Fap work in the countryside. Medical obstetric and gynecological care

Residents of rural areas - 38 million people, which is about 26% of total strength population Russian Federation. Is the country's rural population different high level life? - If only in the reports of local officials ... Is the social infrastructure developed in the village? “Unfortunately, no more than yes. Have the necessary working conditions for rural residents been created by modern standards? - Far from everywhere (to put it mildly). Rural labor itself, which has not actually changed in its principles for many decades, leaves its mark on the health of those who are engaged in such labor. And the question that has already been raised on the pages of our information and analytical portal - the question of why the Russian village is dying out, is also closely related to the painful issue of rural health.

This issue is so painful for millions of Russians that any mention of it causes a sharp reaction. Explainable...

So, how to get a fast and qualified medical care in the countryside? Officially, there is everything for this. As the main option - an equipped feldsher-obstetric station with a professional health worker, and preferably several. He will meet, listen, diagnose, advise, prescribe a drug, referral, etc., etc. FAP is the largest pre-hospital outpatient facility providing primary health care rural population and plays big role in medical and preventive care, carrying out a complex of preventive and recreational activities, as well as in sanitary and anti-epidemic work. The creation of the FAP was caused by the peculiarities inherent in healthcare in the countryside, the need to bring medical care closer to the population in conditions large radius services of the district hospital (ambulatory) in relation to all available settlements.

FAP provides early detection of infectious patients, conducts primary anti-epidemiological measures in outbreaks, current sanitary supervision over the territory of populated areas. important place in the activities of the feldsher-obstetric station, it actively conducts sanitary and educational work among the population. Paramedics and midwives take direct involvement in organizing and conducting medical examinations, annual clinical examination of the rural population.

We can say that FAP is the face of medicine in rural areas. But the whole difficulty lies in the fact that everything is wonderful with FAPs only officially, and even then outside of statistics and exclusively in the language of local reporting. The face of medicine in the countryside may not come out ...

In practice - most of FAPs have long and firmly become obsolete, and in many settlements there are no FAPs at all. The message is often this: “what kind of FAP is there if there are 30 households left in the village, and there are no youth at all.” The fact that the departure of this very youth may be “somehow” connected, among other things, with the lack of elementary medical care, reporters and analytical references for budget variations do not particularly care.

According to the independent monitoring fund "Health" with reference to the data of the Accounts Chamber, in 2015 there were 31.6 thousand FAPs in Russia - in all regions of the country. However, not all of them are currently working. As it turns out, many are listed only on paper. That is, the FAP as a building, it seems, exists, but as a real medical institution, it seems to be not with personnel and equipment ... And this despite the fact that in the vast majority of cases, the FAP is the only place in the village, where you can buy basic medicines. Well, pharmacy chains do not go where customers, albeit regular ones, are extremely few. Do not go.

The issue of the availability of primary health care in rural areas and remote areas was discussed at a meeting between Russian President Vladimir Putin and Minister of Health of the Russian Federation Veronika Skvortsova. It was in August last year.

Veronika Skvortsova cited statistics from the Ministry of Health of the Russian Federation characterizing the scale of the problem:

63% of rural residents seek medical help in the city;
- in the period from 2005 to 2011, the number of feldsher-obstetric stations decreased (or, as we like to say, “optimized”) by more than 5 thousand, then the state program came into play, but it clearly does not cover the needs: from 2013 to In 2015, only 460 FAPs were opened;
- in some villages FAPs work once a week; villages with fewer than 100 people found themselves without any medical care at all;
- 17.5 thousand settlements do not have any medical infrastructure, of which 11 thousand have more than 20 km to the nearest doctor;
- in 35% of settlements where there is no medical care, there is also no public transport;
- in regions with low population density, such as, for example, Kamchatka Krai, No mobile teams;
- the time of arrival of the ambulance in the village can reach several hours. Or maybe this "carriage" does not reach the patient at all for the most banal reason - mud, the road was "carried".

The Ministry of Health, as he claims, keeps this situation under control. In 2016, the Minister of Health signed an order to organize the provision of primary health care to rural residents.

According to the order settlements with a population of more than 2 thousand people must have an outpatient clinic. With the number of inhabitants from 301 to 2 thousand people, the settlement must have a FAP or a medical outpatient clinic. With a population of 100-300 people, medical care should be provided through the FAP or outreach forms of work (choice).

In search of a solution to the problem, regional authorities are looking for different ways.

