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Interview with Sergei Brilyov, anchor of Vesti V Subbotu [News on Saturday] Programme on Rossiya TV Channel

May 16, 2009

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VESTI V SUBBOTU TV PROGRAMME ANCHOR SERGEI BRILYOV: Good evening, Mr President.

PRESIDENT OF RUSSIA DMITRY MEDVEDEV: Good evening.

SERGEI BRILYOV: This is the fourth time you are giving an interview to our programme here in the Kremlin. It has become something of a tradition. On this programme, broadcasting on the Rossiya and Vesti channels, there will be no getting away from political and economic matters. But there is one subject that you raised during the last interview, and that was medicines. It would be worth perhaps coming back to this subject in the broader context and discussing health and the healthcare system in general. What is the diagnosis of our healthcare system today? Has it been affected by the crisis, and with what consequences?

DMITRY MEDVEDEV: You have raised an issue of great importance for everyone in our country. Everyone thinks about health and healthcare, of course, no matter what the circumstances, and no matter what their financial situation or age. Any ordinary person thinks about their health.  

Looking at our healthcare system, of course there are problems. These problems have their roots both in the past legacy that we have inherited, and in what is happening in general in the economy. In other words, our healthcare system’s overall well-being is affected at once by past problems, and by the current economic situation. But at the same time, I want to make it clear right at the start of our conversation, that not only will all of the priorities we set before the crisis began, including when we began work on the National Project on Healthcare, go ahead as planned, but we will not cut back financing for them. In this respect, everything is continuing according to plan.

It is another matter that in some areas we will have to adjust the pace of work. But we will nevertheless continue developing medical treatment based on advanced technology, provision of medicines, and work on the most high priority healthcare areas such as oncology, tuberculosis, cardiovascular disease. In short, we will continue all of the work we began earlier.

SERGEI BRILYOV: Could you perhaps give a bit more detail, all the more so as you were one of those involved in launching the national [priority] projects. There is no question that some serious progress has been made, but what specific fate awaits many of the big projects that were launched? What is happening with them now?

DMITRY MEDVEDEV: I think we succeeded in stoking the engine and picking up quite good momentum. This does not mean that there have not been problems, but overall, results so far have been not bad. In the area of high-technology medical treatment, for example, we decided to open 15 centres around the country. Today, some of these centres are not simply ready, but are already providing medical treatment. Last year, a centre opened in Penza, and this year, we will open centres in Cheboksary and Astrakhan. But these centres are in effect already working, already treating patients. These are centres specialised in cardiovascular diseases, treatment of injuries, and orthopaedic problems.  

We will continue this work and this year will open several more centres of this kind. These advanced technology centres are being set up using a module technology approach that makes it possible to get the centres themselves ready quickly, fill them with modern equipment, and have them start work in quite short time. At the same time, if technology changes - and the world is always on the move of course, thinking up new medical treatment methods - with the necessary financing, we can remove some of the equipment and replace it with new equipment. This is the whole point of the module-based approach. But aside from these special centres, I can tell you that we are also setting up 82 regional cardiovascular disease treatment centres today. 

SERGEI BRILYOV: All around the country?

DMITRY MEDVEDEV: Yes. This is probably an especially important step, because we know that cardiovascular disease is the biggest cause of death here.

Furthermore, we are setting up 240 specialised cardiovascular departments. This will make a total of around 300 specialised cardiovascular treatment centres. These priorities remain unchanged.

Coming to another area of medicine, we introduced the system of childbirth certificates. This has been one of the most successful steps taken as part of the National Project on Healthcare. More than 90 percent of expecting mothers and mothers who have already given birth have received these certificates. The results have been, first, increased financing for healthcare, and specifically for maternity consultations and hospitals and departments specialised in this area. This has made it possible to increase the wages of doctors and nurses working there. But most important, and what women were hoping for most of all, there has been an increase in the quality of medical care. This is a good result. The number of childbirths has increased by almost 7 percent over the last year. The demographic situation remains very problematic, and the [demographic] trend is still far from ideal, but a 6-7 percent increase in the number of births is nevertheless a very good result and I hope it will continue. At the same time, there has been a decrease in infant mortality, and this is also a very important indicator, because we had very serious problems in this area. The infant mortality situation remains problematic today, but in some regions we now have figures similar to those in European countries. 

