The PMR Healthcare Development Concept was presented by the Minister Alexei Tsurcan during the extended meeting on Pridnestrovian medicine. According to him, this document is the result of joint work of representatives of the PMR Ministry of Health, the Government, the Supreme Council, the medical community of the republic and representatives of the World Health Organization.
Alexey Tsurcan began the presentation with information on the staffing of medical institutions of the republic. Staffing with doctors - is 84.4%, paramedical staff - 91%, junior - 97.4%. The number of doctors per 1000 population is comparable in Pridnestrovie with Russia and Germany. This number is much lower in the United States, Japan, Britain and Finland. There is much more mid-level medical staff there, and the qualification level of this category of specialists is much higher. The PMR Health Minister, speaking on behalf of the developers of the Concept, concludes that the basis for personnel policy should be the increase in the number and competence of nurses and feldshers. The speaker spoke about the significant staff of hospital doctors and consultative clinics, the excessive amount of which he associates with the excess bed capacity and increased demand from the population. One of the main reasons for this situation is the inefficiency of the primary health care system. Alexey Tsurcan assigns the most important role to the doctors of the local service, highlighting the preventive work. At the same time, a 50% deficit of district doctors has been recorded to date. In this regard, the authors of the draft concept consider the increase in the number of primary care doctors and retraining as general practitioners a priority. They will take on the solution of 70-85% of health problems, which will significantly reduce the need for narrow specialists and inpatient care, said Alexey Tsurcan. According to him, until the middle of 2022 it is planned to send about a hundred more doctors to the sites. It seems reasonable to the developers of the Pridnestrovian Healthcare Development Concept to divide the sectors (it is assumed that there will be 359, whereas today there are 236 of them with 133 specialists working for them) and the transition to the standard of 1 doctor per 1200 people. Naturally, decent wages are expected to be paid: for general practitioners, they should be higher than for other specialists.
If the proposed concept is adopted, changes will be expected to the ambulance service. It seems appropriate to centralize it, which will increase the response rate, as well as optimize maintenance costs.
Inconsistency of the fixed network with real needs is another problematic aspect for today's medicine. Only 70% of the bed fund is used. Unacceptably low workload leads to a decrease in medical practice, which affects a decrease in the level of competence of medical personnel. Head physicians present at the meeting cited the practice of obstetrics as an example. According to the results of the past year, out of 3470 children born in Pridnestrovie, more than half were born in Tiraspol and Bendery. For comparison: only 70 children were born in Kamenka. That is, the load on specialists in the districts varies significantly. The developers of the program document see the solution of the issue in the reorganization. In particular, it is proposed to divide the stationary network into three levels: district, inter-district and republican. Moreover, according to the draft Concept of Health Development, in the near future it is planned to increase the number of feldsher-obstetric centers and rural medical ambulances. This measure will make medical care available.
Another important issue is personnel policy. The document presents a plan for training and securing graduates of medical schools in the republic, improving the qualifications of Pridnestrovian doctors, including in collaboration with specialists from near and far abroad. It is supposed that students of the Faculty of Medicine of PSU will be given the opportunity to work in medical institutions as secondary medical personnel after the third year (in case of successful passing of the corresponding exam).
In the discussion part of the meeting, Vadim Krasnoselsky drew attention to the need to include in the program document a mechanism for protecting the interests of doctors. Alexey Tsurcan said that the Ministry of Health specialists, together with parliamentarians, are working on law-in-draft on the legal protection of medical workers. This year, it is planned to submit it to the Supreme Council. They also discussed the system of providing paid medical services to the population. According to the developers of the Concept, it should be preserved. The mechanism is being improved. Vadim Krasnoselsky emphasized that a balanced and systematic approach is needed in this issue, financial transparency must be ensured.
The meeting participants spoke about the pricing policy in the pharmaceutical field, mechanisms for increasing the prestige of the medical profession, increasing public confidence in doctors, and the ethics of the doctor-patient relationship.
The PMR Prime Minister Alexander Martynov during the working discussion noted that the situation in the Pridnestrovian healthcare system has always been difficult, but now it can be described as critical.
Summing up the meeting, the President emphasized that the Concept is a voluminous strategic document that not only indicates the vector of development of the healthcare system for the coming years, but also includes a fairly detailed reform plan that combines all state target programs.
