Europe and Central Asia Knowledge Brief
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This is a regular series of notes highlighting recent analyses, good practices, and lessons learned from the development work program of the World Bank’s Europe and Central Asia Region.
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Restructuring Regional Health Systems In Russia(World Bank, Washington, DC, 2010-10) Marquez, Patricio V. ; Lebedeva, NadezhdaThe delivery of health services in Russia is a federal, regional and municipal responsibility. Reform of the regional health systems, which suffer from over-reliance on curative and inpatient care, deteriorating infrastructure and equipment, and poor quality of services, is a major challenge for the country. From 2003-2008, the World Bank helped strengthen the stewardship capacity of Russia's Federal Ministry of Health and Social Development (MOHSD) and restructure health systems in two pilot regions: the Chuvash Republic and Voronezh oblast. In both regions, hospital bed numbers were reduced while simultaneously increasing service delivery capacity at the primary care, specialized ambulatory, and long-term care facility levels through the introduction of new technologies, clinical protocols, and resource allocation mechanisms that link payments to performance.
Battle Against Tuberculosis : Some Gains in Russia(World Bank, Washington, DC, 2010-09) Marquez, Patricio V. ; Jakubowiak, Wieslaw ; Pashkevich, Dmitry D. ; Grechukha, Vladimir A.Across Russia, the deep socio-economic crisis of the 1990s and early 2000s provided fertile ground for the spread of Tuberculosis (TB). Indeed, as noted, 'people who were already living very precariously saw their real incomes drop by 25 percent to 30 percent at a time when government spending was also falling.' As a result, social and health conditions deteriorated, and TB spread rapidly. Russia also had one of the highest rates of imprisonment in the world that, coupled with adverse conditions in prisons, increased the risk of TB, HIV and other infectious diseases among prisoners. The Project was designed in accordance with the federal targeted social disease prevention and control program (2002-2006). About 80 percent of project funds were allocated for TB control with the goal of contributing to a leveling-off or reduction in morbidity, mortality and transmission of TB. The project covered 79 of the 83 regions across the vast Russian territory - from the Baltic Sea to the Pacific Ocean, strengthening both the civilian and prison health systems.
Dangerous Roads : Russia’s Safety Challenge(World Bank, Washington, DC, 2010-07) Marquez, Patricio V. ; Bliss, Anthony G.As in many countries of the Europe and Central Asia Region (ECA), vehicle ownership in Russia has grown faster in the last decade than the decline in the rate of fatalities per vehicle. At the same time, road safety policies and interventions have not kept pace with the boom in motorization. In 2008, the motor vehicle fleet in the country exceeded 41 million cars, up 24 percent from 2004, and the number of drivers licensed increased by 40 percent during this period. In 2008, Russia saw nearly 30,000 road traffic deaths and about 271,000 non-fatal road traffic injuries. While these figures represent a drop of 13 percent from 2004, Russia's road traffic mortality rate is still five times higher than what is seen in several European Union (EU) countries, about twice more than in the United States, higher than in other Eastern European countries such as Poland and Hungary, and higher than the average for Commonwealth of Independent States (CIS) countries.
Confronting ‘Death on Wheels’ : Making Roads Safe in ECA(World Bank, Washington, DC, 2010-01) Marquez, Patricio V. ; Banjo, George A. ; Chesheva, Elena Y. ; Muzira, StephenRoad traffic injuries (RTIs) have become a major public health challenge in many low- and middle-income countries (LMICs). About 90 percent of the 1.3 million deaths and 50 million injuries from road traffic crashes worldwide each year occur in LMICs, although these countries have only 48 percent of the world's registered vehicles. Increasing motorization and urbanization in LMICs could double this toll by 2030. The difference in road crashes between LMICs and high-income countries (where many road deaths still occur), is stunning. ECA countries have experienced rapid growth in the number of passenger cars on the roads over the last two decades. In the Commonwealth of Independent States (CIS), there was a 120 percent increase in passenger cars per 1,000 persons from 64 in 1990 to 141 in 2003. Similar trends were observed in countries in southeastern Europe. Vehicles in many Europe and Central Asia (ECA) countries tend to be old and have sub-standard safety features. Length of roads and highways (in km.) has also increased since the 1990s by 18 percent and 157 percent in the CIS, 21 percent and 75 percent in European Union (EU)-10 countries, and 46 percent and 144 in southeastern Europe, respectively. In spite of significant investments in road infrastructure since the 1990s, in some ECA countries the roads still suffer from poor maintenance and under-investment.