Europe and Central Asia Knowledge Brief

2014-06, Shulga, Ivan, Sukhova, Anna, Khachatryan, Gagik

Prosperity from economic growth is not shared evenly among Russia's population and regions. Local communities and rural territories face serious development challenges: including poor living conditions, infrastructure, and services and lack of citizens' participation in decision-making processes. The Russian Federation Local Initiatives Support Program (RF LISP) aims to address community challenges by introducing a participatory approach to the development and rehabilitation of local-level social infrastructure. Specifically, LISP channels funds from regional budgets to finance participatory projects in poorer local communities. For the period 2009-14, LISP has been implemented in six regions and has resulted in more than 1,200 projects with over 1 million beneficiaries. Key factors for LISP success are the following: (i) mainstreaming of LISP into the national administrative system and budget process, and (ii) providing the Bank's technical assistance at all stages of project implementation to share international experience in community-driven development (CDD) projects, and ensuring transparency and quality of LISP procedures.

2010-02, Marquez, Patricio, Bonch-Osmolovskiy, Mikhail

In large measure, this is due to the relatively low level of public health spending in the country (about 3.6 percent of gross domestic product (GDP) in 2008) that underlines the significant gap between the constitutional commitment to a range of medical care services and the actual funding to pay for them. While drugs are supposed to be provided to hospital patients free of charge, an estimated 80 percent of inpatients still have to pay part of the costs of their medicines and most outpatients must purchase them from pharmacies. The outpatient drug program under mandatory health insurance covers only around 16 million people (11 percent of the total population in the country), with more than half of them opting to receive cash rather than in-kind benefits under the 2005 'monetization' of prescription drug benefits. Those who continue with the in-kind benefits appear to be the ones greatest in need of drugs. The situation is further aggravated by the country's ineffective enforcement of controls on wholesale and retail mark-ups for medicines. Household expenditure on drugs accounted for about 30 percent of total health expenditure in Russia, as compared to 12 percent in Organization for Economic Co-operation and Development (OECD) countries in 2008.

2010-10, Marquez, Patricio V., Lebedeva, Nadezhda

The 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.

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.