For example, in Belgorod region, which in many respects acts as a standard in the Russian Federation, rely on mobility. The mobile feldsher-midwife point has been running for the second year in areas where there are no feldshers at all. The same mobile medical stations operate in the Chelyabinsk, Orenburg, Sakhalin regions, on Yamal and in the Komi Republic.

AT medical organizations Ivanovo region 47 medical teams have been formed to travel to rural areas, delivery of rural patients to central district hospitals and specialized health care facilities has been organized.

AT Voronezh region within the framework of the project “Quality of life. Zdorovye” over the past two years, buildings of 59 feldsher-obstetric stations and 12 medical outpatient clinics have been built.

Nevertheless, the measures taken are not enough to improve the situation with rural medicine. They exist, that's a fact. But once again - they are not enough for such a huge country. Even despite the positive reports from the regions, the negative trend in terms of rural residents' access to medical care continues to persist. In some regions, it is getting worse.

Even in the 21st century, the majority of rural residents do not have the opportunity to pass a normal medical examination and cannot afford full treatment. For many villagers, trips to the district hospital are very expensive, and they are indebted. In this regard, the death rate in rural areas cannot but grow, which often exceeds the birth rate by several times. And this causes concern about the state of demographics in the countryside. To put it mildly, anxiety...

In conclusion, I would like to note the following thing: FAP is not just main part infrastructure where you can get first aid, advice on the treatment of diseases, consult, take a referral to a medical appointment at a district clinic, get an injection or buy medicine, but also ... (and for a rural resident this is sometimes no less important) - to find understanding on the part of a man in a white coat - a man who is truly prayed for in the villages as the one who can come to the rescue at the very difficult moment. This is moral support, the effect of which is sometimes no less than that of therapy.

I would like this problem, which is directly related to demography, to be dealt with progressively and professionally in state structures.

Chapter 12

12.1. GENERAL PROVISIONS

In 2008, 1,749 central district hospitals, 481 district hospitals, 39,179 feldsher-obstetric stations operated in the rural health care of the Russian Federation, employing 46.2 thousand doctors and 208 thousand nurses.

The organization of medical care for rural residents is based on the same principles as for the urban population. However, the special way of life of the villagers, the settlement system, is low (compared to the city) population density, poor quality, and sometimes the lack of roads, the specifics of agricultural labor leave their mark on the system of organizing medical care for rural residents. This applies to the type, capacity, location of health care institutions, their provision with qualified medical personnel and access to specialized medical care. These features also dictate the need to develop and introduce differentiated standards for certain types of resources. For example, for rural areas located on large territories with low population density (Far North, Siberia, Far East), the population standard for organizing a feldsher-obstetric station or a center for general medical (family) practice should be significantly lower than that in the south of the country, where the population density is higher, settlements are located close to each other and there is a good transport connection.

12.2. INTEGRATED THERAPEUTIC AREA

The main feature of providing medical care to the rural population is its staging. Conventionally, there are three stages in the organization of medical care for the rural population

(Fig. 12.1).

Rice. 12.1. Stages of providing medical care to the rural population

First stage- healthcare institutions of a rural settlement, which are part of a complex therapeutic area. At this stage, rural residents receive pre-medical care, as well as the main types of medical care (therapeutic, pediatric, surgical, obstetric, gynecological, dental).

The first medical institution, which, as a rule, a rural resident turns to is feldsher-obstetric station(FAP). It functions like structural subdivision district or central district hospital. FAP is advisable to organize in settlements with a population of 700 or more at a distance to the nearest medical institution over 2 km, and if the distance exceeds 7 km, then in settlements with a population of up to 700 people.

The feldsher-obstetric station is entrusted with the solution of a large complex of medical and sanitary tasks:

Carrying out activities aimed at preventing and reducing morbidity, injuries and poisoning among the rural population;

Decrease in mortality, especially infant, maternal, working age;

Provision of pre-medical medical care to the population;

Participation in the current sanitary supervision of preschool and school educational institutions, communal, food, industrial and other facilities, water supply and cleaning of populated areas;

Carrying out house-to-house rounds according to epidemiological indications in order to identify infectious patients, persons in contact with them and persons with suspected infectious diseases;

Improving the sanitary and hygienic culture of the population.

Thus, the FAP is a healthcare institution to a greater extent preventive focus. It may be entrusted with the functions of a pharmacy point for the sale of ready-made products to the public. dosage forms and other pharmaceutical products.

The work of the FAP is directly headed by manager. In addition to him, a midwife and a visiting nurse work at the FAP.

