The forum is taking place on September 6–7 at the Expo Centre Central Exhibition Complex. More than 600 people are taking part, including Government members, heads of federal agencies, regional ONF activists, and healthcare sector experts such as scientists, practicing doctors and teachers at medical schools.
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Excerpts from transcript of Russian Popular Front forum For Quality and Affordable Medicine!
President of Russia Vladimir Putin: Good afternoon, friends and colleagues,
First of all, I want to thank you for choosing one of the most relevant subjects this year, a subject of vital importance to everybody. Last year, the ONF tackled the subject of education, which is also a crucially important issue and concerns practically every single person and every Russian family. As for healthcare – what can you say, this is about life itself, health, and quality of life.
We having been giving this issue our constant attention of late and I hope that amongst everything else, the forum’s sessions and discussions have noted the positive changes taking place in this vital sector. Even so, a great many problems remain, more than enough issues that still need to be resolved. I am sure that these subjects will be the ones most discussed: the ratio of fee-paying and free medicine, the quality of medical services, the pharmaceuticals sector, training for doctors, and so on. Of course, no matter which angle you take, each of these issues is, as in the case of pharmaceutical preparations, a vital component, and absolutely essential for the country to be confident and for our people to feel at ease.
Of course, training of medical personnel and the social guarantees they receive, their level of wages, are exceptionally important issues. This has to be in harmony with the people for whom medical workers perform their labour and with the people who are to receive their services. I know medical workers do not like the word ‘services’, but let me call it that.
I am sure you have discussed these matters and I very much want to hear the conclusions you reached. Let me assure you that, as was the case last year, we will take the most serious measures to implement the ideas and proposals that come out of the ONF’s work in this area.
I think it is very important that in your preparations for this session and for the work yesterday, you worked directly with people, with patients and with the professional community, to identify what we are getting right, and where there are still problems. This kind of direct contact with the public and public feedback is extremely important. Ultimately, this is why we set up the Russian Popular Front in the first place.
I will conclude here and give the floor to the session’s chair and the head of the ONF. Of course, I would like later to hear the ideas you came up with as a result of your discussions yesterday and today, and then we will discuss all of these issues. Please, go ahead.
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Vladimir Putin: I understand that we are now starting on the presentation of specific issues that were examined during the sessions. I want to take the opportunity right now to thank Mr Govorin [Co-Chairman of the ONF Regional Headquarters in Trans-Baikal Territory Nikolai Govorin] for giving such a broad overall summary of the discussions that took place. The issues he mentioned will no doubt be examined in more detail during our discussion today, but I want to make a few comments right away, if you permit.
First, Mr Govorin spoke of the need for a moratorium on the reforms that have begun, the changes, optimisation, call it what you will. The way I see it though, the sense of this work you have been pursuing all year is not to put a stop to all changes, but to set them on the right track. If you see that something is not being done right, not done on time, or not done as was planned, the most important thing is to adjust the reforms, make needed and timely corrections.
But we cannot overlook the positive results that have been achieved over these last years, and the fact is that we have achieved a lot over these last few years. Financing is absolutely crucial here of course, federal and regional financing. I can tell you that overall, the state authorities are financing everything that was planned in the healthcare development programmes. Average financing for healthcare over the last 3–4 years has come to 3.6 percent of GDP. This is neither a lot, nor a little. It is a fairly solid figure. This year, financing was slightly higher, and our preliminary estimates suggest that the amount will be slightly lower next year, but overall, financing will remain at around this share of GDP. Let’s see how the situation looks at the end of what has been for the Government the difficult job of preparing the budget for 2016.
On the subject of rural areas, this is something we will certainly discuss in more detail. Of course, this issue concerns me greatly too. In our work on strengthening primary healthcare, we put considerable resources into rural healthcare over the period through to 2014 inclusive. Of total financing allocated, around 30 percent (27.7 percent, I think it was) went into healthcare in rural areas. But practice shows that whenever there is talk of cutbacks and optimisation, for some reason, they always begin in the rural areas.
This is perhaps justified from a purely economic point of view, given that you only have a few people living in some little village, and maintaining a paramedic centre there is more expensive in general than running an inter-district hospital. But if people have no way of getting medical assistance other than in their little medical centre that has been open for decades already, you cannot just close it down. I have heard people tell sad jokes about how the latest village facility has just closed down and the only medicine available to them now is garlic. In some cases, it’s hard to know what even to say in reply. Therefore, we must, of course, pay more attention to healthcare in the countryside.
