Public health services

Information on development of public health services
in the Jewish Autonomous Region

The Jewish Autonomous Region was formed according to the decision of the Presidium of the General Executive Committee of the USSR from May, 7, 1934, with the centre in Birobidzhan.

The region is located in the southern part of the Russian Far East. In the west it borders on the Amur Region, in the east – on the Khabarovsk Territory, in the south its border passes along the Amur River during 584 km and coincides with the frontier of Russia and China.

The area of the region is 36,3 thousand sq. km, population of the region is 185,5 thousand persons (for 01.01.2008), 122,7 thousand persons of them are town-dwellers and 62,8 thousand persons are countrymen. In the region there are 36 municipal formations.

The system of public health services of the autonomy has come a long way from the date of its establishment. It arose on a thinly populated territory, i.e. practically in an empty place. Today it is a complex of medical, prophylactic establishments and organizations, in which thousands of employees render a full set of medical services, promoting improvement of health of the region’s population.

Work of many physicians is appreciated. 27 doctors are awarded with the honorary title "Honorary Doctor of the Russian Federation", 8 paramedical workers - with the honorary title "Honorary Worker of Public Health Services of the Russian Federation”. Seven medical workers carry a rank "Honorary Citizen of the JAR". About 380 persons are awarded with orders and medals.

The network of medical institutions is submitted by 17 establishments of public health services including stationary divisions, 5 of which are specialized regional official bodies of public health services.

Phthisiological, psychiatric and narcological services are centralized at a level of regional specialized treatment and prophylactic establishments.

The out-patient and polyclinic help in the region is rendered in polyclinic branches of treatment and prophylactic establishments, 9 ambulance stations, 3 independent polyclinics, 61 paramedical and obstetrician stations and 15 health centers, which are structural divisions of ambulance stations, district, and central district hospitals.

The system of rendering of the first help includes one emergency station and 14 branches and is submitted by 103 emergency teams, 8 of them are medical ones, 4 - medical specialized cardiological ones, 91 – paramedical ones.

In the region technologies, which let to substitute inpatient treatment (day time hospitals, hospitals of day time stay, hospitals in-home), are developed: there are 10 of them at hospitals, and 19 - in out-patient and polyclinic establishments.

Activity of bodies and establishments of public health services of the Jewish Autonomous Region in the last years is carried out within the framework of the Concept of development of public health services and medical science in the Russian Federation till 2010 and performance of powers of the subject in connection with the introduction into action of the Federal Law from August, 22, 2004 № 122-FZ and the Federal Law from July, 4, 2003 № 95-FZ.

In the region formation of the network of regional state and municipal establishments of public health services, to which objects of the regional and municipal property are transferred to operative management by bodies of the state and municipal property, is completed.

At calculation of cost of the Territorial Program of state guarantees of rendering to citizens of the Russian Federation of free-of-charge medical aid are used specifications confirmed by the Government of the Russian Federation.

The Territorial Fund of the Obligatory Medical Insurance finances the insurance medical organizations working on the territory of the region, which carry out payment of medical aid by treatment and prophylactic establishments for actually executed volumes of work.

The main implement of realization of the social and economic policy in the region is development and realization of regional and branch target programs, which allow concentrating available financial resources for the decision of key problems facing to branch.

Due to efforts, which are undertaken by the regional government on strengthening material base of public health services, a new building of a maternity department together with a maternity welfare clinic, which meets modern requirements of construction of similar objects of public health services, has been constructed. They are equipped with modern equipment including those of expert class. Hospitals, out-patient and polyclinic establishments, paramedical and obstetrician stations of the region have been enriched with modern equipment as a result of realization of the priority national project in sphere of public health services and regional target programs.

In regional public health services methods of prophylactic and treatment of diseases, public health cares, works of initial parts of public health services, ambulance stations, polyclinics, emergency stations, municipal hospitals are constantly improved.

One of the basic directions developed at the present stage in the organization of system of public health services is increase of its structural efficiency. Regional specialized establishments, centres concentrating expensive medical equipment, the newest medical technologies and highly professional staff will be further developed. Technologies, which let to substitute hospitals and save resources, will be developed more actively.

Work on the organization of nursing wards and medical and social help will be continued together with bodies of social protection.

The special attention is given to personnel policy. Due to realization of the regional target program "Medical Staff" it was possible to achieve high parameters of certification of doctors and paramedics. In the region 58,0 % of doctors and 54,4 % of paramedics have qualifying classes. 114 graduates of regional schools are trained on target directions in medical high schools of the Far East. In the region scientific and practical conferences with participation of leading experts of the Far East federal district, Moscow, Saint Petersburg are regularly carried out. A number of doctors are members of editorial councils of medical magazines, are members of boards of scientific organizations. For the last years 3 Ph.D. theses and 2 doctoral theses are defended by regional doctors on local material.

The department of public health services of the regional government, bodies of the government together with interested organizations carry out work on improvement of health of the regional population, reduction of death rate, duly revealing of socially significant diseases and their prevention, constant improvement of quality of medical aid.

In January – August 2008 birth rate made 13,6 on 1000 population. For 8 months of 2008 1685 children were born alive, that on 51 children more than in 2007 (1634 children).