In spite of important role FAPov, the leading medical institution at the first stage of providing medical care to residents

the village serves local hospital, which in its composition may have a hospital and a medical outpatient clinic. The types and volume of medical care in the district hospital, its capacity, equipment, staffing of medical personnel largely depend on the profile and capacity of other medical institutions that are part of the healthcare system municipal district(rural settlement). The main task of the district hospital is to provide the population with primary health care.

Outpatient care for the population is the most important section of the work of the district hospital. She may turn out dispensary as part of the structure of the hospital, and independent. The main task of the outpatient clinic is to carry out preventive measures to prevent and reduce morbidity, disability, mortality among the population, early detection of diseases, medical examination of patients. Doctors of the outpatient clinic receive adults and children, make house calls and emergency care. Paramedics can also take part in the reception of patients, however, medical care in the outpatient clinic should mainly be provided by doctors. In the district hospital, an examination of temporary disability is carried out, and if necessary, patients are sent to the MSE.

In order to bring specialized medical care closer to the villagers, doctors from the central district hospital, according to a certain schedule, go to the outpatient clinic to receive patients and select them, if necessary, for hospitalization in specialized institutions. AT recent times in many subjects of the Russian Federation, the process of reorganization of district hospitals and outpatient clinics into centers of general medical (family) practice is underway.

12.3. CENTRAL REGIONAL HOSPITAL

Second phase providing medical care to the rural population - these are health care institutions of the municipal district, and among them the leading place is occupied by central district hospital (CRH). The CRH provides the main types of specialized medical care and at the same time performs the functions of a health management body on the territory of the municipal district.

The capacity of the Central Regional Hospital, the profile of specialized departments in its composition depend on the population, structure and level of care.

leftness, other medical and organizational factors and are determined by the administrations of municipalities. As a rule, CRHs have a capacity of 100 to 500 beds, and the number of specialized departments in it is at least five: therapeutic, surgical with traumatology, pediatrics, infectious diseases and obstetrics and gynecology (if there is no maternity hospital in the area).

The chief physician of the central district hospital is the head of health care of the municipal district, appointed and dismissed by the administration of the municipal district.

Approximate organizational structure the central district hospital is shown in Fig. 12.2.

methodological, organizational and advisory assistance doctors of complex therapeutic areas, paramedics of FAPs are carried out by specialists from central district hospitals. Each of them, according to the approved schedule, goes to the complex therapeutic site for medical examinations, analysis of dispensary work, selection of patients for hospitalization.

In order to bring specialized medical care closer to the rural population, regional medical centers. The functions of such centers are performed by large CRHs (with a capacity of 500-700 beds), capable of providing the population of a given municipal district with the missing types of specialized inpatient and outpatient medical care.

The structure of the Central District Hospital has polyclinic, which provides primary health care to the rural population in the direction of paramedics FAPs, outpatient doctors, centers of general medical (family) practice.

The provision of out-of-hospital and inpatient medical and preventive care to children in a municipal district is entrusted to children's consultations(polyclinics) and children's departments of the central regional hospitals. The preventive and curative work of children's polyclinics and children's departments of district hospitals is carried out on the same principles as in urban children's polyclinics.

The provision of obstetric and gynecological care to women in the municipal district is entrusted to women's consultations, maternity and gynecological departments of central district hospitals.

The functional responsibilities of medical personnel, accounting and reporting documentation, and the calculation of statistical indicators of the activity of the Central District Hospital do not fundamentally differ from those in city hospitals and APUs.

Rice. 12.2. Approximate organizational structure of the central district hospital

12.4. REGIONAL (TERIOR, REGIONAL, REPUBLICAN) HOSPITAL

Third stage providing the rural population with medical care is represented by healthcare institutions of the subject of the Federation, and among them leading role regional (territorial, district, republican) hospitals play. At this stage, specialized medical care is provided in all major specialties.

Regional (regional, district, republican) hospital is a large multidisciplinary medical and preventive institution designed to provide in full specialized assistance not only to rural residents, but to the entire population of the subject of the Russian Federation. It is a center for organizational and methodological management of medical institutions located in the region (krai, district, republic), and is the basis for the specialization and advanced training of doctors and paramedical personnel.

The approximate organizational structure of the regional (regional, district, republican) hospital is shown in fig. 12.3.

