To reach the objectives that the President of the Russian Federation presented on September 5, 2005 in a meeting with the Russian Government, leaders of the Federal Assembly and the Presidium of the State Council of the Russian Federation, the Russian Ministry of Health and Social Development and the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being developed the National Priority Project in Public Health. Project activities are addressing the main assignments of the Concept of the Health Care and Medical Science Development in the Russian Federation up to 2010 that was approved by the Russian Government Enactment № 1387 from November 5, 1997.
The project aims to:
- Decrease mortality, disability and morbidity;
- Make medical care more accessible for the population and improve the quality of care;
- Develop a prevention-oriented health care system;
- Increase the role of primary health care (including general practitioners, paediatricians, and other specialists);
- Create conditions to expand out-patient medical services;
- Increase hi-tech medical care to satisfy the population’s demand.
The implementation period for the project is 2006-2008.
Socio-economic outcomes of the project
The following outcomes of the project are expected:
- Decreased mortality and disability rates among the population of the Russian Federation by ensuring higher accessibility and higher quality of the provided medical care;
- Satisfy the demand of the Russian Federation population for free high-tech medical services;
- Improved living standards for patients who need hi-tech medical care (minimize waiting period to get treatment, maintain ability to work on a permanent or temporary basis);
- Solve social problems in terms of providing medical care to those who need social support from the state;
- Decreased economic losses by recovering the labour forces and decreased material losses for disability payments and sick benefits.
Objectives and priorities of the project
Specific objectives of the project include:
- Primary health care development (financial compensations, training and retraining of medical workers, equipping health care settings with diagnostic equipment):
- Prevention (population immunization within the national vaccination programme, detection and treatment of people with HIV infection, hepatitis B and hepatitis C, medical examination of new-born children, clinical examination of the working population);
- Provision of hi-tech medical care.
An operational schedule and activity plan were developed to implement the National Priority Project, including the identification of the responsible persons for the implementation of every activity, scheduled indicators of project implementation and funding.
The National Project has the following priorities: Primary health care development, provision of hi-tech medical care, information support and project management.
Figure 1. Number of cases of hepatitis B and number of people vaccinated against hepatitis B in Leningrad oblast, Russian Federation, 2004-2007
Figure 2. Hepatitis B incidence rate (per 100,000) in Leningrad oblast in 1996-2007 as compared with the Russian Federation
Infectious disease prevention
The section “Primary Health Care Development” consists of eight components and includes several measures to prevent infectious diseases including prevention of HIV-infection, hepatitis B and hepatitis C, diagnostics and treatment of HIV infected patients, and additional immunization of population within the national vaccination programme, as well as vaccination against influenza.
The specific objectives concerning vaccination are as follows:
- Decrease in incidence of hepatitis B to 3 per 100,000 persons. To reach this objective, there are plans to vaccinate 10 million people in 2006, namely school children under 17 years of age not previously vaccinated, and 15 million people in 2007, namely young people from 18 to 35 years of age not previously vaccinated.
- Decrease in incidence of rubella to 10 per 100,000 persons and elimination of congenital rubella syndrome. To reach this objective there are plans to vaccinate in 2006 children aged 5-7 years and girls aged 14-17 years who have never had rubella and who have not been vaccinated, and in 2007 children aged 8-14 years and women aged 18- 25 who have never had rubella and who have not been vaccinated.
- Annual purchase of 450,000 doses of inactivated polio vaccine (IPV) was planned in 2006 and 2007 to vaccinate 150,000 infants from risk groups to prevent the possibility of developing complications from vaccinating with the live polio vaccine.
- Annual vaccination of 24 million people against influenza was planned in 2006 and 2007 to protect high risk groups from being infected and from developing any influenza-caused complications.
The measures addressing the prevention of HIV-infection, hepatitis B and hepatitis C aims at reducing the HIV incidence by 1000 persons yearly. Indicators for the project include the number of people tested and the number treated. By the end of 2007, over 23 million people had been HIV-tested for prevention purposes and more than 30 thousand had received treatment.
