The Leadership of the Presidential Administration, the PMR Government, the Ministry of Health and PSU were invited to the working discussion, initiated by the President. The main issues on the agenda are the draft Concept of development of health care of the PMR, improvement of the system of receiving medical education and continuation of work on updating infrastructure of medical institutions.
The essence of the eight-year concept of the development of the medical industry was presented at the meeting by the PMR Minister of Health Alexei Tsurcan. He noted that the creation of the project was preceded by serious analytical work by representatives of specially created working groups and interdepartmental commissions, which included international experts. Conclusion of specialists: one of the most serious problems of Pridnestrovian medicine is the inefficiency of the system of primary health care. We are talking about the activities of clinics, dispensaries, obstetric centers. A serious shortage of district physicians and pediatricians was recorded. As a result, a situation has arisen, when medical activity prevails over prophylactic, which has led to a growing need of the population for expensive treatment in the hospital. “If we talk about the financing of the polyclinic sector and the hospital sector, then 70% goes to the financing of hospitals. Although the trend throughout the world is completely different: at least it is 50 to 50, or more attention is paid to polyclinics, including financial”, the minister noted.
The proposal to give a central place in the health care system to the local doctor is conceptual. The principle of dividing into sections is preserved, and their number, according to the project, is increasing, which will reduce the burden on the doctor. The effective standards of our health care system are 1500 people per therapist, international ones, which are proposed to be approached 1200-1300. “If we take the new standards, taking into account the population of the republic, then we need approximately 290 district therapists (today we have 180 sectors) and 90 pediatricians. In total, we are talking about 380 doctors who will be responsible for the population entrusted to them”, said Alexei Tsurcan.
The model of general medical practice of district doctors requires their retraining. In this regard, there is a special advanced training program. In the therapeutic service, an important role will be played by preventive, consulting, explanatory activities, as well as medical examination of the population. Strengthening the primary health care level will allow 70% of problems to be solved at the level of polyclinics, according to the developers of the draft Concept of Health Development until 2026. Today, the “map” is being prepared, on which a complete picture of the availability and need for medical facilities in each locality will be visible. The plan of measures necessary for the practical implementation of the Concept is being developed. This work should be completed by August of this year, said Alexei Tsurcan. The program of state guarantees is also on the agenda, the adoption of which will make it possible to clearly define what is free of charge in Pridnestrovian healthcare, and which services are provided on a commercial basis. The wording “everything is free, but within the framework of existing financial opportunities” gives grounds for discrepancies, misunderstandings and dissatisfaction on the part of citizens. “We want to approach more specifically, more honestly, so that our citizens clearly understand: state funds are absolutely enough for this, partly, there are quotas for benefit recipients, and everything else is for a fee”, explained the government’s position Aleksey Tsurcan.
Another priority direction reflected in the Concept is the centralization of the ambulance service. To date, these are five different stations that act separately. It is proposed to introduce the republic-wide dispatching service with a single number “103” without specifying the city or district code. As for the state of the infrastructure, there are plans to overhaul the buildings and premises of the stations, to build the necessary boxes and garages for cars. 36 million rubles are allocated for these purposes. More than a dozen ambulances will be purchased this year. The total demand in the republic is 38. The personnel problem needs to be solved. Despite the recent increase in the salary level of doctors and paramedics of ambulance, there are still not enough specialists. The topic of material incentives for medical workers was discussed during the meeting not only in the context of the functioning of the ambulance service, but also in the context of the health care sector as a whole. At the same time, the President noted that it’s wrong to consider salary growth or allowances as a motivational tool: comfortable working conditions should be created, working space should be organized, professional growth prospects and protection of the physician are important.
Another aspect that the President pays special attention to is building the relationship between the health worker and the patient. Vadim Krasnoselsky returned to the topic of public discontent with health care. The President cited the statistics of complaints addressed to him, noting that a significant proportion of them are directly related to the behavior of medical staff and the quality of medical services. Citing specific examples, the President noted, “The human factor is fundamental in any business. No matter how good, even the ideal mechanism, corruption and rudeness will destroy it. The negative attitude of one particular doctor or nurse can eliminate all the efforts of the administrative apparatus. I have great respect for the work of doctors, among them there are many excellent specialists, decent people. It is very disappointing when individuals cast a shadow on the system as a whole, putting an end to the efforts of others by their behavior”, said the President. He urged to be attentive to the appeals of citizens, not leaving any signal without response. According to Vadim Krasnoselsky, “it is not only and not so much to bring the perpetrator to justice as to fix the problem, draw conclusions and prevent such things from happening in the future”.
Summing up the discussion of the draft Concept of Health Development of the PMR, the President recommended not to focus on the already prescribed provisions, but to listen to the opinions of specialists, especially existing physicians and theorists who are preparing future doctors, to make necessary adjustments in working order in order to get the optimal document, implementation of which will improve the situation in health care. The President ordered the creation of a Consultative Council under the Ministry of Health. The list of persons to be proposed for inclusion in it should be submitted to the President before approval.
They spoke in the course of the meeting on the Capital Investment Fund as a source of funds for updating the medical infrastructure. 50 million rubles have been allocated from it for the construction and repair of 33 facilities for the current year. The President again returned to the question of the need for field leaders of the relevant ministry to go to the field to assess the feasibility of including one or another object in the program and analyzing incoming proposals.
They discussed tenders for the purchase of medicines and medical equipment at the meeting. There are complaints about the procedure. The mechanism should be as transparent as possible, the President emphasized, noting that, if necessary, appropriate changes should be made to the legal framework.
The four-hour discussion on improving the health care system of the republic held at the site of the Presidential Administration is an integral part of the large-scale work of the state apparatus aimed at improving the situation in this area. This question is under the personal control of the President.
