Approved Decree of the Government of the Russian Federation dated April 15, 2014 No. 294. This resolution recognized the Decree of the Government of the Russian Federation dated December 24, 2012 No. 2511-r, which has become invalid.

Responsible executor: Ministry of Health of the Russian Federation (). Co-executor: Federal Medical and Biological Agency ().

Program participants: Ministry of Foreign Affairs of the Russian Federation, Ministry of Defense of the Russian Federation, Ministry of Industry and Trade of the Russian Federation, Ministry Agriculture Russian Federation, Ministry of Labor and social protection Russian Federation, Ministry of Finance of the Russian Federation, Ministry of Economic Development of the Russian Federation, Ministry of Energy of the Russian Federation, Federal tax service, Federal Service for the Execution of Punishments, Federal Service for Supervision of Healthcare, Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Federal Service bailiffs, federal agency Air Transport, Federal Agency for Sea and River Transport, Federal Agency for Scientific Organizations, Federal Agency for Management state property, Federal Highway Agency, Federal Compulsory Medical Insurance Fund.

first stage: 2013 - 2015
second stage: 2016 - 2020

Volumes of budget allocations, thousand rubles

	2013	2014	2015	2016	2017	2018	2019	2020
Facilities federal budget(according to a preliminary estimate of 2451185163.2 thousand rubles)	413096449,8	357154180,6	260503600,8	262867673,8	263304352,2	286879826,8	299241851,9	308137227,3
Funds of the consolidated budgets of the constituent entities of the Russian Federation (according to a preliminary estimate of 11079448074.3 thousand rubles)	855100000	1278914456	1336464817,5	1396605734,3	1459452992,4	1525128377	1586133512,1	1641648185
Funds of the Federal Compulsory Medical Insurance Fund (according to a preliminary estimate of 13090239782 thousand rubles)	1059200000	1240116074,5	1452032467,1	1521253067,1	1684669055,1	1857824179,3	2042263268,1	2232881670,8
TOTAL:
The total amount of funds is:	26 620 873 019,5

Expected results of the Program implementation

decrease in mortality from all causes to 11.4 cases per 1000 population;
reduction in infant mortality to 6.4 per 1,000 live births;
reduction in mortality from diseases of the circulatory system to 622.4 cases per 100,000 population;
reduction in mortality from road traffic accidents to 10 cases per 100,000 population;
reduction in mortality from neoplasms (including malignant ones) to 190 cases per 100,000 population;
reduction in mortality from tuberculosis to 11.2 cases per 100,000 population;
reduction in the consumption of alcoholic products (in terms of absolute alcohol) to 10 liters per capita per year;
reducing the prevalence of tobacco use among the adult population to 26 percent;
reduction in the number of registered patients diagnosed with active tuberculosis for the first time in their lives (per 100,000 population) to 61.6 cases per 100,000 population;
the provision with doctors will be 40.2 people per 10,000 population;
the number of paramedical personnel per 1 doctor will be 3 people;
increase in the ratio of the average salary of doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education providing medical services (ensuring the provision of medical services), to the average wages for the subject of the Russian Federation up to 200 percent;
increasing the ratio of the average salary of the average medical (pharmaceutical) personnel (personnel providing conditions for the provision of medical services) to the average salary in the constituent entity of the Russian Federation up to 100 percent;
increasing the ratio of the average salary of junior medical personnel (personnel providing conditions for the provision of medical services) to the average salary in the constituent entity of the Russian Federation up to 100 percent;
increasing the ratio of the average salary of paramedical (pharmaceutical) and junior medical personnel (personnel providing conditions for the provision of medical services) to the average salary in the constituent entity of the Russian Federation up to 100 percent;
increase in life expectancy at birth to 74.3 years

2. In the Russian Federation, federal programs for the protection and promotion of public health are financed, measures are taken to develop state, municipal, and private healthcare systems, and activities that contribute to the strengthening of human health, the development of physical culture and sports, and environmental and sanitary and epidemiological well-being are encouraged.

The obligation of the state to finance federal programs for the protection and promotion of public health is an important guarantee of the right of citizens to health care. The appearance of this norm in the Constitution of the Russian Federation was due, to a greater extent, to the crisis situation in the healthcare system in the early 1990s. 20th century

In the era of a rather abrupt transition to market relations, the state was brought to the brink of bankruptcy and significantly reduced the allocations intended for medicine. Impoverished medical research institutes were closed, doctors were not paid their salaries on time, there were not enough nurses whose salaries were unbelievably low, hospitals and polyclinics could not purchase new equipment, instruments and medicines. It should be added that only war veterans, the disabled and some others were entitled to benefits when purchasing necessary medicines. social categories. After all, at that time production almost stopped in Russia, including instrument making and the pharmaceutical industry, and the import of medical equipment and medicines was extremely expensive.

As a result, the health of Russians deteriorated sharply, a demographic crisis began - the death rate exceeded the birth rate. Men often did not live up to the retirement age - 60 years. “In that era of economic instability,” explains R. Oganov, a well-known cardiologist and academician of the Russian Academy of Sciences, “people suffered most from cardiovascular and oncological diseases, as they experienced constant stress from losing their jobs, not paying salaries and being unable to support their families. Employers V commercial organizations forced people to work overtime for free, which also undermined their health.

The absence of economic levers that stimulate, with the help of material interest, an increase in volume and improvement in quality medical care gradually led to a crisis in the health care system.

Thus, in the circumstances prevailing at that time, fixing in the Constitution of the Russian Federation the financing of federal programs for the protection and promotion of health, including comprehensive measures for the prevention of diseases, the provision of medical care, medical education of the population, and the development of certain forms of healthcare, was dictated by the urgent need to urgently resolve crisis problems. at the highest level.

The implementation of the state policy in the field of protecting the health of citizens, the development, approval and financing of health development programs are entrusted to the Government of the Russian Federation and the governments of the constituent entities of the Federation. Government program Russian Federation " Health Development"from 2013 to 2020. The state program includes subprograms: "Disease prevention and promotion of a healthy lifestyle. Development of primary health care"; "Improving the provision of specialized, including high-tech medical care, emergency, including emergency specialized medical care, medical evacuation"; "Development and implementation of innovative methods of diagnostics and treatment"; "Maternal and child health care"; "Development of medical rehabilitation and sanatorium treatment, including for children"; "Rendering palliative care, including for children"; " Staffing of the healthcare system"; "Development of international relations in the field of health care"; "Expertise and control and supervisory functions in the field of health care"; "Medical and sanitary provision of certain categories of citizens"; "Program implementation management".

In addition, there are also Federal targeted programs

Federal Target Program "World Ocean" (Subprogram "Development and Use of the Arctic")

Federal target program "Housing" (Measures to provide housing for certain categories of citizens")

Federal Target Program "Prevention and Control of Socially Significant Diseases" (Subprogram "Diabetes Mellitus". Subprogram "Tuberculosis". Subprogram "Vaccinal Prevention". Subprogram "HIV Infection". Subprogram "Oncology". Subprogram "Sexually Transmitted Infections". Subprogram "Viral hepatitis" Subprogram "Mental disorders" Subprogram "Arterial hypertension")

Federal Target Program "Improving Road Safety"

Federal Target Program "Development of State Statistics of Russia"

Federal Target Program "Children of Russia" (Subprogram "Healthy Generation". Subprogram "Children and Family")

Federal Target Program "Social Support for the Disabled" (Subprogram "Social Support and Rehabilitation of the Disabled Due to Combat Operations and Military Trauma")

Federal target program "Economic and social development of the Far East and Transbaikalia"

Federal target program "South of Russia"

Supposed construction of perinatal centers:

Federal Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow

Construction of medical centers for the provision of specialized medical care in the field of obstetrics, gynecology and neonatology (perinatal centers).

3. Concealment by officials of facts and circumstances that pose a threat to the life and health of people entails liability in accordance with federal law.

