VZCZCXRO1389
RR RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHMO #1811/01 1100414
ZNR UUUUU ZZH
R 200414Z APR 07
FM AMEMBASSY MOSCOW
TO RUEHC/SECSTATE WASHDC 9545
INFO RUEAUSA/DEPT OF HHS WASHDC
RUEHYG/AMCONSUL YEKATERINBURG 2377
RUEHVK/AMCONSUL VLADIVOSTOK 2061
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHPH/CDC ATLANTA GA

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