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:

• ratio of salaries of doctors and workers medical organizations with higher medical (pharmaceutical) or other higher education, to secondary 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 salaries of junior medical personnel (personnel providing conditions for the provision of medical services) to the average salary in the corresponding region – 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.

Formation among the population of a responsible attitude towards their health, cessation of smoking, alcohol and drug abuse, provision of conditions for maintaining healthy image life, 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 health policy.

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.

Federal law“On compulsory medical insurance” provides for the inclusion of high-tech medical care in the compulsory system from 2015 health insurance. 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 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 of 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.

Taking into account forecasts for the intensive introduction of biomedical technologies into advanced healthcare practices in 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 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 a high standard of living, a 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 area of ​​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 the prescribed time frame, which is what this section of the Program is aimed at ensuring. 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, existing pediatric medical organizations do not meet modern requirements that make it possible to care 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. Not fully provided with quality medical care children with cancer, 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, 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 the medical and social problems of providing accessible, effective sanatorium and resort treatment to the population, and the economic problems of forming 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, subsidizing the interest rate on loans 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.

Pursuant to the Decree of the President of the Russian Federation of May 7, 2012 No. 598 “On improving public policy in the field of healthcare" in the constituent entities of the Russian Federation, it is envisaged to adopt programs aimed at improving the qualifications of medical personnel, assessing the level of their qualifications, gradually eliminating the shortage of medical personnel, as well as developing differentiated measures of social support for medical workers, primarily the most scarce specialties.

Increasing Russia's role in global health

Main directions international relations in the field of health care should be to ensure Russia's strong and authoritative position in the world community, which best meets the interests of the Russian Federation as one of the influential centers of the 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 interaction with other federal executive authorities, executive authorities of the constituent entities of the Russian Federation, and 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 calculating the full cost of 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 activities depends State program"Health Development".

Russian Federation
"Health Development"

Rules
provision and distribution of subsidies from the federal budget to the budgets of constituent entities of the Russian Federation for one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand . Human

With changes and additions from:

1. These Rules establish the goals, conditions and procedure for the provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation in order to co-finance the expenditure obligations of the constituent entities of the Russian Federation to make one-time compensation payments to medical workers (doctors, paramedics) who arrived (moved) to work in rural areas settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people (hereinafter referred to as subsidies).

2. Subsidies are provided within the limits of budgetary obligations communicated to the Ministry of Health of the Russian Federation as the recipient of federal budget funds for the provision of subsidies for the purposes specified in paragraph 1 of these Rules.

3. The selection criteria for a constituent entity of the Russian Federation to provide a subsidy are:

a) the presence of a list of vacant positions of medical workers in medical organizations and their structural divisions approved by the authorized executive body of the constituent entity of the Russian Federation in the field of healthcare (hereinafter referred to as the authorized body), upon replacement of which one-time compensation payments are made for the next financial year (program register of positions), developed on the basis of an approximate list of positions of medical workers in medical organizations and their structural divisions providing primary health care, upon replacement of which one-time compensation payments are made for the next financial year (program register of positions), approved by the Ministry of Health of the Russian Federation;

b) the presence of an application from the highest executive body of state power of a constituent entity of the Russian Federation for participation in the event, containing information about the planned number of participants in the event (doctors, paramedics).

4. The subsidy is provided on the basis of an agreement on the provision of a subsidy concluded between the Ministry of Health of the Russian Federation and the highest executive body of state power of the constituent entity of the Russian Federation, prepared (formed) using the state integrated information system public finance management "Electronic budget" in accordance with the standard form approved by the Ministry of Finance of the Russian Federation (hereinafter referred to as the agreement).

5. The conditions for providing a subsidy are:

a) the procedure for providing one-time compensation payments to medical workers (doctors, paramedics) who are citizens of the Russian Federation and who do not have outstanding financial obligations under an agreement on targeted training, approved by a regulatory legal act of a constituent entity of the Russian Federation (with the exception of medical organizations with a staffing level of less than 60 percent), who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements, or cities with a population of up to 50 thousand people and entered into an employment contract with a medical organization subordinate to the executive body of a constituent entity of the Russian Federation or a local government body, for full-time working conditions with the duration of working hours established in accordance with Article 350 of the Labor Code of the Russian Federation, with the performance of labor functions in a position included in the program register of positions provided for in paragraph 3 of these Rules, in the amount of:

2 million rubles for doctors and 1 million rubles for paramedics who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements located on the territory of the Far Eastern Federal District, in the regions of the Far North and equivalent areas , Arctic zone of the Russian Federation;

1.5 million rubles for doctors and 0.75 million rubles for paramedics who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements located in remote and hard-to-reach areas. The list of remote and hard-to-reach territories is approved by the highest executive body of state power of the constituent entity of the Russian Federation;

1 million rubles for doctors and 0.5 million rubles for paramedics who arrived (moved) to work in rural settlements, or workers' settlements, or urban-type settlements (except for those indicated in paragraphs two and three of this subclause), or cities with a population of up to 50 thousand people;

b) presence in the budget of a constituent entity of the Russian Federation budget allocations, provided for the financial support of the expenditure obligations of the constituent entity of the Russian Federation, for the purpose of co-financing which a subsidy is provided, in the amount necessary to fulfill these obligations, including the amount of the subsidy planned to be provided;

c) conclusion of an agreement in accordance with paragraph 10 of the Rules for the formation, provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation, approved by Decree of the Government of the Russian Federation of September 30, 2014 N 999 “On the formation, provision and distribution of subsidies from the federal budget to the budgets of the constituent entities Russian Federation" (hereinafter referred to as the Rules for the formation, provision and distribution of subsidies).