In order to ensure the constitutional right to health protection, the Constitution of the Russian Federation prohibits the concealment by officials of facts and circumstances that pose a threat to the life and health of people. The presence of this constitutional norm guarantees citizens of the Russian Federation freedom of access to information, protection from deliberate concealment of information, from the dissemination of knowingly unreliable or false information about the state of the environment, epidemics, disasters, etc. Thus, the Criminal Code of the Russian Federation in Art. 237 provides for liability for concealing information about circumstances that endanger the life and health of people. Code of the Russian Federation on administrative offenses contains ch. 13 on administrative offenses in the field of communications and information, the norms of which provide for liability for violations of the rules for the dissemination of mandatory messages, obstruction of the dissemination of products by the media. If the concealment of facts or circumstances that pose a threat to the life and health of people caused physical, material or moral harm, it is subject to compensation by the guilty persons or organizations in accordance with Civil Code RF (ch. 59). The norms of labor legislation, as the main obligations of the employer, fix informing employees about the conditions and labor protection in the workplace, about the risk of damage to health (Article 212 of the Labor Code of the Russian Federation).

APPENDIX No. 6
to the state program of the Russian Federation
"Health Development"

Rules
provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation and the city of Baikonur for the implementation of certain activities of the state program of the Russian Federation "Health Development"

1. These Rules establish the procedure for granting and distributing subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation and the city of Baikonur (hereinafter referred to as the constituent entities of the Russian Federation) for the implementation of certain measures of the state program of the Russian Federation "Health Development" (hereinafter referred to as the subsidy).

2. The subsidy is provided for the purpose of co-financing the expenditure obligations of the constituent entities of the Russian Federation related to the implementation of the following activities:

a) financial support for the purchase of diagnostic tools for the detection, determination of the sensitivity of Mycobacterium tuberculosis and monitoring the treatment of persons with multidrug-resistant tuberculosis, in accordance with the list approved by the Ministry of Health of the Russian Federation, as well as medical devices in accordance with the standard of equipment provided for by the procedure providing medical care to patients with tuberculosis;

b) financial support for the purchase of diagnostic tools to detect and monitor the treatment of persons infected with the human immunodeficiency virus, including in combination with hepatitis B and (or) C viruses;

c) financial support for medical activities related to the donation of human organs for the purposes of transplantation (transplantation), including carrying out measures for the medical examination of the donor, ensuring the safety of donor organs until they are withdrawn from the donor, withdrawal of donor organs, storage and transportation of donor organs and other activities, aimed at ensuring this activity;

d) financial provision of expenses for organizational measures related to the provision of persons with drugs intended for the treatment of patients with malignant neoplasms of the lymphoid, hematopoietic and related tissues, hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher's disease, multiple sclerosis, as well as after organ transplantation and ( or) tissues, including the storage of medicines, the delivery of medicines to pharmacy organizations, the creation and maintenance of electronic databases for the accounting and movement of medicines within the constituent entities of the Russian Federation;

e) financial support for the implementation of measures to prevent HIV infection and hepatitis B and C, including with the involvement of socially oriented non-profit organizations in the implementation of these activities;

f) providing financial support in the fulfillment of expenditure obligations of the constituent entities of the Russian Federation and (or) local budgets arising from the construction (reconstruction, including with elements of restoration, technical re-equipment) of state-owned objects of the constituent entities of the Russian Federation (municipal property) or the acquisition of real estate objects into state ownership of the constituent entities of the Russian Federation (municipal property), within the framework of the subprogram "Improving the provision of specialized, including high-tech, medical care" of the state program of the Russian Federation "Health Development" (hereinafter referred to as objects).

3. The subsidy is provided within the budget allocations provided for in the federal law on the federal budget for the current financial year and planning period, and limits budget commitments approved by the Ministry of Health of the Russian Federation for the purposes specified in paragraph 2 of these Rules.

4. The selection of subjects of the Russian Federation to receive a subsidy is carried out by the Ministry of Health of the Russian Federation annually, taking into account the following criteria:

a) in order to receive a subsidy for the implementation of the activities specified in subparagraph "a" of paragraph 2 of these Rules:

subparagraph "a" of paragraph 2 subparagraph "a" of paragraph 15 of these Rules;

b) to receive a subsidy for the implementation of the activities specified in subparagraphs "b" and "e" of paragraph 2 of these Rules:

the presence in the constituent entity of the Russian Federation of medical organizations subordinate to the executive authorities of the constituent entities of the Russian Federation that provide medical care to persons infected with the human immunodeficiency virus, including in combination with hepatitis B and (or) C viruses;

the existence of a state program of the subject of the Russian Federation, including the activities specified in subparagraphs "b" and "e" of paragraph 2, subparagraphs "b" and "e" of paragraph 15 of these Rules;

c) to receive a subsidy for the implementation of the activities specified in subparagraph "c" of paragraph 2 of these Rules:

the presence in the constituent entity of the Russian Federation of medical organizations subordinate to the executive authorities of the constituent entities of the Russian Federation, and (or) municipal medical organizations engaged in medical activities related to the donation of human organs for the purposes of transplantation (transplantation);

the existence of a state program of the subject of the Russian Federation, including the activities specified in subparagraph "c" of paragraph 2 of these Rules, and containing the target indicator for their implementation, specified in subparagraph "c" of paragraph 15 of these Rules;

the presence of an application from the highest executive body of state power of a constituent entity of the Russian Federation for participation in the events provided for by subparagraph "c" of paragraph 2 of these Rules, containing the following information:

the presence of a regulatory legal act of the constituent entity of the Russian Federation, which determines the measures for organizing the donation of human organs for the purposes of transplantation (transplantation);

the number and name of medical organizations subordinate to the executive authorities of a constituent entity of the Russian Federation, and (or) municipal medical organizations located on the territory of a constituent entity of the Russian Federation, licensed to carry out medical activities that provide for the performance of work (services) for the removal and storage of organs and (or ) human tissues for transplantation purposes;

the number and name of medical organizations subordinate to the executive authorities of a constituent entity of the Russian Federation, and (or) municipal medical organizations located on the territory of a constituent entity of the Russian Federation, licensed to carry out medical activities that provide for the performance of works (services) in surgery (transplantation of organs and (or) ) tissues);

the number and name of medical organizations subordinate to the executive authorities of a constituent entity of the Russian Federation, and (or) municipal medical organizations located on the territory of a constituent entity of the Russian Federation, licensed to carry out medical activities that provide for the performance of works (services) for the transportation of organs and (or) tissues human for transplant purposes;

the number of patients (donors) whose donor organs were removed during their lifetime for the purpose of transplantation (transplantation) in medical organizations subordinate to the executive authorities of a constituent entity of the Russian Federation and municipal medical organizations located on the territory of a constituent entity of the Russian Federation (according to the reporting financial year) ;

the number of patients (recipients) who received high-tech medical care by transplantation (transplantation) of donor organs taken from living donors in medical organizations subordinate to the executive authorities of a constituent entity of the Russian Federation, and (or) municipal medical organizations located on the territory of a constituent entity of the Russian Federation Federation (according to the reporting financial year);

the number of donor organs, including donor organs, taken from living donors for the purpose of transplantation (transplantation) in medical organizations subordinate to the executive authorities of a constituent entity of the Russian Federation, and (or) municipal medical organizations located on the territory of a constituent entity of the Russian Federation (according to the data of the reporting financial year ), including:

the total number of donor organs transplanted (transplanted) of which was carried out in medical organizations state system health care, including federal medical organizations, municipal medical organizations located on the territory of a constituent entity of the Russian Federation (according to the data of the reporting financial year);

the number of donor organs donated free of charge for the purpose of transplantation (transplantation) in medical organizations the state healthcare system, including federal medical organizations, municipal medical organizations located on the territory of other constituent entities of the Russian Federation (according to the data of the reporting financial year);

d) to receive a subsidy for the implementation of the activities specified in subparagraph "d" of paragraph 2 of these Rules:

the presence in the constituent entity of the Russian Federation of citizens registered in the Federal Register of Persons with Hemophilia, Cystic Fibrosis, Pituitary Dwarfism, Gaucher's Disease, Malignant Neoplasms of Lymphoid, Hematopoietic and Related Tissues, Multiple Sclerosis, persons after transplantation of organs and (or) tissues;