The functional responsibilities of medical personnel, the methodology for calculating statistical indicators, and the accounting and reporting documentation of a regional (regional, district, republican) hospital do not fundamentally differ from those in city or central district hospitals. At the same time, the organization of the work of the regional (regional, district, republican) hospital has its own characteristics. One of these features is the presence in the hospital consultative polyclinic, where residents of all municipal districts (urban districts) of a constituent entity of the Russian Federation come for help. For their accommodation, a boarding house or hotel for patients is organized at the hospital.

As a rule, patients are sent to the advisory polyclinic after a preliminary consultation and examination by district (city) specialist doctors. Patients are hospitalized in the inpatient departments of the hospital, as a rule, according to the referrals of specialists from district, city, central district hospitals, ambulance teams and departments of emergency and planned advisory care.

Rice. 12 .3. Approximate organizational structure of a regional (regional, district, republican) hospital

Another feature of the regional (regional, district, republican) hospital is the presence in its composition departments of emergency and planned advisory assistance, which, using the means of air ambulance or ground vehicles, provides emergency and advisory assistance with travel to remote settlements. In addition, the department provides delivery of patients to specialized regional and federal medical centers.

The Department of Emergency and Planned Consultative Assistance operates in close connection with regional center disaster medicine. In cases of occurrence emergencies practical work brigades of specialized medical care of constant readiness carry out sanitary tasks.

Unlike the Central District Hospital, in the regional (regional, district, republican) hospital functions organizational and methodological department much wider. In fact, it serves as an analytical center and scientific and methodological base for the healthcare management body of a constituent entity of the Russian Federation for the introduction of modern medical and organizational technologies into practice.

To organizational activities The department includes holding regional feldsher (nursing) conferences, summarizing and disseminating the best practices of healthcare institutions, organizing medical examinations of the population, scheduled visits of specialists, publishing instructional and methodological materials, etc.

Research work is one of the activities of the regional (regional, district, republican) hospital. It includes holding together with the departments medical universities and research institutes of research, the introduction of scientific results into the practical work of medical institutions, the organization of scientific conferences and seminars, the work learned societies doctors and others.

Further ways to improve the organization of medical care for rural residents are to develop a network of general medical (family) practice centers, strengthen the material and technical base and equip inter-district centers based on large central district hospitals with modern medical equipment, provide ambulance stations (departments) with sanitary transport and means of communication , development

air ambulance services, the introduction of telemedicine, the development of high-tech types of medical care on the basis of regional (territorial, district, republican) hospitals. Approximation to the population of specialized types of medical care should follow the path of development of its exit forms (field clinics, mobile dental offices, fluorographic installations, etc.). Important condition increasing the availability of medical care to rural residents - staffing health care institutions medical workers. To solve this problem, it is necessary to switch to a contract-targeted form of training and distribution of personnel, provide housing for young specialists, introduce effective system material incentives for labor.

Public health and health care: a textbook / O. P. Shchepin, V. A. Medic. - 2011. - 592 p.: ill. - (Postgraduate education).

Dear Vladimir Volfovich! Medical assistance in the countryside is a matter of special importance. Every year the villages and the inhabitants living in them are getting older. And with age, sadly, health problems come. Where to go? Who to contact?

Quick and qualified assistance can be obtained on the spot - at the rural feldsher-obstetric station (FAP). It is easier to get to it, and a well-known paramedic will meet here, and there are enough medicines here. FAP is a very important part of rural infrastructure. This is the place where you can not only get first aid, recommendations for the treatment of colds, viral diseases, consult, get a referral for a medical appointment at the Central District Hospital, make an injection, prescribe or buy medicines, but also meet and chat with friends. Indeed, in some places even bread is brought to the first-aid post, so that people can receive here not only medical assistance, but also moral and spiritual support. Now in some settlements all socially significant objects for the villagers are in one place: budget funds forced to unite under one roof the FAP, the library, the post office, the village club, the school.

And this is very important for an elderly person who finds it difficult to walk far. Continues economic crisis, in connection with this, is the question of closing FAPs being raised in our district?

- Neither the administration of the municipal district, nor the administration of the Central District Hospital, and even more so the administration rural settlements no such question is raised. On the contrary, everyone understands that FAP is needed in rural areas. There is no one to replace him. In spite of economic difficulties, the district administration allocates funds for the maintenance of FAPs, and this is a rather large expense item: heating, lighting, medicines, equipment, etc. Reading these lines, tears involuntarily well up.

