, and maternal mortality to 5–8% is possible only with the development of the economy, transport infrastructure, and a responsible attitude of the population towards their health, comparable to the level of the most developed countries of Western Europe.

Reducing the infant mortality rate from 8.5% (taking into account the new registration criteria) to 6.4% will save at least 4,000 children's lives annually. Since each death of a child causes an underproduced contribution to GDP of 6 million rubles, the total loss of GDP, if the indicator remains at the current level, will be 24 billion rubles. Even if we take into account the possible payment of disability pensions to a maximum of 5% of saved children, this amount will amount to 100 million rubles, and the total increase in GDP due to saved lives will be 23.9 billion rubles. But these calculations, of course, cannot take into account the full benefits of the implementation of the program - improving the quality of care will lead to a decrease in the mortality of children under 5 and under 17 years of age, which will further increase the expected increase in the contribution to GDP, increase the satisfaction of the population with the healthcare system in the country which, indirectly, can contribute to an increase in the birth rate.

Since the mortality of newborns is 55–70% of infant mortality and 40% of the mortality of children under 5 years old, an important direction in reducing the mortality of the child population is to improve care for newborns, an extremely significant aspect of which is the development of a network of perinatal centers. The perinatal center is not only a clear and vivid evidence of the state's care for mothers and children, it is inherently high-tech centers that allow you to provide effective care for the most severe pathology, develop innovative methods of treatment (as well as fetal and neonatal surgery, resuscitation-intensive care for mothers and children in critical conditions). The creation of a network of perinatal centers will make it possible to move throughout the country to a full-fledged and effectively functioning three-level system for providing medical care to women during pregnancy and childbirth and newborns, which will improve the qualifications of medical personnel and the quality of medical care in all obstetric institutions without exception. In fact, within the framework of the Program, it is planned to create a coherent system not only to provide assistance differentiated by levels, but also a system of interaction, monitoring, and training of personnel using simulation centers. It is envisaged to create a completely new system of relationships between obstetric and pediatric institutions in the territory, tightening requirements and creating opportunities for full and adequate patient routing, changing reporting forms, and creating new approaches to staff motivation.

After the mass commissioning of perinatal centers in 2010–2011, maternal mortality in the country decreased from 22.0 per 100,000 live births in 2009 to 16.2 in 2011, i.e. by 26.4%, infant mortality - from 8.1 per 1000 live births to 7.4, respectively, i.e. by 8.6%. Moreover, in the constituent entities of the Russian Federation, where perinatal centers operate, the decline in indicators was more significant.

In fact, thanks to the perinatal centers, conditions were created for the transition of the Russian Federation in 2012 to the international birth registration criteria recommended by WHO, starting from a body weight of 500.0 g, which, although formally will lead to a certain increase in infant mortality, but at the same time time, will save more than a thousand children's lives every year. To solve the problem of improving the nursing of children with extremely low body weight and reducing the level of disability in this contingent, the section of the program related to improving the equipment of intensive care units and pathology of newborns is also aimed, since the process of life support for these children requires the most modern high-tech equipment. This section is inextricably linked with the development of a network of perinatal centers.

A well-functioning system of early detection and correction of developmental disorders is extremely important to reduce child mortality. The most effective tool for the prevention of congenital and hereditary diseases is a comprehensive prenatal (prenatal) diagnosis, including ultrasound and biochemical screening for maternal serum markers, an individual risk program, and invasive diagnostic methods (molecular genetic, cytogenetic studies, sequencing). The effectiveness of prenatal diagnosis can only be ensured by a mass examination of pregnant women in a timely manner, which is what this section of the Program is aimed at. The development of neonatal surgery is aimed at ensuring effective correction of disorders detected during prenatal diagnosis, and early correction of metabolic changes detected during neonatal screening will allow in the future to create opportunities and conditions for a sick child for normal development, education, professional training, subsequent employment and a fulfilling life. Further development of prenatal diagnostics will make it possible to reduce the number of children born with congenital developmental anomalies by 50% and reduce the death rate of children from severe malformations by 50–70%.

Until now, there is a high need for the development of specialized medical care for children. In 14 regions of the Russian Federation, there are no regional, republican, regional multidisciplinary children's hospitals. In a number of regions, the existing pediatric medical organizations do not meet modern requirements that allow nursing children with severe pathologies, including children of the first year of life and, first of all, those born with low and extremely low body weight. This situation requires resolution, as it does not allow to ensure the full availability and quality of medical care for children. Children with oncological diseases are not fully provided with high-quality medical care, a system for providing medical care to children with autoimmune diseases and diseases of immune genesis has not been created, neurosurgical and traumatological and orthopedic care for children remains inaccessible, and psychiatric, narcological and TB care requires serious modernization.

The key to improving the quality of medical care for children will be the development of multidisciplinary and specialized pediatric hospitals in the constituent entities of the Russian Federation, taking into account regional needs for specific types of medical care.

