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Despite the Health Care national project being implemented since 2019, the headlines are full of the information about violations in this sector. Violations in the implementation of the Health Care national project were revealed, in particular, in Kalmykia.
Violations are Everywhere
The prosecutor's office of the Yashalta district found violations related to the illegal change of the terms of the contract by the customer of the Yashalta District Hospital.
It was found that, contrary to the requirements, the parties had concluded an additional agreement not stipulated by law to change the terms of the contract and the performance of works. The customer was brought to administrative responsibility in the form of a fine of 20,000 rubles ($329.28.)
In Chuvashia, the deadline for the completion of major repairs in the building of the outpatient clinic of the Morgausch Central Regional Hospital, which is being carried out within the framework of the national project, was disrupted. According to the government procurement website, the work is being done by the Aesthetic Group company, which is registered in Odintsovo, the Moscow Region. According to the terms of the contract worth 22.6 million rubles ($372,086.4), the contractor was to complete the facility by October 15 of this year.
However, it became clear during the visit of the Minister of Health of the Republic Vladimir Stepanov to the Morgaushsky district on October 13 that the works were far from being completed. The builders were installing the ventilation system, changing the electrical wiring, roofing, and interior finishing, although the deadline was two days away.
Despite this, Stepanov only lightly scolded the representative of the contractor. According to him, “repair of social facilities should be carried out in accordance with approved schedules, and the delay is unacceptable.” The republican Ministry of Health was not informed about any additional sanctions against the Aesthetic Group to the general public.
The Bashkortostan FAS of Russia, in turn, found violations in the purchase of equipment for a new children's polyclinic in Baymak. The cost of the contract is more than 44 million rubles ($724,416.) It was found that the customer demanded non-existent parameters of ventilation equipment.
“The antimonopoly authority found that the customer's technical requirement specified non-existent parameters of ventilation equipment. Such restrictions are contrary to the law on the contracting system. An administrative case will be initiated,” said the representatives of the press-service of the Bashkortostan FAS.
How are you, Siberia?
Prosecutors of regions of the Siberian Federal District (SFD) in the first half of 2022 revealed more than 500 violations of the law within the framework of the Health Care national project, made over 270 representations about the elimination of violations of the law and issued 40 warnings about the inadmissibility of violations of the law.
Based on materials of prosecutor's inspections, investigative authorities of the Republic of Khakassia and Tomsk region initiated four criminal cases. At the initiative of prosecutors, 149 persons incurred administrative or disciplinary liability for violations.
The Omsk region was in the top 3 for the number of detected violations in the implementation of the national project in the SFD. Violations were found in the sector of contracting for the supply of medical equipment, as well as violations of time limits for the overhaul of specialized institutions.
In Khakassia, Federal Antimonopoly Service fined 10.5 million rubles ($172,872) for collusion in the bidding for the Health Care national project. The Agregat and ST&M companies entered into a cartel and also entered into an anticompetitive agreement with the customer, the Department of the Committee of the Republic of Khakassia.
Restriction of competition led to the maintenance of prices at the bidding and reduction of the number of potential participants. The customer and participants of the trade procedures for the supply and installation of modular medical and obstetric stations and medical outpatient clinic in Khakassia were fined 10.5 million rubles. In addition, officials have been fined 100,000 rubles ($1,646.4).
In Tomsk, the prosecutor's office initiated criminal investigation into fraud and negligence in connection with the failure to meet deadlines for the construction of the Surgical Building of the Tomsk Oncological Dispensary and the embezzlement of budgetary funds during its construction.
In spring 2022, the court fined the contractor 13.5 million rubles ($222,264) for failure to meet deadlines. The regional authorities explained the postponement by July 1 by the need to finalize the project, the rising price of construction materials, and the pandemic. The building was not completed by July 1, and the deadline was pushed back to October.
Novosibirsk Region Takes Wooden Spoon
In 2022, the Federal Antimonopoly Service found violations in the purchase of medical equipment worth 347 million rubles ($5.3 mln) within the framework of the Health Care national project in the Novosibirsk Region.
As stressed by the antimonopoly agency, the organizations in their bids inappropriately specified additional characteristics of X-ray tomographs and ultrasound machines for the examination of heart and blood vessels. The state institutions were found guilty of violating the law on contractual system.
Prosecutor's office of Novosibirsk Region also established facts of acceptance of works not complying with terms of state contracts performed in five obstetric stations. The cost of the work amounted to more than 1 million rubles ($16,464.)
In Chistoozerny district, the official contractor was held administratively liable and must pay a fine of 50,000 rubles ($823.2) on the decision of the prosecutor for breach of the terms of construction of a first-aid station.
In 2022, the auditors of the Accounts Chamber of the Novosibirsk Region revealed violations of 136 million rubles ($2.2 mln) in the implementation of the Health Care National project in the region, of which 97 million rubles ($1.6 mln) were made in the central clinical hospital.
In addition, the inspectors found violations in the procurement of the project on combating cardiovascular disease. 6 vascular centers and 12 primary vascular departments were created in the region. The project costs amounted to 481.6 million rubles ($8 mln) (94.4% of the plan) in 2021, while in the first quarter of 2022 it was only 14.1 million rubles ($232,142.4) (1.8% of the plan).
Despite the fact that about 308.9 million rubles ($5.1) has been allocated for the purchase of medical equipment, the bulk of the equipment (61.9%) in regional vascular centers and primary vascular departments is more than 80% worn out. The equipment purchased in 2021 in the amount of 16 units is not in operation due to the lack of appropriate specialists in the institution.
Corruption is Health Care National Project’s Enemy
According to the General Prosecutor's Office, the percentage of corruption-related crimes in the national project is 68.4% which is more than in other national projects.
At one of the Federation Council meetings Prosecutor General Igor Krasnov stated that the Health National Project was subject to corruption more than any other national projects. The percentage of corruption-related crimes was 68.4%.
Semion Galperin, President of League for Protecting Doctors agrees with it. “Corruption is the main reason for what is going on. Our officials are not responsible for the results of their work. They are only responsible for the formal fulfillment of some actions. If an official has to buy something, he buys it and reports back. Nobody cares what will happen to it from here on.
“Well, in principle the problem is that we have officials, in particular from the health care, does not depend on the people for whom they must work. That is, neither from medical workers, nor from doctors, nor from patients. They depend only on their own system and they report to each other.”
According to Galperin, this is not how medicine functions in the world. And in a civilized society this industry should be as bureaucratic as possible.
According to experts, in order for the good intentions of the national project to benefit our medicine, and not to turn into a new “optimization,” it is necessary to solve the problem of deficit in the State Guarantees Program.
The way proven by world practice is to turn the compulsory medical insurance system into a real social insurance, which consolidates budgetary and non-budgetary sources of financing of medical care for the population: state costs, solidarity contributions of employees and employers and co-payments from patients, integrated with the compulsory medical insurance rates and clinical guidelines.
So far, the problems of the national project have been solved with the help of the prosecutor's office.
* The Bashkort public association is recognized as an extremist organization, banned in the Russian Federation by the decision of the Supreme Court of the Republic of Bashkortostan of 16.09.2020