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Saturday, December 29, 2007

Annals of the Horror of Russian Healthcare

Paul Goble reports more evidence of the Kremlin's total indifference to the plight of the vast majority of Russia's people outside Moscow as it continues its obscession with waging cold war and turning Moscow itself into a Potemkin-like showpiece:

The network of apothecary shops that had supplied Russians living in rural areas with medications in the past has almost completely disintegrated, and as a result, some 38 million Russians -- almost 30 percent of the country’s total population -- cannot easily obtain the drugs they need even when they have the money to buy them. Not only are many of these people suffering horribly as a result, but a significant percentage of them is dying prematurely, driving down life expectancies among Russians and further complicating the resolution of the country’s much-discussed demographic difficulties. Such a situation is especially tragic given the Russian Federation’s celebrated wealth from oil and gas, but it is even more disastrous because it appears to be in large measure the result not so much of the transition from communism to capitalism but rather of pathetically bad planning by legislators and other officials.

In the words of the Moscow newspaper Gazeta [on December 26th], these officials “successfully destroyed the old system” in which often poorly trained medical workers dispensed medications in rural areas without figuring out how to put “in its place” a new and more effective one. As is often the case with such situations, there were good intentions all around. Moscow officials wanted to ensure that apothecary shops would be large and well-stocked and that these outlets would be operated by licensed pharmacists to ensure that the right medicines were dispensed. In principle, of course, that is laudable, but such licensing requirements ignore several fundamental realities. On the one hand, most of the relatively small number of licensed pharmacists have gravitated to the cities where incomes are higher. And on the other, most villages are too small to support either one of them or a modern apothecary shop.

Moscow officials seem to have been operating on the assumption that village residents could easily travel to district or regional cities for their medicines. But that ignores two of Russia’s biggest problems: its impassable roads and its often even more horrible weather.
At the present time, approximately one-third of Russia’s villages are not connected to the outside world by roads of any kind. And even those that are find themselves in difficulty: in the spring and fall because of mud and in the winter, often very long in Russia’s northern regions, because of unplowed snow. Of course, as the Moscow newspaper pointed out, access to medications is far from perfect even in the cities. The Russian Federation does not produce some basic medications or import enough for those who could benefit from them. And not every urban resident has the money to purchase those that may be on the shelves.

According to Gazeta, officials at the Russian Federation’s health ministry have discussed all these problems repeatedly. But they lack the funds to buy more drugs or to pay for the upkeep of pharmacies in most rural areas, and market forces Moscow now hopes to rely on are typically insufficient to address in a serious way either problem. Unless something is done and done soon, however, many more Russians in rural areas are going to become victims of a system that may reward young people in the major cities with new wealth and opportunities. And as these rural Russians become conscious of their common status and their large number, they could become politically important. The daily paper suggested that in many villages, the only thing such Russians could do is to pray so that they will get well without having to take any medications. But it is entirely possible that at least some of them will first focus their anger at those politicians and commentators who suggest that life is getting better in Russia with each passing year.

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