Solving the issue of state support for the construction and reconstruction of regional (regional, republican) children's multidisciplinary hospitals, the structure of which must fully comply with modern requirements, will ensure the real achievement of the goals and objectives of the Program. Moreover, this section is inextricably linked with the development of a network of perinatal centers. Since on the basis of perinatal centers medical care is provided to children only in the first days and months of life, children's hospitals should be the most important part of a functional network that provides the entire cycle of care for a child.

The problem of preventing vertical transmission of HIV from mother to child remains topical. Despite the high numbers of chemoprophylaxis for HIV-infected pregnant women, the transmission of infection through perinatal contacts remains high, in the whole country at a level of about 6%, which probably indicates an insufficiently high effectiveness of chemoprophylaxis of vertical transmission of HIV from mother to child, and dictates the need to improve systems for providing this type of assistance and its monitoring.

Development of the provision of medical rehabilitation to the population and improvement of the system of sanatorium and resort treatment, including for children

An important component of solving the problem of improving the quality and accessibility of medical care is the development of a system of medical rehabilitation, sanatorium and resort treatment. An analysis of the provision of medical rehabilitation in the Russian Federation showed that it requires serious reorganization and bringing it into a coherent system of comprehensive rehabilitation.

At present, difficulties in the accessibility of medical rehabilitation are associated with a shortage of rehabilitation beds, the slow introduction of modern, certified in Russia, integrated rehabilitation technologies, an insufficient number of professionally trained medical personnel, and a weak material and technical base of rehabilitation institutions.

The shortage of beds to provide assistance in the medical rehabilitation of children, both at the federal level and at the level of the constituent entities of the Russian Federation, as well as the shortage of trained medical personnel (doctors and paramedical workers) does not fully satisfy the need for these medical services. Currently, only 50% of the children who need it receive medical rehabilitation.

The problem of increasing the availability and quality of medical rehabilitation and sanatorium treatment is also relevant in pediatrics and is due to an increase in the number of children suffering from severe chronic (disabling) diseases and children with disabilities. As of January 1, 2012, more than 500,000 disabled children were registered in the Russian Federation, of which more than 340,000 are in need of medical rehabilitation. The need for rehabilitation assistance to other contingents of children is much higher. Currently, only 50% of the children who need it receive medical rehabilitation.

Solving the problems of health protection and social protection of children suffering from severe chronic (disabled) diseases, children with disabilities and their families is possible while ensuring the availability and quality of medical rehabilitation through the further development of a network of specialized rehabilitation institutions for children (regional, interdistrict), as well as complexes for the implementation of high-tech methods of treatment with beds (branches of hospitals) for aftercare and rehabilitation. Solving this problem will reduce the load on "expensive" beds in hospitals and increase their throughput.

The current level of development of world medicine requires an objective assessment (according to the criteria of evidence-based medicine) of the effectiveness of spa treatment, as well as the improvement of existing and the development of new health and treatment methods.

At the moment, there is an urgent need for a set of measures aimed at maintaining the potential of the resort sector and the formation of a modern resort complex, capable of solving both the medical and social problems of providing affordable, effective sanatorium treatment for the population, and the economic problems of forming the sphere of resort business. At the same time, it should be taken into account that the decline of the resort business in Russia, of course, has become one of the important factors in the deterioration of the nation's health indicators. Under these conditions, the restoration of the system of sanatorium treatment and rehabilitation, its accessibility for the bulk of the population, the revival of Russian resorts is an important national task that can make a great contribution to improving the level of public health of the people.

Providing medical care to terminally ill patients, including children

Against the background of the demographic aging of the population in the Russian Federation, the number of patients in need of palliative care is increasing every year.

Extremely important are not only medical, but also social, spiritual and psychological aspects of providing palliative care to incurable patients.

The main directions in the provision of palliative care to incurable patients should be not only the reduction of patients' suffering, but also adequate psychological assistance, social support, and communication with relatives, which make it possible to prepare family members for the inevitable end.

In order to create optimal conditions for children suffering from incurable, life-limiting diseases, as well as to help family members in conditions of an incurable illness of a child, it is planned to develop a network of medical and social institutions specializing in providing palliative care to children in the Russian Federation (opening departments of palliative care for children in multidisciplinary hospitals and independent hospice institutions), based on an approximate calculation of 2-3 beds per 100 thousand children.

The concept of palliative care is that the fight against pain, the solution of the psychological, social or spiritual problems of patients is of paramount importance. Thus, the main task of providing medical care to a dying patient is to ensure, as far as possible, a decent quality of life for a person at its final stage.

Creation of palliative care departments will reduce the load on expensive beds, where resuscitation and intensive care is provided, by at least 15%.

It should be noted that at present, in educational medical institutions at the undergraduate level, at the departments of public health and health care, the organizational and socio-medical aspects of palliative care are not presented.

This indicates the need to introduce teaching the basics of palliative care not only to university students, but also at the postgraduate stage, both for doctors of all specialties and for healthcare organizers.