This all applies to Kirov region. We are residents Kursk region, Sovietsky district. Our situation with FAPs is completely opposite. FAPs are closed even when locals still need them. Our administration does not want to pay for electricity and heating, calling these costs not targeted spending of budget funds. Paramedics are licensed in neighboring villages and forced to go there to work, while the attached areas remain the same.

But how many of our old people are able to cover great distances when there is no regular transport connection? One gets the impression that local officials do not understand the essence of the work of a paramedic. Come to the office in the morning, get the necessary injections and vaccinations, and go to the site to those who are completely unable to walk, take care of children, and collect people for a routine examination. It turns out that people are forced to go to the paramedic's house and wait for him there. But there is no equipped office, a quartz lamp for disinfection. The paramedic will not agree to give injections at home, and has every right to do so.

And where to store the vaccine for vaccinations, in the refrigerator with food or what? So our administration makes healers out of paramedics, and in this flagrant violation all laws and regulations. We, residents of the village of Mikhailoannenka, Sovetsky District, Kursk Region, ask you to take all measures to return the FAP to the people. It was closed in 2009, but the local administration found funds for lighting and partial heating, which made it possible to continue to receive the necessary medical care. Instead of the FAP, there was an office for the paramedic. After some time, the library and the village council were transferred to the same building, which is what they do in those regions where they are trying to save on heating and lighting.

But the head of the village council changed and decided to move closer to her home and returned the village council to former place. She was asked to leave at least the light, but she said that this was not the intended use of budget funds. None of her convolutions turned towards people. Pursuing her own interests, she found funds to repair the old village council. Maybe our entire administration lives in a completely different country? After all, the president himself spoke about priorities in healthcare, about the availability of medical care.

The former FAP building, built in the late sixties, is made of brick and has a service life of 150 years, and is in excellent condition. Repairs were made there when the village council was transferred, and now it is waiting for gradual destruction. There is nowhere to even vote. They always find money for themselves, but they don’t want to think about people. We have many other problems as well. There is no road to the FAP, and during snowfalls people leave their cars on the highway, or at home for the whole winter, with no chance to leave.

For several years now, a new water tower has flaunted throughout the village, which was never put into operation, the pumps do not work, and the water from the old water tower is not suitable for cooking. And all these difficulties accompany the villagers all their lives. With each elected official, people hope for a change for the better, but it only gets worse, and the administration is not even going to solve these problems, and those who should take care of people kill with their indifference. Can you make the government work? 22.08.

2016 Residents of the village of Mikhailoannenka.

Unity of principles for the provision of medical and preventive care urban and rural population: 1) preventive character; 2) precinct; 3) mass character; 4) specialization of medical care 5) general availability.

The peculiarity of the provision of medical and preventive care to the rural population:

1) stages of assistance

2) mobile types of medical care (field medical teams).

Features of the organization of rural medical care:

1) low density population - the number of rural population in 2004 2.803.600, 2005 2.744.200, 2006 2.691.500. Compared to 2002, the rural population decreased by 118 thousand. In 2005, 90,307 people were born, of which 24,205 (26.8%) were born in rural areas. The birth rate in 2005 was 9.2 in the Republic of Belarus, in the countryside - 8.9. Mortality in the countryside is 2.2 times higher than in the city. infant mortality 6.4 in general, 9.3 in rural areas. Life expectancy in the countryside is 64.52, in the city 70.53.

Population - the number of people in the locality. The average rural population is 200 people.

2) scattered settlements on a large territory - rural settlements 24 thousand sq. Average density population in the Republic of Belarus is 48 people per km2, in the village - 10 people per km2. Proximity - the distance between settlements, service radius - the distance from the settlement where there are medical institutions to the most remote settlement, the inhabitants of which are attached to this institution for medical care. This value is manageable and varies depending on the population.

3) poor quality of roads

4) the specifics of agricultural labor: seasonality, weather dependence

5) conditions, lifestyle, traditions

6) low availability of specialists

Stages of providing medical and preventive care to the rural population and the main organizations:

Stage I - earlier - a rural medical site (SVU), including a complex of medical institutions:

A) a rural district hospital (SUB, provides both outpatient and inpatient care) or a rural medical outpatient clinic (SVA, provides only outpatient care)

B) feldsher-obstetric station (FAP)

C) health centers (if available) industrial enterprise in the service area).

Currently There is no SVU, SVA and district hospitals are branches of the Central District Hospital, FAPs are branches of SVA.

The main function of the stage: rendering first before medical assistance, the first qualified medical aid with possible elements specialized medical care.

