Medicine in the village. Where to go for treatment?
Rural residents - 38 million people, representing about 26% of the total population of the Russian Federation. Does the rural population of the country differ in high living standards? - If only in the reports of local officials ... Is the social infrastructure developed in the countryside? - Unfortunately, too, no more than yes. Have the working conditions for rural residents been created by modern standards? - Not everywhere (to put it mildly). Rural work itself, which has not actually changed in its principles over many decades, leaves its mark on the health of those who are engaged in such work. And the question that has already been raised on the pages of our information and analytical portal - the question of why the Russian village is dying out, is also closely connected with the urgent issue of rural health care.
This question is so painful for millions of Russians that any affecting it causes a sharp reaction. Explainable ...
So, how to get fast and qualified medical assistance in the countryside? Officially - everything for this is available. As the main option - equipped obstetric point with a professional health worker, and better - a few. Meet, listen, diagnose, advise, write out the drug, direction, etc., etc. FAP is the largest pre-medical outpatient polyclinic institution providing primary health care to the rural population and plays an important role in treatment and preventive care, conducting a set of preventive and health measures, as well as in sanitary and anti-epidemic work. The creation of FAPs is caused by the features inherent in rural health care, the need to bring medical care closer to the population in a large radius of care for the local hospital (outpatient clinic) in relation to all existing settlements.
The FAP provides early detection of infectious patients, carries out primary anti-epidemic measures in the outbreaks, and current sanitary supervision of the territory of populated areas. An important place in the activity of the feldsher-midwife center is occupied by the active conduct of sanitary-educational work among the population. Medical assistants and midwives are directly involved in organizing and conducting medical examinations, the annual medical examination of the rural population.
It can be said that FAP is the face of medicine in rural areas. But that's the whole difficulty, that with FAPs everything is great only officially, and even then outside of statistics and exclusively in the language of local reporting. The face of medicine in the village may not come out ...
In fact, most of the FAPs are morally obsolete for a long time, and in many localities there are no FAPs at all. The message is often this: “what kind of a FAP should they have if there are 30 yards left in the village and there are no young people at all”. The fact that the departure of this very young person can be “somehow” connected, including with the lack of elementary medical care, report makers and analytical information for budget variations is not particularly worried.
According to the information of the Independent Monitoring Foundation “Health” with reference to the data of the Accounts Chamber, in 2015 in Russia there were 31,6 thousand FAPs - in all regions of the country. However, not all work now. As it turns out, many are listed only on paper. That is, the FAP as a building, it seems, is there, but as a real medical institution - with staff and equipment, it seems, and not ... And despite the fact that in the vast majority of cases, FAP is the only place in the village where you can buy basic medicines . Well, do not go to the pharmacy network to where customers even if constant, but very few. Do not go.
The issue of the availability of primary medical care in the village and remote areas was discussed at a meeting of Russian President Vladimir Putin with the Minister of Health of the Russian Federation Veronika Skvortsova. It was in August last year.
Veronika Skvortsova cited the statistics of the Ministry of Health of the Russian Federation characterizing the scale of the problem:
- 63% of rural residents seek medical help in the city;
- in the period from 2005 to 2011, the number of obstetric points decreased (or, as we like to say, “optimized”) by more than 5 thousand, then the state program entered, but it clearly does not cover the needs: from 2013 to 2015 year was open only 460 FAP;
- in some villages FAPs work once a week; villages with fewer than 100 people were left without any medical assistance at all;
- 17,5 thousand settlements have no medical infrastructure, of which in the 11 thousand - to the nearest doctor more than 20 km “on the move”;
- in 35% of settlements where there is no medical care, there is also no public transport;
- in regions with low population density, such as, for example, the Kamchatka Territory, there are no mobile brigades;
- The time of arrival of the ambulance carriage to the village can reach several hours. Or maybe this “carriage” doesn’t reach the patient at all for the most banal reason - a thaw, the road is “razvezlo”.