On the subject of the fact that we have a shortage of healthcare sector workers while at the same time cutting back jobs in some places, the issue here is not the cutbacks and shortages themselves, but the fact that we need people who meet modern demands and can ensure a high quality of work. If optimisation takes place here and there, it is not a sign of any disaster. What is important here is that highly qualified modern specialists replace the people laid off. Essentially, you made this point yourself when you said we need to pay more attention to training personnel. Thank you.
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Vladimir Putin (in reply to forum participants speaking about medicine advertising and the development of the pharmaceutical industry): I believe the doctor has just said something very important: we need control and a system, or some principles [of advertising], because there is only one principle working now: the market principle of promoting goods at any cost. This, on the one hand, is obvious, but the problem is how to choose the right thread in this delicate fabric, making sure the product is promoted without killing advertising completely, but also without over-bureaucratising decision-making, the way our colleague from the pharmaceutical industry suggested, a person involved in pharmaceutics as a business. He actually suggested increasing the number of medicines that should be sold only by prescription. But we know that one of the problems polyclinics face today is long queues, it is still the case. And this will make these queues even longer.
We have to strike the right balance here. We will not be able to cover everything in this discussion, but we will analyse your work over the past year and all the discussions you had over the two days and will make decisions and issue instructions to the Government, the ministries, agencies and regions. I would like to hear suggestions from you, I am simply asking for your help here. I would like the interested people, who are professionals, to make good proposals that could be put into practice.
And à propos, I can inform you, or rather remind you that by 2018 we are planning to bring the pharmaceutical industry to the level when about 90 percent of medicines currently in use in Russia will be localised in Russia.
Addressing our colleague who has just spoken and all those involved in this activity, I would like to remind you that if we bring in certain substances and then mix them here, this would not mean local production. We need to have the substances produced here, on the territory of the Russian Federation. We need our colleagues involved in this business (I would like to tell those who do not know and remind those who do that this is a very profitable business: the rate of return is so high that even some criminal activities known as super-profitable can wish for the same) to invest in the development of our own national pharmaceutical industry.
We have launched a programme that cost about 150 billion [rubles] to develop our own pharmaceutical industry. However, without your involvement, involvement of your colleagues and businesspeople working in this sector we will not be able to resolve this problem. The federal funding is only designed to create conditions, to give an impetus to the development of this business. I strongly hope we will achieve this. This is the first thing.
The second thing I would also like to talk about is something we have never spoken about and do not plan to: that we would prohibit the import of certain substances or equipment. We will never do it. We simply need to develop their production here so that we have competitive products, not only generics, but we have to develop and introduce our own formulas. I know that many of our pharmaceutical companies have wonderful, highly skilled specialists working for them, they have created entire research teams capable of coming forth with new formulas and even expanding the range of medicines we would produce here, in Russia, and promote them on the global market.
Let us consider such instruments together.
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Vladimir Putin: Regarding civil servants who prefer to undergo medical treatment abroad, this issue is similar to that of opening bank accounts abroad. If a person does not trust the national banking system, they have the right to open a bank account abroad, but in the case of civil servants, especially high-ranking ones, this only means they do not wish to work properly, because if they wanted to do their job properly they would have been working to improve our banking and financial system. That way they would have been confident that they could keep their savings (earned in an honest way, of course) in Russian financial institutions.
Where does our Finance Minister keep his money? Mr Siluanov, where do you keep your money? (Laughter)
Finance Minister Anton Siluanov: Mr President, the Finance Ministry uses the services of a Russian commercial bank.
Vladimir Putin: Not the Finance Ministry, Mr Siluanov, but you personally – where do you keep your money?
Anton Siluanov: I wanted to say that Finance Ministry employees use the services of a Russian commercial bank, and that is where I keep my savings and my account.
Vladimir Putin: Ms Golodets, where do you get medical treatment?
Deputy Prime Minister Olga Golodets: I do it in the Russian Federation, I have some favourite clinics. Unfortunately, the result is not always there, but that is exactly the problem of our system that we need to resolve together.
