WHO`s Projects in the North Caucasus

WHO has volunteered, as part of the UN appeal launched at the end of November, to provide the population of the North Caucasus with emergency medical kits, essential drugs, and support to local medical services. The health situation among these people should be closely monitored in order to act fast when new threats emerge to their health. WHO and UNICEF together with several humanitarian nongovernmental organizations are planning a coordinated action to help the affected people suffering from the hostilities in Chechnya.

In late October 1999, the Office of the Special Representative of the WHO Director-General was joined by Dr. Berit Olsen, a Norwegian physician with extensive work experience in crisis situations. She took part in the needs assessment mission organized by the UN for the North Caucasus. She wrote in her reports that the health situation of the people fleeing Chechnya was under severe threat as epidemics easily spread under such crowded and unhygienic conditions. Cold weather is an additional strain on the refugees, in particular, on children and old people. The psychological stress should not be underestimated either, she said.

A bulletin on the emergency in health care in the North Caucasus has been prepared and will be updated weekly by the WHO office in Moscow. It will contain information on the health situation of the refugees, such as communicable and non-communicable diseases, mental health, and nutrition.

The report has details on activities planned by WHO in health care, drugs and food supplies, water and sanitation. It is available by e-mail through either b.olsen@who.org.ru

Fight Against Tuberculosis

In November 1999, WHO organized a course for 24 laboratory experts from the Stavropol Territory and Vladikavkaz to improve their skills in direct sputum microscopy as a way to diagnose tuberculosis patients early. Training was provided at the Central Tuberculosis Research Institute of the Russian Academy of Medical Sciences in Moscow. Dr. Nana Gvetadze and Dr. Vladimir Puzanov were the main lecturers, and the organizational responsibility was under Professor Valentin Chukanov.

At the end of the course, UNICEF donated 25 binocular microscopes to the laboratories from which the trainees came in order to allow them to fully practice their newly acquired skills, which are essential in the implementation of the WHO-advocated anti-tuberculosis strategy called DOTS (Direct Observation Treatment Short-course). This method makes the treatment of tuberculosis more effective and cheaper than the traditional way of dealing with the disease.

Due to the positive feedback, WHO is planning to repeat the course for experts from other regions of the North Caucasus, where the spread of tuberculosis raises deep concern because of the overcrowding in places where the people fleeing from Chechnya are living.

Conference in Vologda

In October, the WHO office in Russia organized in Vologda, together with the Health Ministry of the Russian Federation and the Administration of the Vologda Region, an International conference on ways to improve efficiency and quality of health care services. The conference was held together with representatives of five other former Soviet republics, namely Armenia, Belarus, Georgia, Moldova, and Ukraine. This high-level group of about 50 health care experts has met for such seminars since 1996 under the auspices of EASTNET Network sponsored by the WHO Regional Office for Europe.

The conferees agreed that health services must focus more on quality and be more interested in doing the right things instead of just doing the things right. Even in situations of financial constraints, about 30 per cent of all activities provided by health services are estimated to be of no real value from the health point of view. If such drawbacks are eliminated, there would be a better chance for people to get medical services they really need and whenever they need. Cross specialization is another cause of inefficient health care. Countries with well functioning family doctor systems can provide services cheaper and in a more satisfactory manner for the patients. To have a surgeon treat a common cold is not only expensive but can also be dangerous.

The conference participants went home with a lot of good ideas which they had learned from their international colleagues. Not only did they hear about good practices, but they also shared their failures so that others could avoid repeating the same mistakes.

There was one lesson they all had learned by now: market forces and privatization do not make the health services more efficient and cost-effective. Only sustainable every day work and comprehensive approach to the health issues can lead to durable positive results.

World AIDS Day

On December 1, the Russian Federation and many countries around the world marked World AIDS Day. A press conference was organized on November 29 by the Ministry of Health of the Russian Federation. Partners, including UN Agencies, were invited to participate. Gennady Onischenko, First Deputy Minister of Health , chaired the press conference.

The latest statistics (November 22, 1999) from the Russian AIDS Prevention and Control Center showed the total number of HIV-positive cases in the Russian Federation to be 23,509. Concern was expressed by speakers at the press conference regarding the dynamics of HIV infections (see diagram). In 1998 the total number of HIV-cases was 10,592, and in 1997 it was 7,064. The regions with the highest number of registered HIV-positive cases are the Moscow Region (4,012), Moscow City (3,308), the Kaliningrad Region (2,589), the Irkutsk Region (2,191), and the Krasnodar Territory (2,160).

Ministry of Health awards were given to five Russian journalists for their reporting on HIV/AIDS issues. Also it was announced that a concert, Russian Youth against AIDS, would be arranged in the evening of World AIDS Day, December 1.

The concert, which was held in the Gorbunov Cultural Center in Moscow, was organized by the NGOs Focus and PSI (Population Services International) with the support of the Ministry of Health of the Russian Federation, USAID, MSF Holland, UNDP, UNHCR, UNFPA, UNICEF and WHO co-sponsored the event.

Popular Russian rock groups Splin, IFK, Tequila Jazz, Delfin, Masha i Medvedi and Zdob si Zdub were featured, and information on HIV/AIDS was distributed to the crowd. The artists openly encouraged the 3,000 attending youth to practice safe sex and say «no» to drugs, to avoid HIV infection. MTV Russia broadcast the concert the same evening.

People Living with HIV/AIDS

The First National Meeting of People Living with HIV/AIDS (PLWHA) was held in Moscow on October 12-16, 1999. The Meeting, which was organized by the Russian NAMES Fund and sponsored by UNDP and Roche Pharmaceuticals, brought together, for the first time, 70 PLWHA from 20 Russian regions. Supported by UNAIDS and the Ministry of Health of the Russian Federation, the Meeting discussed the possibilities and role of the media in reporting on HIV-related issues, legal aspects of HIV/AIDS, alternative treatment and psychological assistance to HIV-positive people and relatives.

During the Meeting, the idea of creating a national network of PLWHA gradually emerged and was put on record at the concluding session. The Meeting elected five participants representing Moscow, Belgorod, Kaliningrad, Nizhny Novgorod and Vladivostok, to draft a conception and plan for setting up a Russian PLWHA Network.

At the Paris Summit in 1994, 41 national governments, including the Russian government, declared that greater involvement of PLWHA is «critical to ethical and effective national responses to the epidemic». The involvement of PLWHA is important since they have experience from living with HIV/AIDS. They could participate in the response to the HIV epidemic at all levels, including policy- and decision-making. In this respect it was emphasized that the role of local associations and community-based organizations is significant.

The establishment of the Russian PLWHA Network could constitute a key initiation of the process of Greater Involvement of People Living with or Affected by HIV/AIDS (GIPA) in the Response to the HIV Pandemic. GIPA is supported and promoted by UNAIDS.

The next National Meeting is anticipated to be held in September 2000.