6. A one-time compensation payment is provided by the authorized body to a medical worker from among the medical workers specified in paragraph 1 of these Rules (hereinafter referred to as medical workers), once on one of the grounds specified in subparagraph “a” of paragraph 5 of these Rules. The authorized body has the right to decide to provide a medical worker with a one-time compensation payment:

a) if he has obligations related to targeted training (targeted training), subject to his conclusion employment contract with a medical organization whose staffing level is less than 60 percent;

b) provided that the medical worker who has fulfilled the obligations related to targeted training (targeted training) continues to work in the same medical organization located in a rural locality, or a workers’ village, or an urban-type village, or a city with a population of up to 50 thousand. Human.

7. A medical worker who has entered into an agreement with a medical organization on the provision of a one-time compensation payment (hereinafter referred to as the agreement) accepts the obligations:

a) perform labor duties for 5 years from the date of conclusion of the contract for positions in accordance with the employment contract, subject to the extension of the contract for the period of non-fulfillment of the labor function in full (except for the rest period provided for by the Labor Code of the Russian Federation);

b) return to the budget of the constituent entity of the Russian Federation part of the one-time compensation payment, calculated in proportion to the unworked period from the date of termination of the employment contract until the expiration of the 5-year period (except for cases of termination of the employment contract on the grounds provided for in paragraph 8 of part one of Article 77 and paragraphs 5 - 7 part one of Article 83 of the Labor Code of the Russian Federation), as well as in case of transfer to another position or enrollment in additional professional programs;

c) return to the budget of a constituent entity of the Russian Federation part of a one-time compensation payment, calculated in proportion to the unworked period from the date of termination of the employment contract, in the event of dismissal due to conscription military service(in accordance with paragraph 1 of part one of Article 83 of the Labor Code of the Russian Federation) or extend the validity of the contract for the period of non-fulfillment functional responsibilities(at the choice of a medical professional).

8. The total amount of the subsidy (S total) is determined by the formula:

S total = S 1i + S 2i + S 3i,

S li - the amount of the subsidy to the budget of the i-th subject of the Russian Federation participating in the corresponding financial year in the implementation of the activities provided for in paragraph 1 of these Rules, insofar as they relate to medical workers who arrived (moved) to work in rural settlements or workers' settlements , or urban-type settlements (with the exception of medical workers specified in paragraphs 10 and these Rules), or cities with a population of up to 50 thousand people;

S 2i - the amount of the subsidy to the budget of the i-th subject of the Russian Federation participating in the corresponding financial year in the implementation of the activities provided for in paragraph 1 of these Rules, insofar as they relate to medical workers who arrived (moved) to work in rural settlements or workers' settlements , or urban-type settlements located on the territory of the Far Eastern Federal District, in the regions of the Far North and equivalent areas, in the Arctic zone of the Russian Federation;

S 3i - the amount of the subsidy to the budget of the i-th subject of the Russian Federation participating in the corresponding financial year in the implementation of the activities provided for in paragraph 1 of these Rules, insofar as they relate to medical workers who arrived (moved) to work in rural settlements or workers' settlements , or urban-type settlements located in remote and hard-to-reach areas.

9. The amount of the subsidy to the budget of the i-th subject of the Russian Federation, participating in the corresponding financial year in the implementation of the activities provided for in paragraph 1 of these Rules (S 1i), insofar as they relate to medical workers who arrived (moved) to work in rural settlements, either workers' settlements, or urban-type settlements (with the exception of medical workers specified in paragraphs 10 and these Rules), or cities with a population of up to 50 thousand people, is determined by the formula:

S 1i = (V 1plani 1 + F 1plani 0.5) L i ,

V 1plani - the number of doctors who are planned to receive one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

1 - the amount of a one-time compensation payment provided to the doctor, equal to 1 million rubles;

F 1plani - the number of paramedics who are planned to receive one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

0.5 - the amount of a one-time compensation payment provided to a paramedic, equal to 0.5 million rubles;

paragraph 13

10. The amount of the subsidy to the budget of the i-th subject of the Russian Federation participating in the corresponding financial year in the implementation of the activities provided for in paragraph 1 of these Rules (S 2i), insofar as they relate to medical workers who arrived (moved) to work in rural settlements, either workers' settlements or urban-type settlements located on the territory of the Far Eastern Federal District, in the regions of the Far North and equivalent areas, in the Arctic zone of the Russian Federation, is determined by the formula:

S 2i = (V 2plani 2 + F 2plani 1) L i ,

V 2plani - the number of doctors who are planned to receive one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

2 - the amount of a one-time compensation payment provided to the doctor, equal to 2 million rubles;

F 2plani - the number of paramedics who are planned to receive one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

1 - the amount of a one-time compensation payment provided to a paramedic, equal to 1 million rubles;

L i is the maximum level of co-financing of the expenditure obligation of the i-th subject of the Russian Federation from the federal budget, determined in accordance with paragraph 13 of the Rules for the formation, provision and distribution of subsidies.

11. The amount of the subsidy to the budget of the i-th subject of the Russian Federation participating in the corresponding financial year in the implementation of the activities provided for in paragraph 1 of these Rules (S 3i), insofar as they relate to medical workers who arrived (moved) to work in rural areas, either workers' settlements or urban-type settlements located in remote and hard-to-reach areas, is determined by the formula:

S 3i = (V 3plani 1.5 + F 3plani 0.75) L i ,

V 3plani - the number of doctors who are planned to receive one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

1.5 - the amount of a one-time compensation payment provided to the doctor, equal to 1.5 million rubles;

F 3plani - the number of paramedics who are planned to receive one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

0.75 - the amount of a one-time compensation payment provided to a paramedic, equal to 0.75 million rubles;

L i is the maximum level of co-financing of the expenditure obligation of the i-th subject of the Russian Federation from the federal budget, determined in accordance with paragraph 13 of the Rules for the formation, provision and distribution of subsidies.

