Pariy V. Medical-social and preventive grounds for the modern reorganization of rural primary health care

The subject of the dissertation is scientific substantiation and development of the system of reorganization of rural primary health care. This complex medical-social research involved the study of rural primary health care situation in Zhytomyr and Khmelnytskyy regions and comparative analysis of the data obtained against the official data characterizing the country as a whole. Qualimetric and semantic indices of the logistical support of primary health care institutions in the countryside have been defined, methods of assessing such indices have been worked out. The infrastructure of rural primary health care net has been studied. Structural components of rural primary health care system have been analyzed, its staff resources with their quantitative and qualitative parameters in particular. The ways of improving the aforesaid parameters, above all, professional training, have been scientifically substantiated. The state of economic instruments of rural primary health care management has been studied, the funding of the primary-level medical institutions in particular, and the negative characteristics of this process. Proposals have been developed aimed at improvement of economic grounds for increasing the effectiveness of the rural primary health care system. The preventive basis of rural primary health care and the structure of the existing preventive technologies have been studied. A model of preventive activities of first-aid clinics and village hospitals has been created. The dissertation shows that the up-to-date preventive technologies serve the most effective instrument for improvement of rural primary health care. Methodological basis for health care education activities and propaganda of healthy way of life has been developed. The means of reanimation of dispensary work in rural health care system have been scientifically substantiated, involving application of relevant algorithms of such dispensary work. The research also involved the study of informational and scientific-informational resources of primary health care and technology of using such resources. It is shown that the intention of effective reorganization of rural primary health care is not feasible without the aforesaid resources. The author has developed a model system of applying scientific-informational technologies in doctors' work in rural areas (in a general practitioner's work in particular). A new subsystem of health care has been studied - the Medical Aid Fund, which may serve the prototype of voluntary medical insurance mechanism and an additional source of funds for primary health care, in the countryside in particular. The research shows that the rural population suffers from defective health care. The main defects of the existing health care system have been studied. It is shown that the government is prematurely giving up the mechanisms regulating provision of population with medicines, which hinders the process of improving health care system in general, not only its primary link. The author has developed practical recommendations concerning improvement of rural primary health care addressed to health care managerial authorities, and a set of practical recommendations for the science of social hygiene.