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MODERNISATION OF RUSSIAN HEALTH SERVICES
By Olga SOBOLEVSKAYA, RIA Novosti
For many years Russia has cultivated healthy living habits. Even in films made in the 30-80th, positive characters were usually healthy people, fond of sport. Young people showed preference for medicine, and entrance to medical institutes was sought every year by increasing numbers of applicants.
The early 1990s brought a crisis to the cost-free system of health care. The state, as it rather rapidly switched over to market conditions, found itself on the brink of bankruptcy and had to considerably cut back on its allocations for medicine. Poorly-funded research medical institutes were forced to close down, doctors had their wages delayed, there was a shortage of trained nurses whose pay was incredibly low, and hospitals and policlinics could not afford to buy new equipment, instruments or medicines. It should also be added that reduced prices for required medical preparations existed only for war veterans, disabled people and some other social categories. It was a time when production in Russia was almost brought to a halt, including in instrument-making and pharmaceuticals, while the import of medical equipment and medical supplies was very costly.
The boldest of the reformers were insisting on the introduction of paid medicine and commercial medical establishments. When these did appear, it emerged that their services could be afforded only by very few people, and besides their quality was very varied.
In this situation, the Russians' health sharply deteriorated, triggering off a demographic crisis -- with the death rate exceeding the birth rate. Males not infrequently failed to live up to their pensionable age of 60 years. In that period of economic instability, explains Rafael Oganov, a cardiologist and member of the Russian Academy of Medical Sciences, people suffered most from cardio-vascular and oncological diseases, since they were under a constant stress -- fear of losing their jobs, receiving irregular wage payments, or the impossibility of keeping a family. Employers in commercial organisations made people work overtime without pay, which also impaired their health.
The economic woes of the interim period and a sharp fall in living standards led to the re-emergence of seats of infectious diseases which the Russians thought they put behind them.
And still doctors sometimes did unbelievable things in saving human lives and advancing science. They found effective ways of dealing with such painful illnesses as cancer disease, hypertension, and heart ailments, and carried out sophisticated operations. Research institutes continued their work. Russian medical scientists made a series of discoveries: they, for example, developed what no one else in the world was able to do -- a hydro-gel lens introduced into the eye and curing the patient's long sight. And the medical profession hoped that authorities would take note of the disastrous plight of medicine.
Today the health services are looking up. There is a special source for medical financing -- a system of obligatory health insurance, which requires contributing 3.6 per cent of the wage bill to the needs of health services. In the case of the working population, the contributions are paid by employers, and of the non-working people, by executive authorities.
Federal and local authorities are financing the upgrading of hospitals and specialised research institutes of health care -- for example, the famed Sklifosovsky hospital whose doctors have saved many lives. New oncological and cardiological centres are also under construction.
A major aspect of health services modernisation is, according to Russian medical specialists, the appearance in policlinics of family doctors or general practitioners who will replace sector therapists. Such doctors must be able to make a diagnosis and render patients required assistance, including surgical, and only in complicated cases to send them on to specialists. This system will enable doctors to better know their patients and shift the burden of primary care from hospitals, which are often overstretched, to policlinics. Already there is a federal centre of family medicine, and the new system is being run on a trial basis in Moscow, St Petersburg and some Siberian cities.
The modernisation of the health services is bringing fruit. According to Yuri Shevchenko, Russia's Health Minister, the number of infectious diseases across the country has diminished, life expectancy is growing, and the birth rate is on the rise.
In 2001, the government adopted a series of programmes on health, he added. Availability of medical services which are to remain mainly free to all sections of the population, medical prevention, and popularisation of healthy living, all these are their key provisions. Starting with September, all children and teenagers up to 18 will be screened in order, Shevchenko said, "to draw up a plan of further medical and health-building measures".
It is noteworthy that the number of those seeking enrolment at medical institutes is growing again. Today the medical profession is more and more often described not only as heroic, but also as prestigious.