SERGEI BRILYOV: It is great to have new centres, but you yourself grew up in an ordinary district of what was then Leningrad, and I am sure you know full well that people go to their ordinary local hospitals and medical centres, where there are queues, and where the state of the buildings themselves leaves a lot to be desired. What can be done to bring these local-level healthcare centres up to standard?

DMITRY MEDVEDEV: All of our hospitals, with the rare exception of privately financed centres, are absolutely ordinary hospitals with all the ensuing consequences. Of course we realise that conditions leave a lot to be desired. This is a problem with many different aspects, but we need to tackle it by taking absolutely specific measures targeting specific areas.   

To give an example of what I mean, I visited Ryazan just recently, and during that trip, someone got in touch with me via the internet and proposed that I take a look at the situation in the infectious diseases department at their local hospital. We went and took a look, and it is certainly enough to make you want to cry. Everything was in a dreadful state.

SERGEI BRILYOV: Yes, the photos were all over the internet.

DMITRY MEDVEDEV: Not just the internet but all over the media in general. I ended up issuing a specific instruction to address the situation. I was told that this instruction is being carried out now and that everything will be brought into order there by September. That is one way of responding to the situation.

SERGEI BRILYOV: But it’s not possible to settle every problem by going directly to the President.

DMITRY MEDVEDEV: Yes, the President cannot settle every individual problem, and in any case, this is probably not the best message to send out to the country. A great deal depends on the specific situation, on the specific people in charge, and on the circumstances in the region, in the municipality. 

We began at one point working on setting up centres where paramedics and maternity  nurses work. There is a big shortage of this kind of healthcare service, especially in rural areas, where the situation is very serious in general.

SERGEI BRILYOV: Yes, we in the cities are not even familiar with these centres.   

DMITRY MEDVEDEV: Not everyone is familiar with them, but these centres provide primary healthcare services in the rural areas. In the regions that have made serious efforts these centres have undergone a real transformation. They now have new equipment, new buildings, and the medical staff have received special housing. In other words, these are all things that need to be dealt with at the regional level, depending on the specific circumstances. There is no other way. There is no general solution. What is needed is investment in specific healthcare facilities. 

SERGEI BRILYOV: In this particular case, money is probably not the only key to happiness?

DMITRY MEDVEDEV: Of course. The situation depends on the stance taken by the regional authorities, and by the people working at municipal level. If they make this work a priority, there is always a way of finding at least a bit of funding, but if these issues are not given priority, nothing happens.  

SERGEI BRILYOV: Another specific issue is that of blood donation. Here at work, there was a notice up a few days ago, asking for help with getting blood from some specific blood group. People who have encountered this situation know that you end up having to call around your friends and acquaintances looking for someone with the right blood group. Do you think it is time to start looking at setting up some kind of federal blood bank, or a centralised blood bank of some kind? How should we resolve this problem? 

DMITRY MEDVEDEV: The idea of a blood bank is indeed a task at the federal level. We are in fact in the process of setting up just such a blood bank, rebuilding lost capacity and even launching special plasma production facilities. One of them is in Kirov, and I think this is a good example of a project being implemented in practice. This is a state-level task, and we will resolve this problem.

SERGEI BRILYOV: Mr President, another specific issue is the swine flu that has been in the headlines over these last few days. I would like to give a brief personal example. 

I was returning via Europe from a business trip in America a few days ago. When we landed in Moscow, contrary to the stereotype image of things here, Russian health service workers boarded the plane and did a very efficient job of taking the temperature of everyone flying in from Mexico or the USA. When I was in transit in Europe, there were no checks of any kind. This example just goes to show that different countries are not coordinating their responses very well. 

Do you think that the world and Russia in particular, will manage to cope with this new threat?

DMITRY MEDVEDEV: Your example also shows that our medical services can work effectively. This example is obviously in our favour, because it shows that we are keeping checks on the situation with people arriving in the country, and this helps to explain why this strain of the flu virus has not caused any problems as yet in our country. I think that on the whole, this is a problem that can be fully resolved. We all need to work hard now on research, create a mono-vaccine, and the whole world is now engaged in this work. I think a vaccine will be developed soon.  