Providing the healthcare system with highly qualified and motivated personnel

In this direction, the most urgent task remains to create a system of continuing professional education in order to train highly qualified specialists focused on continuous improvement of their own knowledge, skills and abilities necessary to achieve and maintain a high quality of professional activity.

It is planned to carry out measures to improve the system of practical training of medical and pharmaceutical workers in order to improve the quality of professional training, expand the list of skills and abilities acquired by a specialist during the training period.

Training programs for medical and pharmaceutical specialists at the stages of postgraduate and additional professional education will be formed and implemented, as well as advanced training programs for scientific and pedagogical workers of educational and scientific organizations implementing medical and pharmaceutical education programs, developed taking into account changes in the training of medical and pharmaceutical specialists in connection with the introduction of federal state educational standards for secondary and higher professional education of the third generation.

Until 2020 development is planned professional standards medical and pharmaceutical workers, which will allow the formation of unified approaches to determining the level of qualification and set of competencies of medical and pharmaceutical workers necessary for professional activities.

A system of accreditation of medical and pharmaceutical specialists will be created and implemented, which will allow for personal admission of specialists to a specific type of professional activity, taking into account the competencies acquired during the training.

Together with the constituent entities of the Russian Federation, it is planned to take measures to improve the quality of life of medical and pharmaceutical workers and their families, reduce the outflow of personnel from the industry, including by providing specialists with residential premises, land plots, housing subsidies, subsidizing interest rate on a loan for the purchase of housing by medical and pharmaceutical workers, granting children of certain categories of medical and pharmaceutical workers the right to extraordinary enrollment in preschool educational institutions.

Educational events will also be organized to increase the prestige of the profession.

Together, the solution of these tasks will improve the quality of training of medical and pharmaceutical specialists, reduce the shortage of medical personnel and, as a result, improve the quality of medical care and pharmaceutical services provided to citizens of the Russian Federation.

In pursuance of Decree of the President of the Russian Federation of May 7, 2012 No. 598 “On improving the state policy in the field of healthcare”, the subjects of the Russian Federation provide for the adoption of programs aimed at improving the qualifications of medical personnel, assessing the level of their qualifications, and gradually eliminating the shortage of medical personnel, as well as the development of differentiated measures of social support for medical workers, primarily the most scarce specialties.

Increasing the role of Russia in global health

The main directions of international relations in the field of health care should be to ensure a strong and authoritative position of Russia in the world community, to the greatest extent meeting the interests of the Russian Federation as one of the influential centers of the modern world; creation of favorable external conditions for the modernization of Russia; formation of good neighborly relations with neighboring states; search for agreement and concurring interests with other states and interstate associations in the process of solving problems determined by Russia's national priorities in the field of health protection, creating on this basis a system of bilateral and multilateral partnerships; comprehensive protection of the rights and legitimate interests of Russian citizens and compatriots living abroad; promoting an objective perception of the Russian Federation in the world; support and popularization of domestic healthcare in foreign countries.

Cooperation with the member states of the Commonwealth of Independent States and the Eurasian Economic Community remains a priority area of Russia's foreign policy in healthcare. The development of health issues within the framework of the Asia-Pacific Economic Cooperation should also be considered important.

Improvement of control and supervisory functions

The main task of the functioning of the quality and safety control system of medical activities will be to control the process of providing medical care, its compliance with approved standards and procedures for providing medical care, and the interaction of medical personnel with patients.

The interaction of the subjects of the system of quality control and safety of medical activities, their activities, powers and responsibilities are regulated by regulatory legal acts approved in the prescribed manner.

The main task of state control (supervision) in the field of medicines circulation will be control over the circulation of medicines and its compliance with the current legislation of the Russian Federation.

The main objective of the functioning of the system of state control over the circulation of medical devices is to identify and withdraw from circulation low-quality medical devices, as well as falsified and counterfeit medical devices with subsequent disposal and destruction, identify and prevent possible negative consequences of the use and use of medical devices in circulation on the territory Russian Federation, warnings about the facts of this kind of potential users, as well as medical personnel.

An important task in the development of health care is the modernization of state forensic activities in the Russian Federation. Forensic medical and forensic psychiatric examinations in the Russian Federation are a special medical and legal type of activity aimed at providing bodies of inquiry, investigation and court with the results of special studies obtained in compliance with legal norms, carried out by experts or doctors involved in the production of an examination, licensed as a separate type of medical activity.

In addition, state forensic medical institutions perform an important function in determining the causes and nature of defects in the provision of medical care.

In this regard, the task is to determine unified approaches to expert activities in the Russian Federation, to create a unified methodological basis for the production of forensic psychiatric and forensic medical examinations, to provide a modern material and technical base for all state institutions that carry out forensic psychiatric and forensic medical examinations. .

