Target health program. Federal target programs. Providing a healthy and safe living environment

Tatarnikov M.A. Research Institute of Public Health and Healthcare Management of the Moscow Medical Academy I.M.Sechenova

The program-targeted method is the most important tool for the implementation of state socio-economic policy, incl. and in the field of health. Federal targeted programs(FTP) are a complex of research, development, production, socio-economic, organizational and economic and other activities, linked in terms of resources, performers and timing of implementation. effective solution tasks in the field of state, economic, environmental, social and cultural development Russian Federation(RF). Their most important feature is the identification of priority problems and ways of solving them, taking into account the possibilities of financing program activities at the federal, regional or local levels. Thus, program-targeted management allows not only to concentrate resources on priority areas, but also to implement an integrated approach to solving the most pressing health problems based on intersectoral interaction.

FTPs in the field of public health protection stimulate the participation of the constituent entities of the Russian Federation in solving health problems in their territories on the basis of co-financing or the adoption and implementation of their own similar programs.

Currently, a regulatory and methodological framework has been created that defines the rules for the consideration, approval and financing of FTPs. In working with target programs, the following stages are distinguished:

selection of problems for software development;
making a decision on the development of a target program and its formation;
examination and evaluation of the target program;
approval of the target program;
managing the implementation of the target program and monitoring the progress of its implementation.

According to the current legislation, any legal and individuals... However, as a rule, the Ministry of Health and Social Development of Russia and its subordinate institutions act in this capacity.

The selection of problems for their software development and solution at the federal level is determined by the following factors:

the significance of the problem;
the inability to comprehensively solve the problem within an acceptable time frame and the need state support to solve it;
fundamental novelty and high efficiency of technical, organizational and other measures necessary for the large-scale dissemination of progressive achievements;
the need to coordinate cross-sectoral relations to solve this problem.

When substantiating the need to solve problems by program methods at the federal level, the priorities and goals of social economic development RF, the results of the analysis of the economic and social state of the country. In accordance with the approved procedure, proposals must contain:

name of the problem and analysis of the causes of its occurrence;
possible ways solving the problem;
the need for financial resources and possible sources of their provision (federal budget, budgets of the constituent entities of the Russian Federation, extra-budgetary funds);
preliminary assessment of socio-economic efficiency and consequences from the implementation of the program;
government customers and developers of the target program, the time and cost of preparing the target program.

The Ministry of Economic Development (MED), together with the Ministry of Finance of Russia and other interested federal executive bodies and executive bodies of the constituent entities of the Russian Federation, on the basis of forecasts of the socio-economic development of the country, prepares proposals for solving this problem using program methods at the federal level and sends them to the Government of the Russian Federation. The Government of the Russian Federation, on the basis of the submitted proposals, makes a decision on the preparation of an appropriate target program, the timing and cost of its development, and determines the state customer.

The state customer is responsible for the timely and high-quality preparation and implementation of the target program, prepares the initial task for its formation, manages the actions of developers, manages the executors of the program after its approval, ensures the effective use of funds allocated for the implementation of the program. The state customer of the FTP in the field of public health protection is, as a rule, the Ministry of Health and Social Development of Russia.

The target program consists of the following sections:

content of the problem and justification of the need to solve it using software methods;
main goals and objectives, terms and stages of program implementation;
system of program activities;
resource support of the program (at the expense of federal budget and off-budget sources, budgets of the constituent entities of the Russian Federation and with the distribution of expenses by regions of the country);
mechanism for the implementation of the program;
organizing program management and monitoring the progress of its implementation;
evaluating the effectiveness of the program;
passport of the target program.

Attached to the draft target program explanatory note, a business plan with socio-economic and feasibility studies, a preliminary budget application for appropriations from the federal budget to finance the program for the next year, a sheet of agreement with interested federal executive bodies and, if necessary, agreements (contracts) of intent between the state the customer of the program with enterprises, organizations, government bodies of the constituent entities of the Russian Federation, confirming the financing of the program from extra-budgetary sources, the budgets of the constituent entities of the Russian Federation.

The Ministry of Economic Development and the Ministry of Finance of the Russian Federation evaluate the submitted draft target program, while drawing Special attention on the:

the priority nature of the problem proposed for the software solution;
the validity and complexity of program activities, the timing of their implementation;
the need to attract outside budget funds, funds from the budgets of the constituent entities of the Russian Federation for the implementation of the program in conjunction with the possibilities of its state support at the expense of centralized resources;
the effectiveness of the program delivery mechanism;
socio-economic efficiency of the program as a whole, the expected final results of the program implementation.

The MED, with the participation of the Ministry of Finance, prepares an opinion on the draft target program and preliminary budget application. Taking into account the comments and suggestions, the state customer of the target program, together with its developers, finalizes the draft program. The revised draft of the target program is re-sent to the Ministry of Economic Development.

In case of a positive assessment, the Ministry of Economic Development, in agreement with the Ministry of Finance of Russia, submits a draft target program for approval to the Government of the Russian Federation.

Target programs and state customers are approved by the Government of the Russian Federation. Government customers are provided financial resources in the amount established by the federal budget, and are responsible for the implementation of federal target programs. The interaction of several state customers under one program is carried out by the state customer - the coordinator, determined by the Government of the Russian Federation.

The forms and methods of organizing the management of the implementation of the target program are determined by the state customer. The current management of the FTP for the protection of public health is carried out by the directorate formed by the state customer, headed by one of the Deputy Minister of Health of the Russian Federation, who is responsible for the implementation of the target program.

The implementation of the target program is carried out on the basis of government contracts(agreements) concluded by the state customer of the program with all executors of program activities. The selection of objects and projects of program activities and their performers is carried out on a competitive basis.

The MED, with the participation of interested public authorities, organizes expert reviews of the implementation of individual target programs. At the same time, attention is drawn to the fulfillment of the deadlines for the implementation of program activities, to the targeted and effective use of financial resources and the end results of the program.

At present, the main operating FTP in the field of health care is the program "Prevention and control of socially significant diseases (2007-2011)", which includes the subprograms "Diabetes mellitus", "Tuberculosis", "HIV infection", "Oncology", "Sexually transmitted infections", "Viral hepatitis", "Mental disorders", "Arterial hypertension" and "Vaccine prophylaxis" approved by the Decree of the Government of the Russian Federation of 10.05.2007 N 280 (as amended by the Government of the Russian Federation of 18.02.2008 N 95 , dated 02.06.2008 N 423, dated 09.04.2009 N 319). The program is an essential component of the national priority project "Health".