the existence of a state program of the subject of the Russian Federation, including the activities specified in subparagraph "d" of paragraph 2 of these Rules, and containing the target indicator for their implementation, specified in subparagraph "d" of paragraph 15 of these Rules;

e) in order to receive a subsidy for the implementation of the activities specified in subparagraph "e" of paragraph 2 of these Rules:

the presence of an act of the President of the Russian Federation or the Government of the Russian Federation or an order or instruction of the President of the Russian Federation or an order of the Chairman of the Government of the Russian Federation on the construction (reconstruction, including with elements of restoration, technical re-equipment) or the acquisition of an object on the territory of a particular subject of the Russian Federation;

the obligation of the highest executive body of state power of a constituent entity of the Russian Federation to co-finance construction (reconstruction, including with elements of restoration, technical re-equipment) or the acquisition of an object into state ownership of a constituent entity of the Russian Federation (municipal property) at the expense of funds consolidated budget subject of the Russian Federation or funds from extrabudgetary sources in accordance with the level of co-financing provided for in clause 13 of these Rules;

the existence of a state program of the constituent entity of the Russian Federation, including the activities specified in subparagraph "e" of paragraph 2 of these Rules, and containing the target indicators for their implementation specified in subparagraphs "e" - "h" of paragraph 15 of these Rules.

5. The subsidy is provided on the basis of an agreement between the Ministry of Health of the Russian Federation and the highest executive body of state power of a constituent entity of the Russian Federation on the provision of a subsidy (hereinafter referred to as the agreement), which is concluded in accordance with the standard form of the agreement approved by the Ministry of Finance of the Russian Federation.

6. The conditions for granting a subsidy and its spending are:

a) approved legal acts of the constituent entity of the Russian Federation, activities for which subsidies are provided for co-financing and which include:

organization of preventive measures in the subject of the Russian Federation aimed at preventing and reducing mortality from tuberculosis;

organizing the activities of medical organizations in accordance with the procedure for providing medical care to patients with tuberculosis, as well as the procedure for providing medical care in case of a disease caused by the human immunodeficiency virus (HIV infection);

organization of medical activities related to the donation of human organs for the purpose of transplantation (transplantation);

organizing activities to prevent HIV infection and hepatitis B and C;

organization of activities related to the storage, delivery to pharmacy organizations of drugs intended for the treatment of patients with malignant neoplasms of lymphoid, hematopoietic and related tissues, hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher's disease, multiple sclerosis, as well as after organ transplantation and (or) tissues, for the creation and maintenance of electronic databases for the accounting and movement of these medicinal products within the constituent entities of the Russian Federation;

a list of objects for the co-financing of the construction or acquisition of which subsidies are provided;

b) the presence in the budget of the constituent entity of the Russian Federation of budget allocations provided for the implementation of the measures specified in paragraph 2 of these Rules;

c) the use of cost-effective project documentation reuse (if such documentation is available) in relation to the activities specified in subparagraph "e" of paragraph 2 of these Rules (in the part related to the construction of facilities);

d) the return by the constituent entity of the Russian Federation of funds to the federal budget in accordance with paragraphs 16 - 19 of the Rules for the formation, provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation, approved by Decree of the Government of the Russian Federation of September 30, 2014 N 999 "On the formation, provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation" (hereinafter referred to as the Rules for the formation, provision and distribution of subsidies).

7. The total amount of the subsidy provided to the budget of the subject of the Russian Federation () is determined by the formula:

subparagraph "a" of paragraph 2 of these Rules;

The amount of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current fiscal year in the implementation of the measures provided for by subparagraph "b" of paragraph 2 of these Rules;

The amount of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of the measures provided for by subparagraph "c" of paragraph 2 of these Rules;

8. The amount of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of the activities provided for in subparagraph "a" of paragraph 2

The amount of subsidies distributed among the budgets of the constituent entities of the Russian Federation in the current financial year;

0.163259 - share financial support implementation of the measures provided for in subparagraph "a" of paragraph 2

The number of patients with tuberculosis as of January 1 of the current year in the i-th subject of the Russian Federation;

Growth rate of TB patients in a constituent entity of the Russian Federation compared to the previous year (relative to the same indicator in the previous year);

The level of estimated budgetary security of the constituent entity of the Russian Federation for the next financial year, calculated in accordance with the methodology for distributing subsidies for equalizing the budgetary security of the constituent entities of the Russian Federation, approved by Decree of the Government of the Russian Federation of November 22, 2004 N 670 "On the distribution of subsidies for equalizing the budgetary security of the constituent entities of the Russian Federation Federation".

9. The amount of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of the activities provided for in subparagraph "b" of paragraph 2 of these Rules () is determined by the formula:

0.264659 - the share of financial support for the implementation of measures provided for by subparagraph "b" of paragraph 2 of these Rules in the total amount of subsidies distributed among the budgets of the constituent entities of the Russian Federation;

0.01 - coefficient of the cost of a screening test for antibodies to the human immunodeficiency virus;

The population of the i-th subject of the Russian Federation, according to the Federal State Statistics Service, at the beginning of the reporting year;

Coefficient of the number of persons subject to examination for human immunodeficiency viruses (the ratio of the number of persons subject to examination in reporting year, and the total population of the Russian Federation);

The number of people infected with the human immunodeficiency virus who were under dispensary observation (excluding patients receiving antiretroviral therapy) in the i-th subject of the Russian Federation in the reporting year;

The growth rate of the number of people infected with human immunodeficiency viruses who were under dispensary observation in the reporting year (relative to the same indicator in the previous year). If the number of people infected with the human immunodeficiency virus who were under dispensary observation in the reporting year is less than in the previous one, the specified coefficient () is assigned a value equal to one;

2.5 - coefficient of cost of studies of CD4 lymphocytes and viral load during antiretroviral therapy;

Number of people who received antiretroviral therapy in the i-th subject of the Russian Federation in the reporting year;

Growth rate of the number of people who received antiretroviral therapy in the i-th subject of the Russian Federation, compared with the previous year (ratio to the same indicator in the previous year). If the number of people receiving antiretroviral therapy in the reporting year is less than in the previous year, the coefficient () is assigned a value equal to one.

10. The amount of the subsidy provided to the budget of the subject of the Russian Federation participating in the current financial year in the implementation of the activities provided for in subparagraph "c" of paragraph 2 of these Rules () is determined by the formula:

0.022553 - the share of financial support for the implementation of measures provided for by subparagraph "c" of paragraph 2 of these Rules in the total amount of subsidies distributed among the budgets of the constituent entities of the Russian Federation;

The number of donor organs removed for transplantation (transplantation) in medical organizations subordinate to the executive authorities of the i-th subject of the Russian Federation, and (or) municipal medical organizations located on the territory of the i-th subject of the Russian Federation, in the reporting financial year.

11. The amount of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of the activities provided for in subparagraph "d" of paragraph 2 of these Rules () is determined by the formula:

0.075724 - the share of financial support for the implementation of measures provided for by subparagraph "d" of paragraph 2 of these Rules in the total amount of subsidies distributed among the budgets of the constituent entities of the Russian Federation;

The number in the i-th subject of the Russian Federation of citizens recorded in the Federal Register of persons with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, malignant neoplasms of lymphoid, hematopoietic and related tissues, multiple sclerosis, persons after transplantation of organs and (or) tissues;

n is the number of recipients of the subsidy (subjects of the Russian Federation).

12. The amount of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of the measures provided for in subparagraph "e" of paragraph 2 of these Rules () is determined by the formula:

0.05546 - the share of financial support for the implementation of measures provided for by subparagraph "e" of paragraph 2 of these Rules in the total amount of subsidies distributed among the budgets of the constituent entities of the Russian Federation;

Population of the i-th subject of the Russian Federation aged 15 - 49, according to the Federal State Statistics Service, at the beginning of the reporting year;

n - the number of subjects of the Russian Federation - recipients of the subsidy.