12. The volume of budgetary allocations for financial support of the expenditure obligations of a constituent entity of the Russian Federation for the implementation of one-time compensation payments to medical workers, for the purpose of co-financing of which a subsidy is provided, is approved by the law of the constituent entity of the Russian Federation on the budget of the constituent entity of the Russian Federation (determined by the consolidated budget breakdown of the budget of the constituent entity of the Russian Federation) based on the need to achieve the values ​​of the result of using the subsidy established in the agreement - the share of medical workers who are actually provided with one-time compensation payments in the total number of medical workers who are planned to receive these payments.

The amount of a subsidy to the budget of a constituent entity of the Russian Federation in a financial year cannot exceed the amount of funds for the fulfillment in the financial year of expenditure obligations of a constituent entity of the Russian Federation related to the implementation of measures provided for in paragraph 1 of these Rules, taking into account limit level co-financing the expenditure obligation of a constituent entity of the Russian Federation from the federal budget, determined in accordance with paragraph 13 of the Rules for the formation, provision and distribution of subsidies.

13. The subsidy is transferred in the prescribed manner to an account opened by the territorial body Federal Treasury in the institution of the Central Bank of the Russian Federation to account for transactions with budget funds of a constituent entity of the Russian Federation.

14. To assess the results of using the subsidy, an indicator is used - the share of medical workers who are actually provided with one-time compensation payments in the total number of medical workers who are planned to receive the specified payments (percentage) (I i), calculated by the formula:

V facti - the number of doctors who were actually provided with one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

F facti - the number of paramedics who were actually provided with one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

V plani - the number of doctors who are planned to receive one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year;

F plani - the number of paramedics who are planned to receive one-time compensation payments in the i-th subject of the Russian Federation in the corresponding financial year.

15. The assessment of the effectiveness of the use of the subsidy is carried out by the Ministry of Health of the Russian Federation based on a comparison of the value of the results of the use of the subsidy established in the agreement and the value of the results of the use of the subsidy actually achieved at the end of the reporting year, provided for in paragraph 14 of these Rules.

16. The procedure and conditions for the return of funds from the budgets of the constituent entities of the Russian Federation to the federal budget in the event of a violation of the obligations stipulated by the agreement, as well as the grounds for exempting the constituent entities of the Russian Federation from the application of financial liability measures are established in paragraphs 16 - 18 and the Rules for the formation, provision and distribution of subsidies.

17. Control over the implementation by constituent entities of the Russian Federation of the measures provided for in paragraph 1 of these Rules is carried out by the Federal Service for Surveillance in Healthcare.

18. Monitoring of compliance by constituent entities of the Russian Federation with the conditions for the provision of subsidies is carried out by the Ministry of Health of the Russian Federation and authorized bodies of state financial control.

Tatarnikov M.A. Research Institute of Public Health and Health Management MMA named after. I.M Sechenova

The program-target method is the most important tool for implementing state socio-economic policy, incl. and in the field of health. Federal target programs (FTP) are a complex of research, development, production, socio-economic, organizational, economic and other activities linked by resources, implementers and implementation deadlines, ensuring effective solution tasks in the field of state, economic, environmental, social and cultural development of the Russian Federation (RF). Their most important feature is the identification of priority problems and ways to solve them, taking into account the possibilities of financing program activities at the federal, regional or local levels. Thus, program-targeted management allows not only to concentrate resources on priority areas, but also to implement an integrated approach to solving the most pressing health problems based on intersectoral interaction.

Federal targeted programs in the field of public health stimulate the participation of constituent entities of the Russian Federation in solving health problems in their territories on the basis of co-financing or the adoption and implementation of their own similar programs.

Currently, a regulatory, legal and methodological framework has been created that defines the rules for the consideration, approval and financing of federal targeted programs. When working with target programs, the following stages are distinguished:

1. selection of problems for software development;
2. making a decision on the development of a target program and its formation;
3. examination and evaluation of the target program;
4. approval of the target program;
5. management of the implementation of the target program and monitoring the progress of its implementation.

According to the current legislation, any legal and individuals. However, as a rule, the Ministry of Health and Social Development of Russia and its subordinate institutions act in this capacity.

The selection of problems for their software development and solution at the federal level is determined by the following factors:

• significance of the problem;
• the inability to comprehensively solve the problem within an acceptable time frame and the need for government support to solve it;
• fundamental novelty and high efficiency of technical, organizational and other measures necessary for the large-scale dissemination of progressive achievements;
• the need to coordinate intersectoral connections to solve this problem.

When justifying the need to solve problems using program methods at the federal level, the priorities and goals of social economic development Russian Federation, results of analysis of the economic and social state of the country. In accordance with the approved procedure, proposals must contain:

• name of the problem and analysis of the reasons for its occurrence;
• possible ways problem solving;
• the need for financial resources and possible sources of their provision (federal budget, budgets of constituent entities of the Russian Federation, extra-budgetary funds);
• preliminary assessment of the socio-economic effectiveness and consequences of the program;
• government customers and developers of the target program, the time and cost of preparing the target program.

The Ministry of Economic Development (MED), together with the Ministry of Finance of Russia and other interested federal executive authorities and executive authorities of the constituent entities of the Russian Federation, based on forecasts of the socio-economic development of the country, prepares proposals for solving this problem using program methods at the federal level and sends them to the Government of the Russian Federation. Based on the submitted proposals, the Government of the Russian Federation makes a decision on the preparation of an appropriate target program, the timing and cost of its development, and determines the state customer.

The state customer is responsible for the timely and high-quality preparation and implementation of the target program, prepares the initial task for its formation, manages the actions of the developers, manages the program implementers after its approval, and ensures the effective use of funds allocated for the implementation of the program. The state customer of the federal target program in the field of public health protection is, as a rule, the Ministry of Health and Social Development of Russia.

The target program consists of the following sections:

• the content of the problem and the rationale for solving it using software methods;
• main goals and objectives, timing and stages of program implementation;
• system of program events;
• resource support for the program (from the federal budget and extra-budgetary sources, budgets of constituent entities of the Russian Federation and with the distribution of expenses among the regions of the country);
• program implementation mechanism;
• organizing program management and monitoring the progress of its implementation;
• evaluation of program effectiveness;
• passport of the target program.