The effectiveness of the implementation of federal state sanitary and epidemiological supervision and the organization of ensuring the sanitary and epidemiological well-being of the population is achieved by the combined activities of the territorial bodies of Rospotrebnadzor, which directly carry out control and supervision activities, as well as Rospotrebnadzor institutions that provide control and supervision, through a wide range of laboratory studies, the implementation of scientific and research and scientific and methodological developments, implementation of anti-plague measures.

Reducing the harmful effects of environmental factors on the population will be ensured by measures to ensure a safe environment for the population - atmospheric air, water bodies, soil; improving food quality and safety; ensuring radiation safety of the population.

Medico-biological provision of public health protection

An important factor in ensuring the radiation, chemical and biological safety of the population and territories served by the Federal Medical and Biological Agency is the system of medical and sanitary support of the FMBA of Russia, one of the main tasks of which is to take measures to identify and eliminate the influence of especially dangerous factors of physical, chemical and biological nature on the health of employees of serviced organizations and the population of serviced territories.

System medical support of such enterprises and facilities includes conducting preliminary medical examinations, pre- and post-shift medical examinations, periodic medical examinations, carrying out medical and preventive and rehabilitation and rehabilitation measures, monitoring the health of employees of enterprises and the population.

The goal of health care in the field of medical and sanitary and biomedical support of elite sport is to prevent the incidence and disability of athletes and to consistently increase the level of their provision with biomedical technologies for effective adaptation to intense sports loads.

The main tasks in the field of medical and biomedical support for athletes of the national teams of the Russian Federation: the formation of an infrastructure for medical and preventive purposes, territorially integrated with the training bases for the sports teams of the Russian Federation, which makes it possible to ensure 100% coverage of candidates for the sports teams of the Russian Federation by type sports with all kinds of medical care during training and competitive activities; providing qualified medical personnel for sports teams of the Russian Federation; implementation of biomedical technologies that provide the training and competitive level of training of candidates for the sports teams of the Russian Federation in sports.

The FMBA of Russia carries out activities to prevent and eliminate the consequences of emergency situations directly or through its territorial bodies, subordinate organizations in cooperation with others federal authorities executive authorities, executive authorities of the constituent entities of the Russian Federation, local governments.

The objectives of the sphere of protection of certain categories of citizens from the effects of especially dangerous factors of a physical, chemical and biological nature are to ensure breakthrough results in medical research that can give rise to new drugs, technologies and products, the development of innovative infrastructure for the provision of health care to certain categories of citizens.

Ensuring the systemic organization of health care

In modern conditions, the creation and functioning of distributed information systems and analytical tools for data processing are the "gold standard" of the organization of sectoral management. The introduction of new medical technologies is impossible without the parallel implementation of information systems that optimize the process of providing services. The creation of such systems is required to solve issues related to the calculation of the full cost of medical services, forecasting the required volume and cost of medical care and drug provision, assessing staffing needs in the healthcare sector, assessing and forecasting the epidemiological situation. Thus, the task of introducing and using modern information and telecommunication technologies in healthcare is a key enabling task, the solution of which determines the effectiveness of most of the activities of the State Program "Health Development".

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Consistent implementation of the state policy in the field of healthcare, the implementation of federal and regional medical and social programs have made it possible to achieve certain results in preserving the health of the inhabitants of the Russian Federation and improving the performance of the healthcare system.

The interest of state authorities, heads of organizations and enterprises of the region in solving the problems of protecting the health of citizens has increased.

However, despite the measures taken, a number of unresolved problems remain in the health care of Russia. Among them is the continuing discrepancy between the state's obligations to provide Russian citizens with free medical care and the financial resources allocated for this purpose.

There is a lack of access to medical care, especially for the poorest segments of the population, and a high differentiation of municipalities in terms of public health and the provision of health care with the necessary resources. The commercialization of state and municipal health care is growing, one of the reasons for which is the lack of effective existing mechanisms for state regulation in this area.

Despite the additional financial and material and technical resources allocated by the state for the development of health care, the effectiveness of their use remains low. The lack of a system of motivation adapted to market mechanisms does not allow the full use of the available reserves of health workers to improve the volume and quality of medical care provided to the population. A number of issues remained unresolved related to the training and retraining of qualified health workers, the development of a set of measures for their social protection.

Most of the population does not have a motivated value attitude to their own health as a necessary life resource, which, in turn, is the main factor hindering the formation of a healthy lifestyle among the population. Behavioral factors and bad habits still have a great influence on the state of public health: the prevalence of alcoholism, smoking, lack of interest in physical education among a significant part of the population.

Despite the emerging positive trend, the average life expectancy in the Russian Federation remains at a low level (men - 61.8; women - 74.2 years) and lags behind a number of developed countries. For example, in Japan this figure is 78.6 for men, 85.6 for women, 77.8 and 82.8 in Norway, respectively, and 78.5 and 82.9 in Sweden.

The mortality rate of the population of working age remains high, primarily due to cardiovascular diseases, malignant neoplasms, and traffic accidents. In the morbidity of the population, the proportion of neurotic and mental disorders is increasing, due to the use of alcohol, psychotropic substances, there is an increase in occupational morbidity associated with unsatisfactory working conditions, violation of sanitary and hygienic norms and rules.

