Sunday, May 8, 2016

Putin’s Health Care ‘Optimization’ a Cascading Disaster, Agranat Says

 Paul Goble

            Staunton, May 8 – Vladimir Putin’s health care “optimization” campaign – his euphemism for closing medical facilities where the numbers of users are too low – is leading to more abortions, fewer births, higher infant and child mortality, and the demise of social and economic activity in many Russian regions near the capital, according to Alisa Agranat.

                The Regnum journalist who earlier this year attracted attention for a story about provincial hospitals entitled “Fatal Medical Reform: Russia is Not Moscow” ( now offers a new one, “How They are Killing Us: Is It Possible in Russia to Give Birth for Free and Near Home” (

            Agranat writes with despair that “the struggle of ‘effective managers with health care continues in Russia’s hospitals and birthing facilities in small cities,” without any discussion with the local population about its impact. Indeed, she writes, “it is not excluded that the law about universal free health care soon will be done away with ‘at the request of the toilers.’”

            She surveys the many places in Tula oblast where facilities have been closed and where people either have to brave often impassable roads – which themselves can lead to more medical problems – go to overcrowded facilities in faraway cities, or simply do without medical care and in the case of many, die.

            In one Tula village, Agranat continues, “health care is clearly seeking to achieve pre-revolutionary ‘heights,’” but in fact the situation there is worse than under the tsars because not only are its hospitals  and birthing facilities being closed but there is no money even for visiting nurses and no one is being trained to work there.

            This situation is hitting those at both ends of the age structure especially hard.  Pensioners simply can’t get the care they need and die sooner than they should, and those who are about to give birth must travel 33 kilometers to reach any medical help. That may not sound like much, but the roads are so bad that you can’t travel at night and the bumpiness may lead mothers to give birth before they can even get to the birthing facility.

            Worse, many of the regional hospitals to which villagers are now forced to go aren’t happy to see their new patients given that their facilities are already overloaded. At best, those who come can expect to wait in ever longer lines; at worst, they won’t be treated at all, all in the name of saving money.

            In neighboring Yaroslavl oblast, Agranat continues, the “optimization” campaign is in full swing, and ever more hospitals and birthing facilities are being closed.  The consequences are echoed in headlines which at best echo what happened there in “the wild 1990s.”

            Among the examples of such headlines, she gives the following:  “A Woman Almost Gives Birth in a Fire Engine,” “Doctors from Uglich who Refused to Help a Bleeding Woman from Myshkin Should be Punished,” and “Yaroslavl ‘Optimization’: 7  Birthing Facilities Closed, 4 Children and a Mother with Many Children Die.”

            Under the Putin program, Agranat continues, any birthing facility in which fewer than 500 children are born is considered “unprofitable” and has been ordered to be closed down. Those who had expected to go there must go to others further away, and they are sometimes turned away if their births are expected to be “complicated.”

            Despite all this, she says, “the population complains surprisingly little.”  On the one hand, many people there are parents with children who came to the countryside out of a belief that it would be a better place to raise their offspring.  And on the other, many are committed Orthodox Christians. But over time, “optimization” is changing their attitudes.

            Orthodox priests, Agranat points out, are playing a role in this transformation. They have warned that the destruction of villages by closing birthing facilities will lead to more abortions and more infant deaths have turned out to be correct.  And people in their parishes are taking notice.

            “In Yaroslavl,” the Regnum journalist writes, “there is a modern perinatal center, but the rods to it are far from ideal. Often in order to reach a hospital or a birthing facility, patients need to be in remarkably good health or have the assistance of higher powers.” And in bad weather, even that is not enough.

             One has the impression, Agranat says, that “the population for whom the state exists is living a separate life. And the population’s only obligation is to make medical care profitable for the state.”  That has led to the departure of people who can move and the early death of those who can’t.

            Family ties are being broken, and both factories and farms are closing because their workers can’t get medical care, she points out, arguing that it is “time to reorient” the country’s medical policies from a short-term concern about profit to a longer term one in which the birth and growth of health citizens will pay big dividends in the future.

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