REPORT

About the work done

For 2012

Nurse

Urological office

MBUZ Polyclinics No. 2

Patraeva Lidia Vladimirovna

Specializing in nursing

Introduction.

Introductory part:

Priority areas for healthcare reform in the Russian Federation,

The main federal target programs for protecting public health.

Main part:

1. Characteristics of the area of ​​clinic No. 2, its organizational structure.

2. Population grid.

3. Urological service.

4. Organization of the work of a nurse in the urological office.

5. Qualitative indicators.

6. Dispensary work.

7. Anti-epidemic work of a nurse in a urological office.

8. Sanitary educational work.

Final part:

NOTES in the work of a clinic nurse.

General conclusions and prospects for the near future.

I Introduction

It was decided to carry out the modern healthcare reform in the form of modernization, which makes it possible to solve a number of problems within a short period of time (2–3 years), such as: finding internal resources for financing healthcare, increasing the efficiency of the healthcare system, strengthening the technical base of medical institutions. The goal of the ongoing reform is to increase accessibility and quality medical care for the general population. The main direction of healthcare reform is to preserve the health of the population. In this regard, the resolution developed priority areas for healthcare reform.

Basic principles:

Priority of disease prevention measures.

Ensuring sanitary well-being.

Public health education.

Promotion of healthy lifestyles.

Ensuring the guarantee and accessibility of free medical and pharmaceutical care for citizens.

Security public policy in the field of women's and children's health.

Development of technologies that ensure the birth of viable children.

Reducing healthcare costs for hospital services and increasing the volume and quality of outpatient services:

a) day hospitals;

b) improving the provision of medicines to the population;

c) creation unified system information support in the healthcare system;

d) development of diagnostic services.

Improving the mandatory health insurance and ensuring the completeness and timeliness of receipt of insurance premiums.

The reform provides for the development of a new model of a polyclinic - economical, maximally focused on the specific patient: the development of outpatient surgery centers, day care departments, and home hospitals on the basis of polyclinics. A gradual transition to providing medical care based on the principle of a family doctor is being intensified. According to these priority areas, territorial and federal programs.

Protecting the health of the population in the Republic of Belarus is one of the priority areas of social policy.

II Introductory part

Priority areas for reform in Russian Federation.

1) Development of a set of measures to ensure accessibility and improve the quality of medical care for the population.

2) Development of preventive healthcare.

3) Investment project to create a network of federal medical centers providing high-tech types of medical care.

4) Measures to improve the provision of medicines to certain categories of citizens entitled to receive state social assistance.

5) Proposals for attracting non-state investments in healthcare.

6) Carrying out measures to provide primary health care facilities with medical personnel.

7) Carrying out measures aimed at preventing the introduction and spread of especially dangerous and widespread infectious diseases, toxic substances and hazardous products on the territory of the Russian Federation, eliminating measles and maintaining the status of the country free of polio, programs for the prevention of HIV infection and drug addiction aimed at health-preserving behavior teenagers

8) Expanding the list of diseases for which follow-up treatment (rehabilitation) of patients in sanatorium and resort institutions is provided at the expense of social insurance funds.

9) Approval of emergency medical care standards.

10) Creation of favorable economic conditions for organizations implementing programs for promoting health and preventing diseases among workers, as well as for investors directing their funds to improve social conditions and environmental conditions that promote a healthy lifestyle. It is necessary to improve at the federal and territorial levels the legislative and regulatory framework in the field of labor protection, the environment, creating conditions for physical education and increasing physical activity, regulating advertising and sale of tobacco products.

11) A clear distinction between free and paid medicine and thereby protect the state from citizens’ demands that exceed the budget’s capabilities.

As part of the implementation of the national project “Health”, polyclinic No. 2 was allocated the following equipment:

Electrocardiograph 6 channel “MAS – 1200 ST”

Express analyzer

Hardware software package for screening assessment of psychophysiological and somatic health

Heart Screening System

Angion Screening System

Spirometer

Bioimpedance meter

Smokelyizer

Puloximeter

Analyzer with.

Main federal programs for the protection of public health.

1. Federal target program “Improving the All-Russian Service for Disaster Medicine.”

The decision of this program is of a state nature. One of the main tasks of the service is participation in training the population and rescuers in first aid in emergency situations. The All-Russian Disaster Medicine Service has been created in the Russian Federation.