Attached to the draft target program are: explanatory note, a business plan with socio-economic and feasibility studies, a preliminary budget request for allocations from the federal budget to finance the program for the next year, a sheet of agreement with the interested federal executive authorities and, if necessary, agreements (agreements) of intent between the state the customer of the program with enterprises, organizations, government bodies of the constituent entities of the Russian Federation, confirming the financing of the program from extra-budgetary sources, budgets of the constituent entities of the Russian Federation.

The Ministry of Economic Development and the Ministry of Finance of the Russian Federation evaluate the presented draft target program, paying special attention to:

• the priority nature of the problem proposed for a software solution;
• validity and complexity of program activities, timing of their implementation;
• the need to attract extra-budgetary funds, funds from the budgets of constituent entities of the Russian Federation for the implementation of the program in conjunction with the possibilities of its state support at the expense of centralized resources;
• effectiveness of the program implementation mechanism;
• socio-economic effectiveness of the program as a whole, expected final results of the program.

The Ministry of Economic Development, with the participation of the Ministry of Finance, prepares a conclusion on the draft target program and preliminary budget request. Taking into account comments and suggestions, the state customer of the target program, together with its developers, finalizes the draft program. The revised draft target program is re-sent to the Ministry of Economic Development.

In case of a positive assessment, the Ministry of Economic Development, in agreement with the Ministry of Finance of Russia, submits a draft target program for approval to the Government of the Russian Federation.

Target programs and government customers are approved by the Government of the Russian Federation. Government customers are provided financial resources in the amount established by the federal budget, and are responsible for the implementation of federal target programs. The interaction of several state customers under one program is carried out by the state customer - coordinator, determined by the Government of the Russian Federation.

Forms and methods of organizing management of the implementation of the target program are determined by the state customer. The current management of the Federal Targeted Program for the protection of public health is carried out by a directorate formed by the state customer, headed by one of the Deputy Ministers of Health of the Russian Federation, responsible for the implementation of the target program.

The implementation of the target program is carried out on the basis of government contracts (agreements) concluded by the state customer of the program with all implementers of program activities. The selection of objects and projects of program activities and their performers is carried out on a competitive basis.

The Ministry of Economic Development, with the participation of interested government bodies, organizes expert inspections of the progress of implementation of individual target programs. At the same time, attention is paid to meeting the deadlines for the implementation of program activities, to the targeted and effective use of financial resources and the final results of the program.

Currently, the main current federal target program in the field of healthcare is the program “Prevention and Control of Socially Significant Diseases (2007-2011)”, which includes the subprograms “Diabetes Mellitus”, “Tuberculosis”, “HIV Infection”, “Oncology”, “Sexually transmitted infections”, “Viral hepatitis”, “Mental disorders”, “Arterial hypertension” and “Vaccine prevention”, approved by Decree of the Government of the Russian Federation of May 10, 2007 N 280 (as amended by Decree of the Government of the Russian Federation of February 18, 2008 N 95 , dated 06/02/2008 N 423, dated 04/09/2009 N 319). The program is an important component of the national priority project “Health”.

Characteristics of the problem the program is aimed at solving

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 Decree of the Government of the Russian Federation dated December 11, 2006 N 1706-r, the list of socially significant diseases approved by the Decree of the Government of the Russian Federation dated 01.12.2004 N 715, the procedure for the development and implementation of federal target programs and interstate target programs in the implementation of which the Russian Federation participates, approved by Decree of the Government of the Russian Federation dated 06.26.1995 N 594.

The need to prepare and implement the Program is caused by a number of socio-economic factors influencing the decline in the quality of life of the population, including excessive stress loads, 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 rate 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.

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

The number of newly registered cases of HIV infection reached 37.7 thousand cases, in correctional institutions of the Federal Penitentiary Service - 2 thousand cases, the share 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 those who died from malignant neoplasms within a year from the date of diagnosis among patients registered for the first time in the previous year - 31.6 percent, mortality from malignant neoplasms per 100 thousand population was 186.8 cases for men, 93.5 cases for women.

The incidence of syphilis is 72 cases per 100 thousand 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 - 23.4 cases per 100 thousand children. . At the same time, the share of specialized medical institutions monitoring the variability of sexually transmitted infections in the total number of dermatovenerological institutions is 15 percent. The total number of adolescent specialized centers for the prevention and treatment of sexually transmitted infections does not exceed 12 in the country as a whole.

The incidence of acute viral hepatitis B and C is currently 8.6 and 4.5 cases per 100 thousand population, respectively, chronic viral hepatitis B and C - 51.4 cases per 100 thousand population.

The share of patients covered by team forms of psychiatric care in the total number of observed patients is 5 percent, the share 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 vascular disorders of the brain (cerebrovascular diseases, including stroke) due to arterial hypertension is 5776 cases per 100 thousand population, and mortality from vascular disorders of the brain (cerebrovascular diseases, including stroke) due to arterial hypertension is 325 cases per 100 thousand 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 thousand population, respectively.

The main goals and objectives of the program, the period of its implementation, as well as target indicators and indicators

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

The objectives of the Program are:

1. improving methods of prevention, diagnosis, treatment and rehabilitation for socially significant diseases;
2. development and implementation of modern methods of prevention, diagnosis, treatment and rehabilitation for socially significant diseases based on advanced technologies;
3. construction and reconstruction of specialized medical institutions.

The Program provides for the implementation of a set of interrelated measures for the prevention, diagnosis, treatment and rehabilitation of socially significant diseases throughout the entire period of the Program implementation.

Program implementation mechanism

The state customer - coordinator of the Program is the Ministry of Health and Social Development of Russia, the state customers of the Program are the Ministry of Health and Social Development of Russia, federal Service for supervision in the field of consumer rights protection and human well-being, Federal Penitentiary Service and Russian Academy of Medical Sciences.