13. The amount of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of the measures provided for by subparagraph "e" of paragraph 2 of these Rules is determined by an act of the President of the Russian Federation or the Government of the Russian Federation or in accordance with the instruction or instruction of the President of the Russian Federation or by an order of the Chairman of the Government of the Russian Federation on the construction (reconstruction, including with elements of restoration, technical re-equipment) or the acquisition of an object, taking into account the quantitative assessment of the corresponding costs.

The level of co-financing of the expenditure obligation of a constituent entity of the Russian Federation cannot be set higher than 95 percent of the expenditure obligation.

Starting from 2018, the maximum level of co-financing of the expenditure obligation of a constituent entity of the Russian Federation from the federal budget is determined in accordance with paragraph 13 of the Rules for the formation, provision and distribution of subsidies and cannot exceed the maximum level of co-financing of the expenditure obligation of a constituent entity of the Russian Federation from the federal budget, established by the Government of the Russian Federation.

The targeted distribution of subsidies by facilities, indicating the amount of subsidies, is approved by an act of the Government of the Russian Federation on the proposals of the Ministry of Health of the Russian Federation, agreed with the Ministry of Finance of the Russian Federation and the Ministry of Economic Development of the Russian Federation.

14. The transfer of the subsidy is carried out to the account of the territorial body Federal Treasury opened to him in the institution Central Bank of the Russian Federation to account for operations with budget funds of a constituent entity of the Russian Federation.

15. To assess the effectiveness of the use of the subsidy, the following indicators are used:

a) coverage of the population with preventive examinations for tuberculosis (percentage);

b) medical examination coverage for HIV infection of the population of the subject of the Russian Federation (percentage);

16. Evaluation of the effectiveness of expenditures of the budgets of the constituent entities of the Russian Federation, the source of financial support for which are subsidies, is carried out by the Ministry of Health of the Russian Federation on the basis of a comparison of the values of the performance indicators for the use of subsidies established by the agreement and the performance indicators for the use of subsidies actually achieved at the end of the reporting year, provided for in paragraph 15 of these Rules.

17. Issues related to the procedure for the return of funds by the constituent entities of the Russian Federation in the event of a violation of the obligations stipulated by the agreement in terms of achieving the values of the performance indicators for the use of the subsidy, including the procedure for calculating the amount of funds to be returned, the timing of the return, the grounds for exempting the constituent entities of the Russian Federation from the application of liability measures for violation of the obligations stipulated by the agreement, as well as the procedure for using the returned funds by the main manager of federal budget funds, are resolved in accordance with paragraphs 16 - 19 of the Rules for the formation, provision and distribution of subsidies.

18. Authorized body subject of the Russian Federation submits to the Ministry of Health of the Russian Federation:

a) quarterly, no later than the 10th day of the month following the reporting quarter - a report on the implementation of budget expenditures of the constituent entity of the Russian Federation, the source of financial support for which is a subsidy, in the form and in the manner approved by the Ministry of Health of the Russian Federation in agreement with the Ministry Finance of the Russian Federation;

b) annually, before February 1, - a report on the achievement of the performance indicators for the use of the subsidy in the manner and in the form approved by the Ministry of Health of the Russian Federation.

19. Control over the implementation by the constituent entities of the Russian Federation of the measures specified in subparagraphs "a" - "e" of paragraph 2 of these Rules is carried out by the Federal Service for Surveillance in Healthcare.

Control over the observance by the constituent entities of the Russian Federation of the conditions for granting subsidies is carried out by the Ministry of Health of the Russian Federation and the federal executive body exercising the functions of control and supervision in the financial and budgetary sphere.

I approve

Chief Physician of GBUZ RB GB

G. Kumertau

___________ O.A. Astakhov

REPORT

FOR 2015

Afonina Evgeniya Valerievna

NURSE ROOM

PEDIATRIC DEPARTMENT

State state-financed organization health care of the Republic of Bashkortostan City hospital of the city of Kumertau

To assign the second qualification category in the specialty

"Nursing in Pediatrics"

Kumertau

I. Introduction

1. Health care reform 3

2.Main federal health programs

population 7

3.Biography 8

II.Main part

4. Health care of the city 9

5. Characteristics of the pediatric department 11

6. Performance indicators of the pediatric department 13

7. Basic orders governing the work of a nurse 16

pediatric department

8.Organization of the work of a pediatric ward nurse 19

branches

9. Sanitary and anti-epidemic work of the ward nurse of the 27th pediatric department

10. Sanitary and educational work 32

III. Final part.

11. Conclusions 34

12. Offers 35

13. References 36

Health care reform.

Health care is a series of socio-economic and medical reforms aimed at maintaining and improving the health of each individual and the population as a whole. The goal of health care reform is to preserve and develop the state municipal health care system, organize their activities, as well as the activities of the private health care system to maximize the rights of citizens in the field of health care.

Health care reform offers the following priority tasks:

1. From inpatient care to outpatient care - this is an increase in the volume of medical care in the clinic, the introduction of hospital-replacing technologies: day hospitals in the clinic, at home;

2. From specialized care to general medical practice, family medicine, when medical care is as close as possible to the place of residence and is a long process;

3. From increasing the amount of resources in the industry to their efficient use;

4. From the volume of medical services to their quality;

5. From increasing the number of beds, to their rational use, re-profiling and phasing of inpatient care;

6. From an increase in the number of doctors and paramedical workers to the quality of their work - improving the quality of professional training of personnel, the system of practical health care providing primary medical care.

7.From public funding to funding from various sources: paid services.

8. Providing the population with medicines accessible to all segments of the population.

9. From partial - to full provision of the rights and obligations of the patient. This is the provision of free, affordable and qualified assistance to the population of a doctor and a medical institution, the right to receive an insurance medical policy.

10. From the treatment of diseases to their prevention and promotion of public health. This is to ensure the priority of disease prevention, the creation of centers for psycho-prophylactic support. Publications of articles promoting healthy lifestyle life. Provision of good-quality food products, water supply, maternal and child health care; immunization against major infectious diseases; prevention of endemic diseases.

In order to improve the health of the population of Russia, reduce the level of morbidity, disability, mortality, increase the availability and quality of medical care, strengthen primary health care, develop a preventive focus in healthcare, and meet the population's need for high-tech types of medical care, the national project "Health" was developed, which successfully is being implemented.

National project "Health"

The main objectives of the priority national project in the health sector:

1. Strengthening the health of the population of Russia, reducing the level of morbidity, disability, and mortality.

2. Increasing the availability and quality of medical care.

3. Strengthening primary health care, creating conditions for the provision of effective medical care at the prehospital stage:

Training and retraining of general (family) practitioners, district general practitioners and pediatricians;

Increasing salaries for primary health care workers, feldsher-midwife stations and ambulances;

Strengthening the material and technical base of the diagnostic service of primary medical care, emergency medical care.

4. Development of a preventive focus in health care:

Prevention of HIV infection, hepatitis B and C , detection and treatment of HIV patients;

Additional immunization of the population within the framework of the national vaccination schedule;

Introduction of new screening programs for newborns;

Additional medical examination of the working population;

Providing medical care to women during pregnancy and childbirth in state and municipal health care institutions.

5. Satisfying the needs of the population in high-tech medical care:

Increasing the volume of high-tech medical care;

Construction of new centers of high medical technologies;

Training for these centers of highly qualified doctors and nurses.

Measures to address major health problems require efficient spending budget funds, focused on the end result, shifting the focus of medical care to the primary link (pre-hospital stage), preventive focus of health care.

Federal target programs

for the protection of the health of the population of the Russian Federation.

1. Construction of medical centers for the provision of specialized medical care in the field of obstetrics, gynecology and neonatology (perinatal centers).

2. Republican target program "Formation of a healthy lifestyle among the population of the Republic of Bashkortostan, including the reduction of alcohol and tobacco consumption and the fight against drug addiction, for 2011-2015".

3. Republican target program "Prevention and control of socially significant diseases in the Republic of Bashkortostan (2011-2015)" The program includes subprograms "Oncology", "Sexually transmitted infections", "Vaccinal prophylaxis", "Diabetes mellitus".