The parameter tends to grow in all districts of the region, especially in Birobidzhanskiy, Leninskiy, and Oktyabrskiy districts. In countryside the level of birth rate is higher than in the city district as usual. It is necessary to note the positive tendency within last five years - increase of a parameter of normal deliveries from 27% in 2003 up to 35,3 % in 2007 (the Russian Federation (2004) - 32,9 %).

In January – August 2008 in comparison with January – August 2007 the level of population loss in the region reduced in 10 persons or in 3,4 %. At the same time advantage of died persons number over born persons made 16,9 % (in January – August 2007 - 18,1 %).

In January – August 2008 the general number of died persons was 1970. Thus death rate depending on the following reasons has made: cardiovascular diseases – 1110 persons (56,3 %), new growths – 249 persons (12,6 %), tuberculosis – 81 persons (4,1 %).

In January – August 2008 infant mortality rate has decreased in half in comparison with the same period of the last year. From 1000 children born in January – August 2008 13 children at age till 12 months died (in January – August 2007 – 26 children). Among the reasons of infant mortality deaths of states originated in perinatal life prevail.

Maternal mortality rate in 2008 is not present (in 2007 – 40,9 on 100 thousand of children born alive - 1 case).

Decrease of number of persons, who are considered to be disabled, is marked, both adults and children.

For development of law and information provision in the region are accepted:

• Law of the JAR from 07.02.2007 N 74-oz "On measures of social support of foster homes in the Jewish Autonomous Region";
• Law of the JAR from 07.02.2007 N 72-oz "On size and order of payment of money resources on support of children in families of guardians (tutors) and foster homes, and on payment of foster homes in the Jewish Autonomous Region";
• Decision of the JAR Government from 10.04.2007 N 105-pp "On order of granting of meal to children from needy families, who are trained in general educational establishments, located in the territory of the Jewish Autonomous Region";
• Decision of the JAR Government from 08.05.2007 N 137-pp "On the statement of payment order of annual lump-sum for a child – schoolboy/schoolgirl from a large family";
• Decision of the JAR Government from 25.09.2007 N 256-pp "On the order of payment of money resources on meal, purchase of clothes, footwear, soft stock to children - orphans and children who have stayed without care of parents, living (lived) in families";
• Law of the JAR from 24.11.2004 N 352-oz (redaction from 18.09.2008) "On payment of workers of regional state bodies";
• Law of the JAR from 05.12.2007 N 263-oz (redaction from 18.09.2008) "On the regional budget for 2008";
• Decision of the JAR Government from 26.08.2008 N 238-pp "On the regional target program "Ecology of the JAR" for 2009";
• Decision of the JAR Government from 26.08.2008 N 239-pp "On the regional target program "Improvement of demographic situation in the JAR" for 2009";
• Decision of the JAR Government from 29.07.2008 N 207-pp "On the regional target program "Precaution of drug addiction in the territory of the JAR" for 2009";
• Decision of the JAR Government from 29.07.2008 N 196-pp "On the regional target program of "Children - orphans" for 2009";
• Decision of the JAR Government from 29.01.2008 N 11-pp "On monetary norm on a free-of-charge meal to donors of unitary plasma, to donors of double plasma, to donors of rare groups of blood in regional state establishments";
• Decision of the JAR Government from 22.08.2008 N 139 "On confirmation of the order of establishment of duration of doctors and paramedical personnel pluralistically in regional state establishments where there is their lack".

Innovational methods of examination and treatment are introduced in practice of work of patient care institutions:

• Technique of rupture plasty by propylene is mastered;
• Vascular operations are introduced;
• Replacement of abdominal aorta;
• Endosurgical operations;
• Operations of pancreas;
• Plasty in case of tracheoesophageal fistula.

Interdepartmental interaction in sphere of public health services is carried out in the region on the basis of contracts between the department of public health services of the JAR Government and medical divisions of the Department of Internal Affairs, the corrections administration, the Birobidzhan frontier group, the regional branch of the All-Russian public organization "Russian Red Cross".

Inter-regional interaction is carried out within the framework of the agreement on trade and economic, scientific and technical and social and cultural cooperation between the Administration of the Amur Region and the Government of the Jewish Autonomous Region, the agreement on trade and economic, scientific and technical and social and cultural cooperation between the Government of the Khabarovsk Territory and the Government of the Jewish Autonomous Region.

The international cooperation in the sphere of public health services is carried out with the frontier province of the People’s Republic of China Heilongjiang, cities of Jiamusi and Hegang.

The exchange of delegations of heads of bodies and establishments of public health services, medical workers of both countries, realization of joint scientific and practical conferences, exhibitions are carried out.

In 2006 within the framework of the Year of Russia in the People’s Republic of China the international scientific and practical conference in the city of Hegang on the theme "Topical questions of public health services" was carried out. In 2007 during the Year of China in Russia the scientific and practical conference was carried out in Birobidzhan.

In forthcoming years before public health services of the region complicated problems will stand. It is necessary to provide effective functioning of complete, organizational and economically flexible system of rendering of medical aid at municipal and regional levels. It should become accessible to the population, not depend on the status of citizens, level of incomes and residence. Thus social justice in society regarding rendering medical aid will be achieved.