General provisions

In 2008 in rural health Russian Federation there were 1749 central district hospitals, 481 district hospitals, 39,179 feldsher-obstetric stations, which employed 46.2 thousand doctors and 208 thousand paramedical personnel.

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 resources.

For example, for rural areas located on large territories with a 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 good transport links.

Integrated therapeutic area

The main feature of the provision of medical care rural population lies in its stages. Conventionally, there are three stages to the organization of medical care for the rural population (Fig. 12.1).

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

The first stage - health care institutions rural settlement, which are part of the 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 a 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, municipal, food, industrial and other facilities, water supply and cleaning of populated areas;
. conducting 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 in more 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 the head. In addition to him, a midwife and a visiting nurse work at the FAP.

In spite of important role FAPs, the leading medical institution at the first stage of providing medical care to the villagers is the district hospital, which may include 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 hospitals. medical institutions included in the healthcare system of the 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. It can be an outpatient clinic 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.

Outpatient doctors 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, district hospitals and outpatient clinics are being reorganized into centers of general medical (family) practice.

O.P. Shchepin, V.A. Medic

Maxim DENISOV

What money is spent on should work effectively

The title of the article may lead to some bewilderment for a regular reader of the NSG - here you are, they wrote, they wrote that FAPs will not be repaired in any way, and now they suddenly ask why they are needed at all. How it is? In fact, there is no contradiction here.

Of course, people living in countryside must have access to medical services, and feldsher-midwife stations are designed to bring these services closer geographically. However, the whole question is, what kind of services? Sometimes, a health worker in such a FAP can only give an injection and bandage, which elementary things, in principle, should be taught to every citizen in high school.

But to this point we will return. In the meantime, let's pay attention to the official message published on the website of the Government Penza region. “Governor of the Penza region Vasily Bochkarev instructed the heads of administrations of urban districts and municipal districts create special commissions that should monitor the logistics of health care institutions. The corresponding instruction was given during the meeting, which was held via videoconference on Monday, November 10, 2014.”

“Local leaders need to know the state medical institution and have information about activities aimed at the development of the healthcare industry. The head or his deputy for social affairs should go to the facilities once a week and personally get acquainted with the situation - check the conditions of the patients, the availability of medicines and the quality of food. Representatives should be involved in this work political parties by deputies, public organizations and fund health insurance", - said Vasily Bochkarev.

The governor also pointed out the inadmissibility of lagging behind the schedule for the repair of feldsher-midwife stations. According to the Ministry of Health of the Penza Region, 81% of FAPs have been repaired. In this regard, Vasily Bochkarev drew the attention of the meeting members to strict observance work schedules.

It is curious that when the NSG drew attention to the same thing a month ago (“Unfulfilled order”, NSG No. 38 (135) of October 9, 2014), the Ministry accused us of publishing “inaccurate facts” and “incorrect” posing the question. And we, rubbing our hands, were waiting for a dressing down from the Penza Ministry of Health to the governor. Now they will pour him on the first number - they will know how to be incorrect with unreliable facts! But, for some reason, they did not wait ...

But the most interesting thing in the message is not this, but the following information: “Within the framework of the subprogram “Disease Prevention and Formation healthy lifestyle life. Development of Primary Health Care» state program"Development of healthcare in the Penza region for 2014–2020" for overhaul 70.9 million rubles were allocated to regional feldsher and obstetric centers and 99.1 million for the purchase of medical equipment. A list of 163 FAPs in need of repair has been compiled, as well as a list of 5.5 thousand pieces of equipment to bring them in line with the equipment standard.”

Once again, we emphasize "equipment to bring it in line with the equipment standard"! Meanwhile, they report to us only about repairs. Silence about the quality of subsequent medical care. Meanwhile, this is exactly what the governor had previously emphasized. At the session of the Legislative Assembly on April 22, one of the deputies, addressing the governor, said that residents of the Penza region often ask questions about the work of FAPs regarding improving the quality of medical care in rural areas. “When checking the work of FAPs, we are faced with the fact that often no more than six people a month come to receive them.

