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Over the past few months I’ve been working on a project on ‘discourses of health system reform in Russia’. This has focused on publicly available documents and discussions around health care in Russia from the last 5 years or so. I recently gave a paper to colleagues, presenting some preliminary analysis relating to ‘official’ discourse (i.e. from government, ministry or representatives). As my colleagues are health academics rather than Russianists, there’s necessarily a lot of background.
My accompanying slides are below. I am sharing in the spirit of openness and welcome comments/ questions on the content.
However, the slides were produced to accompany an oral presentation (not yet written up) which explained /filled out the detail. I wonder how useful sharing a slideshow that was intended to be illustrative rather than tell the whole story, is.. Comments on that welcome, too.
Health and Policy 
Kate, I have worked on a project in the Russian healthcare system, and later I married my Project Office Manager. She has had to go back to Russia in the last two weeks to care for her father who had a stroke three weeks ago.
Whilst in Russian my wife is faced constantly with addressing blatant corrupt practices – having to pay doctors and nurses to do what any professional should do without a bribe; having to pay the local pharmacist over the odds to dispense the drugs my father in law needs; and basically having to bribe everyone she needs help from.
She also complains that as there are no drug licensing regulations it is possible for her to buy any drug and to dispense it to her “patient”. That she says leads people to mis-treat conditions. Sounds very dangerous to me. Fortunately my wife is well instructed about what drugs to buy and what quantities to dispense.
There is no social care facility to which my father in law can be admitted, and the local hospital has only one medical specialist in post – a paediatrician, who chooses to work part time in the public system but is paid to be working full time. The hospital provides no hotel services viz, linen, food, kitchen, laundry, or ward cleaning. So why admit anyone?
There is snow on the ground and the temperature is way below zero. So getting out of her father’s flat to go shopping for essential supplies is difficult.
My wife has lived outside Russia for the last ten years, and she says that being back in Russia she feels like, “An Idiot Abroad” – a reference to the Sky TV programme.
The practices in the health care system outside St Petersburg and Moscow are often barbaric or worse still non-existent.
If I can provide any further advice or support then do not hesitate to let me know as my wife and I have a genuine desire to improve the healthcare services for all Russian citizens. Our relatives still live there and they need and deserve a better health service.
Finally, read Gogol’s book, “Dead souls” – it will give you a better understanding of the Russian soul, and help you to appreciate why corruption is so institutionalised.
Good luck with the work
Stuart
Thanks for reading & commenting. I’m sorry to hear about your father-in-law. All of what you relate, sadly, chimes with what I have been reading. When I lived in Russia for periods in the 1990s, although I didn’t have health problems myself I did note that in general people would avoid visiting a doctor at all costs. There was a lot of mixing and matching medication on the basis of friends’ recommendations, etc. Similarly if a doctor was required one did not just go and queue at the clinic – you would phone that friend-of-a-friend’s daughter in law (or whatever) who was a doctor and do things ‘informally’, to try to guarantee a human level of service.
As you say, at least your father-in-law is lucky in that your wife has some knowledge and means, but even then, the services sound terribly inadequate to support them both.
The ambitious plans the government has sound great and address many of the points you raise regarding social care, equipment, proper pay and regulated terms and conditions of work for medical staff, very clear ‘state guarantees’ of free care etc. So, at least the problems are officially recognised….but some of these problems and practices seem so deeply embedded, it is hard to feel convinced that throwing lots of money at it and issuing decrees will achieve much. As you indicate with your Gogol recommendation (thanks), administrative malpractice has long historical and cultural roots.
My work on this at a very early stage and has just been ‘desk-based’ so far, so my sense of what’s really happening in the health system is impressionistic (reading others’ accounts; anecdotal stuff). The next stage will be to try to identify funding opportunities to develop it and do some field research.
As I mentioned I have spent time in Russia, I did undergraduate and postgraduate degrees around Russian and Russia (not on the health care system as such), but I have not been there since the late 90s.
I’d be interested in hearing about your consulting/project experiences in Russia – how long ago was that?
Best wishes, Kate.
Thanks for the email, Let us meet Kate – phone me VOIP 020 8144 9080