The Ministry of Health, as he claims, keeps this situation under control. In 2016, the Minister of Health signed an order to organize the provision of primary health care to rural residents.
According to the order, populated areas with the number of inhabitants more than 2 thousand people should have an ambulatory. When the number of inhabitants is from 301 to 2, thousand people must have a FAP or outpatient clinic. With the number of 100-300 residents, medical assistance should be provided through the FAP or field work (choice).
In search of a solution to the problem, regional authorities are looking for different ways.
For example, in the Belgorod region, which by many parameters in the Russian Federation acts as a standard, rely on mobility. A mobile obstetric point for the second year runs in areas where there are no medical assistants at all. The same mobile medical stations operate in the Chelyabinsk, Orenburg, Sakhalin regions, on Yamal and in the Komi Republic.
The medical organizations of the Ivanovo region formed 47 medical teams for visits to rural areas, organized the delivery of rural patients to central district hospitals and specialized healthcare institutions.
In the Voronezh region in the framework of the project “Quality of life. Health ”over the past two years, the building has been built 59 obstetric stations and 12 medical ambulance stations.
Nevertheless, measures taken to improve the situation with rural medicine are not enough. They are - it is a fact. But once again - they are not enough for such a huge country. Even despite the positive reports from the regions, the negative trends in terms of access of rural residents to medical care continues to persist. In a number of regions - it is aggravated.
Most rural residents in the 21st century also do not have the opportunity to undergo a normal medical examination and cannot afford complete treatment. For many villagers the trip to the district hospital is very expensive, and the debts. In this regard, the death rate in rural areas, which is often several times higher than the birth rate, cannot but grow. And this causes concern about the state of demography in the countryside. To put it mildly, anxiety ...
In conclusion, I would like to note the following thing: the FAP is not just an important part of the infrastructure where you can get first aid, advice on treating diseases, consult, take a referral to a district clinic, give an injection or buy medicine, but also . (and for the rural dweller it is sometimes equally important) - to find understanding from the person in the white coat - a person who is truly prayed in the villages as someone who can come to the aid at the most difficult moment. This is moral support, the effect of which is sometimes no less than from therapy.
I would like this problem, directly connected with demography, in state structures to be dealt with progressively and professionally.
This question is so painful for millions of Russians that any affecting it causes a sharp reaction. Explainable ...
So, how to get fast and qualified medical assistance in the countryside? Officially - everything for this is available. As the main option - equipped obstetric point with a professional health worker, and better - a few. Meet, listen, diagnose, advise, write out the drug, direction, etc., etc. FAP is the largest pre-medical outpatient polyclinic institution providing primary health care to the rural population and plays an important role in treatment and preventive care, conducting a set of preventive and health measures, as well as in sanitary and anti-epidemic work. The creation of FAPs is caused by the features inherent in rural health care, the need to bring medical care closer to the population in a large radius of care for the local hospital (outpatient clinic) in relation to all existing settlements.
The FAP provides early detection of infectious patients, carries out primary anti-epidemic measures in the outbreaks, and current sanitary supervision of the territory of populated areas. An important place in the activity of the feldsher-midwife center is occupied by the active conduct of sanitary-educational work among the population. Medical assistants and midwives are directly involved in organizing and conducting medical examinations, the annual medical examination of the rural population.
It can be said that FAP is the face of medicine in rural areas. But that's the whole difficulty, that with FAPs everything is great only officially, and even then outside of statistics and exclusively in the language of local reporting. The face of medicine in the village may not come out ...
In fact, most of the FAPs are morally obsolete for a long time, and in many localities there are no FAPs at all. The message is often this: “what kind of a FAP should they have if there are 30 yards left in the village and there are no young people at all”. The fact that the departure of this very young person can be “somehow” connected, including with the lack of elementary medical care, report makers and analytical information for budget variations is not particularly worried.