The implementation of the Program is carried out on the basis of government contracts concluded by government customers with the implementers of the Program activities in accordance with the Federal Law "On placing orders for the supply of goods, performance of work, provision of services for state and municipal needs", as well as co-financing of the expenditure obligations of a constituent entity of the Russian Federation for the relevant regional (municipal) programs (plans).

Interaction between government customers and executive authorities of the constituent entities of the Russian Federation is carried out on the basis of agreements.

The implementation of the Program in the constituent entities of the Russian Federation is carried out through a set of measures aimed at reducing the incidence of socially significant diseases, improving methods of their prevention and early diagnosis, ensuring the quality of treatment and rehabilitation.

To manage the implementation of the Program activities, a coordination council (hereinafter referred to as the council) is created, formed from officials of the state customer - the Program coordinator, state customers of the Program and interested federal executive authorities.

The Council performs the following functions:

• develops proposals on the topics and volumes of financing of orders for the supply of goods, performance of work and provision of services within the framework of the Program;
• reviews materials on the progress of implementation of Program activities;
• organizes inspections of the implementation of Program activities, target and effective use funds allocated for their implementation;
• prepares recommendations for the effective implementation of Program activities, taking into account the progress of the Program implementation and trends in the socio-economic development of the Russian Federation;
• identifies scientific, technical and organizational problems during the implementation of the Program;
• considers the results of the examination of projects and activities proposed for implementation in the next financial year, in terms of their content and cost.

The Council approves the following developed by government customers:

Detailed organizational and financial plans for the implementation of Program activities;

Indicators for monitoring the implementation of Program activities.

The Council is headed by the Deputy Ministry of Health and Social Development of Russia. The regulations on the council and its composition are approved by the Minister of Health and Social Development of the Russian Federation.

Ministry of Health and Social Development of Russia:

• exercises control over the activities of government customers of the Program;
• prepares draft regulatory legal acts of the Government of the Russian Federation necessary for the implementation of the Program;
• annually, if necessary, clarifies the mechanism for implementing the Program, target indicators and indicators, costs for the implementation of Program activities;
• prepares, taking into account the progress of implementation of the Program in the current year, and submits in the prescribed manner to the Ministry of Economic Development a consolidated budget request for financing the activities of the Program in the next financial year;
• quarterly submits to the Ministry of Economic Development statistical, reference and analytical information on the progress of implementation of the Program as a whole, monitoring data on the implementation of Program activities;
• submits annually, before February 1, to the Ministry of Economic Development and the Ministry of Finance of Russia in the prescribed form, a report on the progress of work under the Program, the results achieved and the effectiveness of the use of financial resources;
• initiates, if necessary, expert reviews of the progress of implementation of individual Program activities;
• submits to the Ministry of Economic Development and the Ministry of Finance of Russia proposals to adjust measures for the implementation of the Program or to terminate its implementation;
• upon completion of the Program, submits a report to the Ministry of Economic Development and the Ministry of Finance of Russia on the implementation of the Program and on the effectiveness of the use of financial resources for the entire period of its implementation.
• Government customers of the Program:
• carry out ongoing management of the implementation of the Program;
• draw up a detailed organizational and financial plan for the implementation of Program activities;
• in the event of a reduction in the volume of funding for Program activities from the federal budget, additional measures are developed to attract funds from extra-budgetary sources to achieve results characterized by the target indicators of the Program, and, if necessary, develop proposals for their adjustment within the established time frame;
• make proposals to clarify target indicators and indicators, costs for the implementation of Program activities and subprograms, as well as to improve the mechanism for its implementation;
• ensure the effective use of funds allocated for the implementation of the Program;
• organize quarterly reporting on the implementation of the Program and subprograms, as well as monitoring the implementation of program activities;
• organize expert inspections of the implementation of individual activities of the Program and subprograms;
• carry out management of the activities of the implementers of the Program activities as part of the implementation of program activities;
• carry out the selection on a competitive basis of performers of works (services), suppliers of products for each event of the Program and subprograms, as well as the conclusion of government contracts (agreements);
• organize the use of information technologies for the purpose of managing and monitoring the implementation of the Program, ensure placement on the Internet of the text of the Program, regulatory legal acts, methodological materials regarding the management of the implementation of the Program and monitoring the implementation of its activities, as well as materials on the progress and results of the Program implementation;
• agree with the state customer - the Program coordinator and the main interested participants of the Program on the possible timing of the implementation of activities, volumes and sources of funding;
• quarterly provide the state customer - the Program coordinator with statistical, reference and analytical information on the progress of implementation of the Program activities;
• if necessary, submit proposals to the state customer - coordinator of the Program to extend the period or to terminate the implementation of the Program;
• submit annually, before January 25, to the state customer - the Program coordinator, in the prescribed form, a report on the progress of the Program, the results achieved and the effectiveness of the use of financial resources.

Assessment of the socio-economic effectiveness of the program

The effectiveness of the Program is assessed based on comparison with data for 2005 and taking into account the need to achieve the following indicators:

reduction in the proportion of complications in diabetes mellitus to 28 percent;

an increase in the average life expectancy of men with type I diabetes mellitus to 55.3 years, women - to 59.1 years;

an increase in the average life expectancy of men with type II diabetes mellitus to 71.5 years, women - to 73.5 years;

reduction in the incidence of tuberculosis in correctional institutions of the Federal Penitentiary Service to 1,495 cases per 100 thousand people;

an increase in the abacillation rate of tuberculosis patients registered at the end of the year to 35.9 percent;

reduction in mortality from tuberculosis to 17.8 cases per 100 thousand population, including in correctional institutions of the Federal Penitentiary Service - up to 140 cases per 100 thousand people;

reduction in the number of newly registered cases of HIV infection during the year to 31 thousand cases, in correctional institutions of the Federal Penitentiary Service - to 1.6 thousand cases;

