RUSSIA: MIXED REVIEWS ON NATIONAL HEALTH PROJECT

UNCLAS SECTION 01 OF 03 MOSCOW 001811

SIPDIS

SENSITIVE
SIPDIS

DEPARTMENT FOR OES/IHA AND EUR/RUS
USAID FOR GH, E&E
HHS FOR OGHA
BERLIN ALSO FOR LABOR COUNSELOR HAGEN

E.O. 12958: N/A
TAGS: TBIO SCUL SOCI RS
SUBJECT: RUSSIA: MIXED REVIEWS ON NATIONAL HEALTH PROJECT

REF: A. ST. PETERSBURG 75

B. MOSCOW 510

MOSCOW 00001811 001.2 OF 003


THIS CABLE IS SENSITIVE BUT UNCLASSIFIED. NOT FOR INTERNET
DISTRIBUTION.


1. (SBU) SUMMARY: With thepQ`j6th
three main components: improving primary care by raising health
sector salaries and purchasing new equipment and ambulances;
strengthening prevention and treatment for infectious diseases; and
making high-tech health care more widely available. A separate
program was also launched to improve care during pregnancy, labor,
and delivery. The overall funding for the project was 96.8 billion
rubles ($3.7 billion) in 2006.

Raising Salaries for Doctors and Nurses
--------------


3. (U) In 2006, several thousand primary care doctors and
pediatricians received additional training and 680,000 health care
providers (one third of all health care workers) received
significant salary increases. Average salaries in the health sector
increased from 5,300 rubles ($204) per month before the project was
launched to 8,590 rubles ($330). The monthly salary for primary
care doctors and for pediatricians is now 14,000-23,000 rubles
($538-885),while nurses earn 7,500-15,000 rubles ($288-577) per
month. Emergency medical workers and licensed practical nurses also
received raises.


4. (U) The number of primary care doctors has increased from 66,900
to 73,400, though some growth occurred because specialist physicians
moved to higher paying primary care jobs. There has also been an
influx of young doctors and nurses to the primary care sector,
reducing the share of primary care doctors who have reached
retirement age from 30 percent to 20 percent. The number of nurses
in primary care increased from 74,900 to 81,900, and the share of
retirement age nurses declined from 25 percent to 13 percent.

Buying Equipment and Ambulances
--------------


5. (U) The project also sought to improve primary care by purchasing
new diagnostic equipment and ambulances. By 2006, 65 percent of
Russian ambulances were beyond their intended useful life or were
not functioning. Some 22,652 pieces of equipment were purchased in
2006 (54 percent from local manufacturers and 46 percent from
foreign firms). Many health care facilities in remote rural areas
received ultrasound and endoscopic equipment for the first time.
Some 6,722 ambulances and 93 emergency resuscitation vehicles were
purchased, which comprises about one third of Russia's entire
ambulance fleet. (NOTE: Few emergency vehicles are equipped with
resuscitation and oxygen equipment, and ambulances are often simply
station wagons used to transport patients to hospitals. END NOTE)

An Ounce of Prevention and Treatment
--------------


6. (SBU) The project's main prevention and treatment activities
included therapy for people living with HIV/AIDS or hepatitis;
vaccination programs; and physical examinations of the working age
population (age 35-55). Nearly 15,000 people were receiving
antiretroviral therapy by the end of 2006, though about 1,000 later
stopped treatment. Nearly 5,000 HIV-positive pregnant women
received preventive treatment, as did 3,465 babies born to
HIV-positive mothers. Other HIV/AIDS prevention activities, such as
AIDS messages in schools and to the young, were a low priority and
received comparatively little funding from the government in 2006.

MOSCOW 00001811 002.2 OF 003




7. (U) More than four million children received vaccinations against
rubella; more than nine million young people were vaccinated against
hepatitis B; 22 million people received seasonal flu vaccinations;
and 118,800 people were vaccinated against polio. Some 6.7 million
people aged 35-55 (seven percent of the working age population)
underwent physical examinations, which revealed 46,000 new cases of
diabetes, 6,700 cases of cancer, and 670 cases of tuberculosis. The
government also spent 10.5 billion rubles ($404 million) improving
prenatal, labor, and delivery services through equipment upgrades
and salary increases for staff.

Investing in High-Tech Health Care
--------------


8. (U) High-tech health care was provided to 128,000 patients at a
cost of 8.4 billion rubles ($323 million),including a 36 percent
increase in funding for organ transplants and cardiovascular
surgery. The government's definition of "high-tech care" includes
organ transplants, brain surgery, cardiovascular surgery, and cancer
treatments. Construction of seven new high-tech medical centers was
started. Four of the new centers will specialize in cardiovascular
surgery, two in trauma, and one in neurosurgery.