Description of the problem to be solved by the program

The federal target program "Prevention and control of socially significant diseases (2007-2011)" (hereinafter referred to as the Program) was developed in accordance with the order of the Government of the Russian Federation of 11.12.2006 N 1706-r, the list of socially significant diseases approved by the Decree of the Government of the Russian Federation of 12/01/2004 N 715, the procedure for the development and implementation of federal target programs and interstate target programs, in the implementation of which the Russian Federation participates, approved by the Decree of the Government of the Russian Federation of 06/26/1995 N 594.

The need to prepare and implement the Program is caused by a number of factors of a socio-economic nature that affect the decline in the quality of life of the population, including excessive stress loads, a decrease in the level of sanitary and hygienic culture, as well as still high rates morbidity, disability and mortality, despite the implementation of the federal target program "Prevention and control of diseases of a social nature (2002-2006)".

The share of complications in diabetes mellitus is currently 35 percent. Limb amputations were performed in 1 percent of patients. In total, for the first time during the year, 38.6 thousand people were recognized as disabled due to diabetes mellitus.

The incidence of tuberculosis in correctional institutions of the Federal Penitentiary Service is currently 1515 cases per 100 thousand people, mortality - 153.4 cases per 100 thousand people, the proportion of cases of cessation of bacterial excretion - 73.5 percent, mortality from tuberculosis - 22.6 cases per 100 thousand population.

The number of newly registered cases of HIV infection reached 37.7 thousand cases, in correctional institutions of the Federal Penitentiary Service - 2 thousand cases, the share of HIV-infected pregnant women included in the program for preventing HIV infection in newborns was 75 percent.

The proportion of patients with visual localizations of malignant neoplasms detected at stages I and II, in total number of patients with visual localizations of the tumor is 67.6 percent, the proportion of deaths from malignant neoplasms within a year from the date of diagnosis among patients first registered in the previous year is 31.6 percent, mortality from malignant neoplasms per 100 thousand of the population is 186.8 cases for men, 93.5 cases for women.

The incidence of syphilis is 72 cases per 100 thousand of the population, in correctional institutions of the Federal Penitentiary Service - 176.6 cases per 100 thousand people, the incidence of syphilis in children - 21.2 cases, gonorrhea - 23.4 cases per 100 thousand of the child population ... At the same time, the share of specialized medical institutions monitoring the variability of sexually transmitted infection pathogens in the total number of dermatovenerological institutions is 15 percent. The total number of adolescent specialized centers for the prevention and treatment of sexually transmitted infections does not exceed 12 in the country as a whole.

The incidence of acute viral hepatitis B and C is currently 8.6 and 4.5 cases per 100 thousand of the population, respectively, of chronic viral hepatitis B and C - 51.4 cases per 100 thousand of the population.

The proportion of patients covered by brigade mental health services in the total number of observed patients is 5 percent, the proportion of patients requiring inpatient psychiatric care in the total number of observed patients is 16 percent. At the same time, the average duration of a patient's treatment in a psychiatric hospital is 75.6 days, and the proportion of repeated hospitalizations in a psychiatric hospital during the year is 20 percent.

The incidence of cerebrovascular disorders (cerebrovascular diseases, including stroke) due to arterial hypertension is 5776 cases per 100 thousand of the population, and the mortality rate from vascular disorders of the brain (cerebrovascular diseases, including stroke) due to arterial hypertension is 325 cases per 100 thousand of the population.

95% coverage of children with preventive vaccinations is maintained. The incidence of diphtheria and measles is currently 0.25 and 1.6 cases per 100 thousand of the population, respectively.

The main goals and objectives of the program, the period of its implementation, as well as target indicators and indicators

The objectives of the Program are to reduce the incidence, disability and mortality of the population with socially significant diseases, increase the duration and improve the quality of life of patients suffering from these diseases.

The objectives of the Program are:

improvement of methods of prevention, diagnosis, treatment and rehabilitation for socially significant diseases;
development and implementation modern methods prevention, diagnosis, treatment and rehabilitation for socially significant diseases based on advanced technologies;
construction and reconstruction of specialized medical institutions.

Within the framework of the Program, it is envisaged to carry out a set of interrelated measures for the prevention, diagnosis, treatment and rehabilitation of socially significant diseases throughout the entire period of the Program implementation.

Program implementation mechanism

The state customer - the coordinator of the Program is the Ministry of Health and Social Development of Russia, the state customers of the Program are the Ministry of Health and Social Development of Russia, the Federal Service for Supervision of Consumer Rights Protection and Human Welfare, the Federal Service for the Execution of Punishments and the Russian Academy of Medical Sciences.

The implementation of the Program is carried out on the basis of government contracts concluded by government customers with the executors of the Program activities in accordance with the Federal Law "On placing orders for the supply of goods, performance of work, provision of services for state and municipal needs", as well as co-financing of expenditure obligations of the constituent entity of the Russian Federation for the relevant regional (municipal) programs (plans).

Interaction of government customers with the executive authorities of the constituent entities of the Russian Federation is carried out on the basis of agreements.

The implementation of the Program in the constituent entities of the Russian Federation is carried out through a set of measures aimed at reducing the incidence of socially significant diseases, improving methods of their prevention and early diagnosis, ensuring the quality of treatment and rehabilitation.

To manage the implementation of the activities of the Program, a coordination council (hereinafter referred to as the council) is created, formed from officials of the state customer - the coordinator of the Program, state customers of the Program and interested federal executive bodies.

The Council performs the following functions:

develops proposals on the topics and volumes of financing orders for the supply of goods, performance of work and provision of services within the framework of the Program;
considers materials on the course of implementation of the Program activities;
organizes checks on the implementation of the Program activities, targeted and effective use of funds allocated for their implementation;
prepares recommendations for the effective implementation of the Program activities, taking into account the progress of the Program implementation and trends in the socio-economic development of the Russian Federation;
identifies scientific, technical and organizational problems during the implementation of the Program;
considers the results of the examination of projects and activities proposed for implementation in the next financial year, in terms of their content and cost.

