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Health service in Russia during last 100 years

Prokhorov B.B.

For the last 100 or so years the Russian medical care went through quite complex changes. This was the way of success and failures, achievements and tragedies and the results are being quite controversial.

At the end of XIX beginning of XX century the local medical care became much closer to people, especially to rural inhabitants. Local doctors significantly decreased the infant and mother mortality, increased sanitary conditions of the cities, improved sanitary statistics. However, the local medical care had too little time, to accomplish all the progressive actions planned by Russian doctors during their conferences and meetings. The WW I and then the October Revolution terminated their activities.

Before the WW I, 17 medical faculties of the universities and medical institutions were located in Russia, with about 1000 doctors graduating annually. In large cities, the primary medical care to incoming patients was provided in 1230 day-care hospitals and clinics. More than 1/3 of all cities did not have hospitals, 26 % of all hospitals possessed 5 and less beds, 53 % 620 beds and only 21 % had more than 20 beds. Only 9 cities had first-aid stations. Only 7,5 thousand beds were available for pregnant and women in labour, with only 5% of all deliveries proceeded in special hospitals. Obstetrician assistance was delivered mainly by female obstetricians and midwives. 342 doctors were working in sanitary organization, present in 73 cities and 40 areas of Russia. In total, 28 sanitary laboratories were included in this organization.

During the Soviet period, in spite of all grief and distress that happened upon Russia, practically all infectious diseases, that previously were the main cause of mortality, were eliminated. The important achievement of Soviet medical care was the development of joint state epidemic service.

The widespread introduction of dispensary and ubiquitous qualified out-patient and clinic services should be considered as one of the achievements of domestic health care.

The network of prenatal care dispensaries, maternity hospitals, obstetrics and gynecology sections in hospitals, kolkhoz maternity hospitals and obstetric stations with medical assistant in rural areas, provided a qualified medical care to all women in labor. Special departments of prenatal pathology were created in many cities. The works of prenatal care dispensaries contributed to significant decrease in maternal mortality, still-born and infant mortality.

Child welfare was delivered by medicalpreventive centers: polyclinics, hospitals, child care departments in general hospitals, nurseries, departments of school hygiene , sanitary-epidemic stations etc. The network of dispensary children care was accomplished by pediatricians and health-visitors. Special departments (surgery, neuropathology etc.) were created in child hospitals and polyclinics. More than 3 thousand stations and about 6 thousand groups of first-aid help are providing 24-hour service to patients and sick persons.

When the war aftereffects and after-war devastation were bridged by the beginning of the 1960-s, a significant advances were achieved in the work of medical services and improvement of population health. The average life expectancy has increased more than twice and the infant mortality has decreased, comparing to the beginning of the century. However, the erroneous strategy designed for health care and difficult life conditions led to situation, when during the subsequent decades and till present time, the public health in Russia not only has improved but even deteriorated. The comparison of modest achievements of domestic medicine with those impressive advances, seen in the economically developed countries (including countries that were defeated in WWII Germany and Japan) suggests that development of Soviet Health Care was proceeding along the wrong way.

At least 12 main causes of deterioration of public health can be named at present:

1. The lack of priorities for public health in the work of local governing institutions and other administrative institutions including local administration.

2. Maintaining the consumer-like attitude of the population to their own family and surrounding people health and to personal health. The lack of true interest in the majority of people to improving personal health (the lack of self-protecting attitude). Low quality medical knowledge and sanitary-hygiene practice.

3. Fast growth of accidents, poisonings and traumas due to increasing drinking and alcoholism, drug usage and toxic substances usage. The mortality from traumas increased in 1,8 times in 1994 comparing to 1990, the mortality from cirrhosis and drunk psychoses increased from 18,2 to 68,8 thousands ( in 3,8 times). The number of murders increased from 15,6 to 32,3 thousands ( in 2,1 times).

4. As a reaction to the transition period (1991-1994)

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