The differentiation of health indicators of the population continues, depending on the social and property status. The incidence of infectious and socially significant diseases remains high, the prevalence of which is still significantly affected by the inadequate standard of living of the majority of the population (low wages and pensions, deterioration of living conditions, work, rest, environmental conditions, quality and structure of nutrition and etc.).

Medical and social diagnostics and analysis of problems that characterize the current state of public health, as well as the study of the social demands of society in the field of healthcare, allowed the authors to develop, scientifically substantiate and present to the Ministry of Health and Social Development of the Russian Federation a set of measures to improve healthcare at the regional level.

These measures, in particular, were included in the set of measures for the development of healthcare in the Russian Federation for the period up to 2020, which were considered and approved by the II Congress of the Russian public organization"Russian Society for the Organization of Public Health and Public Health".

Thus, the priority areas for improving the healthcare system are as follows:

1. Reducing the gap in health indicators between individual regions of the Russian Federation and economically developed countries.
2. Improving the health of children, adolescents, women.
3. Maintaining the health of the elderly.
4. Reducing the level of socially significant diseases.
5. Reducing the prevalence of infectious diseases.
6. Ensuring a healthy and safe living environment.
7. Formation of a healthy lifestyle.
8. Improving the mechanisms of state guarantees in providing the population with free medical care.
9. Improving the efficiency of the healthcare management and financing system.
10. Creation of the necessary conditions for the innovative development of healthcare.
11. Modernization of the system of training and retraining of personnel in health care.
12. Improving the legal framework for healthcare.

1. Reducing the gap in population health indicators between individual regions of the Russian Federation and economically developed countries

The current gap in the health indicators of the population of Russia and economically developed countries is primarily due to the lack of evidence-based state policy in the field of protecting the health of citizens, insufficient resource support for the industry, as well as the imperfection of mechanisms for the effective use of material, technical, financial, allocated for health care needs. personnel and other resources.

To solve this problem, it is necessary, first of all, to implement the following measures:

Development and implementation (at the federal, regional and municipal levels) of an effective state policy in the field of protecting the health of citizens;
. introduction of the index of humanitarian development as a criterion for assessing the socio-economic development of regions;
. analysis of the reasons for the revealed differences in the health indicators of the population from different socio-economic groups;

Introduction of monitoring and evaluation of the effectiveness of measures taken to eliminate existing differences in population health indicators in certain socio-economic groups;
. ensuring greater accessibility of medical and social assistance to low-income groups of the population through a flexible system of benefits, allowances, etc.

2. Improving the health of children, adolescents, women

The answer to the question whether Russia will be able to overcome the demographic crisis in the foreseeable future or not depends largely on the implementation of this priority area of healthcare development.

That is why it is necessary to set and solve strategic tasks to reduce the infant mortality rate on average in the Russian Federation to 7.5%o (in the constituent entities of the Russian Federation that have reached this value, this indicator will be reduced to the average European level); a reduction by at least 50% of the mortality and disability associated with accidents and acts of violence among children; reducing the number of children born weighing less than 2500 g by at least 20%; a decrease in the maternal mortality rate on average in the Russian Federation to 18.5 per 100 thousand live births (in the constituent entities of the Russian Federation that have reached this value, this indicator has decreased to the average European level).

The most important targets are to reduce the incidence of mortality and disability among schoolchildren and adolescents (associated with acts of violence and accidents) by at least 50%; reducing the number of young people who are characterized by harmful behaviors associated with the use of drugs, tobacco and alcohol by 30%; reduce the number of pregnancies in adolescent girls by at least 25%.

To achieve these objectives, the following set of measures is required:

Expansion and intensification of preventive activities, including clinical examination of children of all ages;
. increasing the volume of specialized and high-tech medical care for children;
. introduction of high-tech methods for diagnosing and preventing hereditary diseases and congenital malformations in children;
. creation of a network of modern perinatal centers in the country;
. provision of maternity hospitals with modern medical equipment and special sanitary transport;
. development of family planning and safe motherhood services;
. integration of obstetric institutions with a general medical and specialized network;
. implementation of the WHO principles for integrated management of childhood illnesses;
. implementation of the WHO criteria for assigning the status of "Baby Friendly Hospital";
. approximation of primary health care services to the conditions of everyday life of schoolchildren and adolescents (home environment, schools and other educational institutions, places of recreation);
. development and implementation of regional medical and social programs to improve the health of adolescents, including young men of pre-conscription and military age;
. development and implementation of interdepartmental programs on drug addiction, suicide, alcohol consumption, accident prevention;
. implementation of the WHO concept on the formation of health-promoting schools;
. implementation of WHO criteria for assigning the status of “Adolescent Friendly Hospital”, etc.

3. Maintaining the health of the elderly

This priority direction, of course, has not only medical and social, but also political significance.