Implementation of the project in Leningrad oblast
Measures aimed at preventing the emergence and spread of communicable diseases play an important role in preserving the people’s health. Therefore, additional immunization of population is included in the National Priority Project in Public Health.
Leningrad oblast surrounds St Petersburg city and has 1.6 million inhabitants. To implement this part of the project in Leningrad oblast a special working group has been established in the Leningrad oblast Government. An activity plan for the implementation of the project activities has been approved, departmental regulations have been issued, the population strata eligible for additional immunization against viral hepatitis B, rubella, polio and influenza have been estimated, and equipment required for vaccine transportation and storage at levels 2-3-4 of the cold chain has been identified. 116 additional vaccination teams have been established and equipped as required.
The project called for hepatitis B vaccination of all children from 1 to 17 years of age and all adults from 18 till 55 who have not been previously vaccinated. Vaccination of these age groups is meant to prevent the most active social contingents from becoming involved in the epidemiological process in the immediate future, decrease the number of virus carriers, limit the spread of the virus, and interrupt the primary routes of transmission.
The project also called for mandatory rubella vaccination of all children from 1 to 17 years of age who have never had rubella and who have not been previously vaccinated, and girls from 18 to 25 years of age who have never had rubella and who have not been previously vaccinated.
Figure 3. Age group specific hepatitis B incidence rates in Leningrad oblast during 2003-2007
Figure 4. Number of cases of rubella and number of people vaccinated against rubella in Leningrad oblast, Russian Federation, 2004-2007
The additional vaccination campaign started in Leningrad oblast in the beginning of March 2006. The immunization plan was completed according to schedule.
In 2006-2007 vaccination against viral hepatitis B covered over 170,000 persons, including 120,504 persons vaccinated in accordance with the National Priority Project in Public Health. Among children aged 1 - 17 years, more than 97% were vaccinated against hepatitis B.
In 2006, mass vaccination against influenza was conducted for the first time in Leningrad oblast. 221,707 people, or 14 % of the total population, were vaccinated against influenza before the season started. Vaccination coverage in 2007 was 16.1%. The target groups were children attending preschool institutions (kindergartens), school children in grades 1-11, medical workers, and employees in educational institutions.
During the project implementation period 114,766 children under 14 years of age, 13,630 women from 18 to 25 years of age were vaccinated against rubella. As a result, over 95% of children under 14 are vaccinated against rubella and 93% of 6 year old children are revaccinated against rubella.
Incidence of hepatitis B, rubella and influenza
The incidence of hepatitis B in Leningrad oblast decreased from 11.14 per 100,000 inhabitants in 2006 to 9.96 in 2007 (Fig 1). However, the incidence rate is still 1.9 times higher than the Russian Federation rates as a whole (Fig 2).
The highest incidence rate (31.3 per 100,000) was registered in the age group 20-29 years that comprised 46% of the cases (Fig 3). During the last five years the incidence rate has decreased markedly in the age group of 15-19 years (52.5 per 100,000 in 2003 and 13.0 in 2007). Morbidity in the age group of 30-39 years has a great influence on the total incidence rate of viral hepatitis B.
The overall incidence rate of rubella fell from 95.8 per 100,000 in 2005 to 52.1 in 2007. Rubella is mostly registered among children. Out of the total 821 registered cases of rubella, 722 (89%) were children under 14 years old. Non vaccinated children constitute 55.5% of the cases.
The incidence of influenza decreased from 1458 cases per 100,000 in 2006 to 447 in 2007.
An extension of the vaccination programmes against hepatitis B, rubella and influenza was successfully implemented in the Leningrad oblast and resulted in a 12% reduction of hepatitis B incidence, 18% reduction of rubella incidence and marked reduction of the influenza incidence. The project will continue with the aim to further reduce the burden of these diseases.