As for the current situation, our country has the necessary amounts of medicines. If we can organise production of a new vaccine we will be completely covered. Overall, the situation is under control. I think that we are properly prepared to resist this strain of the flu.

SERGEI BRILYOV: This brings us back to the subject we began with – medicines, more specifically, their cost, especially the cost of imported medicines. This is an issue much talked about today.

What can be done to address this problem and keep this situation under control?

DMITRY MEDVEDEV:  We can keep this situation under control, and indeed, it is quite simply our duty to do so. This is vital not just for the state of our pharmaceuticals market, but for the lives and health of millions of people in our country, people with a lot of money, and people who, unfortunately, have very little money to spare.

SERGEI BRILYOV: Absolutely.

DMITRY MEDVEDEV: This is a task for the state authorities at every level. What can I say? We have taken what I think are quite effective steps to bring order to this area. But the crisis has had a serious impact, because our own production covers only around 30 percent of the market, and we import the remaining 70 percent of medicines.

SERGEI BRILYOV: Unfortunately.

DMITRY MEDVEDEV: Yes, unfortunately. Our pharmaceuticals industry is not yet ready to fill the gap. In this situation, changes in the foreign exchange rate inevitably lead to imported medicines becoming more expensive.

SERGEI BRILYOV: But the price rises often go a lot beyond the exchange rate changes…

DMITRY MEDVEDEV: Yes, the price rises are such that it is simply painful to watch. Indeed, these price rises are not in proportion with the foreign exchange rates fluctuation. I said as much in one of my interviews, and this sent a signal. Our colleagues in the regions started to investigate this issue. The prosecutors also started to investigate. What should we do? We need to keep track of the situation at local level, because our pharmaceuticals market is made up of several different segments. The first segment is that of costly medicines used for treating seven types of illness. The second segment is that of supplementary medical provision financed by various sources, including the federal budget. This segment is managed at regional level and represents tens of billions of roubles. In total, around 80 billion roubles have been allocated this year for medicines. In this situation, it is the regions’ responsibility to ensure that medicines are sold at normal prices. I have been told that often, unfortunately, medicines are purchased with mark-ups, or a supplement to the sale price, shall we say, amounting to 80 or sometimes even 100 percent. 

SERGEI BRILYOV: Kickbacks, in other words.

DMITRY MEDVEDEV: Yes, there are cases of kickbacks and cases where the mark-ups on the sale price are simply unacceptably high. The anti-monopoly officials, prosecutors and other law enforcement agencies need to get to examine such cases and work out exactly what is going on. These cases involve everyday medicines, ordinary medicines such as aspirin and anti-viral medicines, and this is an unacceptable situation. There must be a very tough response to such practices. 

Finally, there is a third segment of medicines, those that are sold freely through pharmacies. This is the unregulated market. In this segment, we need to keep watch on the prices set by the manufacturers. We are in the process of getting this monitoring system into place, so as to ensure that these prices are set correctly, and are made public, so that we can see how such and such a price was arrived at. 

So, these are the three main segments of our market: costly medicines, medicines that are part of supplementary medicine provision and medicines provided through the state medical benefit system (we have more than five million people entitled to medicines through this system at the moment), and finally, the free pharmaceuticals market. If we can properly regulate the situation in each of these three areas, we will have a normal pharmaceuticals market.

SERGEI BRILYOV: You think we can achieve this goal?

DMITRY MEDVEDEV: I am confident we can, but we need to work on it at every level – federal, regional and municipal.

SERGEI BRILYOV: There is also a fourth segment – self-treatment. This is an age-old Russian pastime. It’s probably not just a Russian pastime – all around the world you see it happening. And then you have all kinds of quacks on the scene as well, offering this or that special treatment method…

DMITRY MEDVEDEV: Miracle cures.

SERGEI BRILYOV: Yes, miracle cures that have the reverse effect. Self-treatment in general often has the reverse effect. People think they are familiar enough with the medicines available, and decide to take their treatment into their own hands, swallow a tablet here or there. What is your view on this problem?