People who have worked for decades and have reached old age have the right to demand a higher level of medical care from society. In this case, the public health challenges are to increase the average life expectancy by at least 5-7%, as well as to increase by 30-50% the number of people at the age of 80 with a level of health that allows them to maintain independence. , self-respect and a proper place in society.

Achieving these results is, of course, not the task of the health system alone.

To solve them, an intersectoral approach is required with the implementation of the following set of measures:

Coordination of activities of health and social protection services;
. development of primary health care, taking into account the real needs of older people;
. systematic preventive measures aimed at improving hearing, mobility (replacement of the head of the hip joint), vision, prosthetics;
. organization of geriatric service in all subjects of the Russian Federation;
. improving the quality and accessibility of rehabilitation assistance;
. training of specialists in the field of palliative care;
. development of a network of hospitals for incurable patients (hospice);
. creation of conditions for the worthy departure of elderly sick people from life (providing the opportunity to die in the place that they choose, and surrounded by the people they wanted to see, if possible without pain and torment), etc.

4. Reducing the level of socially significant diseases

For many years, this priority area in health care has remained more of a political declaration than a system of targeted, results-oriented actions, as evidenced by the analysis of the prevalence and socio-economic consequences of socially significant diseases, presented in the section - Conducting an in-depth study of the structure and level of "sociopathy", identification of their main trends and cause-and-effect relationships make it possible to scientifically substantiate a set of interrelated tasks for their prevention and reduction.

These tasks, first of all, include the need to reduce mortality rates associated with cardiovascular diseases by an average of 40%; reduction in mortality from malignant neoplasms of various localizations by at least 15% and a decrease in mortality due to lung cancer by 25%; a 30% reduction in amputations, blindness, kidney failure and other serious disorders associated with diabetes.

Among this set of tasks, the most important are also the reduction of morbidity, disability and mortality associated with chronic respiratory diseases, musculoskeletal disorders and other common chronic diseases; prevention of mental disorders and reduction in the number of suicides by at least 30%; reduction in mortality and disability due to traffic accidents and other accidents by at least 30%. ensuring a reduction in the prevalence and mortality rates associated with HIV infection, AIDS and other sexually transmitted diseases, etc.

To solve these problems and achieve specific results, it is necessary to implement a set of measures, differentiated for each of the socially significant diseases separately.

Prevention and treatment of cardiovascular diseases:

Development and implementation of modern medical preventive technologies for high-risk groups for the development of cardiovascular complications;
. development of modern methods of prevention, diagnosis and treatment of arterial hypertension and its complications;
. development of evidence-based programs for the organization of rehabilitation treatment of patients with stroke and acute myocardial infarction;
. creation of an effective system for the prevention of arterial hypertension and its complications;
. creation of a system for monitoring the implementation of measures for the prevention and treatment of arterial hypertension;
. improvement of the system of the state register of patients with arterial hypertension;
. improvement of methods of rehabilitation of patients with arterial hypertension, etc.

Prevention and treatment of diabetes mellitus:

Conducting research to study the causes and mechanisms of development of diabetes mellitus, its complications;
. improving methods of prevention, diagnosis and treatment of diabetes mellitus;
. equipping diabetological units of specialized healthcare institutions with the necessary equipment;
. organizing the work of schools for the education of patients with diabetes mellitus;
. monitoring of diabetes mellitus and its complications;
. ensuring the functioning of the state register of persons with diabetes mellitus;
. creation of mobile medical and preventive modules, introduction of modern medicines and diagnostic systems into clinical practice, etc.

Prevention and treatment of malignant neoplasms:

Construction and reconstruction of specialized medical institutions providing assistance to the population with oncological diseases;
. conducting research in the field of etiology and pathogenesis of malignant neoplasms;
. conducting scientific research in the field of prevention, diagnosis and treatment of malignant neoplasms;
. information support of the national register of substances, products, production processes, domestic and natural factors that are carcinogenic to humans;
. ensuring the functioning of the state register of patients with malignant neoplasms;
. improving the provision of specialized medical care to patients with malignant neoplasms, etc.

Prevention and treatment of mental disorders and their consequences:

Improving the psycho-emotional climate at home and at work;
. systematic training of local doctors, general practitioners on the diagnosis and treatment of depressive conditions;
. development of a system of psychiatric emergency wards;
. conducting fundamental and applied research on the study of factors affecting mental health;
. teaching the population rational behavior in extreme and stressful situations, etc.

Prevention of injuries and deaths as a result of road traffic accidents and accidents:

. improvement of the modern system of air ambulance and transportation of victims as soon as possible to the place of specialized medical care;
. development and implementation of standards for the provision of medical care to victims of road accidents;
. organizing training for personnel of life support services (Ministry of Internal Affairs, Ministry of Emergency Situations, etc.) in providing first aid;
. ensuring interaction, in the provision of emergency medical care to victims of road accidents and emergencies, of health services, the Ministry of Internal Affairs, the Ministry of Emergency Situations, federal and regional executive authorities;
. equipping with modern medical equipment, sanitary transport, communication facilities of healthcare organizations involved in the provision of specialized medical care to victims of road accidents, accidents, etc.

