Public Councils in Regions

An overview of the Public Councils at the Departments of the Federal Service on Surveillance in Healthcare and Social Development in constituent territories of the Russian Federation

14.09.2008

A.Saversky, Public Council on patients’ rights protection, Roszdravnadzor (Federal Service on Surveillance in Healthcare and Social Development)

As reported earlier, in order to disseminate the experience of the Public Council on Patients’ Rights Protection at the Roszdravnadzor, on January 25, 2008, Roszdravnadzor Head N.Yurgel signed the #210-Pr/08 order  ‘About establishing public councils at Roszdravnadzor departments in constituent territories of the Russian Federation (RF).’

In accordance with the order, public councils must have been established at Roszdravnadzor Healthcare Departments before April 1, 2008.

On February 12, 2008, Roszdravnadzor issued the Recommended Practice book ‘About establishment and activities of public councils at Roszdravnadzor Departments among the constituent territories of the Russian federation.’

Eight months later after the order was published, all Russian constituent territories saw Public Councils at the Roszdravnadzor Territory Bodies established in full.

The first Partial overview of the activities of public councils at Roszdravnadzor Territory Bodies based on Internet and media materials as of September 14, 2008 is presented here:

“Looking through materials at hand and those available on the Internet and in media, it follows that the councils have been staffed with medical profession representatives, lawyers, journalists, scientists, public people. Generally speaking, the establishment and beginning of the activities of councils are developing positively and with good dynamics. There is every reason to believe that thanks to these activities, it will not be long before the society has a robust network of public experts being council members, who will be able, without bias, to assess situations in the healthcare, to provide recommendations to the state and local governments with regards to improving things in the healthcare, while the Roszdravnadzor gains an effective field for the state and communities to debate.

Membership in the majority of the councils is promising in that quality work will be performed in regions. Well, one can see it in their work plans, for instance, in the work plan of the Public Council on patients’ rights protection at the Roszdravnadzor in the Kabardino-Balkarian Republic for 2008 (http://07.reg.roszdravnadzor.ru/Default.aspx?pageid=61&pageindex=12).

On the other hand, while establishing councils in a number of regions quite a lot of physicians and few people independent of the medical profession have entered the council staffs, which presupposes inclinations in developing work plans and viewpoints of such councils that would reflect problems mostly of the medical profession, and, therefore, cannot ensure that actual problems of patients and in healthcare in general are found out and solved. Thus, in the Irkutsk region, 12 council members out of 18 are respectable people, nevertheless belonging to the medical profession elite in this Russian constituent territory; they are the heads of state medical education institutions and state medical organizations, of medical associations, they are public officers and just other persons who are dependent on the healthcare system in the RF. In the Kurgan region, three council members out of 8 (which is plainly understaffed) are officers of the Roszdravnadzor Territory Body along with its head. Should two healthcare officers join this number, who have entered the council, then effective work can hardly be expected there. Still, we believe that drawbacks like those will be eliminated under the influence of different factors, including, for instance, public pressure, while the heads of Roszdravnadzor Territory Bodies ought to carefully pay attention to staff ratio.

Unfortunately, very few councils managed to have the commencement of their work covered in media. The details of their activities are either unavailable or can be accessed on formal websites only that are poorly visited. In this respect, it is worth mentioning that, by the establishment of councils, it is expected, in particular, to initiate definition of problems in healthcare and active discussion of those in the community. This objective cannot be solved without media. However, the activities of the Councils in the regions of Tatarstan and Tomsk are positively contrasting, as they are reflected in numerous good publications.

Another difficulty must be paid attention to, which is the correct positioning of councils within regional bodies of power. Keeping in mind that councils are consultative bodies only within bodies of the Roszdravnadzor, it makes one doubt that they have the right to give recommendations (in effect, instructions) to state’s bodies.

For instance, a number of important recommendations to state’s bodies have been given by the Decision of the Public Council at the Roszdravnadzor Department in the Kirov region as of July 31, 2008 (http://43.reg.roszdravnadzor.ru/Data/Sites/files/PubSovet/Решение%202%20общественного%20совета.doc); as an example goes, ‘To recommend the Department of Penitentiary Service in the Kirov region to take measures on keeping to standards…

…To recommend the healthcare department in the Kirov region to carry out an analysis of complaints, … to take measures aimed at more stability in providing people with pharmaceuticals…’

As a matter of fact, the actions taken in this particular decision are undoubtedly important and correct, however, in a situation like this the council is reduced to mere asking the above-mentioned authorities to consider a relevant issue, since it is clear that these authorities are not obliged to follow recommendations and instructions of a public council at the Roszdravnadzor Territory Body. Knowing one’s niche is essential, for to claim one’s needs too hard may obstruct the council’s activities altogether, and other agencies may turn a deaf ear to the council because of its unprofessionalism in finding a way to collaborate and a position. I don’t claim this will happen but it is quite possible, and one cannot fully justify the risk – the problems seem delicate and need patience, don’t they?

Here is another example of misunderstanding of ‘who is who?’: as the website of the Plenipotentiary representative on human rights in the Perm region (http://ombudsman.perm.ru/news/2008/04/11/1419/?) reports, the Chairman of the Public Council of the Roszdravnadzor Territory Body was elected there. However, the Council Chairman is appointed as the head of the Roszdravnadzor Territory Body, since the Council itself was established at that authority’s order. Fair election is simply out here.

Thus, regardless of someone’s wish to have more democracy and, at the same time, the rule of power, the Public Councils are what they are. In particular, they cannot carry out examinations at their own decision, for they have not been granted this right (unless there is a relevant decision by a Roszdravnadzor Territory Body); they may consult people but must do it for free. In point of fact, councils are no panacea, and they cannot protect patients in Russia as they have neither money nor powers to do so. Nevertheless, they are still quite helpful as an institute of Civil Society, as a consultative and advisory body, and we all need to correctly make a use of this opportunity.

I wish you every success as you start these wide activities!

Margarita Mikheeva