4. The program of state guarantees of free provision of medical care to citizens in the Republic of Belarus for 2014-2016

5. Departmental target program of the Ministry of Health of the Republic of Bashkortostan "Safe blood for 2012-2014"

6. Departmental target program of the Ministry of Health of the Republic of Bashkortostan "Treatment of viral hepatitis in the Republic of Bashkortostan for 2013-2015"

7. Departmental target program of the Ministry of Health of the Republic of Bashkortostan "Tuberculosis" for 2013-2015"

Biographical information.

I, Afonina Evgenia Valerievna, was born in 1988.

In 2008 she graduated from the Sterlitamak Medical School, Kumertau branch, with a degree in Nursing.

I have been working in the State Budgetary Institution of Healthcare of the Republic of Belarus in Kumertau since 2008.

The strategic goal of the Program is: improving the system of protecting the health of citizens in order to prevent diseases, preserve and strengthen the physical and mental health of each person, maintain his long-term active life, and provide him with medical care. The strategic goal of the Program is achieved by 2020 through decrease in the values of the following indicators:

mortality from all causes - up to 10.3 cases per 1000 population;
infant mortality - up to 6.4 cases per 1000 live births;
maternal mortality- up to 15.5 cases per 100 thousand population;
mortality from diseases of the circulatory system - up to 551.4 cases per 100 thousand population;
mortality from road traffic injuries - up to 10 cases per 100 thousand of the population;
mortality from neoplasms - up to 189.5 cases per 100 thousand population;
mortality from tuberculosis - up to 8.2 cases per 100 thousand population;
consumption of alcoholic products (in terms of absolute alcohol) - up to 10 liters per capita per year;
the prevalence of tobacco use among the adult population is up to 25%;
the prevalence of tobacco use among children and adolescents is up to 15%;
incidence of tuberculosis - up to 35.0 cases per 100 thousand population;

increasing by 2020 the values of the following indicators:

life expectancy at birth up to 75.7 years;

achievement by 2018 of the values of the following indicators:

the ratio of salaries of doctors and employees of medical organizations with higher medical (pharmaceutical) or other higher education to the average salary in the corresponding region - 200%;
the ratio of the salary of the average medical (pharmaceutical) personnel to the average salary in the corresponding region - 100%;
the ratio of the salary of junior medical personnel (personnel providing conditions for the provision of medical services) to the average salary in the corresponding region is 100%.

Program objectives

The tasks of turning Russia into global leader world economy, reaching the level of developed countries in terms of social well-being dictate new requirements for the healthcare system.

Ensuring the priority of prevention in the field of health protection and the development of primary health care

In the direction of solving this problem, it is necessary to increase the efficiency of primary health care, optimize the total number of beds, and increase the efficiency of inpatient care. The practical implementation of the transition to a healthy lifestyle is impossible without bringing preventive medicine closer to the person. In this regard, the priority is to provide the population, primarily healthy people and people with chronic diseases without exacerbation, with preventive care within walking distance. It is necessary to develop and implement mechanisms to stimulate the polyclinic level for the earliest possible detection of diseases and to prevent the development of diseases to the stage leading to hospitalization. The implementation of these measures is aimed at improving the indicators of temporary disability of the working population.

Formation of a responsible attitude towards their health among the population, refusal of smoking, alcohol and drug abuse, provision of conditions for a healthy lifestyle, correction and regular monitoring of behavioral and biological risk factors for non-communicable diseases at the population, group and individual levels should become the most important direction of policy in the field of health protection.

Non-communicable diseases (diseases of the circulatory system, oncological diseases, respiratory diseases and diabetes mellitus) cause more than 80% of all deaths in the population of the Russian Federation, with 56% of all deaths due to cardiovascular diseases. The development of non-communicable diseases is based on a single group of risk factors associated with an unhealthy lifestyle (smoking, physical inactivity, poor diet, alcohol abuse).

The World Health Organization has identified 7 leading risk factors that make the main contribution to premature mortality in Russia, including:

high blood pressure (35.5%), hypercholesterolemia (23%),
smoking (17.1%),
unhealthy diet, insufficient consumption of fruits and vegetables (12.9%),
obesity (12.5%),
alcohol abuse (11.9%), low physical activity (9%).

Risk factors can accumulate in individuals and interact with each other, creating a multiple effect: the presence of several risk factors in one person increases the risk of death from diseases of the circulatory system by 5-7 times.

Based on the experience of many countries (Finland, USA, UK, New Zealand and others) have shown that lifestyle modification and reduction of risk factors can slow down the development of circulatory system diseases both before and after the onset of clinical symptoms.

Systematic analysis shows that lifestyle and nutritional changes can reduce the risk of death from coronary heart disease both in the population and among patients with this disease. Thus, stopping smoking reduces the risk by 35% and 50%, respectively, increasing physical activity by 25% and 20–30%, moderate alcohol consumption by 25% and 15%, changing at least 2 factors in nutrition by 45%. % and 15–40%.

Another systematic analysis shows that the treatment of patients with coronary heart disease and other diseases of the circulatory system with drugs from the group of antiplatelet agents reduces the risk of complications in such patients by 20-30%, beta-blockers - by 20-35%, ACE inhibitors - by 22-30%. 25%, statins - by 25-42%.

An analysis of the reasons for the significant reduction in mortality from diseases of the circulatory system in many countries showed that the contribution of recovery (lifestyle changes) and the reduction of risk factors in reducing such mortality ranges from 44% to 60%.

Factor analysis of the causes leading to high rates of cancer incidence and mortality showed that the influence of group A factors (tobacco smoking, excessive alcohol consumption, overweight, nutritional imbalance, other factors (production, natural environment, housing, the impact of infectious carcinogenic factors, etc.) .) is 65%, and group B factors (delayed detection and treatment of precancerous diseases, late diagnosis of cancer, lack of screening, lack of formation and monitoring of risk groups, irregular preventive examinations of the population, lack of medical examination of risk groups, lack of oncological alertness of doctors in the primary network, lack of educational work among the population, insufficient work to motivate the population for active and conscious participation in screening activities, the absence of unified screening programs at the federal level, the absence of a register of persons included in screening programs) is 35%.

The basis for promoting a healthy lifestyle, along with informing the population about the dangers of tobacco consumption, irrational and unbalanced nutrition, low physical activity, abuse of alcohol, drugs and toxic substances, should be training in hygiene, work and study rules. At the same time, increasing the motivation of the population to maintain a healthy lifestyle should be accompanied by the creation of appropriate conditions for this. In addition, priority should be given to measures not only for the timely detection of risk factors and non-communicable diseases, but also for their timely correction.

When reforming the system of primary health care for the population, the tasks of changing the system of providing assistance to the rural population come to the fore; modernization of existing institutions and their divisions; alignment of patient flows with the formation of uniform routing principles; development of new forms of medical care - hospital replacement and outreach methods of work; development of emergency care on the basis of outpatient departments; improving the principles of interaction with hospitals and ambulance units.

lining up modern system provision of primary health care to the population should include both the smallest settlements and large cities.

Improving the efficiency of providing specialized, including high-tech, medical care, ambulance, including emergency specialized, medical care, medical evacuation

High-tech medical care is part of specialized medical care and includes the use of new, complex and (or) unique, as well as resource-intensive methods of treatment with scientifically proven effectiveness, including cellular technologies, robotic technology, information technology and genetic engineering methods developed on the basis of achievements medical science and related branches of science and technology.

To improve the availability and quality of medical care, measures will be taken to improve the organizational system for providing specialized, including high-tech, medical care, to improve the provision of medical care for socially significant diseases, including patients with diseases of the circulatory system, tuberculosis, oncological, endocrine and some other diseases, the introduction of innovative methods of treatment into practice, the development of infrastructure and resource support for healthcare, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization.

The Federal Law "On Compulsory Medical Insurance" provides for the inclusion of high-tech medical care in the system of compulsory medical insurance from 2015. One of the conditions for such inclusion is the development of the possibility of providing high-tech medical care in medical institutions of the constituent entities of the Russian Federation.