2. Federal target program “Preventing the spread of the disease caused by the human immunodeficiency virus (HIV infection) in the Russian Federation.”

The main goal of the program is to prevent the spread of a disease called HIV infection in the Russian Federation.

The program includes the main tasks of prevention, carrying out preventive and anti-epidemic measures, preventing nosocomial infection, ensuring the safety of medical procedures, improving the diagnosis and treatment of HIV infection, social protection of their family members, medical workers, and training of medical personnel.

3. Federal target program “Children of Russia”.

The main objectives are to improve psychiatric and medical-psychological care to the population and implement a long-term program for the protection of mental health of the population of the Russian Federation.

4. the federal law“About Veterans” dated 01/02/2000

A package of regulatory documents has been developed here.

5. Federal Law “On social protection of citizens exposed to radiation as a result of the Chernobyl disaster” dated November 24, 1995.

A package of documents has been developed for this law, which sets out the main current legal regulations to the radiation risk contingent.

III Main part

Source: Ministry of Economic Development of Russia

By Order of the Government of the Russian Federation dated December 24, 2012 No. 2511-r, the state program of the Russian Federation “Health Development” was approved.

The goal of the State program is to ensure accessibility of medical care and increase the efficiency of medical services, the volumes, types and quality of which must correspond to the level of morbidity and the needs of the population, and to the advanced achievements of science.

The total volume of financial support for the State program in 2013-2020 at current prices is 30.3 trillion. rubles The estimated amount of funding for the State program is: from funds federal budget 2.7 trillion rubles, funds from the consolidated budgets of the constituent entities of the Russian Federation 10.5 trillion. rubles, funds Federal Fund compulsory health insurance 17.1 trillion. rubles The additional need for federal budget funds is stated in the amount of 3.4 trillion. rubles

The State program includes 11 subprograms that define the main vectors for the development of the healthcare system: disease prevention and the promotion of a healthy lifestyle, the development of primary health care, improving the provision of specialized, including high-tech medical care, the development and implementation of innovative diagnostic and treatment methods , maternal and child health care, development of medical rehabilitation and sanatorium-resort treatment, including for children, staffing of the healthcare system, development international relations in the field of health care, examination and control and supervisory functions in the field of health care, health care provision for certain categories of citizens.

As a result of the implementation of the State program by 2020, it is planned to achieve the following indicator values:

1. Mortality from diseases of the circulatory system is 622.4 cases per 100 thousand population.

2. Mortality from neoplasms (including malignant ones) 190.0 cases per 100 thousand population.

3. Mortality from tuberculosis is 11.2 cases per 100 thousand population.

4. Mortality from road accidents is 10.0 cases per 100 thousand population.

5. Infant mortality rate is 6.4 per 1 thousand births.

6. Reducing the consumption of alcoholic products (in terms of absolute alcohol) to 10.0 liters per capita.

7. The prevalence of tobacco consumption among adults is 25%.

8. The prevalence of tobacco consumption among children and adolescents is 15%.

9. Maternal mortality 15.5 cases per 100 thousand population.

10. Life expectancy at birth is 74.3 years.

11. Ratio of doctors and nursing staff 1:3

12. The average salary of doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education, providing medical services (providing medical services) from the average salary in the corresponding region is 200%.

13. The average salary of paramedical (pharmaceutical) personnel (personnel providing conditions for the provision of medical services) from the average salary in the corresponding region is 100%.

14. The average salary of junior medical personnel (personnel providing conditions for the provision of medical services) from the average salary in the corresponding region is 100%.

The strategic goal of the Program is: improving the system of protecting the health of citizens in order to prevent diseases, preserve and strengthen the physical and mental health of each person, maintain his long active life, and provide him with medical care. The strategic goal of the Program is achieved by 2020 through decrease in the values ​​of the following indicators:

• mortality from all causes – up to 10.3 cases per 1000 population;
• infant mortality - up to 6.4 cases per 1000 live births;
• maternal mortality – up to 15.5 cases per 100 thousand population;
• mortality from diseases of the circulatory system - up to 551.4 cases per 100 thousand population;
• mortality from road traffic injuries – up to 10 cases per 100 thousand population;
• mortality from neoplasms – up to 189.5 cases per 100 thousand population;
• mortality from tuberculosis – up to 8.2 cases per 100 thousand population;
• consumption of alcoholic products (in terms of absolute alcohol) – up to 10 liters per capita per year;
• prevalence of tobacco consumption among adults – up to 25%;
• the prevalence of tobacco consumption among children and adolescents is up to 15%;
• incidence of tuberculosis – up to 35.0 cases per 100 thousand population;

increasing the values ​​of the following indicators by 2020:

