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HEALTH CARE TO RURAL POPULATION

IN RUSSIAN FEDERATION

Under conditions of medical reforms in Russia, medical students should know how to
organize rural public health and workers’ training.
The main task of rural public health is the complete satisfaction of the villagers` necessities
with the highly qualified health care.
Health care to rural population in Russia is founded on the same organizational principals
like to urban one:
 unity of medical and preventive arrangements;
 guarantee of free health care;
 continuity of health care (out-patient and in-patient);
 district-territorial principle of service;
 specialization and integration of the health care;
 special attention to social important groups of population (children, women,
working population).

But there are differences between rural and urban areas which are determined with the
whole series of the factors:
 Social-economic conditions;
 Specific agricultural labor and living conditions in the countryside;
 Transportation and road condition within the rural area, etc.;
 Settling nature and service radius of the villagers;
 Medico-demographic peculiarities;
 Sex and age structure peculiarities;
 Degree of the demographic density;
 Morbidity and invalidity state;
 Way of life;
 Natural conditions;
 Development of the infrastructures in the whole and separately of health facilities.
These factors leave traces on the medical aid nature (its volume and quality) for
villagers and demand the special organizational forms and work methods from public health
bodies.
So, the settling nature, the small compactness, the remoteness of the villages from each
other, the distance of the nearest medico-preventive establishment render the significant
influence on the medico-preventive aid availability and make for the low level of the
morbidity( in according with the visits).
The significant part of the village pensioners live alone and need in the care.
The number of chronic diseases increased.
It`s very difficult to provide the qualitative dispensary observation in the countryside.
The insufficient availability of the secondary and tertiary medico-preventive aid, the
inopportune diagnostic and treatment and in- regular dispensary observation promotes the high
level of invalidity.
The specific character of agriculture labor makes for the necessity of moveable medical
help forms.
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Peculiarities of health care to rural population

 STAGES
 Considerable part of premedical care
 Special health facilities in the countryside
 Specific organization and methods of health service

Modern tasks of rural public health in Russia:

 To carry out qualitative out-patient care;
 Preventive orientation;
 Availability of specialized and high technological care;
 Improvement of emergency care;
 To provide sufficient physicians in rural hospitals and out-patient clinics.

The main peculiarity of the medical help organizing to rural population is the stage
character.
STAGES OF HEALTH CARE RENDERING
TO RURAL POPULATION:
I stage – rural medical division:
 Premedical care
 Primary medical care: therapeutic, pediatric, surgical, obstetric and gynecological,
stomatological.
II stage – rayon medical establishments (municipal level):
 specialized medical care
 Primary care to rayon city citizens and nearby villages.
III stages – oblast (kray, okrug, and republic) medical establishments (level of subject
of Russian Federation):
 Narrow-specialized care.

I STAGE
PRIMARY CARE
RURAL MEDICAL DIVISION
Divisional Feldsher and Ambulatory Centre of
hospital obstetric post general practice

In present time, improvement of Primary care rendering to population is very importance

in social politics in Russia.
Rendering of Primary care (PC) like practical realization of Primary Health Care (PHC)
concept is the first level of contact of individuals, the family and community with the national
health system bringing health care as close as possible to where people live and work, and
constitutes the first element a continuing health care process.
Primary Health Care decides the following tasks:
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 Diagnostic and treatment of patients with the most spreading diseases (till recovery or
complete compensation);
 Treatment after receiving other kinds of aid;
 Patients’ need of special reference;
 To carry out preventive arrangements;
 Dispensary observation of patients with goals before nosologic diagnostics and medical-
social prophylaxis;
 Rendering urgent and emergency aid.

The rural medical division (RMD) is a primary medical section in the establishments`
system providing health care to rural population. RMD consists of:
 Divisional hospital (inpatient department) including
 Feldsher and obstetric post (premedical care) and
 Ambulatory (outpatient clinic) (outpatient care) or
Centre of general practice.

Tasks of RMD:
1) rendering of medico-preventive aid to population;
2) anti epidemical work;
3) protection of mother and children health (nursing pregnant women, delivering child
when normal pregnancy, dynamic observation of children and juveniles);
4) sanitary inspectors of the territory, economic objects, educational establishments;
5) analysis of population health;
6) hygienic education of population.

The main establishment of the RMD is a divisional hospital (DH).

Categories:
I - 75 – 100 beds
II - 50 – 75 beds
III - 35 - 50 beds
IV - 25 – 35 beds

S TRU CTU RE OF D IVIS ION AL HOS P ITAL

Ch ie f d o c to r

In -p a tie n t Oth e rs Ou t -p a tie n t

d e p a rtm e n t s u bd iv is io n s d e p a rtm e n t

X-ro o m a n d
Clinical F u n c tio n a l
P h y s io - u ltra s o n ic
laboratory th e ra p y ro o m
d ia g n o s tic
d ia g n o s tic
ro o m
ro o m
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Basic tasks of DH:

1) outpatient and inpatient care to population;
2) medico-preventive and sanitary measures protecting mother and children` health;
3) To preventive measures decreasing morbidity and traumas;
4) introduction of modern diagnostic methods, treatment and preventive methods;
5) leading and control of RMD;
6) anti epidemic measures.

Feldsher and obstetric post (FOP): staff

 Medical assistant (feldsher)
 Obstetrician.

FOP: functions
1) premedical care (about 60%);
2) carrying-out doctor’s prescriptions;
3) children and pregnant women nursing;
4) dispensary observation;
5) measures to increase infant and maternity death rate;
6) sanitary-hygienic education of population.