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A GREATER MEDIATORY EFFORT NEEDED IN MIDEAST
by Professor Vladimir Isayev, Deputy Director of the Institute of Oriental Studies of the Russian Academy of Sciences, RIA Novosti
Israeli Premier Ariel Sharon has repeatedly stated that he does not consider Palestinian leader Yasser Arafat whom the Israelis accuse of turning a blind eye to terrorists, a counterpart at the negotiating table. The Israeli leader said he would rather find another Palestinian leader who would be more convenient. At the same time, not all Israeli officials agree with such an approach. For instance, Israeli Foreign Minister Shimon Peres who insists on the continuation of negotiations with the Palestinians and opposes violence as a means to settle the conflict, has repeatedly stated that there is no alternative to Arafat among the Palestinians and he is the one with whom the Israelis should sign an agreement.
It's highly unlikely that the Israeli Premier, who is striving to preserve his coalition cabinet, will openly oppose Peres, the leader of the "moderate." Such an outcome may result in a government crisis. On the other hand, Sharon's address to the nation proved that he was under heavy pressure from the "right." His decision to create a buffer zone signifies that the "Desert Lion" may virtually eliminate the Palestinian National Authority, which is an old demand of the "hawks," counter to Peres' arguments.
That is the implication of his statement concerning the buffer zone. The zone will undoubtedly cover the whole of the Palestinian Authority and Palestinians will be trapped in a well-guarded reservation. The situation will become similar to that which was in the region before signing the 1993 Madrid understandings and the peace process will have to be restarted.
Such future is not a bright one. Only a joint and energetic effort of all mediators, of all who are interested in the Mideastern peace can change it. Sharon's recent visit to the United States proved that even Washington, Israel's old ally, sees no alternative to peace negotiations. The Americans believe that Arafat plays a key role in the peace process and simultaneously demand that he should double his effort to combat terrorists from radical Muslim organisations. Obviously, the United States desperately needs the Arab world's support of the American anti-terror campaign. Consequently, Washington does not want to spoil its relations with a whole range of Mideastern countries that will undoubtedly oppose Washington's overall support of the Israeli hostility against Palestine.
The European Union, which is accelerating its mediating activities in the Middle East, also promotes the resumption of negotiations. Not accidentally, Shimon Peres visited France following Sharon's address. Unlike other EU member-states, France has always stuck to an unchanged and logic position concerning the Middle East. For 20 years, this country has been insisting on the establishment of a viable Palestinian state as the only way to solve the Mideastern problem. The fact that in Paris, Peres revealed a certain plan envisaging a future mutual recognition of Palestine and Israel, proves that the Israeli leadership has to take into account the position of the international community that was alarmed by Sharon's threatening statements. The visit by Javier Solana, the EU High Representative for the Common Foreign and Security Policy, to the Middle East proves that such concerns exist. Solana met Yasser Arafat in Ramallah and proposed to resume Palestinian-Israeli consultations on security.
The EU position is similar to the Russian vision of the Mideastern settlement. Moscow condemns all terror acts committed by extremists and summons the Palestinian leadership to counteract this evil. At the same time, Moscow believes that terrorists should not be confused with the people of Palestine. Russian officials have repeatedly emphasised the danger of the conflict's escalation and the use of force, which will not bring Israel the long-desired security. Not the elimination of the Palestinian National Authority, but the establishment of an independent Palestinian state, which should be in strict compliance with UN decisions, can bring peace to the region and become a cornerstone of new and peaceful relations.
Negotiations are the only way to peace. They should be launched now, without setting any preliminary conditions or waiting for violence to stop. Otherwise, it will continue and obtain even more dangerous forms. "Only a joint effort of the Israeli and Palestinian leadership in conjunction with the international community can put an end to the present opposition," Russian Foreign Minister Igor Ivanov stated the other day. According to him, Moscow prefers to search for a co-ordinated solution to the crisis within the framework of the movement which unites Russia, the USA, EU and the UN, but the Russians can also step forward with their own initiatives. In a word, Moscow is ready to double its efforts in order to achieve a stable and just peace in the Middle East.