The main tasks of providing emergency, including emergency specialized, medical care, medical evacuation at the present stage should be to provide patients and injured with pre-hospital medical care aimed at preserving and maintaining the vital functions of the body, and delivering them as soon as possible to a hospital to provide qualified specialized medical care. This work should be carried out mainly by feldsher teams.

It is necessary to increase the role and effectiveness of the use of emergency medical teams as intensive care teams and, if necessary, highly specialized teams.

A successful solution to the problems of organizing and providing emergency medical care to the population is possible only in close connection with the improvement of the work of the outpatient service, including the transition to the organization of primary medical care on the principle of a general practitioner (family doctor), day hospitals, hospitals for home.

Development and implementation of innovative diagnostic and treatment methods

In the next decade, developed countries will move to the formation of a new technological base economic systems based on the use of the latest advances in biotechnology, informatics and nanotechnology, including in healthcare. Development information technologies and the advent of advanced technologies for computing and processing information will allow the use of predictive approaches based on modeling in the field of health care. First of all, interest is the possibility of creating epidemiological models that will allow us to analyze and predict the prevalence of various diseases in the population, thereby increasing the effectiveness of preventive measures.

There is an obvious need to form targeted scientific programs for priority areas in order to maintain the health of the population and the formation of a healthy lifestyle, the development and implementation of new effective technologies for early diagnosis in the practice of the healthcare system.

Taking into account the forecasts of the intensive introduction of biomedical technologies into the advanced healthcare practices of developed countries, an important task is to create the necessary conditions for the development and implementation of such products and technologies in the domestic healthcare system.

Improving the efficiency of obstetrics and childhood services

The issues of protecting the health of mother and child are named as priorities in all fundamental documents on the development of health care, the goals of reducing maternal, infant and child mortality are proclaimed among the UN Millennium Development Goals. Reducing maternal, infant and child mortality is very difficult due to the presence of numerous factors, mostly difficult to manage, that affect these indicators. The indicator of maternal mortality depends on the socio-economic state of the country, geographical features, the development of medical care, the cultural and educational level of the population.

In Russia in 2011, the maternal mortality rate was 16.2 per 100,000 live births. At this level of the indicator, 320-350 working-age women die every year, which places a heavy burden on families, reduces the number of children that could be born in the future, and increases the underproduced contribution to GDP. According to the WHO, the average European maternal mortality rate in 2010 was 20 per 100,000 live births and decreased by only 9.1% between 2005 and 2010. The lowest maternal mortality in advanced economies, high density population, developed transport infrastructure. For example, in Germany in 2010 the maternal mortality rate was 7.0 per 100 thousand live births, in France - 8.0, in the UK - 12.0. At the same time, maternal mortality is much higher in Eastern European countries. In particular, in the Republic of Moldova, the maternal mortality rate in 2010 was 41.0 per 100 thousand live births, in Latvia - 34.0, in Ukraine - 32.0, in Romania - 27.0, in Hungary - 21, 0.

In countries with a larger area, with other equal conditions, it is usually higher than in smaller countries - in the USA, the maternal mortality rate was 21.0 in 2010, in Canada -12.

Infant mortality has similar patterns - low infant mortality rates are typical for countries with high level life of the population, a small area of the territory and a high population density. For example, in Germany in 2010 the infant mortality rate was 3.5 per 1,000 live births, in France - 4.1, in the UK - 5.0, in Belgium - 3.5, in Austria - 3.9. In countries with a high standard of living of the population, but a large extent of the territory, the presence of regions with a low population density, the infant mortality rate is somewhat higher. For example, in the United States, the infant mortality rate in 2010 was 6.0 per 1,000 live births, in Canada it was 5.0, and in Australia it was 5.0.

At the same time, in some European countries, the infant mortality rate is higher than in the Russian Federation. In particular, in the Republic of Moldova, the infant mortality rate in 2010 was 11.8 per 1,000 live births, in Ukraine - 9.1, in Romania - 9.8, in Montenegro - 10.0, in Macedonia - 7.7 .

Low rates of maternal and infant mortality correlate to some extent with health care costs (in % of GDP), which are - in the USA - 15.2%, in Germany - 11.1%, in France - 10.1%. In Russia, the growth in health spending from 3.1% to 3.7% of GDP was accompanied by a decline in maternal and infant mortality rates. Infant mortality is influenced by a number of factors that require a multidisciplinary approach.

First of all, this is the state of the material and technical base of obstetric and childhood institutions. Until now, most regions are not fully provided with resuscitation and intensive care beds for newborns, which have modern high-tech equipment. There is no network of perinatal centers that provide medical assistance to the most severe contingent of pregnant women, women in childbirth, puerperas and newborns. In developed countries, perinatal centers are organized at the rate of 1 center per 1 million population in countries with high population density, and per 500 thousand population in countries with low density. With this calculation, the number of perinatal centers in Russia requires a significant increase.

The presence of highly qualified specialists in maternity and childhood institutions plays a huge role in reducing the infant mortality rate. In Russia, there is a huge shortage of personnel for both neonatologists and nurses, which is primarily due to low wages. As a rule, in the Russian Federation, there are from 4 to 10 critically ill newborns per 1 nurse in the intensive care unit for newborns. In the US and Europe, there are 1 extremely sick newborn, or 2 seriously ill newborns, or 3 stable children per 1 nurse.

The level of financing of medical organizations has a great influence on the quality of medical care for newborns born with pathology and the result of their treatment. In the Russian Federation, the cost of treating one child in the intensive care unit is about 200–300 US dollars per day. In the UK, the cost of treatment per day is 1600-2000 pounds. In the USA, depending on the severity of the condition of the newborn, it ranges from 2,000 to 5,000 US dollars, in Europe - from 1,500 to 4,000 euros per day. At the same time, a significant share of the funds falls on the salaries of medical workers.

Other factors also have a significant impact on the level of maternal and infant mortality - the quality of road communication, sufficient availability of automobile and air ambulance transport, a healthy lifestyle of the population, control of migration processes.

Reducing infant and child mortality from injuries, violent actions, neglect by parents from socially disadvantaged families of the health and well-being of their children is the responsibility of not only and not so much medical workers, but social protection authorities, the Ministry of Internal Affairs of Russia, the Ministry of Emergency Situations of Russia, etc.

Thus, by improving the availability, quality and organization of medical care for mothers and children, reducing the number of abortions, it is possible to reduce maternal and infant mortality by 2020 to the level of 6.5–6.0%, maternal mortality to the level of 15.5–15, 0 per 100,000 live births. Reducing infant mortality to 3–4%, and maternal mortality to 5–8% is possible only with the development of the economy, transport infrastructure, responsible attitude of the population to their health, comparable to the level of the most developed countries of Western Europe.

Reducing the infant mortality rate from 8.5% (taking into account the new registration criteria) to 6.4% will save at least 4,000 children's lives annually. Since each death of a child causes an underproduced contribution to GDP of 6 million rubles, the total loss of GDP, if the indicator remains at the current level, will be 24 billion rubles. Even if we take into account the possible payment of disability pensions to a maximum of 5% of saved children, this amount will amount to 100 million rubles, and the total increase in GDP due to saved lives will be 23.9 billion rubles. But these calculations, of course, cannot take into account the full benefits of the implementation of the program - improving the quality of care will lead to a decrease in the mortality of children under 5 and under 17 years of age, which will further increase the expected increase in the contribution to GDP, increase the satisfaction of the population with the healthcare system in the country which, indirectly, can contribute to an increase in the birth rate.