FOP: sanitary work

 early detection of infectious diseases
 Current disinfection
 Observation of infectious patients
 Preventive vaccination
 Dehelmintization
 Current sanitary inspections
 Sanitary-educative work
 Prevention of traumas and pesticide poisonings

AMBULATORY (like independent facility) is like a small urban polyclinic with the
similar structure and functions. They provide:
 early detection of diseases and risk factors;
 timely patients` treatment in an outpatient clinic and at home;
 selection of persons who needs dispensary observation, their timely examination,
treatment and rehabilitation;
 organizing emergency aid;
 temporal disability examination;
 dispensary observation of women and children;
 realizing consultations in doctor`s assistant and obstetric points;
 sanitary and anti epidemic measures;
 referral for advice to district medical establishments;
 Patient referral for medico-social examination in case of the stable disability.
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AMBULATORY: staff
 Therapeutist
 Pediatrician
or family doctor
 Stomatologist
 Obstetrician-gynecologist

AMBULATORY: structure
 Rooms of doctors (therapeutist, pediatrician, stomatologist, obstetrician-gynecologist)
 Physiotherapy room
 Clinical laboratory
 X - room
 Registry
 Functional diagnostics room.

II STAGE

II STAGE
SPECIALIZED CARE
Rayon medical establishments
(Municipal level)
Central rayon hospital
Rayon (city) hospital
Pediatric rayon (city) hospital
Maternity hospital
Woman consultation
Rayon (city) dispensaries
Rayon (city) medical centers
Emergency station
Blood transfusion station

The main medico-preventive establishment of the second stage is a central rayon hospital
(CRH). The CDH is the centre of qualified and specialized medical care. Simultaneously it`s the
administration body and the centre of organizational-methodical and operative management with
all health establishments in rayon.
CRH: STRUCTURE
 Administration;
 Economical section;
 Inpatient ( specialized) departments (7-8 profiles minimum):
- Therapeutic
- Surgical
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- Pediatric
- Obstetric
- Gynecological
- Neurological
- Infectious
- Traumatological and other.
 Outpatient (polyclinic) department (15-17 specialists) with medico-diagnostic rooms and
laboratories;
 subsidiary structural subdivisions:
- medical archive;
- informational-analytical subdivision;
- pathologic-anatomical department;
- emergency and urgent care departments;
- additional diagnostic departments.

Basic tasks of CRH:

1) primary care to rayon centre population;
2) specialized care to all rayon population;
3) emergency and urgent medical care to rayon population;
4) consultative help;
5) management and control of all rayon health facilities including their material-technical
provision;
6) improvement of medical staff skill, rational use of medical personnel and material-
technical resources.
Specialized departments of CRH
 Therapeutic department (30-40 beds)
 Surgical department ( 40-60 beds)
 Gynecological department ( 40)
 Maternity hospital
 Pediatric department ( 30)
Categories of CRH:
I - more than 350 beds;
II - 300 – 350;
III - 250 – 300;
IV - 200 – 250;
V - 150 – 200;
VI - 100 – 150.

Informational-analytical department tasks:

 Analysis of population health indices;
 Analyze of work of rayon health facilities;
 To educate and distribute work experience;
 Planning of preventive medical examinations` carrying out;
 Planning and organization of professional skill improvement of medical staff in rayon;
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 Working out of methods to improve medical care of rayon population.

III STAGE
Narrow-specialized medical care
Oblast (kray, okrug and republic) medical establishments
(level of subject of Russian Federation)
Oblast (kray, okrug and republic) hospitals
Oblast (kray, okrug and republic) Pediatric hospitals
Oblast (kray, okrug and republic) Maternity hospital
Dispensaries (oblast, kray, okrug and republic)
Specialized centers (oblast, kray, okrug and republic)
Blood transfusion stations (oblast, kray, okrug and republic)
Hospitals of veterans of wars (oblast, kray, okrug and republic)
Basic establishment of third stage is oblast (kray, okrug and republic) hospital. These
health facilities are scientific-organizational, methodical and educative centers of rural public
health in the subjects of RF. They provide narrow- specialized care to rural population.
Basic tasks of oblast (kray) hospital:
1) narrow-specialized inpatient and consultative outpatient care;
2) emergency and planned consultative care;
3) introduction of advanced diagnostic methods and treatment in medical practice;
4) improvement of medical staff professional skill;
5) analysis of work of all health facilities in the subject of RF;
6) improvement of quality of medical care to population in the subject of RF;
7) research work.

Oblast (kray) hospital structure:

 Administration: Chief doctor and vices
 Administrative-economical section:
- Archive
- Pharmacy
- Sterilization unit
- Book-keeping
- Medical library
- Laundry
- Cook house and other
 CONSULTATIVE POLYCLINIC:
- emergency and planned consultative department
- centre of medicine of catastrophe
- perinatal centre
- organizational-methodical department
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 Inpatient departments:
- Reception unit
- Therapeutic departments
- Surgical departments
- Operative unit
 Medical-diagnostic subdivisions:
- Laboratory
- Diagnostic centre
- Physiotherapeutic department
- Morgue.

Consultative polyclinic functions:

1) specialized consultative care to patients on the base of referrals of rayon (city) health
facilities;
2) making decision of the following management patients after consultations;
3) emergency and plan consultative aid and consultations of specialists;
4) analysis of work.

Organizational-methodical department functions:

1) Carrying out of regional conferences
2) Summarization and widely practice of advanced experience of health facilities
3) Organization of medical examination of the population and planned departures of
specialists
4) Publication of regulations and methodical documents.