The Council approves the following developed by state customers:

Detailed organizational and financial plans for the implementation of the Program activities;

Indicators for monitoring the implementation of the Program activities.

The Council is chaired by the Deputy Ministry of Health and Social Development of Russia. The regulations on the council and its composition are approved by the Minister of Health and social development Russian Federation.

Ministry of Health and Social Development of Russia:

monitors the activities of state customers of the Program;
prepares drafts of regulatory legal acts of the Government of the Russian Federation necessary for the implementation of the Program;
annually, if necessary, clarifies the mechanism for implementing the Program, target indicators and indicators, expenses for the implementation of the Program's activities;
prepares, taking into account the progress of the Program implementation in the current year, and submits, in accordance with the established procedure, to the Ministry of Economic Development a consolidated budget application for financing the Program activities in the next financial year;
quarterly submits to the Ministry of Economic Development statistical, reference and analytical information on the progress of the Program implementation as a whole, monitoring data on the implementation of the Program activities;
presents annually, until February 1, in the Ministry of Economic Development and the Ministry of Finance of Russia on established form a report on the progress of the Program, the results achieved and the effectiveness of the use of financial resources;
initiates, if necessary, expert reviews of the implementation of individual activities of the Program;
submits to the Ministry of Economic Development and the Ministry of Finance of Russia proposals on adjusting measures for the implementation of the Program or on termination of its implementation;
upon completion of the Program, submits to the Ministry of Economic Development and the Ministry of Finance of Russia a report on the implementation of the Program and on the effectiveness of the use of financial resources for the entire period of its implementation.
State customers of the Program:
carry out the current management of the implementation of the Program;
prepare a detailed organizational and financial plan for the implementation of the Program activities;
in the event of a reduction in the volume of financing of the Program activities at the expense of the federal budget, additional measures are developed to attract funds from extra-budgetary sources to achieve the results characterized by the target indicators of the Program, and also, if necessary, develop, within the established time frame, proposals for their adjustment;
make proposals to clarify target indicators and indicators, costs for the implementation of activities of the Program and subprograms, as well as to improve the mechanism for its implementation;
ensure effective use of funds allocated for the implementation of the Program;
organize the maintenance of quarterly reporting on the implementation of the Program and subprograms, as well as monitoring the implementation of program activities;
organize expert reviews of the implementation of individual activities of the Program and subprograms;
manage the activities of the executors of the Program activities within the framework of the program activities;
carry out the selection on a competitive basis of performers of work (services), suppliers of products for each event of the Program and subprograms, as well as the conclusion of state contracts (agreements);
organize the application information technologies in order to manage and control the implementation of the Program, ensure the placement on the Internet of the text of the Program, regulatory legal acts, methodological materials in terms of managing the implementation of the Program and monitoring the implementation of its activities, as well as materials on the progress and results of the implementation of the Program;
agree with the state customer - the coordinator of the Program and the main stakeholders of the Program on the possible dates for the implementation of activities, volumes and sources of funding;
quarterly provide the state customer - the Program coordinator with statistical, reference and analytical information on the implementation of the Program activities;
if necessary, submit to the state customer - the coordinator of the Program, proposals to extend the period or to terminate the implementation of the Program;
submit annually, by January 25, to the state customer - the coordinator of the Program, in the prescribed form, a report on the progress of the implementation of the Program, the results achieved and on the effectiveness of the use of financial resources.

Assessment of the socio-economic efficiency of the program

Evaluation of the effectiveness of the implementation of the Program is carried out on the basis of comparison with the data for 2005 and taking into account the need to achieve the following indicators:

a decrease in the proportion of complications in diabetes mellitus to 28 percent;

increase average duration life of men with type I diabetes mellitus up to 55.3 years, women - up to 59.1 years;

an increase in the average life expectancy of men with type II diabetes mellitus up to 71.5 years, women - up to 73.5 years;

a decrease in the incidence of tuberculosis in correctional institutions of the Federal Penitentiary Service to 1495 cases per 100 thousand people;

an increase in the rate of abacillation of tuberculosis patients registered at the end of the year to 35.9 percent;

reduction of mortality from tuberculosis to 17.8 cases per 100 thousand people, including in correctional institutions of the Federal Penitentiary Service - up to 140 cases per 100 thousand people;

a decrease in the number of newly registered cases of HIV infection during the year to 31 thousand cases, in correctional institutions of the Federal Penitentiary Service - to 1.6 thousand cases;

an increase in the proportion of HIV-infected pregnant women included in the program for the prevention of HIV infection in newborns to 98 percent;

improvement of indicators characterizing the early detection of malignant neoplasms, including an increase in the proportion of patients with visual localizations of the tumor detected at stages I and II of the disease, up to 73.1 percent;

a decrease in the proportion of patients who died from malignant neoplasms within a year from the date of diagnosis, among patients registered for the first time in the previous year, to 27.8 percent;

a decrease in mortality from malignant neoplasms in men to 171.6 cases per 100 thousand of the population, in women - to 90.1 cases per 100 thousand of the population;

a decrease in the incidence of syphilis to 50.1 cases per 100 thousand people, including in correctional institutions of the Federal Penitentiary Service - up to 150 cases per 100 thousand people;

a decrease in the incidence of syphilis among children to 7.2 cases per 100 thousand of the child population;

a decrease in the incidence of gonorrhea in children to 10.2 cases per 100 thousand of the child population;

an increase in the share of specialized medical institutions monitoring the variability of sexually transmitted infections in the total number of dermatovenerological institutions to 60 percent;

an increase in the number of adolescent specialized centers for the prevention and treatment of sexually transmitted infections to 55;

a decrease in the incidence of acute viral hepatitis B to 2.7 cases per 100 thousand population;

a decrease in the incidence of acute viral hepatitis C to 3.8 cases per 100 thousand population;

reduction of the incidence of chronic viral hepatitis B and C to 36 cases per 100 thousand population;

an increase in the proportion of patients covered by brigade mental health services in the total number of observed patients to 41 percent;

a decrease in the proportion of patients requiring inpatient psychiatric care in the total number of observed patients to 14.5 percent;

reducing the average duration of treatment of a patient in a psychiatric hospital to 73.9 days;

a decrease in the proportion of repeated hospitalizations in a psychiatric hospital during the year to 17.5 percent;

a decrease in the incidence of cerebrovascular diseases in the population to 4680 cases per 100 thousand of the population;

reduction of mortality from cerebrovascular diseases to 270 cases per 100 thousand population;

an increase in the number of newly diagnosed patients with arterial hypertension up to 1000 thousand people per year;

an increase in the number of people trained in health schools for patients with arterial hypertension to 1400 thousand people a year;

maintaining the 95% coverage of children with preventive vaccinations;

a decrease in the incidence of diphtheria to 0.16 cases per 100 thousand of the population;

exclusion of cases of the occurrence of diseases of poliomyelitis;

a decrease in the incidence of measles to 0.8 cases per 100 thousand population.