What to Expect in 2007
--------------


9. (U) In 2007 the GOR plans to spend 127.3 billion rubles ($4.9
billion) on the health project, with similar levels of funding
promised in 2008 and 2009. The GOR hopes to reduce preventable
deaths from car accidents, poisonings, and cardiovascular diseases.
Twice as much money as in 2006, 17.5 billion rubles ($673 million)
will be spent on high-tech medicine and the construction of
high-tech medical centers. The GOR will also continue buying more
medical equipment, another 6,060 ambulances, and 380 vehicles with
neonatal resuscitation equipment, with the goal of reducing the
average ambulance waiting time to 20 minutes. Vaccinations and
therapies for infectious diseases will also continue. In 19 pilot
regions, the government will also streamline health care financing
and salary payments.

Politicians Sing the Project's Praises
--------------


10. (U) Russia's top political leaders, including President Putin
and First Deputy Prime Minister Medvedev (tasked with overseeing the
national projects),say the national health project has already
begun improving the lives of ordinary Russians. They note that 2006
demographic data show improvements in both mortality and fertility
for the first time in seven years. There were 138,000 fewer deaths
in 2006 than in 2005, a six percent decline, and the adult mortality
picture improved for all causes of deaths. The birth rate improved
by a modest one percent, and the infant mortality rate improved by
seven percent. Political leaders make much of the fact that these
positive trends continued in early 2007, with a 9.5 percent
reduction in mortality and 8.5 percent increase in the birth rate.
They also point to other achievements, including reduced waiting
times for diagnostic test results from ten to seven days, and a
reduction in the average waiting time for an ambulance from 35 to 25
minutes. In the case of infectious diseases, hepatitis B cases
declined by 17 percent, while cases of rubella remained stable.

Corruption Remains a Systemic Problem
--------------


11. (SBU) Even with salary increases, average health sector
paychecks remain too low to allow a decent living, prompting doctors
and nurses to seek bribes. According to government studies, the
level of fraud and waste in government procurement under the health
project is somewhat higher (1.3 percent) than for the other four
national projects (in agriculture, education, and housing). While
this is officially considered to be consistent with the general
level of fraud and abuse for government contracts, the actual level
is undoubtedly much higher. Georgiy Satarov, the head of the
anti-corruption NGO INDEM Foundation, stated at a corruption
conference in April that as many as 20 million Russians do not seek
medical care, because they can no longer afford the routine bribes
needed to obtain medical services.


12. (SBU) The National project's focus on equipment purchases has
also led to opportunities for corruption both at the regional and
federal level. The head of the regional Department of Health and
Social Development in Amurskaya Oblast (in the Russian Far East) was

MOSCOW 00001811 003.2 OF 003


arrested in April for supplying old medical equipment to local
hospitals at inflated prices, though she was supposed to be
acquiring new equipment. At the federal level, businesses owned by
or connected to Health Ministry officials are also likely benefiting
financially from the project. It's no secret that Health Minister
Zurabov's wife, Yuliya, owns medical equipment supplier Octopus,
which reportedly controls one fifth of all the equipment purchases
under the national health project.

COMMENT: REVERSING THE LEGACY OF UNDERFUNDING
--------------


13. (SBU) Russia's health care system was chronically under-funded
for far too long, and as Duma Deputy Health Committee Chairman
Gerasimenko has said, the government is now making up for lost time
and years of neglect. First Deputy Prime Minister Medvedev has
rightly characterized the government's spending in the sector in
2006 as "unprecedented," but, after years of neglect, it is still
not clear how quickly Russia will catch up with the quality of care
in much of the rest of Central and Eastern Europe. Even counting
the national health project, Russia is still spending less than
three percent of GDP on health, though some would argue that the GDP
denominator in this figure is distorted, because of Russia's oil and
gas revenues. Some other countries in the region invested more in
health care since the collapse of the Soviet Union and Warsaw Pact,
and are now reaping the benefits. The Czech Republic in the early
1990s began modernizing medical care and investing in hospital
infrastructure and medical equipment. This has translated into a
significant decline in the prevalence of cardiovascular diseases,
lower mortality, and longer life expectancies among the Czech
citizenry.


14. (SBU) Popular expectations that increased salaries in primary
care would lead to better services have not been met. Problems with
health care were identified as one of the chief sources of
complaints from citizens in the annual report released at the
beginning of April by Russia's Human Rights Ombudsman, Vladimir
Lukin. Access to high-tech health care still remains limited and
probably satisfies no more than 15-20 percent of the demand,
according to most experts.


15. (SBU) Many health policy experts believe the project lacks a
comprehensive strategy and is more of a smorgasbord of equipment
purchases and budgetary pork. Some argue the project is not
devoting nearly enough resources to remedying three critical
problems: inequities in access to health care, the overall poor
quality of health services, and the low level of infectious disease
prevention activities. They also note other systemic issues that
have yet to be addressed: the lack of standards of treatment, and
the absence of economic and financial independence of health care
facilities.


16. (SBU) Demographics experts have been skeptical of political
leaders' claims that 2006 and 2007 improvements in Russia's
mortality and fertility statistics resulted from the health project.
Instead, they believe the project could lead to long-term
improvements in the demographics picture only if the increased
funding for health care is sustained over several years. Regardless
of the critics, with First Deputy PM and likely presidential
candidate Medvedev tasked with overseeing the national projects, the
success of the health project will continue to be in the spotlight
in the run-up to the Duma and Presidential Elections.

BURNS