FAPs- created for medical care of 400 people or more at a distance of 2 km or more from a medical institution. Serving over 400 people in the states of the FAP, there are: 1 position of a paramedic or midwife or nurse and 0.5 nurse positions. The cost of FAPs is 1.5-2.0% of the budget of the district WA.

FAP functions:

- provision of pre-medical medical care and timely fulfillment of doctor's prescriptions;

– holding preventive work and anti-epidemic work;

– organization of patronage of pregnant women, children,

– taking measures to reduce infant and maternal mortality;

– hygienic education and education of the population.

Rural Medical Plot (SVU)- served 7-9 thousand people within a radius of 7-9 km.

District hospital- This is the main institution at the SVU, it consists of a hospital and an outpatient clinic. Depending on the number of beds, there can be category I - for 75-100 beds, II - 50-75 beds, III - 35-50, IV - 25-35 beds. At the local hospital All types of qualified medical and preventive care are provided. Great importance has medical assistance to the population during the period field work. Significant work is being done to protect the health of women and children, the introduction modern methods prevention, diagnosis, treatment.

All types of medical and preventive care for pregnant women, mothers and children are provided Local hospital doctor. If there are several doctors, then one of them is responsible for the health of children and women in this area.

At Unprofitable activities of district hospitals, they are closed or converted into departments Rehabilitation of district hospitals, and for medical care of the population open Independent rural medical clinics(SVA), which should include: a general practitioner, a dentist, an obstetrician-gynecologist, a pediatrician. Medical assistance to patients with dental diseases in a district hospital or in a rural outpatient clinic is provided by a dentist (dentist).

From the staff standards of medical personnel of district hospitals:

1. The positions of doctors for the provision of outpatient care to the population are established based on 10,000 population:

2. The positions of doctors of hospital departments are established at the rate of 1 position:

– general practitioner – 25 beds;

– pediatrician – 20 beds;

– surgeon – 25 beds;

– dentist – 20 beds.

The bed capacity of the rural district hospital is 27-29 beds.

Organization of the work of the SMS:

– provision of medical and preventive care to the population

– introduction into practice of modern methods of prevention, diagnosis and treatment of patients

– development and improvement organizational forms and methods of medical care for the population, improving the quality and effectiveness of medical and preventive care

– organization and implementation of a complex of preventive measures among the population of the site

– carrying out therapeutic and preventive measures to protect the health of mother and child

– study of causes general morbidity and morbidity with temporary disability and development of measures to reduce it

– organization and implementation of medical examination of the population, especially children and adolescents

- implementation of anti-epidemic measures (vaccinations, identification of infectious patients, dynamic monitoring of persons who were in contact with them, etc.)

– implementation of current sanitary supervision over the state of industrial and communal premises, water supply sources, children's institutions, institutions Catering;

– carrying out therapeutic and preventive measures to combat tuberculosis, skin and venereal diseases, malignant neoplasms

– organizing and conducting activities for sanitary and hygienic education of the population, propaganda healthy lifestyle life, including rational nutrition, strengthening motor activity; control of alcohol, smoking and other bad habits

– wide involvement of the public in the development and implementation of measures to protect public health

Stage II - Territorial Medical Association (TMO).

Lead TMO Chief Physician of TMO(he is also the chief physician of the Central District Hospital) and his deputies:

- Deputy for medical care population (he is also the head of the organizational and methodological office);

- Deputy for the medical unit (with the number of beds 100 or more);

- Deputy for Medical and Social Expertise and Rehabilitation (with the number of the population being served is at least 30,000 people);

- Deputy for Obstetrics and Childhood (if the number of people served is at least 70,000 people);

- Deputy for economic issues;

- Deputy for the administrative and economic part.

The Medical Council is composed of: chief physician, his deputies, chief physician of the Center for Hygiene and Epidemiology, head of the central district pharmacy, leading specialists of the district, chairman of the district committee of the trade union of medical workers, chairman of the Red Cross and Red Crescent Society.

The decision to establish a TMO is made by a higher health authority. AT small towns and rural areas TMO unites, as a rule, all medical and preventive institutions and replaces the city health department and the Central District Hospital. AT major cities with a population of more than 100,000 people, there may be several TMOs, one of them is the head one.

TMO is a complex of healthcare facilities that are functionally and organizationally interconnected. The composition of the TMO may include:

clinics (adults, children, dental);

antenatal clinics, dispensaries, hospitals, maternity hospitals;

ambulance stations;

children's sanatoriums and other institutions.