Fighting HIV Infection:

Implementation of programs for the exchange of used injection needles for new ones for intravenous drug injectors;
. ensuring wide access to condoms and other personal protective equipment;
. ensuring blood safety through proper screening and testing of donated blood and blood products;
. ensuring effective, anonymous treatment of persons with sexually transmitted diseases, etc.

Prevention and treatment of tuberculosis:

Active detection of TB patients through microscopic examination of sputum and targeted fluorographic examinations;
. implementation at the national level and in accordance with WHO recommendations of a tuberculosis control program based on the DOTS strategy;
. regular and uninterrupted supply of all essential anti-tuberculosis drugs;
. development of special services for monitoring the population of such risk groups as migrants, persons without a fixed place of residence, HIV-infected, etc.

5. Reducing the prevalence of infectious diseases

Despite significant progress in the prevention, early detection and treatment of infectious diseases, there are sufficient reserves in the health system, and every year there are new opportunities to further reduce the prevalence of infectious diseases.

Taking into account the latest scientific achievements in the field of epidemiology of infectious diseases, it is quite realistic to achieve the following results in the next decade:

Carrying out a complex of anti-epidemic measures to prevent the spread of influenza A / HI N1;
. reduction in the prevalence of diphtheria to a level of no more than 0.1 cases per 100,000 population;
. reducing the number of new cases of hepatitis B virus transmission by at least 80%;
. reduction in the prevalence of mumps, whooping cough and invasive infections caused by Haemophilus influenzae type b, to a level of no more than 1 case per 100 thousand of the population;
. reducing the prevalence of congenital syphilis and rubella to no more than 0.01 cases per 1,000 live births;
. implementation in full of the national calendar of vaccine prevention, etc.

6. Ensuring a healthy and safe living environment

Solving the problem of ensuring a healthy and safe human environment is becoming increasingly important due to the increased number of man-made disasters, environmental pollution, and the threat of ecological imbalance.

This problem, along with the problem of forming a healthy lifestyle, is decisive in maintaining and improving the health of the population and should be addressed at the state level with the participation of institutions.

The most important role in its solution is assigned to the service of Rospotrebnadzor. The population of the country should live in a safe environment, in which the impact of hazardous factors for health does not exceed the prescribed international standards. Significant reductions in the levels of physical, chemical and microbial pollutants in water, air, waste and soil that pose a threat to health need to be ensured.

At the same time, it is necessary to provide the population with universal access to sufficient supplies of drinking water of satisfactory quality. The priority task of national security is the prevention of natural and man-made disasters and the fight against their consequences.

To solve these problems, first of all, it is necessary to implement the following set of measures:

. improvement of social and hygienic monitoring integrated into the structure of executive authorities and local self-government;
. creation of a geoinformation system that reflects the spatial and temporal relationships of environmental and health factors;
. reduction in the risk of morbidity by 1.2-1.4 times, depending on the tension of the sanitary and epidemiological situation, provided that the anthropogenic load is reduced by 1.0%;
. creation of a mechanism for predictive analysis of the consequences of political decisions in the field of hygienic safety;
. zoning of the habitat with hygienic ranking of territories according to the degree of danger of a negative impact on health;
. protection of the biosphere according to the criteria of permissible anthropogenic load on the environment, etc.

7. Formation of a healthy lifestyle

The health status of the population, as is known, is more than 50% dependent on the lifestyle of a person, therefore, the formation of a healthy lifestyle among the population is the key to solving many problems associated with a decrease in morbidity, disability, mortality, and an increase in the average life expectancy.

Unfortunately, we have to state that the problem of forming a healthy lifestyle in recent decades has practically fallen out of the system of public and state priorities, which, as a result, has had a negative impact on the health status of citizens of the Russian Federation.

It will take many years for the population to form behavioral strategies for adherence to a healthy lifestyle, the emergence of a dominant value attitude towards their health. But this work must begin now, with the setting of specific tasks and the definition of realistically achievable results.

What tasks for the formation of a healthy lifestyle among the population seem to be necessary to solve in the next decade? First of all, it is necessary to achieve an increase, at least by 25-30%, in the number of people systematically engaged in physical culture, a decrease in the prevalence of overweight by 20-30%, an expansion of the range and availability of food that is safe for health.

To minimize the negative impact on health, especially children, of bad habits, it is necessary to take measures to increase the proportion of non-smokers among people over 17 years of age, at least up to 50%, and up to 95% among people under 15 years of age; reducing alcohol consumption per capita to 10 liters per year and eliminating cases of alcohol consumption by persons under 15 years of age. Similar priorities should include reducing the prevalence of psychoactive drug use by at least 25% and related deaths by at least 50%.

Undoubtedly, these are the priority tasks of various public and social institutions, the state as a whole, but health care should play an important role in solving them.

