Geoscience Reference
In-Depth Information
Despite the problems, all of our Russian interviewees stressed that relations
between the prison authorities and the public sector have been improving. In
general, public health services and the prison authorities are happy to see
old barriers gradually disappear, but it seems to be happening by dint of
sheer necessity. Most often, the pressure for change has come from the civilian
authorities and foreign donors, but there are also examples of the opposite.
In Arkhangelsk, the executive head of the prison authority was described as a
pioneer. He had called directly for closer collaboration with the civilian health
authorities, which was something of a sensation at the time. A representative
from the civilian health authorities in Arkhangelsk called this 'a progressive
step!' and 'a good example for all [Russian] regions!' Our impression is that,
in Arkhangelsk, both the public and, most importantly, the prisons them-
selves realize they need to work together. As an Arkhangelsk prison hospital
official put it: 'Without the assistance of and cooperation with the civilian
sector, we would not have solved any of our problems.' It would have been
impossible to hear anybody say this just a few years back.
Primary health care, specialist rule and new strategies
Structural barriers for preventing the spread of tuberculosis and HIV/AIDS
are also prominent in the civilian health-care system. The Soviet health-care
system, or 'Soviet socialized medicine' as it was labelled by observers from
Capitalist countries, was upheld by the massive, albeit weakening, Soviet
economy. The system itself was demanding in terms of financial and human
resources, and it faced disaster when funding collapsed together with the
Union as a whole. The result was a health-care system poorly adapted to meet
the needs of a new, open economy that emerged in the wake of the demise
of the Soviet Union . 19 Not only did the new economic realities conflict with
those of the old system, but the threat from new and re-emerging infectious
diseases could only be met by a more flexible health-care system.
The new situation required a shift from health control to health service deliv-
ery . Earlier, the curative element was strong, while preventive health was not
highly prioritized . 20 Whereas Soviet-style health care had its control func-
tions and wide-reaching powers to isolate patients and treat them with force
if necessary, post-Soviet society has neither the economic nor the legislative
muscle to maintain this level of 'health inspection'. 21 I t takes time and money
to re-build a health sector, and while it is not within the scope of this chapter
to discuss Soviet health care or its transition in the post-Soviet era, it can be
said that the dissolution of the Soviet Union left behind a highly centralized
system, in which experts were assembled within a few, sizeable institutions
for the treatment of specific diseases. There was little concern for the local
level, and the status of the general practitioner (GP) was, and remains, low.
As wages are higher for specialized doctors, one effect is that many doctors
tend to specialize. The subsequent outcome is too few GPs at the level of local
 
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