Amalgamation of institutions should be expedient, not mandatory. Institutions that are not included in the TMO operate independently. As a rule, these are health centers and centers of hygiene and epidemiology, bureaus forensic medical examination, blood transfusion stations.

Principles of TMT formation:

1. A certain population - optimal size TMO - 100-150 thousand people.

2. Organizational and financial separation of outpatient and inpatient facilities.

3. Coincidence of the boundaries of the TMO service area with the administrative boundaries of the district (city).

4. Rational association of institutions - association of institutions providing medical care to adults and children.

Tasks of TMO- providing affordable and qualified medical and preventive care to the population.

TMO functions:

1. Organization of medical and preventive care for the attached population, as well as for any citizen who seeks medical help.

2. Carrying out preventive measures.

3. Providing first aid to the sick.

4. Timely provision of medical care at the reception, at home.

5. Timely hospitalization.

6. Clinical examination of the population.

7. Conducting a medical and social examination.

8. Carrying out hygienic education and upbringing.

9. Analysis of the activities of health facilities.

The main medical and preventive institutions Stage II are the central district hospital (CRH) and other institutions of the district (see question 102).

For organization Treatment and preventive care for women and children on the this stage the district pediatrician and the district obstetrician-gynecologist are responsible. With a population of more than 70,000 people, the position of deputy chief physician for childhood and obstetrics is appointed - an experienced pediatrician or obstetrician-gynecologist.

Outpatient dental care at stage II, it can be in dental clinics and dental departments of the polyclinic of the Central District Hospital. Stationary dental care in the dental department of the hospital of the Central District Hospital or on special beds for dental patients in the surgical department.

Stage III - the regional hospital and medical institutions of the region.

Regional Hospital is a large multidisciplinary medical and preventive institution that provides highly qualified highly specialized assistance to the residents of the region in full. This is a center for organizational and methodological management of medical institutions located in the region, a base for specialization and advanced training of doctors and paramedical personnel.

The structure of the regional hospital:

1. Stationary.

2. Advisory polyclinic.

3. Other departments (kitchen, pharmacy, mortuary).

4. Organizational and methodological department with a department of medical statistics.

5. Department of emergency and planned advisory assistance, etc. (see question 104).

The bed capacity of the regional hospital for adults is 1000-1100 beds, for children - 400 beds.

Advisory polyclinic provides the population with highly qualified, highly specialized medical care, provides on-site consultations, by phone - correspondence consultations, analyzes the activities of medical institutions, the discrepancy between the diagnoses of the referring institutions and the polyclinic, the diagnoses of the polyclinic and the hospital, analysis of errors. Does not have the right to issue sick leave.

The children's and women's population of the region receives all types of qualified specialized medical care in the advisory polyclinic. Stationary care women find themselves in regional maternity hospitals, regional dispensaries and other medical institutions areas.

Outpatient skilled specialized dental care the patient is in the regional dental clinics, stationary - in the dental departments of regional hospitals.

The number of hospital organizations in the countryside in 2005 was 274, of which 184 district hospitals, hospitals nursing care- 90. The number of outpatient clinics is 3326. Independent medical outpatient clinics for 2005 - 253, general practitioner outpatient clinics for 2005 - 336. FAPs in 2005 - 2524.

IVstage: republican level(RSPC, republican hospitals).

Residents of rural areas - 38 million people, which is about 26% of the total population of the Russian Federation. Does the rural population of the country have a high standard of living? - If only in the reports of local officials ... Is the social infrastructure developed in the village? “Unfortunately, no more than yes. Have the necessary working conditions for rural residents been created by modern standards? - Far from everywhere (to put it mildly). Rural labor itself, which has not actually changed in its principles for many decades, leaves its mark on the health of those who are engaged in such labor. And the question that has already been raised on the pages of our information and analytical portal - the question of why the Russian village is dying out, is also closely related to the painful issue of rural health.

This issue is so painful for millions of Russians that any mention of it causes a sharp reaction. Explainable...

So, how to get fast and qualified medical care in the countryside? Officially, there is everything for this. As the main option - an equipped feldsher-obstetric station with a professional health worker, and preferably several. He will meet, listen, diagnose, advise, prescribe a drug, referral, etc., etc. FAP is the largest pre-medical outpatient clinic providing primary health care to the rural population and plays an important role in medical and preventive care, a set of preventive and health-improving measures, as well as in sanitary and anti-epidemic work. The creation of the FAP was caused by the peculiarities inherent in healthcare in the countryside, the need to bring medical care closer to the population in the conditions of a large service radius of the district hospital (ambulatory) in relation to all available settlements.