It is assumed that the overall economic effect from the implementation of the Program activities will be achieved by reducing the incidence, disability and mortality of the population with socially significant diseases.

The social effectiveness of the implementation of the Program's activities will be expressed in improving the quality and increasing the life expectancy of patients, maintaining labor potential, forming the basis healthy way life, reducing social and psychological tension in society due to the threat of the spread of socially significant diseases.

I approve

Chief physician GBUZ RB GB

G. Kumertau

___________ O. A. Astakhov

REPORT

FOR 2015

Afonina Evgeniya Valerievna

MEDICAL SISTERS OF THE CHAMBER

PEDIATRIC DEPARTMENT

State state-financed organization Healthcare of the Republic of Bashkortostan City Hospital of the city of Kumertau

For assignment of the second qualification category in the specialty

"Nursing in Pediatrics"

Kumertau

I. Introductory part

1. Reforming health care 3

2.Basic federal programs on health protection

population 7

3.Biography 8

II. Main part

4. City health care 9

5. Characteristics of the pediatric department 11

6. Performance indicators of the pediatric department 13

7. Basic orders regulating the work of a nurse 16

pediatric ward

8.Organization of the work of the ward nurse of pediatric 19

branches

9. Sanitary and anti-epidemic work of the ward nurse of the 27th pediatric department

10. Sanitary educational work 32

III. Final part.

11. Conclusions 34

12. Sentences 35

13. References 36

Reforming health care.

Health care is a series of socio-economic and medical reforms aimed at preserving and improving the level of health of each individual and the population as a whole. The goal of health care reform is to preserve and develop the state municipal health care system, organize their activities, as well as the activities of the private health care system to maximize the rights of citizens in the field of health care.

Reforming health care offers solutions to the following priority tasks:

1. From stationary medical care to outpatient - this is an increase in the volume of medical care in a polyclinic, the introduction of hospital-replacing technologies: day hospitals in a polyclinic, at home;

2. From specialized care to general medical practice, family medicine, when medical care is as close as possible to the place of residence and is a long process;

3. From increasing the amount of resources in the industry to their effective use;

4. From volume medical services to their quality;

5.From an increase in the number of beds, to their rational use, re-profiling and phasing of inpatient care;

6. From an increase in the number of doctors and nurses to the quality of their work - improving the quality of professional training, the system of practical health care, providing primary health care.

7.From government funding- to financing from various sources: paid services.

8. Providing the population with medicines available to all segments of the population.

9. From partial - to full provision of the rights and obligations of the patient. This is the provision of free, affordable and qualified medical care to the population and medical institution, the right to obtain a medical insurance policy.

10. From the treatment of diseases to their prevention and health promotion of the population. This is ensuring the priority of disease prevention, the creation of centers for psycho-preventive support. Publication of articles promoting a healthy lifestyle. Supply of good quality food, water supply, maternal and child health; immunization against major infectious diseases; prevention of endemic diseases.

In order to strengthen the health of the population of Russia, reduce the level of morbidity, disability, mortality, increase the availability and quality of medical care, strengthen primary health care, develop preventive health care, meet the needs of the population in high-tech types of medical care, a national project "Health" was developed, which successfully is being implemented.

National project "Health"

The main objectives of the priority national project in the field of health care:

1. Strengthening the health of the population of Russia, reducing the level of morbidity, disability, and mortality.

2. Improving the availability and quality of medical care.

3. Strengthening primary health care, creating conditions for the provision of effective medical care at the pre-hospital stage:

Training and retraining of general (family) practice doctors, local general practitioners and pediatricians;

Increase wages medical professionals primary care, feldsher-obstetric points and ambulance;

Strengthening the material and technical base of the diagnostic service of primary medical care, emergency medical care.

4. Development of preventive health care:

Prevention of HIV infection, hepatitis B and C , identification and treatment of HIV patients;

Additional immunization of the population within the framework of the national immunization schedule;

Introduction of new screening programs for newborns;

Additional medical examination of the working population;

Provision of medical care to women during pregnancy and childbirth in state and municipal institutions health care.

5. Meeting the needs of the population in high-tech medical care:

Increase in the volume of high-tech medical care;

Construction of new high-tech medical technology centers;

Training of highly qualified doctors and nurses for these centers.

Measures to solve the main problems of health care presuppose effective spending of budgetary funds, focused on the final result, a shift in the emphasis of medical care to the primary link (prehospital stage), and a preventive focus of health care.

Federal target programs

for the protection of the health of the population of the Russian Federation.

1. Construction of medical centers for the provision of specialized medical care in the field of obstetrics, gynecology and neonatology (perinatal centers).

2. Republican target program "Formation of a healthy lifestyle among the population of the Republic of Bashkortostan, including reducing the consumption of alcohol, tobacco and combating drug addiction, for 2011-2015."

3. Republican target program "Prevention and control of socially significant diseases in the Republic of Bashkortostan (2011-2015)" The program includes the subprograms "Oncology", "Sexually transmitted infections", "Vaccine prophylaxis", "Diabetes mellitus".

4. The program of state guarantees for the provision of free medical care to citizens in the Republic of Belarus for 2014-2016.

5. Departmental target program of the Ministry of Health of the Republic of Bashkortostan "Safe blood for 2012-2014"

6. Departmental target program of the Ministry of Health of the Republic of Bashkortostan "Treatment of viral hepatitis in the Republic of Bashkortostan for 2013-2015"

7. Departmental target program of the Ministry of Health of the Republic of Bashkortostan "Tuberculosis" for 2013-2015 "

Biographical information.