• life expectancy at birth up to 75.7 years;

achieving the following indicators by 2018:

• the ratio of the salaries of doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education to the average wages in the corresponding region – 200%;
• the ratio of wages of paramedical (pharmaceutical) personnel to the average wage in the corresponding region is 100%;
• The ratio of wages of junior medical personnel (personnel providing conditions for the provision of medical services) to the average wage in the corresponding region is 100%.

Program Objectives

The tasks of transforming Russia into a global leader of the world economy, reaching the level developed countries indicators of social well-being 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 order to solve this problem, it is necessary to increase the efficiency of primary health care, optimize the total bed capacity, and 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 to detect diseases as early as possible and 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.

Forming a responsible attitude towards their health among the population, giving up smoking, alcohol and drug abuse, providing conditions for leading 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 policy direction in field of health care.

Non-communicable diseases (diseases of the circulatory system, cancer, respiratory diseases and diabetes mellitus) are the cause of more than 80% of all deaths in the Russian Federation, with 56% of all deaths caused by cardiovascular diseases. The development of non-communicable diseases is based on a single group of risk factors associated with an unhealthy lifestyle (smoking, low physical activity, poor nutrition, 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 among 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, UK, New Zealand etc.) it has been proven that lifestyle modification and reduction of risk factors can slow down the development of diseases of the circulatory system both before and after the onset of clinical symptoms.

A systematic analysis shows that by changing lifestyle and diet, the risk of death from coronary heart disease can be reduced 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 dietary factors – by 45 % and 15–40%.

Another systematic analysis shows that treatment of patients with coronary heart disease and other diseases of the circulatory system with drugs from the group of antiplatelet drugs reduces the risk of complications in such patients by 20–30%, beta blockers – by 20–35%, ACE inhibitors – by 22– 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 health improvement (lifestyle changes) and reduction of risk factor levels in reducing such mortality ranges from 44% to 60%.

Factor analysis of the reasons leading to high rates of cancer incidence and mortality showed that the influence of group A factors (tobacco smoking, excessive alcohol consumption, excess body weight, nutritional imbalance, other factors (production, natural environment, housing, the influence 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 clinical examination of risk groups, lack of oncological alertness of primary care doctors, lack of educational work among the population, insufficient work to motivate the population for active and conscious participation in screening activities, lack of unified screening programs at the federal level, lack 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 skills to observe the rules of hygiene, work and study regime. At the same time, increasing the motivation of the population to lead 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 identification of risk factors and non-communicable diseases, but also for their timely correction.

When reforming the primary health care system for the population, the tasks of changing the system of care come to the fore rural population; modernization of existing institutions and their divisions; building patient flows with the formation of uniform routing principles; development of new forms of medical care - inpatient replacement and mobile methods of work; development of emergency care on the basis of outpatient departments; improving the principles of interaction with inpatient facilities and emergency medical services.

Lining up modern system provision of primary health care to the population should include both the smallest settlements, and large cities.

Increasing the efficiency of providing specialized, including high-tech, medical care, ambulance, including specialized emergency 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 treatment methods with scientifically proven effectiveness, including cellular technologies, robotic technology, information technology and genetic engineering methods developed on the basis of advances medical science and related branches of science and technology.

To increase the accessibility and quality of medical care, measures will be implemented aimed at improving the organizational system for providing specialized, including high-tech, medical care, improving the provision of medical care for socially significant diseases, including patients with diseases of the circulatory system, tuberculosis, cancer, endocrine and some other diseases, the introduction into practice of innovative treatment methods, the development of infrastructure and resource provision 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 compulsory medical insurance system from 2015. One of the conditions for such inclusion is the development of the ability to provide high-tech medical care in medical institutions subjects of the Russian Federation.

The main objectives of providing emergency medical care, including specialized emergency medical care, and medical evacuation at the present stage should be to provide sick and injured 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 for the provision of qualified specialized medical care. This work should be carried out mainly by paramedic 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.

