System failure

摘要

What Russia needs now to help its small-scale successes become sustainable improvements is for its reborn civil-society movement to make a lot more fuss about one issue common to all regions across Russia's great expanse: the fundamental barrier to uniformly good HIV-prevention and control posed by the decaying, fragmented health system.Si nee the tight reins of central Soviet control have been loosened, Russia's 89 oblasts have been more or less allowed to go their separate ways when it comes to health. This means there is little uniformity between regions, and huge variations in quality and extent of care. Underfunding, however, is an affliction most regions can claim, and lack of money has led to appalling perversions of the concept of free emergency medical care-even for the HIV treatment promised by law. "In the early and mid-1990s it became routineforhospitalsto require patients to provide their own food, linens, bandages, and even essential medications", recalls Bobrik.