I, Afonina Evgeniya Valerievna, was born in 1988.

In 2008 she graduated from the Sterlitamak Medical School of the Kumertau branch with a degree in Nursing.

I have been working in GBUZ RB GB Kumertau since 2008.

APPENDIX N 6
to the state program of the Russian Federation
"Health care development"

Rules
the provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation and the city of Baikonur for the implementation of certain measures of the state program of the Russian Federation "Healthcare Development"

1. These Rules establish the procedure for the provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation and the city of Baikonur (hereinafter referred to as the constituent entities of the Russian Federation) for the implementation of certain measures of the state program of the Russian Federation "Health Development" (hereinafter referred to as the subsidy).

2. The subsidy is provided for the purpose of co-financing the expenditure obligations of the constituent entities of the Russian Federation related to the implementation of the following activities:

a) financial support for the procurement of diagnostic tools for detecting, determining the sensitivity of mycobacterium tuberculosis and monitoring the treatment of persons with multidrug-resistant tuberculosis, in accordance with the list approved by the Ministry of Health of the Russian Federation, as well as medical devices in accordance with the equipment standard provided for by the procedure providing medical care to patients with tuberculosis;

b) financial support for the procurement of diagnostic tools for the detection and monitoring of treatment of persons infected with the human immunodeficiency virus, including in combination with hepatitis B and (or) C viruses;

c) financial support of medical activities related to the donation of human organs for the purpose of transplantation (transplantation), including the implementation of measures for the medical examination of the donor, ensuring the safety of donor organs before their removal from the donor, removal of donor organs, storage and transportation of donor organs and other activities, aimed at ensuring this activity;

( or) tissues, including storage of medicinal products, delivery of medicinal products to pharmacy organizations, creation and maintenance electronic databases data on registration and movement of medicinal products within the constituent entities of the Russian Federation;

e) financial support for the implementation of measures to prevent HIV infection and hepatitis B and C, including with the involvement of socially oriented non-profit organizations in the implementation of these activities;

f) providing financial support for the fulfillment of expenditure obligations of the constituent entities of the Russian Federation and (or) local budgets arising during the construction (reconstruction, including with elements of restoration, technical re-equipment) of state property objects of the constituent entities of the Russian Federation (municipal property) or the acquisition of facilities real estate into state ownership of the constituent entities of the Russian Federation ( municipal property), within the framework of the subprogram "Improving the provision of specialized, including high-tech, medical care" of the state program of the Russian Federation "Development of health care" (hereinafter referred to as facilities).

3. The subsidy is provided within the budgetary allocations provided for in the federal law on the federal budget for the current financial year and planning period, and limits budget commitments approved by the Ministry of Health of the Russian Federation for the purposes specified in paragraph 2 of these Rules.

4. The selection of the constituent entities of the Russian Federation for receiving subsidies is carried out by the Ministry of Health of the Russian Federation annually, taking into account the following criteria:

a) to receive a subsidy for the implementation of the activities specified in subparagraph "a" of paragraph 2 of these Rules:

presence in the constituent entity of the Russian Federation medical organizations subordinate to the executive authorities of the constituent entities of the Russian Federation, providing medical care to patients with tuberculosis;

subparagraph "a" of paragraph 2 subparagraph "a" of paragraph 15 of these Rules;

b) to receive a subsidy for the implementation of the measures specified in subparagraphs "b" and "e" of paragraph 2 of these Rules:

the presence in the constituent entity of the Russian Federation of medical organizations subordinate to the executive authorities of the constituent entities of the Russian Federation providing medical care to persons infected with the human immunodeficiency virus, including in combination with hepatitis B and (or) C viruses;

the presence of the state program of the constituent entity of the Russian Federation, which includes the measures specified in subparagraphs "b" and "e" of paragraph 2 of subparagraphs "b" and "e" of paragraph 15 of these Rules;

c) to receive a subsidy for the implementation of the activities specified in subparagraph "c" of paragraph 2 of these Rules:

the presence in the constituent entity of the Russian Federation of medical organizations subordinate to the executive authorities of the constituent entities of the Russian Federation, and (or) municipal medical organizations carrying out medical activities related to the donation of human organs for the purpose of transplantation (transplantation);

availability of the state program of the constituent entity of the Russian Federation, which includes the measures specified in subparagraph "c" of paragraph 2 of these Rules, and containing the target indicator of their implementation, specified in subparagraph "c" of paragraph 15 of these Rules;

availability of an application from the highest executive body of state power of a constituent entity of the Russian Federation for participation in the events provided for by subparagraph "c" of paragraph 2 of these Rules, containing the following information:

the presence of a regulatory legal act of the constituent entity of the Russian Federation, which determines the measures for organizing the donation of human organs for the purpose of transplantation (transplantation);

the number and name of medical organizations subordinate to the executive authorities of the constituent entity of the Russian Federation, and (or) municipal medical organizations located in the territory of the constituent entity of the Russian Federation, licensed to carry out medical activities, providing for the performance of work (services) for the removal and storage of organs and (or ) human tissue for the purpose of transplantation;

the number and name of medical organizations subordinate to the executive authorities of the constituent entity of the Russian Federation, and (or) municipal medical organizations located in the territory of the constituent entity of the Russian Federation, licensed to carry out medical activities, providing for the performance of work (services) in surgery (organ transplantation and (or ) fabrics);

the number and name of medical organizations subordinate to the executive authorities of the constituent entity of the Russian Federation, and (or) municipal medical organizations located on the territory of the constituent entity of the Russian Federation, licensed to carry out medical activities, providing for the performance of work (services) for the transportation of organs and (or) tissues a person for the purpose of transplantation;

the number of patients (donors) from whom donor organs were removed during their lifetime for the purpose of transplantation (transplantation) in medical organizations subordinate to the executive authorities of the constituent entity of the Russian Federation and municipal medical organizations located on the territory of the constituent entity of the Russian Federation (according to the data of the reporting financial year) ;

the number of patients (recipients) who were provided with high-tech medical care by the method of transplantation (transplantation) of donor organs removed from living donors in medical organizations subordinate to the executive authorities of the constituent entity of the Russian Federation, and (or) municipal medical organizations located on the territory of the constituent entity of the Russian Federation Federation (according to the reporting financial year);