Successful solution to the problems of organizing and providing emergency medical care to the population is possible only in close connection with improving the work of outpatient services, including the transition to the organization of primary medical care on the principle of a general practitioner (family doctor), day care hospitals, hospitals on 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 economic systems, based on the use of the latest achievements in the field of biotechnology, computer science and nanotechnology, including in healthcare. Development information technologies and the advent of advanced computing and information processing technologies will make it possible to apply predictive approaches based on modeling in the field of health care. First of all, interest is generated by 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 to formulate targeted scientific programs in priority areas in order to maintain public health and promote a healthy lifestyle, develop and introduce new effective technologies for early diagnosis into the practice of the healthcare system.

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

Improving the efficiency of maternity and childhood services

Issues of maternal and child health are named as priorities in all fundamental documents on the development of healthcare; 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 control, that influence these indicators. The maternal mortality rate depends on the socio-economic state of the country, geographical features, development of medical care, cultural and educational level of the population.

In Russia in 2011, the maternal mortality rate was 16.2 per 100 thousand live births. At this level of indicator, 320–350 women of working age die annually, which places a heavy burden on families, reduces the number of children who could be born in the future, and increases the underproduced contribution to GDP. According to WHO, the European average maternal mortality rate in 2010 was 20 per 100 thousand live births and during the period 2005–2010 decreased by only 9.1%. The lowest maternal mortality rates are in countries with developed economy, high density population, 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, in Eastern European countries the maternal mortality rate is significantly higher. 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, 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 infant mortality rates are typical for countries with high level population life, small area and 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, but a large territory, and the presence of regions with 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 1000 live births, in Canada - 5.0, in Australia - 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 maternal and infant mortality rates correlate to a certain extent with health care costs (as a percentage of GDP), which amount to 15.2% in the USA, 11.1% in Germany, and 10.1% in France. In Russia, an increase in health care spending from 3.1 to 3.7% of GDP was accompanied by a decrease in maternal and infant mortality rates. The infant mortality rate is influenced by a number of factors that require an interdisciplinary approach.

First of all, this is the state of the material and technical base of obstetrics and childhood institutions. Until now, most regions are not fully provided with intensive care beds for newborns with modern high-tech equipment. A network of perinatal centers has not been formed in which medical care is provided to the most difficult contingent of pregnant women, women in labor, postpartum women 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 personnel shortage of both neonatologists and nurses, which is due, first of all, to low wages. As a rule, in the Russian Federation, for 1 nurse in the neonatal intensive care unit there are from 4 to 10 critically ill newborns. In the USA and European countries, for every 1 nurse there is 1 extremely sick newborn, or 2 seriously ill newborns, or 3 stable children.

The level of funding of medical organizations has a great influence on the quality of medical care for newborns born with pathology and the outcome 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 £1,600–2,000. In the USA, depending on the severity of the newborn’s condition, it ranges from 2000 to 5000 US dollars, in European countries - from 1500 to 4000 euros per day. At the same time, a significant share of the funds goes to salaries of medical workers.

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

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

Thus, by improving the accessibility, 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 thousand live births. Reducing infant mortality to a level of 3–4%, and maternal mortality to 5–8% is possible only with the development of the economy, transport infrastructure, and responsible attitude of the population to 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 affect the preservation of at least 4 thousand children's lives annually. Since each death of a child causes an under-produced contribution to GDP of 6 million rubles, the total GDP loss 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 be 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 all the benefits from the implementation of the program - improving the quality of care will lead to a decrease in the mortality rate of children under 5 years of age and under 17 years of age, which will further increase the expected increase in the contribution to GDP and increase public satisfaction with the health care system in the country , which, indirectly, can help increase the birth rate.

Since newborn mortality is 55–70% of infant mortality and 40% of child mortality under 5 years of age, an important direction in reducing child mortality is improving care for newborns, an extremely important aspect of which is the development of a network of perinatal centers. The perinatal center is not only a vivid and visual evidence of the state’s care for mothers and children, it is essentially a high-tech center that allows for the provision of effective care for the most severe pathologies, the development of innovative treatment methods (as well as fetal and neonatal surgery, intensive care assistance to 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 of providing medical care to women during pregnancy, 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 for providing differentiated assistance by levels, but also a system of interaction, monitoring, and training of personnel using simulation centers. It is planned 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 routing of patients, changing reporting forms, and creating new approaches to motivating staff.