increasing the proportion of HIV-infected pregnant women included in the program to prevent HIV infection in newborns to 98 percent;

improvement of indicators characterizing the early detection of malignant neoplasms, including an increase in the proportion of patients with visual tumor localizations identified at stages I and II of the disease, up to 73.1 percent;

reduction in the proportion of patients who died from malignant neoplasms within a year from the moment of diagnosis, among patients first registered in the previous year, to 27.8 percent;

reduction in mortality from malignant neoplasms in men to 171.6 cases per 100 thousand population, in women - to 90.1 cases per 100 thousand population;

reducing the incidence of syphilis to 50.1 cases per 100 thousand people, including in correctional institutions of the Federal Penitentiary Service - up to 150 cases per 100 thousand people;

reducing the incidence of syphilis in children to 7.2 cases per 100 thousand children;

reducing the incidence of gonorrhea in children to 10.2 cases per 100 thousand children;

increasing the share of specialized medical institutions monitoring the variability of sexually transmitted infections in the total number of dermatovenerological institutions to 60 percent;

increasing the number of adolescent specialized centers for the prevention and treatment of sexually transmitted infections to 55;

reduction in the incidence of acute viral hepatitis B to 2.7 cases per 100 thousand population;

reduction in the incidence of acute viral hepatitis C to 3.8 cases per 100 thousand population;

reducing the incidence of chronic viral hepatitis B and C to 36 cases per 100 thousand population;

increasing the proportion of patients covered by team forms of mental health care in the total number of observed patients to 41 percent;

reducing the proportion of patients in need of inpatient psychiatric care in the total number of observed patients to 14.5 percent;

reduction in the average duration of treatment of a patient in a psychiatric hospital to 73.9 days;

reducing the share of repeated hospitalizations to a psychiatric hospital during the year to 17.5 percent;

reducing the incidence of cerebrovascular diseases in the population to 4680 cases per 100 thousand population;

reducing population mortality from cerebrovascular diseases to 270 cases per 100 thousand population;

increasing the number of newly diagnosed patients with arterial hypertension to 1000 thousand people per year;

increasing the number of people trained in health schools for patients with arterial hypertension to 1,400 thousand people per year;

maintaining a 95 percent level of coverage of children with preventive vaccinations;

reducing the incidence of diphtheria to 0.16 cases per 100 thousand population;

eliminating cases of polio;

reducing the incidence of measles to 0.8 cases per 100 thousand population.

It is assumed that the overall economic effect from the implementation of the Program’s activities will be achieved by reducing morbidity, disability and mortality of the population due to socially significant diseases.

The social effectiveness of the implementation of the Program’s activities will be expressed in improving the quality and increasing the life expectancy of patients, preserving labor potential, forming the foundations of a healthy lifestyle, reducing social and psychological tension in society due to the threat of the spread of socially significant diseases.

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

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

However, despite the measures taken, a number of unresolved problems remain in Russian healthcare. Among them is the persistent discrepancy between the state’s obligations to provide free medical care to Russian citizens and the financial resources allocated for these purposes.

There is insufficient availability of medical care, especially for the least affluent segments of the population, and high differentiation of municipalities in terms of public health indicators and the provision of healthcare with the necessary resources. The commercialization of state and municipal healthcare is increasing, one of the reasons for which is the lack of effective existing mechanisms of state regulation in this area.

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

The majority of the population does not have a motivated value attitude towards their own health as a necessary life resource, which, in turn, turns out to be the main factor preventing the formation of a healthy lifestyle among the population. Behavioral factors and bad habits still have a great influence on public health: the prevalence of alcoholism, smoking, and 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, in Norway 77.8 and 82.8, respectively, in Sweden - 78.5 and 82.9 years.

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

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

Medical and social diagnostics and analysis of problems characterizing the current state of public health, as well as the study of social needs 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 until 2020, which were considered and approved by the II Congress of the Russian Federation. public organization"Russian Society for the Organization of Healthcare and Public Health."

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

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, and women.
3. Preserving the health of older people.
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. Creating the necessary conditions for innovative development of healthcare.
11. Modernization of the system of training and retraining of personnel in healthcare.
12. Improvement legislative framework healthcare.

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

The current gap in health indicators between the population of Russia and economically developed countries is primarily associated with the lack of a scientifically based state policy in the field of protecting the health of citizens, insufficient resource provision for the industry, as well as the imperfection of mechanisms for the effective use of material, technical, financial, and technical resources allocated for healthcare needs. human 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 effective state policy in the field of protecting the health of citizens;
. introduction of the humanitarian development index as a criterion for assessing the socio-economic development of regions;
. conducting an analysis of the reasons for the identified differences in 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 care for 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 of whether Russia will be able to overcome the demographic crisis in the foreseeable future or not largely depends 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% (in the constituent entities of the Russian Federation that have reached this value, reduce this indicator to the average European level); reducing by at least 50% the level of 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%; reducing the average maternal mortality rate 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 will decrease to the European average level).

The most important goals are to reduce 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 have bad behavior habits associated with the use of drugs, tobacco and alcohol by 30%; reducing the number of teenage pregnancies by at least 25%.

To achieve these objectives, it is necessary to implement the following set of measures:

Expansion and intensification of preventive activities, including medical 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;
. providing maternity hospitals with modern medical equipment and special sanitary transport;
. development of family planning and safe motherhood services;
. integration of maternity institutions with the general medical and specialized network;
. implementation of WHO principles for the integrated management of childhood illnesses;
. implementation of WHO criteria for assigning the status of “Baby Friendly Hospital”;
. bringing primary health care services closer to the everyday life conditions of schoolchildren and adolescents (home environment, schools, etc.) educational establishments, places of rest);
. development and implementation of regional medical and social programs to improve the health of adolescents, including boys of pre-conscription and conscription age;
. development and implementation of interdepartmental programs on the problems of drug addiction, suicide, alcohol consumption, and accident prevention;
. implementation of the WHO concept of creating schools that promote health;
. implementation of WHO criteria for assigning the status of “Adolescent Friendly Hospital”, etc.