the number of donor organs, including donor organs, withdrawn from living donors for the purpose of transplantation (transplantation) in medical organizations subordinate to the executive authorities of the constituent entity of the Russian Federation, and (or) municipal medical organizations located on the territory of the constituent entity of the Russian Federation (according to the data of the reporting financial year ), including:

the total number of donor organs transplanted (transplanted) of which was carried out in medical organizations state system health care, including federal medical organizations, municipal medical organizations located on the territory of a constituent entity of the Russian Federation (according to the reporting financial year);

the number of donor organs donated for the purpose of transplantation (transplantation) to medical organizations of the state healthcare system, including federal medical organizations, municipal medical organizations located on the territory of other constituent entities of the Russian Federation (according to the reporting financial year);

d) to receive a subsidy for the implementation of the activities specified in subparagraph "d" of paragraph 2 of these Rules:

the presence in the subject of the Russian Federation of citizens registered in the Federal Register of persons with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher's disease, malignant neoplasms of lymphoid, hematopoietic and related tissues, multiple sclerosis, persons after organ and (or) tissue transplantation;

the presence of the state program of the constituent entity of the Russian Federation, which includes the measures specified in subparagraph "d" of paragraph 2 of these Rules, and containing the target indicator of their implementation, specified in subparagraph "d" of paragraph 15 of these Rules;

e) to receive a subsidy for the implementation of the activities specified in subparagraph "e" of paragraph 2 of these Rules:

the presence of an act of the President of the Russian Federation or the Government of the Russian Federation or instructions or instructions of the President of the Russian Federation or instructions of the Chairman of the Government of the Russian Federation on construction (reconstruction, including with elements of restoration, technical re-equipment) or the acquisition of an object on the territory of a specific constituent entity of the Russian Federation;

the obligation of the supreme executive body of state power of the constituent entity of the Russian Federation to co-finance construction (reconstruction, including with elements of restoration, technical re-equipment) or the acquisition of an object into state ownership of the constituent entity of the Russian Federation (municipal property) at the expense of funds consolidated budget a constituent entity of the Russian Federation or funds from non-budgetary sources in accordance with the level of co-financing provided for in paragraph 13 of these Rules;

the presence of the state program of the constituent entity of the Russian Federation, which includes the measures specified in subparagraph "e" of paragraph 2 of these Rules, and containing the target indicators of their implementation, specified in subparagraphs "f" - "h" of paragraph 15 of these Rules.

5. The subsidy is provided on the basis of an agreement between the Ministry of Health of the Russian Federation and the highest executive body of state power of a constituent entity of the Russian Federation on the provision of a subsidy (hereinafter referred to as the agreement), which is concluded in accordance with the standard form of the agreement approved by the Ministry of Finance of the Russian Federation.

6. The conditions for granting a subsidy and for spending it are:

a) measures approved by legal acts of a constituent entity of the Russian Federation, for which co-financing subsidies are provided and which include:

organizing preventive measures in the constituent entity of the Russian Federation aimed at preventing and reducing mortality from tuberculosis;

organization of the activities of medical organizations in accordance with the procedure for providing medical care to patients with tuberculosis, as well as the procedure for providing medical care for a disease caused by the human immunodeficiency virus (HIV);

organization of medical activities related to the donation of human organs for the purpose of transplantation (transplantation);

organization of activities for the prevention of HIV infection and hepatitis B and C;

organization of activities related to the storage, delivery to pharmacies of medicines intended for the treatment of patients with malignant neoplasms of lymphoid, hematopoietic and related tissues, hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, multiple sclerosis, as well as after organ transplantation and (or) fabrics, for the creation and maintenance of electronic databases for the registration and movement of these medicinal products within the constituent entities of the Russian Federation;

list of objects for co-financing of construction or acquisition of which subsidies are provided;

b) the presence in the budget of the constituent entity of the Russian Federation of budgetary appropriations provided for the implementation of the measures specified in paragraph 2 of these Rules;

c) use cost effective project documentation reuse (if such documentation is available) in relation to the measures specified in subparagraph "e" of paragraph 2 of these Rules (in the part related to the construction of facilities);

d) return by the constituent entity of the Russian Federation of funds to the federal budget in accordance with paragraphs 16-19 of the Rules for the formation, provision and distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation, approved by the Government of the Russian Federation of September 30, 2014 N 999 "On the formation, provision and the distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation "(hereinafter - the Rules for the formation, provision and distribution of subsidies).

7. The total amount of subsidies provided to the budget of the constituent entity of the Russian Federation () is determined by the formula:

subparagraph "a" of paragraph 2 of these Rules;

The size of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of measures provided for in subparagraph "b" of paragraph 2 of these Rules;

The size of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of the measures provided for in subparagraph "c" of paragraph 2 of these Rules;

8. The size of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of measures provided for in subparagraph "a" of paragraph 2

The amount of subsidies distributed between the budgets of the constituent entities of the Russian Federation in the current financial year;

0.163259 - the share of financial support for the implementation of measures provided for in subparagraph "a" of paragraph 2

The number of patients with tuberculosis as of January 1 of the current year in i-th subject Russian Federation;

The growth rate of tuberculosis patients in the constituent entity of the Russian Federation in comparison with the previous year (relative to the same indicator in the previous year);

The level of the estimated budgetary provision of a constituent entity of the Russian Federation for the next financial year, calculated in accordance with the method of distribution of subsidies for equalizing the budgetary provision of constituent entities of the Russian Federation, approved by the Government of the Russian Federation dated November 22, 2004 N 670 Federation ".