Deputy Chairman Vladimir Maltsev is now leaving for the districts to check feldsher-obstetric stations, while he does not warn either the Minister of Health or the head of the district administration about his visits. There are cases when FAPs are either closed for half a day, or there is no doctor there, so the population immediately goes to the hospital. Why then keep this FAP? If we invest a resource, then it must work and be attractive to the population,” the governor replied (quoted by Penza-Press news agency). And at a meeting with the Minister of Health of the region, he clarified: “all residents of the Penza region should receive timely, high-quality and qualified medical care, as well as be able to be examined using modern methods primary diagnostics in all municipalities…

Improving the quality of primary health care is a priority task that we have set ourselves and must solve. FAPs need to install the required medical equipment, which will be used to the maximum, and the staff will be able to work on it.”

How did it happen that the governor's order suddenly disappeared from its main component - the quality of medical care? Officials from the Ministry of Health concentrated their efforts on repairing the premises of the FAP and reported on the planned equipping of them in accordance with the current federal standard. But, alas! With such equipment for FAPs, villagers will still be forced to travel daily to regional centers even for banal, but often quite effective, physiotherapy. So even the "overhauled" FAPs run the risk of remaining "empty" premises.

In this regard, we note that, according to the information available to the editors, the list of 5.5 thousand units of medical equipment, for which almost one hundred million has been allocated, has not yet been approved. And we again take the opportunity to draw the attention of the Ministry of Health of the region and the Government authority in charge of it to the unique Penza development - the AIST-3 apparatus, modernized with an EHF-therapy adder. The device is not only developed and designed by Penza specialists, but is also produced by the Penza enterprise PO "Start".

Equipping with this device, which has a huge range of applications in therapy and rehabilitation measures, Penza FAPs will make it possible to turn them into really working medical institutions that perform their medical and rehabilitation functions. Well, besides, it will allow to preserve and develop a truly innovative production in Penza, the need for which our governor also does not get tired of talking about.

It's a matter of small. The Penza Ministry of Health needs to develop and approve its own standard for equipping FAPs in our region, because. current federal standard contradicts itself, prescribing to carry out measures for medical rehabilitation in the absence of appropriate material equipment in the proposed standard.

The law allows this. All you need is desire and will. This is exactly what bureaucracy, as you know, lacks. It is much more convenient to formally report, ignited only by criticism in the media, and even then it is unproductive. Alas, real action starts only with pressure from above.

According to the information available in the NSG, to this issue showed interest Kozlov S.V. - Deputy Maltseva V.A. (Deputy Chairman of the Government of the Penza Region, in charge of healthcare). This gives some hope that the Penza FAPs will not remain the entourage of the Potemkin villages.

"New social newspaper", No. 43, November 20, 2014
The publication is posted with the permission of the NSG editors.
Address of the editorial office of the New Social Newspaper:
Penza, st. K. Marx, 16. Tel./fax.: 56-24-91, 56-42-02, 56-42-04.

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) the dispersion of settlements over a large area - rural settlements 24 thousand. 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 first aid, 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 of modern methods of prevention, diagnosis, and 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, promotion of a healthy lifestyle, 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 (if the number of people 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 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 in full highly qualified highly specialized assistance to residents of the region. 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 the 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 of the region.

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).

Chapter 12

Chapter 12

12.1. GENERAL PROVISIONS

In 2008, 1,749 central district hospitals, 481 district hospitals, and 39,179 feldsher-obstetric stations operated in the rural health care of the Russian Federation, employing 46,200 doctors and 208,000 paramedical personnel.

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 system of settlement, 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 concerns the type, capacity, location of healthcare institutions, their provision with qualified medical personnel, and the possibility of obtaining 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 in large areas with low population density (the Far North, Siberia, the Far East), the population standard for organizing an 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 as a structural subdivision of the 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 with a more preventive focus. It may be entrusted with the functions of a pharmacy for the sale of finished dosage forms and other pharmacy products to the public.

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

Despite the important role of FAPs, 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 of the 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. Recently, in many subjects of the Russian Federation, there has been a process of reorganization of district hospitals and outpatient clinics into centers of general medical (family) practice.

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 medical assistants 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 institution designed to provide full specialized assistance not only to rural residents, but to the entire population of a constituent entity 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 a consultative 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 Emergency and Planned Advisory Department 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 schools 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 facilities with 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).

Residents of rural areas - 38 million people, which is about 26% of total strength population of the 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 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 clinic providing primary health care to the 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 is actively conducting 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 facility, it seems, it doesn’t exist with personnel and equipment... And 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 Russian Health Minister 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.

Photos used: Facebook / Grigory Galitsyn

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