DMITRY MEDVEDEV: I share what I imagine is the health professionals’ point of view. I think self-treatment is unacceptable because it can endanger your own health. There are no miracle cures, despite what various publications promise. Also, we need to remember that, according to the World Health Organisation at any rate, the overall state of our health can be attributed two thirds to our lifestyle, that is to say, what we eat, what water we drink, what kind of lifestyle we lead in general, and only 10-15 percent to the medical care we receive. So, it might sound like a commonplace, but to a large extent, the state of our health really is in our own hands. 

SERGEI BRILYOV: One of the most accessible ways for Russians to stay in good shape is by spending time at the dacha. Now it is May, and the dacha season has begun. But for many people faced with the economic crisis the dacha now offers not just physical activity and a chance to lie in the sun, but is also a way to feed the family. Statistics show that people are now buying more vegetable seeds to plant rather than decorative plants. This is their response to the crisis. But what is the situation with the ‘dacha amnesty’? Is it not time to finally legalise people’s rights to the land on which they have built their dachas, the land they cultivate and use for their recreation?

DMITRY MEDVEDEV: Yes, it’s long since time to do this. This was why we passed the law on the dacha amnesty. What is the situation today? We have around 20 million people who own garden plots and are members of various groups and cooperatives. This accounts for a large share of our population. Since the law came into force, around 2.5 million people have legalised their rights, registered their ownership. This concerns people who took possession of land before the Land Code came into force, and who in effect had no real legal rights to the land, because they had no legal documents to back up their ownership.

This situation is changing now. There are still some bureaucratic problems to sort out. Not everything can be done as fast as people would like, but around 15 percent of this category of owners have legalised their ownership rights, and this is an important step in the right direction. It is important to keep this process moving. Given the situation in this area, and given the fact that people still have an interest in this, and not everyone has managed yet to legalise their rights for various objective and subjective reasons, I will propose extending the deadline of the dacha amnesty, so as to give as many people as possible the chance to make use of this opportunity.

SERGEI BRILYOV: This is a good piece of news. Thank you, Mr President.

DMITRY MEDVEDEV: Thank you.

* * *

After recording the television programme, Dmitry Medvedev answered a number of questions concerning relations with the European Union, the forthcoming EU-Russia summit in Khabarovsk and the topic of European security:

“Russia is a big country. Last year when we met with our colleagues from the EU, I suggested that they come to Russia to see what it looks like beyond the European part: in the Urals, in Siberia or even in the Far East. Since we think of all this space as European in the broadest sense of the word, I made this suggestion and our European colleagues agreed. No doubt, they will enjoy visiting the Far East, but most importantly, it will give them a better feel for Russia. It’s a way of putting our relations on a firmer footing, making them clearer and more coherent, and questions of mutual understanding are always important when it comes to foreign relations.” 

Dmitry Medvedev also gave his assessment of the current state of the dialogue with Europe on security issues:

“Here is the situation: there was an old set of European institutions that guaranteed security in Europe. These institutions were created in the 70s and they have performed their role. There is a whole range of national alliances in Europe, including the North Atlantic Alliance. But we do not have a single forum in which all the issues can be addressed; hence the idea of a new treaty on European security. What happened in the 90s and what is happening in this decade? Unfortunately, security in Europe is not improving; on the contrary, people seem to think security in Europe can be provided primarily through the expansion of the military-political bloc.

As a military and political bloc NATO is becoming larger and security is becoming more fragmented and more piecemeal. I think that this is bad for everyone concerned, no matter what our negotiating partners say. So we need new approaches. There was the Helsinki Final Act [of the Conference on Security and Cooperation in Europe]; now we need a new document, not something drafted in opposition to NATO but to provide security in Europe. And what does security in Europe involve? It has a whole set of components, it consists of a whole range of countries: there are the European states, that is all the ones in Europe, there’s the United States, there’s Canada, there are all the European organisations such as NATO and the European Union, the Commonwealth of Independent States, and the Collective Security Treaty Organisation. So if we can create a new matrix of relationships, I think it will be effective. In any case, this is obviously better than advancing NATO in every direction. At any rate we are not happy with that idea and we are going to respond to it. What is better, to create a new security structure or conduct military exercises in the vicinity of the places where there was fighting just recently, less than a year ago? We simply want a new level of security for our country, for our people, in light of the experience, the difficult experience, that was ours in the twentieth century.”


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