9. The size of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of measures provided for in subparagraph "b" of paragraph 2 of these Rules () is determined by the formula:

0.264659 - the share of financial support for the implementation of measures provided for by subparagraph "b" of paragraph 2 of these Rules, in the total amount of subsidies distributed between the budgets of the constituent entities of the Russian Federation;

0.01 - coefficient of the cost of screening tests for antibodies to human immunodeficiency virus;

The population of the i-th subject of the Russian Federation, according to the Federal Service state statistics, at the beginning of the reporting year;

The ratio of the number of persons to be screened for human immunodeficiency viruses (the ratio of the number of persons to be screened in reporting year, and the total population of the Russian Federation);

The number of persons infected with the human immunodeficiency virus who were on dispensary observation (except for patients receiving antiretroviral therapy) in the i-th constituent entity of the Russian Federation in the reporting year;

The growth rate of the number of persons infected with human immunodeficiency viruses who were on dispensary observation in the reporting year (relative to the same indicator in the previous year). If the number of persons infected with the human immunodeficiency virus who were on dispensary observation in the reporting year is less than in the previous year, the specified coefficient () is assigned a value equal to one;

2.5 - coefficient of cost of studies of CD4 lymphocytes and viral load during antiretroviral therapy;

The number of people receiving antiretroviral therapy in the i-th subject of the Russian Federation in the reporting year;

The growth rate of the number of people receiving antiretroviral therapy in the i-th constituent entity of the Russian Federation, in comparison with the previous year (relative to the same indicator in the previous year). If the number of people receiving antiretroviral therapy in the reporting year is less than in the previous year, the coefficient () is assigned a value equal to one.

10. The size of the subsidy provided to the budget of a constituent entity of the Russian Federation participating in the current financial year in the implementation of measures provided for in subparagraph "c" of paragraph 2 of these Rules () is determined by the formula:

0.022553 - the share of financial support for the implementation of measures provided for by subparagraph "c" of paragraph 2 of these Rules, in the total amount of subsidies distributed between the budgets of the constituent entities of the Russian Federation;

The number of donor organs removed for the purpose of transplantation (transplantation) in medical organizations subordinate to the executive authorities of the i-th constituent entity of the Russian Federation, and (or) municipal medical organizations located in the i-th constituent entity of the Russian Federation, in the reporting financial year.

11. The size of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of measures provided for in subparagraph "d" of paragraph 2 of these Rules () is determined by the formula:

0.075724 - the share of financial support for the implementation of the measures provided for by subparagraph "d" of paragraph 2 of these Rules, in the total amount of subsidies distributed between the budgets of the constituent entities of the Russian Federation;

The number of citizens in the i-th subject of the Russian Federation registered in the Federal Register of persons with hemophilia, cystic fibrosis, pituitary dwarfism, Gaucher disease, malignant neoplasms of lymphoid, hematopoietic and related tissues, multiple sclerosis, persons after organ and (or) tissue transplantation;

n is the number of recipients of the subsidy (constituent entities of the Russian Federation).

12. The size of the subsidy provided to the budget of the constituent entity of the Russian Federation participating in the current financial year in the implementation of measures provided for in subparagraph "e" of paragraph 2 of these Rules () is determined by the formula:

0.05546 - the share of financial support for the implementation of measures provided for by subparagraph "e" of paragraph 2 of these Rules, in the total amount of subsidies distributed between the budgets of the constituent entities of the Russian Federation;

The population of the i-th subject of the Russian Federation at the age of 15 - 49 years, according to the Federal State Statistics Service, at the beginning of the reporting year;

n - the number of subjects of the Russian Federation - recipients of the subsidy.

13. The size of the subsidy provided to the budget of a constituent entity of the Russian Federation participating in the current financial year in the implementation of measures provided for in subparagraph "e" of paragraph 2 of these Rules is determined by an act of the President of the Russian Federation or the Government of the Russian Federation or in accordance with the instructions or instructions of the President of the Russian Federation or by the order of the Chairman of the Government of the Russian Federation on construction (reconstruction, including with elements of restoration, technical re-equipment) or the acquisition of an object, taking into account the quantitative assessment of the corresponding costs.

The level of co-financing of the expenditure obligation of a constituent entity of the Russian Federation cannot be set higher than 95 percent of the expenditure obligation.

Starting from 2018, the maximum level of co-financing of the expenditure obligation of the constituent entity of the Russian Federation from the federal budget is determined in accordance with paragraph 13 of the Rules for the formation, provision and distribution of subsidies and cannot exceed the maximum level of co-financing of the expenditure obligation of the constituent entity of the Russian Federation from the federal budget established by the Government of the Russian Federation.

The targeted distribution of subsidies by facilities, indicating the amount of subsidies, is approved by an act of the Government of the Russian Federation at the suggestions of the Ministry of Health of the Russian Federation, agreed with the Ministry of Finance of the Russian Federation and the Ministry of Economic Development of the Russian Federation.

14. The transfer of the subsidy is carried out to the account of the territorial body of the Federal Treasury, opened for him in the institution The central bank Of the Russian Federation for accounting of operations with funds of the budget of the constituent entity of the Russian Federation.

15. To assess the effectiveness of the use of the subsidy, the following indicators are used:

a) coverage of the population with preventive examinations for tuberculosis (percent);

b) coverage of the population of the constituent entity of the Russian Federation with medical examination for HIV infection (percent);

16. Evaluation of the efficiency of expenditures of the budgets of the constituent entities of the Russian Federation, the source of financial support of which are subsidies, is carried out by the Ministry of Health of the Russian Federation on the basis of a comparison of the values of the indicators of the effectiveness of the use of subsidies established by the agreement and the indicators of the effectiveness of the use of subsidies actually achieved at the end of the reporting year, provided for in paragraph 15 of these Of the rules.

17. Questions concerning the procedure for the return of funds by the constituent entities of the Russian Federation in case of violation of the obligations stipulated by the agreement in terms of achieving the values of the performance indicators of the use of the subsidy, including the procedure for calculating the amount of funds to be returned, the return period, grounds for exempting the constituent entities of the Russian Federation from the application of liability measures for violation of the obligations stipulated by the agreement, as well as the procedure for using the returned funds by the main manager of the federal budget funds, are resolved in accordance with paragraphs 16-19 of the Rules for the formation, provision and distribution of subsidies.

18. The authorized body of the constituent entity of the Russian Federation submits to the Ministry of Health of the Russian Federation:

a) quarterly, no later than the 10th day of the month following the reporting quarter, - a report on the implementation of budget expenditures of the constituent entity of the Russian Federation, the source of financial support for which is a subsidy, in the form and in the manner approved by the Ministry of Health of the Russian Federation in agreement with the Ministry finance of the Russian Federation;

b) annually, by February 1, - a report on the achievement of the values of the performance indicators for the use of the subsidy in the manner and in the form approved by the Ministry of Health of the Russian Federation.