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LARGE-SCALE MANEUVERS OF SMALL BUSINESS
by RIA-NOVOSTI's Olga SOBOLEVSKAYA
Some experts jokingly refer to Russia's small businesses as "microscopic business". Unfortunately, our small businesses have so far failed to expand their operations in spite of that obvious nationwide economic growth.
This can be checked easily enough. All one has to do is visit any local home-appliance store, which is packed full with foreign-made contraptions. However, any Russian-made goods are almost nowhere to be seen. The famous Central Department Store (GUM) in central Moscow is mostly filled with foreign clothes. Well, this is hardly surprising just because Russia's small enterprises account for less than nine percent of all goods and services. Meanwhile, the respective Western European share is more than 50 percent.
High hopes were pinned on small businesses and the entire private sector back in the late 1980s, that is, during Mikhail Gorbachev's perestroika. The state intended to cut back on part of all federal spending just because financial resources were being depleted at an alarming pace. Among other things, the Soviet government wanted to spend less on small production facilities. This was how sewing, foot-wear, cosmetic and other cooperative businesses came into being.
Small Russian businesses faced a multitude of problems because the required normative-legal base was lacking. Meanwhile, bureaucratic barriers, which were a vestige of the Soviet period, proved to be really effective.
Those emergent small businesses specialized in trade and the food industry, for the most part, because their founders didn't have to spend a lot of time and effort. Add to this quite a favourable market situation of the early 1990s; for example, this country didn't have enough consumer goods at the time. Many businessmen used to buy cheap foreign-made goods wholesale, subsequently selling them in Russia. Quite a few retail markets and commercial stores soon mushroomed all over this country, catering to poor and relatively well-off people. Meanwhile local stores and their sky-high prices used to scare everybody back then.
Some small businesses, production companies, for the most part, met with a sorry fate. To cut a long story short, they became unprofitable as a result of runaway inflation, predatory taxes, the ill-conceived bank-loan system, numerous administrative snags, as well as lack of federal support. Consequently, the number of small enterprises dwindled from 1 million in 1995 to 875,500 in 2000.
According to Prime Minister Mikhail Kasyanov, only eight Russian Federation constituents boast full-fledged small businesses, which specialize in trade and services (just like they did in the past). However, the production sector lacks any small businesses whatsoever. Moreover, small businesses, which get pitifully inadequate investment, are still unable to use state-of-the-art technologies. This situation is something unforgiveable because small businesses instil confidence in the middle class, which is the basis of social stability, and whose expansion encourages economic development, Kasyanov noted.
Nonetheless, Russian small businesses have to perform well-nigh the same "somersaults" for the sake of staying afloat (just like 7-8 years ago, experts say. Russian authorities reduced the number of administrative barriers last year (within the framework of the relevant federal program for encouraging small businesses); according to experts, such barriers impede the performance of small businesses. Streamlined taxes, as well as simpler registration proceedings, are currently being stipulated. Besides, fewer operations have to be licensed at this stage.
Consequently, small businesses in the field of trade and the service sector have been enhanced, also becoming more civilized. Such businesses are fast evolving into medium-sized companies. The Yelki-Palki Russian-cuisine restaurant chain and Komus stationery stores are a case in point. Small businesses can also carve out a niche for themselves inside the housing and municipal-utilities sector, which is currently being overhauled. Some sectoral entities will be privatized some time from now.
Kasyanov is sure that the potential of small businesses must, at long last, be tapped in the most diverse spheres, including the hi-tech production process. With this in mind, we must devise flexible crediting plans, also activating the state-order system, which can serve as a small-business incentive, and providing regular consultative and legal services.