3. Preserving the health of older people

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

People who have worked for decades and reached old age have the right to demand a higher level of medical care from society. In this case, healthcare is faced with the task of increasing the average life expectancy by at least 5-7%, as well as increasing by 30-50% the number of people aged 80 years with a level of health that allows them to remain independent , self-respect and proper place in society.

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

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

Coordination of health and social 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, dental prosthetics;
. organization of geriatric services in all subjects of the Russian Federation;
. improving the quality and availability of rehabilitation assistance;
. training of specialists in the field of palliative care;
. development of a network of hospitals for incurable patients (hospices);
. creating conditions for the dignified departure of elderly sick people from life (providing the opportunity to die in the place they choose, and surrounded by the people they wanted to see, if possible without pain and suffering), etc.

4. Reducing the level of socially significant diseases

For many years, this priority area in healthcare remains more of a political declaration than a system of targeted, results-oriented actions, which is confirmed 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” identifying their main trends and cause-and-effect relationships allows us 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 reduction 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 objectives, the most important are also the reduction of morbidity, disability and mortality rates associated with chronic respiratory diseases, musculoskeletal disorders and other common chronic diseases; preventing mental disorders and reducing suicide rates by at least 30%; reduction in mortality and disability as a result of road 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 for the prevention, diagnosis and treatment of arterial hypertension and its complications;
. development of evidence-based programs for organizing rehabilitation treatment for 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 progress of measures for the prevention and treatment of arterial hypertension;
. improving the system of the state register of patients with arterial hypertension;
. improvement of rehabilitation methods for patients with arterial hypertension, etc.

Prevention and treatment of diabetes:

Conducting research to study the causes and mechanisms of development of diabetes mellitus and its complications;
. improving methods of prevention, diagnosis and treatment of diabetes mellitus;
. equipping diabetes departments of specialized healthcare institutions with the necessary equipment;
. organizing schools to educate patients with diabetes;
. monitoring diabetes mellitus and its complications;
. ensuring the functioning of the state register of people with diabetes;
. creation of mobile treatment and prophylactic 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 cancer;
. conducting research in the field of etiology and pathogenesis of malignant neoplasms;
. carrying out scientific research in the field of prevention, diagnosis and treatment of malignant neoplasms;
. information support for the national register of substances, products, production processes, household and natural factors 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 and general practitioners on the diagnosis and treatment of depressive conditions;
. development of a system of psychiatric emergency rooms;
. conducting fundamental and applied research to study factors influencing mental health;
. teaching the population rational behavior in extreme and stressful situations, etc.

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

. improving the modern system of medical aviation and transporting victims in the shortest possible time to the place of specialized medical care;
. development and implementation of standards for providing 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 when providing emergency medical care to victims of road accidents and emergencies, health services, the Ministry of Internal Affairs, the Ministry of Emergency Situations, federal and regional executive authorities;
. equipping with modern medical equipment, ambulance transport, communications equipment for healthcare organizations involved in providing specialized medical care to victims of road accidents, accidents, etc.

Fighting HIV infection:

Implementation of programs for exchanging used injection needles for new ones for people who inject drugs intravenously;
. ensuring widespread access to condoms and other personal protective equipment;
. ensuring blood safety through appropriate 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 identification of tuberculosis patients using microscopic examination of sputum and targeted fluorographic examinations;
. implementation of a tuberculosis control program based on the DOTS strategy at the national level and in accordance with WHO recommendations;
. regular and uninterrupted supply of all essential anti-tuberculosis drugs;
. development of special surveillance services for the population from risk groups such as migrants, people without a fixed place of residence, HIV-infected people, etc.

5. Reducing the prevalence of infectious diseases

Despite the significant results achieved in the prevention, early diagnosis and treatment of infectious diseases, the healthcare system has sufficient reserves, and every year new opportunities emerge 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 possible to achieve the following results in the next decade:

Carrying out a set of anti-epidemic measures to prevent the spread of influenza A/HI N1;
. reducing the prevalence of diphtheria to a level of no more than 0.1 cases per 100 thousand population;
. reducing the number of new cases of hepatitis B virus transmission by at least 80%;
. reducing 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 population;
. reducing the prevalence of congenital syphilis and rubella to a level of no more than 0.01 cases per 1000 live births;
. full implementation of the national vaccination calendar, etc.

6. Ensuring a healthy and safe living environment

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

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

The most important role in its solution is given to the Rospotrebnadzor service. The country's population must live in a safe environment in which exposure to hazardous health factors does not exceed those provided for international standards. There is a need to achieve significant reductions in physical, chemical and microbial contaminants in water, air, waste and soil that pose a threat to health.

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

To solve these problems, it is first 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 geographic information system, reflecting the spatiotemporal relationship between environmental factors and population health;
. reducing the risk of morbidity by 1.2-1.4 times, depending on the intensity 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 hygiene safety;
. zoning of the habitat with hygienic ranking of territories according to the degree of danger of negative impact on health;
. protection of the biosphere according to the criteria of permissible anthropogenic load on the natural environment, etc.

7. Formation of a healthy lifestyle

The state of health of the population, as is known, depends more than 50% on a person’s lifestyle, therefore the formation of a healthy lifestyle among the population is the key to solving many problems associated with reducing morbidity, disability, mortality, and increasing the average life expectancy.

Unfortunately, we have to admit that the problem of creating a healthy lifestyle in recent decades has practically fallen out of the system of public and state priorities, which as a result has negatively affected the health of citizens of the Russian Federation.

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

What tasks for creating a healthy lifestyle among the population seem necessary to solve in the next decade? First of all, it is necessary to achieve an increase by at least 25-30% in the number of people systematically involved in physical education, a reduction in the prevalence of overweight by 20-30%, and an expansion of the range and availability of healthy food products.