Vladimir Putin: The same is true of educating children – here or abroad. This is especially interesting in regard to people who hold high posts. They should be concerned about improving the healthcare system and receiving medical treatment here, and improving our education and let their children get their diplomas here.
This is a moral choice, of course, but I believe that it would be wrong to prohibit or force people to do things, while motivating people to use services of the national healthcare and education system is something that can be done. Of course, we need to watch the people who make this or that choice. I assure you, this is exactly what I do.
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Vladimir Putin (commenting on the remarks of the National Medical Chamber President Leonid Roshal): It was good to hear that in the course of this discussion we would like to reach some positive solutions. I know that the Healthcare Ministry and our other colleagues were concerned with the way the preparations for this event were going.
I would like to once again stress that the purpose is not to punish someone or bring some issue to light. The purpose is to ensure a better life for our people, to ensure a higher quality of medical services. With this aim in view we have to look for drawbacks, understand them and search for ways of eliminating them. There is nothing personal here; we are both doing the same thing.
What our esteemed colleague Dr Roshal, whom many people love, said is absolutely right: we do have quite a few problems here too. However, he mentioned the annual medical examinations. I would like to remind you that we have launched regular medical examinations for children from birth to the age of 17. Moreover, back in 2007–2008 we introduced medical examinations for orphans and children without parental care or in a difficult life situation. Now we have moved to mass scale annual medical examinations for children from birth to the age of 17. But that is not the point.
During my recent meeting with Ms Skvortsova [Healthcare Minister] I asked her “What’s next?” Suppose a health problem has been found. We have to ensure that children do not develop chronic problems based on medical conditions discovered during annual medical examination. We have created several hundred special centres for children all over the country to treat them once a certain disease or disease susceptibility has been detected. This is an area we need to move ahead in, to expand this network. This is one thing.
The other thing about the centres: we are building 32 perinatal centres, along with high technology medical centres (this is actually also high-technology medicine) and we definitely need to carefully continue this work. We have to achieve a further reduction of child and maternal death rates, though here we do have visible progress, a certain result.
Mr Roshal just mentioned children with extremely low body weight. You know, after we switched over to international standards, infant mortality practically didn’t increase in our country, and where it did grow a little it was due to tougher standards, and it eventually levelled out, primarily in locations with perinatal centres. This is not just some facility in a specific town – an entire network is being created.
First of all, healthcare in a region improves significantly once a perinatal or high technology centre opens there, and the level of training of specialists improves, and others also start raising their qualifications. This turned out to be very important: this is where the situation improves not only in terms of personnel training or available equipment, but also in terms of overall level of medicine. We have to make sure that we do not, under any circumstances – as some of our colleagues have said here – lose whatever we have achieved here in the past years.
In this connection, I would like to note that we do not intend to cut funding. I said that over the past 3–4 years the average figure was 3.6 percent [of the GDP]. It varied: we had 3.8 [percent], 3.5 and 3.4. In the current difficult conditions, we need to at least maintain this average level. We will work for this; at least this is what I will ask the relevant Government structures to keep in mind as they draft the budget for next and subsequent years. As for personnel training, I believe we have already switched to training using third generation standards. We have to move along here as well, of course, and develop further.
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Vladimir Putin: Unfortunately, I need to move on to the next event. I have already said that in the course of such a discussion we would hardly be able to cover everything and raise all the questions that you have been discussing this year and over the past two days. Therefore, I proceed from the idea that Mr Govorukhin [Co-Chairman of the Russian Popular Front Central Headquarters] and our other colleagues will summarise it all and we will study it very carefully and will try – actually, will definitely implement certain things. Meanwhile, I would like to ask you to monitor how this is done.
I would like to conclude this meeting with something Mr Roshal has already mentioned. I would like to thank all medical workers. Despite a lot of criticism you get (it is fair in part, and you understand this), I would like to nevertheless thank you for your work, for dedicating your lives to this noble cause. This is a very interesting and useful job, though we tend to think of doctors only when we get sick. But be that as it may, we always know that this is one of the most called for and honourable missions in the world, has been since the beginning of time, ever since humans realised they were humans. Let us all hope that through our joint work, in this case within the Russian Popular Front, we will make it even better for the benefit of the citizens of the Russian Federation.
Thank you very much.