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

In fact, thanks to perinatal centers, conditions were created for the transition of the Russian Federation in 2012 to the international birth registration criteria recommended by WHO, starting with 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 allow saving more than a thousand children's lives every year. The section of the program regarding improving the equipment of intensive care units and pathology of newborn children is also aimed at solving the problem of improving the care of children with extremely low body weight and reducing the level of disability in this contingent, 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.

To reduce child mortality, a well-functioning system for early detection and correction of developmental disorders is extremely important. The most effective tool for the prevention of congenital and hereditary diseases is comprehensive prenatal (prenatal) diagnostics, 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 diagnostics can only be ensured by mass examination of pregnant women within a specified time frame, which is what the this section Programs. The development of neonatal surgery is aimed at ensuring effective correction of disorders identified during prenatal diagnosis, and early correction of metabolic changes identified during neonatal screening will make it possible in the future to create opportunities and conditions for a sick child for normal development, education, professional training, subsequent employment and a full life. Further development of prenatal diagnostics will make it possible to reduce the number of children born with congenital anomalies by 50% and reduce the mortality rate of children from severe malformations by 50–70%.

There is still a high need for the development of specialized medical care for children. In 14 regions of the Russian Federation there are no regional, republican, or regional children's multidisciplinary hospitals. In a number of regions there are medical organizations pediatric specialists do not meet modern requirements that allow caring for children with severe pathologies, including children in the first year of life and, first of all, those born with low and extremely low body weight. This situation requires resolution, since it does not allow ensuring the full availability and quality of medical care for children. Children with cancer are not fully provided with high-quality medical care, a system for providing medical care to children with autoimmune diseases and diseases of immune origin has not been created, neurosurgical and traumatological and orthopedic care for children remains inaccessible, and psychiatric, drug addiction 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.

Solution of the problem state support construction and reconstruction of regional (territorial, 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 perinatal centers provide medical care 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 to the child.

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

Development of medical rehabilitation for 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- spa 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.

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

The shortage of hospital beds to provide medical rehabilitation assistance to 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 paramedics) does not allow us to fully satisfy the need for these medical services. Currently, only 50% of children who need it receive medical rehabilitation.

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

Solving the problems of health protection and social protection of children suffering from severe chronic (disabling) diseases, children with disabilities and their families is possible by ensuring the accessibility and quality of medical rehabilitation through the further development of a network of specialized children's rehabilitation institutions (regional, interdistrict), as well as complexes for the implementation of high-tech treatment methods with beds (branches of hospitals) for after-care and rehabilitation. Solving this problem will reduce the load on “expensive” hospital beds and increase their capacity.

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

At the moment, there is an urgent need for a set of measures aimed at preserving the potential of the resort sector and the formation of a modern resort complex capable of solving both medical and social problems of providing accessible, effective sanatorium and resort treatment to the population, and economic problems formation of the resort business. 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. In these conditions, the restoration of the system of sanatorium treatment and health improvement, its accessibility for the bulk of the population, the revival of Russian resorts seems to be an important national task that can make a great contribution to improving the level of public health of the people.

Providing medical care to incurable patients, including children

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

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

The main directions in providing palliative care to incurable patients should be not only reducing the suffering of patients, but also adequate psychological assistance, social support, communication with relatives, allowing to prepare family members for the inevitable ending.

In order to create optimal conditions for children suffering from incurable, life-limiting diseases, as well as to help family members in conditions of a child’s incurable illness, it is planned to develop a network of medical and social institutions specializing in providing palliative care to children in the Russian Federation (opening palliative care departments 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, solving 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 the person at its final stage.

The creation of palliative care departments will reduce the load on expensive beds where intensive care is provided by at least 15%.

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

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 health care managers.

Providing the healthcare system with highly qualified and motivated personnel

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

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

Training programs for medical and pharmaceutical specialists will be formed and implemented at the stages of postgraduate and additional professional education, 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 implementation of federal state educational standards for secondary and higher professional education of the third generation.

Development planned until 2020 professional standards medical and pharmaceutical workers, which will allow the formation of unified approaches to determining the level of qualifications and set of competencies of medical and pharmaceutical workers necessary to engage in professional activities.