Since the mortality of newborns is 55–70% of infant mortality and 40% of the mortality of children under 5 years old, an important direction in reducing the mortality of the child population is to improve care for newborns, an extremely significant aspect of which is the development of a network of perinatal centers. The perinatal center is not only a clear and vivid evidence of the state's care for mothers and children, it is inherently high-tech centers that allow you to provide effective care for the most severe pathology, develop innovative methods of treatment (as well as fetal and neonatal surgery, resuscitation-intensive care for mothers and children in critical conditions). The creation of a network of perinatal centers will make it possible to move throughout the country to a full-fledged and effectively functioning three-level system for providing medical care to women during pregnancy and childbirth and newborns, which will improve the qualifications of medical personnel and the quality of medical care in all obstetric institutions without exception. In fact, within the framework of the Program, it is planned to create a coherent system not only to provide assistance differentiated by levels, but also a system of interaction, monitoring, and training of personnel using simulation centers. It is envisaged to create a completely new system of relationships between obstetric and pediatric institutions in the territory, tightening requirements and creating opportunities for full and adequate patient routing, changing reporting forms, and creating new approaches to staff motivation.

After the mass commissioning of perinatal centers in 2010–2011, maternal mortality in the country decreased from 22.0 per 100,000 live births in 2009 to 16.2 in 2011, i.e. by 26.4%, infant mortality - from 8.1 per 1000 live births to 7.4, respectively, i.e. by 8.6%. Moreover, in the constituent entities of the Russian Federation, where perinatal centers operate, the decline in indicators was more significant.

In fact, thanks to the perinatal centers, conditions were created for the transition of the Russian Federation in 2012 to the international birth registration criteria recommended by WHO, starting from a body weight of 500.0 g, which, although formally will lead to a certain increase in infant mortality, but at the same time time, will save more than a thousand children's lives every year. To solve the problem of improving the nursing of children with extremely low body weight and reducing the level of disability in this contingent, the section of the program related to improving the equipment of intensive care units and pathology of newborns is also aimed, since the process of life support for these children requires the most modern high-tech equipment. This section is inextricably linked with the development of a network of perinatal centers.

A well-functioning system of early detection and correction of developmental disorders is extremely important to reduce child mortality. The most effective tool for the prevention of congenital and hereditary diseases is a comprehensive prenatal (prenatal) diagnosis, including ultrasound and biochemical screening for maternal serum markers, an individual risk program, and invasive diagnostic methods (molecular genetic, cytogenetic studies, sequencing). The effectiveness of prenatal diagnosis can only be ensured by a mass examination of pregnant women in a timely manner, which is what this section of the Program is aimed at. The development of neonatal surgery is aimed at ensuring effective correction of disorders detected during prenatal diagnosis, and early correction of metabolic changes detected during neonatal screening will allow in the future to create opportunities and conditions for a sick child for normal development, education, professional training, subsequent employment and a fulfilling life. Further development of prenatal diagnostics will make it possible to reduce the number of children born with congenital developmental anomalies by 50% and reduce the death rate of children from severe malformations by 50–70%.

Until now, there is a high need for the development of specialized medical care for children. In 14 regions of the Russian Federation, there are no regional, republican, regional multidisciplinary children's hospitals. In a number of regions, the existing pediatric medical organizations do not meet modern requirements that allow nursing children with severe pathologies, including children of the first year of life and, first of all, those born with low and extremely low body weight. This situation requires resolution, as it does not allow to ensure the full availability and quality of medical care for children. Children with oncological diseases are not fully provided with high-quality medical care, a system for providing medical care to children with autoimmune diseases and diseases of immune genesis has not been created, neurosurgical and traumatological and orthopedic care for children remains inaccessible, and psychiatric, narcological and TB care requires serious modernization.

The key to improving the quality of medical care for children will be the development of multidisciplinary and specialized pediatric hospitals in the constituent entities of the Russian Federation, taking into account regional needs for specific types of medical care.

Solution of the problem state support construction and reconstruction of regional (regional, republican) children's multidisciplinary hospitals, the structure of which must fully comply with modern requirements, will ensure the real achievement of the goals and objectives of the Program. Moreover, this section is inextricably linked with the development of a network of perinatal centers. Since on the basis of perinatal centers medical care is provided to children only in the first days and months of life, children's hospitals should be the most important part of a functional network that provides the entire cycle of care for a child.

The problem of preventing vertical transmission of HIV from mother to child remains topical. Despite the high numbers of chemoprophylaxis for HIV-infected pregnant women, the transmission of infection through perinatal contacts remains high, in the whole country at a level of about 6%, which probably indicates an insufficiently high effectiveness of chemoprophylaxis of vertical transmission of HIV from mother to child, and dictates the need to improve systems for providing this type of assistance and its monitoring.

Development of the provision of medical rehabilitation to the population and improvement of the system of sanatorium and resort treatment, including for children

An important component of solving the problem of improving the quality and accessibility of medical care is the development of a system of medical rehabilitation, sanatorium and resort treatment. An analysis of the provision of medical rehabilitation in the Russian Federation showed that it requires serious reorganization and bringing it into a coherent system of comprehensive rehabilitation.

At present, difficulties in the accessibility of medical rehabilitation are associated with a shortage of rehabilitation beds, the slow introduction of modern, certified in Russia, integrated rehabilitation technologies, an insufficient number of professionally trained medical personnel, and a weak material and technical base of rehabilitation institutions.

The shortage of beds to provide assistance in the medical rehabilitation of children, both at the federal level and at the level of the constituent entities of the Russian Federation, as well as the shortage of trained medical personnel (doctors and paramedical workers) does not fully satisfy the need for these medical services. Currently, only 50% of the children who need it receive medical rehabilitation.

The problem of increasing the availability and quality of medical rehabilitation and sanatorium treatment is also relevant in pediatrics and is due to an increase in the number of children suffering from severe chronic (disabling) diseases and children with disabilities. As of January 1, 2012, more than 500,000 disabled children were registered in the Russian Federation, of which more than 340,000 are in need of medical rehabilitation. The need for rehabilitation assistance to other contingents of children is much higher. Currently, only 50% of the children who need it receive medical rehabilitation.

Solving the problems of health protection and social protection of children suffering from severe chronic (disabled) diseases, children with disabilities and their families is possible while ensuring the availability and quality of medical rehabilitation through the further development of a network of specialized rehabilitation institutions for children (regional, interdistrict), as well as complexes for the implementation of high-tech methods of treatment with beds (branches of hospitals) for aftercare and rehabilitation. Solving this problem will reduce the load on "expensive" beds in hospitals and increase their throughput.

The current level of development of world medicine requires an objective assessment (according to the criteria of evidence-based medicine) of the effectiveness of spa treatment, as well as the improvement of existing and the development of new health and treatment methods.

At the moment, there is an urgent need for a set of measures aimed at maintaining the potential of the resort sector and the formation of a modern resort complex capable of solving both the medical and social tasks of providing affordable, effective sanatorium treatment to the population, and economic problems formation of the sphere of resort business. At the same time, it should be borne in mind that the decline of the resort business in Russia, of course, has become one of the important factors deteriorating health indicators of the nation. Under these conditions, the restoration of the system of sanatorium treatment and rehabilitation, its accessibility for the bulk of the population, the revival of Russian resorts seems to be an important national task that can contribute huge contribution to improve the public health of the people.

Providing medical care to terminally ill patients, including children

Against the background of the demographic aging of the population in the Russian Federation, the number of patients in need of palliative care is increasing every year.

Extremely important are not only medical, but also social, spiritual and psychological aspects of providing palliative care to incurable patients.

The main directions in the provision of palliative care to incurable patients should be not only the reduction of patients' suffering, but also adequate psychological assistance, social support, and communication with relatives, which make it possible to prepare family members for the inevitable end.

In order to create optimal conditions for children suffering from incurable, life-limiting diseases, as well as to help family members in conditions of an incurable illness of a child, it is planned to develop a network of medical and social institutions specializing in providing palliative care to children in the Russian Federation (opening departments of palliative care for children in multidisciplinary hospitals and independent hospice institutions), based on an approximate calculation of 2-3 beds per 100 thousand children.

The concept of palliative care is that the fight against pain, the solution of the psychological, social or spiritual problems of patients is of paramount importance. Thus, the main task of providing medical care to a dying patient is to ensure, as far as possible, a decent quality of life for a person at its final stage.

Creation of palliative care departments will reduce the load on expensive beds, where resuscitation and intensive care is provided, by at least 15%.