According to the information of the Independent Monitoring Foundation “Health” with reference to the data of the Accounts Chamber, in 2015 in Russia there were 31,6 thousand FAPs - in all regions of the country. However, not all work now. As it turns out, many are listed only on paper. That is, the FAP as a building, it seems, is there, but as a real medical institution - with staff and equipment, it seems, and not ... And despite the fact that in the vast majority of cases, FAP is the only place in the village where you can buy basic medicines . Well, do not go to the pharmacy network to where customers even if constant, but very few. Do not go.
The issue of the availability of primary medical care in the village and remote areas was discussed at a meeting of Russian President Vladimir Putin with the Minister of Health of the Russian Federation Veronika Skvortsova. It was in August last year.
Veronika Skvortsova cited the statistics of the Ministry of Health of the Russian Federation characterizing the scale of the problem:
- 63% of rural residents seek medical help in the city;
- in the period from 2005 to 2011, the number of obstetric points decreased (or, as we like to say, “optimized”) by more than 5 thousand, then the state program entered, but it clearly does not cover the needs: from 2013 to 2015 year was open only 460 FAP;
- in some villages FAPs work once a week; villages with fewer than 100 people were left without any medical assistance at all;
- 17,5 thousand settlements have no medical infrastructure, of which in the 11 thousand - to the nearest doctor more than 20 km “on the move”;
- in 35% of settlements where there is no medical care, there is also no public transport;
- in regions with low population density, such as, for example, the Kamchatka Territory, there are no mobile brigades;
- The time of arrival of the ambulance carriage to the village can reach several hours. Or maybe this “carriage” doesn’t reach the patient at all for the most banal reason - a thaw, the road is “razvezlo”.
The Ministry of Health, as he claims, keeps this situation under control. In 2016, the Minister of Health signed an order to organize the provision of primary health care to rural residents.
According to the order, populated areas with the number of inhabitants more than 2 thousand people should have an ambulatory. When the number of inhabitants is from 301 to 2, thousand people must have a FAP or outpatient clinic. With the number of 100-300 residents, medical assistance should be provided through the FAP or field work (choice).
In search of a solution to the problem, regional authorities are looking for different ways.
For example, in the Belgorod region, which by many parameters in the Russian Federation acts as a standard, rely on mobility. A mobile obstetric point for the second year runs in areas where there are no medical assistants at all. The same mobile medical stations operate in the Chelyabinsk, Orenburg, Sakhalin regions, on Yamal and in the Komi Republic.
The medical organizations of the Ivanovo region formed 47 medical teams for visits to rural areas, organized the delivery of rural patients to central district hospitals and specialized healthcare institutions.
In the Voronezh region in the framework of the project “Quality of life. Health ”over the past two years, the building has been built 59 obstetric stations and 12 medical ambulance stations.
Nevertheless, measures taken to improve the situation with rural medicine are not enough. They are - it is a fact. But once again - they are not enough for such a huge country. Even despite the positive reports from the regions, the negative trends in terms of access of rural residents to medical care continues to persist. In a number of regions - it is aggravated.
Most rural residents in the 21st century also do not have the opportunity to undergo a normal medical examination and cannot afford complete treatment. For many villagers the trip to the district hospital is very expensive, and the debts. In this regard, the death rate in rural areas, which is often several times higher than the birth rate, cannot but grow. And this causes concern about the state of demography in the countryside. To put it mildly, anxiety ...
In conclusion, I would like to note the following thing: the FAP is not just an important part of the infrastructure where you can get first aid, advice on treating diseases, consult, take a referral to a district clinic, give an injection or buy medicine, but also . (and for the rural dweller it is sometimes equally important) - to find understanding from the person in the white coat - a person who is truly prayed in the villages as someone who can come to the aid at the most difficult moment. This is moral support, the effect of which is sometimes no less than from therapy.
I would like this problem, directly connected with demography, in state structures to be dealt with progressively and professionally.
Information