FAP provides early detection of infectious patients, conducts primary anti-epidemiological measures in outbreaks, current sanitary supervision over the territory of populated areas. An important place in the activity of the feldsher-obstetric center is occupied by the active conduct of sanitary and educational work among the population. Paramedics and midwives are directly involved in the organization and conduct of medical examinations, annual medical examinations of the rural population.

In fact, most of the FAPs have long and firmly become obsolete, and in many settlements there are no FAPs at all. The message is often this: “what kind of FAP is there if there are 30 households left in the village, and there are no youth at all.” The fact that the departure of this very youth may be “somehow” connected, including with the lack of basic medical care, the compilers of reports and analytical reports for budget variations, is not particularly worrisome.

According to the independent monitoring fund "Health" with reference to the data of the Accounts Chamber, in 2015 there were 31.6 thousand FAPs in Russia - in all regions of the country. However, not all of them are currently working. As it turns out, many are listed only on paper. That is, there seems to be a FAP as a building, but as a real medical institution - with personnel and equipment, it seems, not ... And this despite the fact that in the vast majority of cases the FAP is the only place in the village where you can buy basic medicines . Well, pharmacy chains do not go where customers, albeit regular ones, are extremely few. Do not go.

Veronika Skvortsova cited statistics from the Ministry of Health of the Russian Federation characterizing the scale of the problem:

63% of rural residents seek medical help in the city;
- in the period from 2005 to 2011, the number of feldsher-obstetric stations decreased (or, as we like to say, “optimized”) by more than 5 thousand, then the state program came into play, but it clearly does not cover the needs: from 2013 to In 2015, only 460 FAPs were opened;
- in some villages FAPs work once a week; villages with fewer than 100 people found themselves without any medical care at all;
- 17.5 thousand settlements do not have any medical infrastructure, of which 11 thousand have more than 20 km to the nearest doctor;
- in 35% of settlements where there is no medical care, there is also no public transport;
- in regions with low population density, such as, for example, the Kamchatka Territory, there are no mobile teams;
- the time of arrival of the ambulance in the village can reach several hours. Or maybe this "carriage" does not reach the patient at all for the most banal reason - mud, the road was "carried".

The Ministry of Health, as he claims, keeps this situation under control. In 2016, the Minister of Health signed an order to organize the provision of primary health care to rural residents.

According to the order, settlements with a population of more than 2 thousand people must have an outpatient clinic. With the number of inhabitants from 301 to 2 thousand people, the settlement must have a FAP or a medical outpatient clinic. With a population of 100-300 people, medical care should be provided through the FAP or outreach forms of work (choice).

In search of a solution to the problem, regional authorities are looking for different ways.

For example, in the Belgorod region, which in many respects acts as a benchmark in the Russian Federation, they rely on mobility. The mobile feldsher-midwife point has been running for the second year in areas where there are no feldshers at all. The same mobile medical stations operate in the Chelyabinsk, Orenburg, Sakhalin regions, Yamal and the Komi Republic.

In medical organizations of the Ivanovo region, 47 medical teams have been formed to travel to rural areas, delivery of rural patients to central district hospitals and specialized healthcare facilities has been organized.

In the Voronezh region within the framework of the project “Quality of life. Zdorovye” over the past two years, buildings of 59 feldsher-obstetric stations and 12 medical outpatient clinics have been built.

Even in the 21st century, the majority of rural residents do not have the opportunity to undergo a normal medical examination and cannot afford full-fledged treatment. For many villagers, trips to the district hospital are very expensive, and they are indebted. In this regard, the death rate in rural areas cannot but grow, which often exceeds the birth rate by several times. And this causes concern about the state of demographics in the countryside. To put it mildly, anxiety...

In conclusion, I would like to note the following thing: FAP is not just an important part of the infrastructure where you can get first aid, recommendations for the treatment of diseases, consult, get a referral to a medical appointment at a district clinic, get an injection or buy medicine, but also.. (and for a villager this is sometimes no less important) - to find understanding on the part of a person in a white coat - a person who is truly prayed in the villages as the one who can come to the rescue in the most difficult moment. This is moral support, the effect of which is sometimes no less than that of therapy.

I would like this problem, which is directly related to demography, to be dealt with progressively and professionally in state structures.

Photos used: Facebook / Grigory Galitsyn

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