An accreditation system for 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 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 living quarters, land plots, housing subsidies, subsidies interest rate for a loan for the purchase of residential premises by medical and pharmaceutical workers, granting children of certain categories of medical and pharmaceutical workers the right to priority enrollment in preschool educational institutions.

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

Taken together, solving these problems will improve the quality of training of medical and pharmaceutical specialists, reduce the level of 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 state policy in the field of healthcare,” the constituent entities of the Russian Federation provide for the adoption of programs aimed at improving the qualifications of medical personnel, assessing their level of qualifications, gradually eliminating the shortage of medical personnel, as well as the development of differentiated measures of social support for medical workers, primarily in the most scarce specialties.

Increasing Russia's role in global health

The main directions of international relations in the field of health care should be to ensure strong and authoritative positions of Russia in the world community, which best meet the interests of the Russian Federation as one of the influential centers modern world; creating favorable external conditions for the modernization of Russia; formation of good neighborly relations with neighboring states; searching for agreement and coinciding interests with other states and interstate associations in the process of solving problems determined by Russia’s national priorities in the field of health care, 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.

The priority area of ​​Russian foreign policy in healthcare remains cooperation with member states of the Commonwealth of Independent States and the Eurasian Economic Community. The development of healthcare topics within the framework of the Asia-Pacific Economic Cooperation should also be considered important.

Improving control and supervisory functions

The main task of the functioning of the quality and safety control system is medical activities will be monitoring 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 quality control and safety control system for 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 circulation of medicines will be control over the circulation of medicines and its compliance with the current legislation of the Russian Federation.

The main task of the functioning of the system of state control over the circulation of medical products is to identify and remove from circulation low-quality medical products, as well as falsified and counterfeit medical products, followed by recycling and destruction, identifying and preventing possible negative consequences of the application and use of medical products in circulation in the territory Russian Federation, warnings about facts of this kind to potential users, as well as medical personnel.

An important task in the development of healthcare is the modernization of state forensic activities in the Russian Federation. Forensic medical and forensic psychiatric examinations in the Russian Federation are a special medico-legal type of activity aimed at providing the 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 examination, licensed as a separate type of medical activity.

In addition, state forensic medical expert institutions perform an important function in determining the causes and essence 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, create a unified methodological basis for the production of forensic psychiatric and forensic medical examinations, provide a modern material and technical base for all government institutions carrying 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 supervisory activities, as well as Rospotrebnadzor institutions that provide control and supervision, through a wide range of laboratory studies, scientific research research and scientific and methodological developments, implementation of anti-plague measures.

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

Medical and biological support for public health protection

An important factor in ensuring radiation, chemical and biological safety of the population and territories served by the Federal Medical and Biological Agency is the medical and sanitary support system of the Federal Medical and Biological Agency of Russia, one of the main tasks of which is to carry out measures to identify and eliminate the influence of particularly 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 treatment and preventive and rehabilitation measures, and monitoring the health of enterprise personnel and the population.

The goal of healthcare in the field of medical, sanitary and medical and biological support for elite sports is the prevention of morbidity and disability in athletes and the consistent increase in their level of provision with medical and biological technologies for effective adaptation to intense sports loads.

The main tasks in the field of medical and medical-biological support for athletes of national teams of the Russian Federation: the formation of infrastructure for treatment and prophylactic purposes, territorially integrated with the training bases of sports teams of the Russian Federation, allowing for 100% coverage of candidates for sports teams of the Russian Federation by type sports with all types of medical care during training and competitive activities; provision of qualified medical personnel to sports teams of the Russian Federation; implementation of medical and biological technologies that ensure the training and competitive level of training of candidates for 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 other federal authorities executive power, executive power bodies of the constituent entities of the Russian Federation, local government bodies.

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

Ensuring the systematic organization of health care

In modern conditions, the creation and operation of distributed information systems and analytical tools for data processing are the “gold standard” for organizing industry management. The introduction of new medical technologies is impossible without the parallel implementation of information systems that ensure optimization of the service delivery process. The creation of such systems is required to resolve issues related to the calculation of the full cost medical services, forecasting the required volume and cost of medical care and drug supply, assessing personnel 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, on the solution of which the effectiveness of most of the activities of the State Program “Health Development” depends.