At the same time, the priority measures with the participation of healthcare in solving the tasks set include the following:

. development and adoption of the "Code of a healthy lifestyle";
. formation of behavioral strategies for adherence to a healthy lifestyle among the population;
. creation of conditions for increasing the value attitude of the population towards their health;
. training of specialists in promoting a healthy lifestyle;
. education of citizens in a healthy lifestyle with the help of information programs specially adapted to different age and social groups of the population;
. organization of schools for patients (patients with bronchial asthma, diabetes mellitus, hypertension, etc.);
. development of anonymous treatment services for alcoholics and drug addicts;
. development of a network of specialized institutions on the formation of a healthy lifestyle, including the training of relevant specialists, etc.

8. Improving the mechanisms of state guarantees in providing the population with free medical care

As noted earlier, one of the painful problems of modern health care is the continuing discrepancy between the state's obligations to provide Russian citizens with free medical care and the financial resources allocated for this purpose.

Achieving such compliance by improving the mechanisms of state guarantees in providing the population with free medical care should be a priority for the activities of state authorities and local governments.

To solve this problem, it is advisable to implement the following set of measures:

. improvement of legislation to ensure the equality of citizens' rights to receive free medical care, the same in volume and quality, in all subjects of the Russian Federation;
. increasing the responsibility of state authorities and local self-government bodies for providing the population with guaranteed free medical care;
. development of standards (protocols) for managing patients that are uniform for all subjects of the Russian Federation;
. improvement of the legal framework governing the division of free and paid medical services in state and municipal healthcare organizations;
. wide awareness of citizens about the rights to receive free medical care, etc.

9. Improving the efficiency of the health management and financing system

In modern conditions, one of the most important areas of healthcare reform is the formation of a new management system.

A system that ensured, above all, the efficient use of material, technical, financial, human and other resources allocated to the industry. Without solving this problem, further building up the resource potential of the healthcare system will not be effective.

The task of delimiting powers in the field of healthcare at the federal, regional and municipal levels of healthcare management remains relevant. Without this, it is impossible to avoid the endless duplication of functions of health authorities and individual medical institutions (federal, regional, municipal) in the provision of certain types of medical care, especially high-tech ones.

The work begun by the Ministry of Health of the Russian Federation in the 90s of the last century on standardization requires further continuation. Improving the management of the industry, improving the quality of medical care, and the efficient use of resources are inconceivable without the development and establishment of relevant standards, rules, requirements, technological regulations for the production of medical goods and services.

The development of evidence-based approaches to the formation of standards (protocols) for managing patients for various types of medical care at all stages of its provision requires special attention.

The introduction of high-tech medical services, the creation of new medical centers that will reduce waiting times and ensure the availability of high-tech types of medical care to patients, regardless of their place of residence, require the rapid development of clinical protocols for managing patients for these types of medical care.

Fundamentally new approaches should be introduced to implement such critical management functions as planning and forecasting. These approaches should be based, first of all, on an in-depth study of the health of the population, modern methods collection and processing of information, effective technologies for making managerial decisions.

First of all, it is necessary to develop and implement organizational, legal and economic mechanisms for the efficient use of financial and other resources. The creation of such mechanisms is seen as possible only on the basis of the organization unified system medical and social insurance and the transition to a single-channel health care financing system.

Certain prospects for improving the efficiency of industry management are associated with the development of legal and organizational mechanisms for public-private partnerships in healthcare.

This concerns, first of all, the creation of conditions for the participation of healthcare organizations of private forms of ownership in the implementation of territorial programs of state guarantees, state support for venture innovation funds that finance high-tech and science-intensive projects in healthcare, support for the development of business associations in healthcare, etc.

O.P. Shchepin, V.A. Medic

Economic components of the state program for the development of health care. Federal target programs

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Program objectives

Ensuring the priority of prevention in the field of health protection and the development of primary health care

Improving the efficiency of providing specialized, including high-tech, medical care, ambulance, including emergency specialized, medical care, medical evacuation

Development and implementation of innovative diagnostic and treatment methods

Improving the efficiency of obstetrics and childhood services

Development of the provision of medical rehabilitation to the population and improvement of the system of sanatorium and resort treatment, including for children

Providing medical care to terminally ill patients, including children

Providing the healthcare system with highly qualified and motivated personnel

Increasing the role of Russia in global health

Improvement of control and supervisory functions

Medico-biological provision of public health protection

Ensuring the systemic organization of health care

1. Reducing the gap in population health indicators between individual regions of the Russian Federation and economically developed countries

2. Improving the health of children, adolescents, women

3. Maintaining the health of the elderly

4. Reducing the level of socially significant diseases

5. Reducing the prevalence of infectious diseases

6. Ensuring a healthy and safe living environment

7. Formation of a healthy lifestyle

8. Improving the mechanisms of state guarantees in providing the population with free medical care

9. Improving the efficiency of the health management and financing system