The Russian authorities are now studying various legislative initiatives of "small" businessmen" rather closely. This is proved by a recent session of the State Council, which is a consultative body, and which is subordinated to the President of Russia. That session was devoted to the relevant federal policy in the field of small businesses. For his own part, President Vladimir Putin has met members of the association of Russian business organizations (Russian acronym, OPOR). This association, which aims to prop up small businesses, comprises representatives of more than 70 public organizations from different Russian regions. OPOR members now cooperate closely with the Russian Parliament, submitting their proposals to specific bills, an OPOR leader, Andrei Nasonov, stressed.
Quite possibly, "microscopic business" will thus evolve into small businesses, saturating local stores with Russian-made goods, in the first place.
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FOG OVER PANKISI GORGE
by Raisa ZUBOVA, RIA Novosti
World agencies have highlighted information about America sending its military instructors to Georgia as hot international news. According to a quoted high-ranking source in the Pentagon, their number may vary between 40 and 150 men.
The media are inclined to link these events with the situation in the Pankisi Gorge in Georgia. The gorge, situated near the Russian border, is known to have received several thousand Chechen refugees since the end of 1999. According to the Russian military, it is also used as a base by Chechen militants, mercenaries and international terrorists.
Georgian and US authorities are denying an American intention to take part in an anti-terrorist operation in the Pankisi Gorge. Official information on both Tbilisi's and Washington's plans is scarce and contradictory. One story has it that Americans will be training Georgia's rapid reaction force to combat terrorism. Another says that they will be preparing a contingent to guard pipelines.
Noteworthy, however, is the fact that the Pentagon leaked information about an American "landing party" for Georgia soon after Georgia's President Eduard Shevardnadze had talks with US Defence Secretary Donald Rumsfeld.
Moscow has always expressed concern over the situation in the Pankisi Gorge -- it is the point used by militants, weapons and financial aid to cross the border into Russia in support of terrorist groups fighting against legitimate authorities and civilians in Chechnya.
Tbilisi is known to have long denied the presence of Chechen militants in the Pankisi Gorge. Then, reluctantly, it conceded that it was not in full control of the region, and so the presence of uninvited guests there was not ruled out. But a raid in October 2001 by a group led by notorious Chechen field commander Ruslan Gelayev, now based in the Pankisi Gorge, to Abkhazia made it clear that Moscow was right in its warnings to the Georgian side.
In March, Georgia's State Security Minister Valery Khaburdzania is going on a visit to the US. Not so long ago he said that a few nationals from Jordan and Saudi Arabia had been detained in Pankisi. These men, while keeping in touch with international terrorist Khattab, operating in Chechnya, tried to form subversion groups in the gorge to carry out terrorist acts in Russia.
When a US-led anti-terrorist campaign was launched in Afghanistan, the Pankisi Gorge as one of the uncontrolled territories became attractive for international terrorists, who found themselves "squeezed" in Afghanistan. So press speculations that terrorist No. 1 Osama bin Laden may show up there are not so fantastic.
Western news agencies say that Georgia may become a third US front (after Afghanistan and the Philippines) to combat international terrorism. In this connection Moscow cannot but draw attention to typical western double standards.
Russia was waging a struggle against international terrorism in Chechnya long before the September 11 terrorist attacks took place in the US, but the western community regarded the militants in Chechnya as "freedom fighters." Today it is evident to everybody that the militants shuttling between Chechnya and the Pankisi Gorge, where they rest, get medical treatment and replenish their supplies, are actually international terrorists. Their presence is also a thorn in the flesh for civilians residing in the Pankisi Gorge.
Moscow has more than once suggested to Tbilisi that they should carry out a joint military operation to free the area of terrorist groups -- but Tbilisi, which must be interested in a quiet Georgian-Russian border, invariably rejected these proposals.
Today it is apparent that the Georgian power ministries have ultimately lost all control over the situation in the Pankisi Gorge. Whether American instructors will help restore it, is a big question. There are many signs that even among law enforcement bodies in Georgia itself there is no consensus on this matter.
Experts note that the unexpected and highly mysterious suicide of Nugzar Sadzhaya, secretary of Georgia's Security Council, only added to tensions within the country. A fog of mystery over the Pankisi Gorge is thickening.
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