19. Control over the conduct by the constituent entities of the Russian Federation of the measures specified in subparagraphs "a" - "e" of paragraph 2 of these Rules is carried out Federal Service on supervision in the field of health care.

Control over compliance by the constituent entities of the Russian Federation with the conditions for granting subsidies is carried out by the Ministry of Health of the Russian Federation and federal body executive power exercising control and supervision functions in the financial and budgetary sphere.

2. The Government of the Russian Federation establishes the procedure for the development and implementation of federal target programs, and the executive authorities of the constituent entities of the Russian Federation establish the procedure for the development and implementation of regional target programs in the field of health care.
3. Regional target programs in the field of health care, including those aimed at equalizing the differences in the level of medical care to citizens living in various administrative-territorial entities of the constituent entity of the Russian Federation, are created on the basis of federal target programs in the field of health care in accordance with the mandatory state norms and regulations, taking into account the characteristics, needs and capabilities of the constituent entities of the Russian Federation. Regional targeted health programs cannot limit government-guaranteed norms and standards included in federal targeted health programs.
4. Federal and regional target programs in the field of health care are formed taking into account state social standards in the field of health care.
5. Local governments participate in the implementation of federal and regional target programs in the field of health care, including investment and personnel policy. In this case, financing of specific programs is carried out at the expense of the federal budget, the budgets of the constituent entities of the Russian Federation, and other funds in the manner established by the legislation of the Russian Federation.
6. In the implementation of federal and regional target programs in the field of health care, in accordance with agreements (contracts), health care organizations, regardless of the form of ownership. The selection of healthcare organizations for the implementation of federal and regional target programs in the field of healthcare is carried out on a competitive basis.

The State Program of the Russian Federation "Development of Health Care" (hereinafter referred to as the State Program) was approved by the Decree of the Government of the Russian Federation dated December 26, 2017 No. 1640 "On Approval of the State Program of the Russian Federation" Development of Health Care ".

Decree of the Government of the Russian Federation of March 29, 2019 No. 380 "On Amendments to the State Program of the Russian Federation" Development of Health Care "approved changes to the State Program regarding adjusting goals, the composition of co-executors and participants, the structure and timing of the pilot State Program, the rules for the provision and distribution subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation.

The state program is developed in accordance with the Rules for the development, implementation and evaluation of the effectiveness of individual government programs Of the Russian Federation, approved by the Decree of the Government of the Russian Federation of October 12, 2017 No. 1242 "On the development, implementation and evaluation of the effectiveness of certain state programs of the Russian Federation."

The state program was prepared taking into account the provisions:

Messages of the President of the Russian Federation to the Federal Assembly of the Russian Federation dated March 1, 2018; dated February 20, 2019;
Decree of the President of the Russian Federation of May 7, 2018 No. 204
"On national goals and strategic objectives of the development of the Russian Federation
for the period up to 2024 ";
The main activities of the Government of the Russian Federation for the period up to 2024, approved by the Chairman of the Government of the Russian Federation D.A. Medvedev on September 29, 2018 No. 8028p-P13;
Methodical instructions for the development of national projects (programs) approved by the Chairman of the Government of the Russian Federation D.A. Medvedev on June 4, 2018 No. 4072p-P6;
Regulations on the organization of project activities in the Government of the Russian Federation, approved by the Government
Russian Federation dated October 31, 2018 No. 1288;

strategic planning documents of the Russian Federation
in the field of health care;
decisions (instructions) of the President of the Russian Federation
and the Government of the Russian Federation; and etc.

Taking into account the Decree of the President of the Russian Federation of May 7, 2018 No. 204 "On national goals and strategic objectives of the development of the Russian Federation for the period up to 2024" (hereinafter - Decree No. 204), the goals of the State Program have been adjusted.

Objectives of the State Program:

1) decrease in mortality of the working-age population by 2024
up to 350 cases per 100 thousand population;

2) reduction by 2024 of mortality from diseases of the circulatory system to 450 cases per 100 thousand population;

3) a decrease in mortality from neoplasms by 2024, including
from malignant, up to 185 cases per 100 thousand population;

4) a decrease in infant mortality by 2024 to 4.5 cases per 1,000 live births.

Target values by year of implementation are indicated
in the passport of the State Program.

The deadline for the end of the implementation of the State program from 2025 has been changed
for 2024 in accordance with the deadline for completing the implementation of the national project "Health". This change was approved by the order of the Government of the Russian Federation dated October 13, 2018 No. 2211-r "On amendments to the list of state programs of the Russian Federation."

The project part of the pilot State program includes the national project "Healthcare" (hereinafter - the National Project).

As part of the National Project, the structural elements reflect
8 federal projects:

"Development of the primary health care system";

"Fight against cardiovascular diseases";

"Fight against cancer";

"Development of children's health care, including the creation modern infrastructure providing medical care to children "

"Provision of medical organizations of the healthcare system with qualified personnel";

"Development of a network of national medical research centers
and the introduction of innovative medical technologies ";

"Creation of a unified digital circuit in health care based on a unified state information system health care (EHISZ) ";

"Development of the export of medical services";

Passports of federal projects are approved by the minutes of the meeting of the project committee for the national project "Health"
dated December 14, 2018 No. 3.

In addition, the structure of the project part of the State Program includes 2 federal projects implemented within the framework of the national project "Demography":

“Strengthening public health”;

"Older generation".

The process part of the State Program includes 24 departmental target programs (VTsP), developed on the basis of individual activities.

The development and approval of VTsP projects was carried out in accordance with
with the Regulation on the development, approval and implementation of departmental
target programs approved by the Resolution of the Government of the Russian Federation of April 19, 2005 No. 239 (as amended on February 23, 2018 No. 196).

The State Program includes in the form of appendices the Rules for the distribution of subsidies from the federal budget to the budgets of the constituent entities of the Russian Federation, as well as summary information on the priority development of priority territories of the Russian Federation. The list of priority territories has been brought in line with clause 1 of the Decree of the President of the Russian Federation of November 3, 2018 No. 632 "On amendments to the list federal districts approved by the Decree of the President of the Russian Federation dated May 13, 2000 No. 849 ".

Target health program. Federal target programs. Providing a healthy and safe living environment