It should be noted that at present, in educational medical institutions at the undergraduate level, at the departments of public health and health care, the organizational and socio-medical aspects of palliative care are not presented.

This indicates the need to introduce teaching the basics of palliative care not only to university students, but also at the postgraduate stage, both for doctors of all specialties and for healthcare organizers.

Providing the healthcare system with highly qualified and motivated personnel

In this direction, the most urgent task remains to create a system of continuing professional education in order to train highly qualified specialists focused on continuous improvement of their own knowledge, skills and abilities necessary to achieve and maintain high quality professional activity.

It is planned to carry out measures to improve the system of practical training of medical and pharmaceutical workers in order to improve the quality of professional training, expand the list of skills and abilities acquired by a specialist during the training period.

Training programs for medical and pharmaceutical specialists at the stages of postgraduate and additional professional education will be formed and implemented, as well as advanced training programs for scientific and pedagogical workers of educational and scientific organizations implementing medical and pharmaceutical education programs, developed taking into account changes in the training of medical and pharmaceutical specialists in connection with the introduction of federal state educational standards for secondary and higher professional education of the third generation.

Until 2020, it is planned to develop professional standards for medical and pharmaceutical workers, which will allow the formation of unified approaches to determining the level of qualification and set of competencies of medical and pharmaceutical workers necessary for professional activities.

A system of accreditation of medical and pharmaceutical specialists will be created and implemented, which will allow for personal admission of specialists to a specific type of professional activity, taking into account the competencies acquired during the training.

Together with the constituent entities of the Russian Federation, it is planned to take measures to improve the quality of life of medical and pharmaceutical workers and their families, reduce the outflow of personnel from the industry, including by providing specialists with residential premises, land plots, housing subsidies, subsidizing the interest rate on a loan for the purchase of housing by medical and pharmaceutical workers, granting children of certain categories of medical and pharmaceutical workers the right to extraordinary enrollment in preschool educational institutions.

Educational events will also be organized to increase the prestige of the profession.

Together, the solution of these tasks will improve the quality of training of medical and pharmaceutical specialists, reduce the shortage of medical personnel and, as a result, improve the quality of medical care and pharmaceutical services provided to citizens of the Russian Federation.

In pursuance of Decree of the President of the Russian Federation of May 7, 2012 No. 598 “On improving the state policy in the field of healthcare”, the subjects of the Russian Federation provide for the adoption of programs aimed at improving the qualifications of medical personnel, assessing the level of their qualifications, and gradually eliminating the shortage of medical personnel, as well as the development of differentiated measures of social support for medical workers, primarily the most scarce specialties.

Increasing the role of Russia in global health

The main directions of international relations in the field of health care should be to ensure a strong and authoritative position of Russia in the world community, to the greatest extent meeting the interests of the Russian Federation as one of the influential centers of the modern world; creation of favorable external conditions for the modernization of Russia; formation of good neighborly relations with neighboring states; search for agreement and concurring interests with other states and interstate associations in the process of solving problems determined by Russia's national priorities in the field of health protection, creating on this basis a system of bilateral and multilateral partnerships; comprehensive protection of the rights and legitimate interests of Russian citizens and compatriots living abroad; promoting an objective perception of the Russian Federation in the world; support and popularization of domestic healthcare in foreign countries.

Priority area foreign policy In healthcare, Russia remains to cooperate with the member states of the Commonwealth of Independent States, the Eurasian Economic Community. The development of health issues within the framework of the Asia-Pacific Economic Cooperation should also be considered important.

Improvement of control and supervisory functions

The main task of the functioning of the quality and safety control system of medical activities will be to control the process of providing medical care, its compliance with approved standards and procedures for providing medical care, and the interaction of medical personnel with patients.

The interaction of the subjects of the system of quality control and safety of medical activities, their activities, powers and responsibilities are regulated by regulatory legal acts approved in the prescribed manner.

The main task of state control (supervision) in the field of circulation of medicines will be to control the circulation of medicines and its compliance with current legislation Russian Federation.

The main objective of the functioning of the system of state control over the circulation of medical devices is to identify and withdraw from circulation low-quality medical devices, as well as falsified and counterfeit medical devices with subsequent disposal and destruction, identify and prevent possible negative consequences of the use and use of medical devices in circulation on the territory Russian Federation, warnings about the facts of this kind of potential users, as well as medical personnel.

An important task in the development of health care is the modernization of state forensic activities in the Russian Federation. Forensic medical and forensic psychiatric examinations in the Russian Federation are a special medical and legal type of activity aimed at providing bodies of inquiry, investigation and court with the results of special studies obtained in compliance with legal norms, carried out by experts or doctors involved in the production of an examination, licensed How separate view medical activity.

In addition, state forensic medical institutions perform an important function in determining the causes and nature of defects in the provision of medical care.

In this regard, the task is to determine unified approaches to expert activities in the Russian Federation, to create a unified methodological basis for the production of forensic psychiatric and forensic medical examinations, to provide a modern material and technical base for all public institutions carrying out forensic psychiatric and forensic medical examinations.

The effectiveness of the implementation of federal state sanitary and epidemiological supervision and the organization of ensuring the sanitary and epidemiological well-being of the population is achieved by the combined activities of the territorial bodies of Rospotrebnadzor, which directly carry out control and supervision activities, as well as Rospotrebnadzor institutions that provide control and supervision, through a wide range of laboratory studies, the implementation of scientific and research and scientific and methodological developments, implementation of anti-plague measures.

Reducing the harmful effects of environmental factors on the population will be ensured by measures to ensure a safe environment for the population - atmospheric air, water bodies, soil; improving food quality and safety; ensuring radiation safety of the population.

Medico-biological provision of public health protection

An important factor in ensuring the radiation, chemical and biological safety of the population and territories served by the Federal Medical and Biological Agency is the system of medical and sanitary support of the FMBA of Russia, one of the main tasks of which is to take measures to identify and eliminate the influence of especially dangerous factors of physical, chemical and biological nature on the health of employees of serviced organizations and the population of serviced territories.

The system of medical support for such enterprises and facilities includes conducting preliminary medical examinations, pre- and post-shift medical examinations, periodic medical examinations, carrying out medical and preventive and rehabilitation and rehabilitation measures, monitoring the health of employees of enterprises and the population.

The goal of health care in the field of medical and sanitary and biomedical support of elite sport is to prevent the incidence and disability of athletes and to consistently increase the level of their provision with biomedical technologies for effective adaptation to intense sports loads.

The main tasks in the field of medical and biomedical support for athletes of the national teams of the Russian Federation: the formation of an infrastructure for medical and preventive purposes, territorially integrated with the training bases for the sports teams of the Russian Federation, which makes it possible to ensure 100% coverage of candidates for the sports teams of the Russian Federation by type sports with all kinds of medical care during training and competitive activities; providing qualified medical personnel for sports teams of the Russian Federation; implementation of biomedical technologies that provide the training and competitive level of training of candidates for the sports teams of the Russian Federation in sports.

The FMBA of Russia carries out activities to prevent and eliminate the consequences of emergency situations directly or through its territorial bodies, subordinate organizations in cooperation with other federal executive authorities, executive authorities of the constituent entities of the Russian Federation, and local governments.

The objectives of the sphere of protection of certain categories of citizens from the effects of especially dangerous factors of a physical, chemical and biological nature are to ensure breakthrough results in medical research that can give rise to new medicines, technologies and products, the development of innovative infrastructure for the provision of health care to certain categories of citizens.

Ensuring the systemic organization of health care

In modern conditions, the creation and functioning of distributed information systems and analytical tools for data processing are the "gold standard" of the organization of sectoral management. The introduction of new medical technologies is impossible without the parallel implementation of information systems that optimize the process of providing services. The creation of such systems is required to solve issues related to the calculation full cost medical services, forecasting the required volume and cost of medical care and drug provision, assessing staffing needs in the healthcare sector, assessing and forecasting the epidemiological situation. Thus, the task of introducing and using modern information and telecommunication technologies in healthcare is a key enabling task, the solution of which determines the effectiveness of most of the activities of the State Program "Health Development".