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

Of course, these are the highest priority tasks of various public and social institutions, the state as a whole, but healthcare should play an important role in solving them.

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

. development and adoption of the “Code of Healthy Lifestyles”;
. formation of behavioral strategies among the population for adherence to a healthy lifestyle;
. creating conditions for increasing the population’s value attitude towards their health;
. training of specialists in promoting a healthy lifestyle;
. teaching citizens a healthy lifestyle through 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 issues of promoting a healthy lifestyle, including 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 healthcare is the persistent discrepancy between the state’s obligations to provide free medical care to Russian citizens and the financial resources allocated for these purposes.

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

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

. improving legislation to ensure equal rights of citizens to receive free medical care, equal in volume and quality, in all constituent entities of the Russian Federation;
. increasing the responsibility of state authorities and local governments for providing the population with guaranteed free medical care;
. development of uniform standards (protocols) for patient management for all subjects of the Russian Federation;
. improvement of the regulatory legal framework regulating 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 healthcare 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, first of all, the efficient use of material, technical, financial, human and other resources allocated to the industry. Without solving this problem, further increasing the resource potential of the healthcare system will not be effective.

The task of delineating powers in the field of healthcare at the federal, regional and municipal levels of healthcare management remains urgent. Without this, it is impossible to avoid endless duplication of functions of health care 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 industry management, improving the quality of medical care, and efficient use of resources are unthinkable without the development and establishment of appropriate standards, rules, requirements, and technological regulations for the production of medical goods and services.

Particular attention is required to the development of evidence-based approaches to the formation of standards (protocols) for the management of patients for various types of medical care at all stages of its provision.

Increasing the flow of high-tech medical services, creating 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 the management of patients for these types of medical care.

Fundamentally new approaches must 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 population health, modern methods collection and processing of information, effective technologies for making management decisions.

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

Certain prospects for increasing 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 private health care organizations in the implementation of territorial programs of state guarantees, state support for venture innovation funds financing high-tech and knowledge-intensive projects in health care, support for the development of business associations in health care, etc.

O.P. Shchepin, V.A. Medic

Approved Decree of the Government of the Russian Federation of April 15, 2014 No. 294. This resolution recognizes that the order of the Government of the Russian Federation of December 24, 2012 No. 2511-r has become invalid.

Responsible executor: Ministry of Health of the Russian Federation(). Co-executor: Federal Medical and Biological Agency ().

Program participants: Ministry of Foreign Affairs of the Russian Federation, Ministry of Defense of the Russian Federation, Ministry of Industry and Trade of the Russian Federation, Ministry Agriculture Russian Federation, Ministry of Labor and Social Protection of the Russian Federation, Ministry of Finance of the Russian Federation, Ministry of Economic Development of the Russian Federation, Ministry of Energy of the Russian Federation, Federal tax service, Federal Penitentiary Service, Federal Service for Supervision of Health Care, Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Federal Service bailiffs, Federal Air Transport Agency, Federal Agency for Sea and River Transport, Federal Agency for Scientific Organizations, Federal Agency for State Property Management, Federal Road Agency, Federal Compulsory Medical Insurance Fund.

• first stage: 2013 – 2015
• second stage: 2016 – 2020

Volumes of budgetary allocations, thousand rubles

	2013	2014	2015	2016	2017	2018	2019	2020
Federal budget funds (according to preliminary estimates 2451185163.2 thousand rubles)	413096449,8	357154180,6	260503600,8	262867673,8	263304352,2	286879826,8	299241851,9	308137227,3
Funds from the consolidated budgets of the constituent entities of the Russian Federation (according to preliminary estimates, 11079448074.3 thousand rubles)	855100000	1278914456	1336464817,5	1396605734,3	1459452992,4	1525128377	1586133512,1	1641648185
Facilities Federal Fund compulsory medical insurance (according to preliminary estimates 13090239782 thousand rubles)	1059200000	1240116074,5	1452032467,1	1521253067,1	1684669055,1	1857824179,3	2042263268,1	2232881670,8
TOTAL:
The total amount of funds is:	26 620 873 019,5

Expected results of the Program implementation

• reduction in mortality from all causes to 11.4 cases per 1000 population;
• reduction in infant mortality to 6.4 cases per 1000 live births;
• reducing mortality from diseases of the circulatory system to 622.4 cases per 100 thousand population;
• reducing mortality from road accidents to 10 cases per 100 thousand population;
• reduction in mortality from neoplasms (including malignant ones) to 190 cases per 100 thousand population;
• reduction in mortality from tuberculosis to 11.2 cases per 100 thousand population;
• reducing the consumption of alcoholic products (in terms of absolute alcohol) to 10 liters per capita per year;
• reducing the prevalence of tobacco use among adults to 26 percent;
• reduction in the number of registered patients diagnosed with active tuberculosis for the first time in life (per 100 thousand population) to 61.6 cases per 100 thousand population;
• the supply of doctors will be 40.2 people per 10 thousand population;
• the number of nursing staff per 1 doctor will be 3 people;
• increasing the ratio of the average salary of doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education, providing medical services (providing medical services), to the average salary in the constituent entity of the Russian Federation to 200 percent;
• increasing the ratio of the average salary of paramedical (pharmaceutical) personnel (personnel providing conditions for the provision of medical services) to the average salary in the constituent entity of the Russian Federation to 100 percent;
• increasing the ratio of the average salary of junior medical personnel (personnel providing conditions for the provision of medical services) to the average salary in the constituent entity of the Russian Federation to 100 percent;
• increasing the ratio of the average salary of paramedical (pharmaceutical) and junior medical personnel (personnel providing conditions for the provision of medical services) to the average salary in the constituent entity of the Russian Federation to 100 percent;
• increase in life expectancy at birth to 74.3 years