8.1. Historical aspects of tuberculosis control in Russia. Ethical and legal bases of tuberculosis treatment


The information about history of struggle with tuberculosis in Russia before 1917 year is obscure, but the official sources usually marked, that in imperial Russia the problem of tuberculosis stood sharper, than somewhere else in Europe, and the state policy in relation to tuberculosis, in general, practically was absent and existed on charitable contribution forms.

After October revolution (1917) organization of struggle with tuberculosis were transferred from charity to a state basis. At the Ministry of public health of the Russian Federation the section on struggle with tuberculosis was authorized. A new medical specialty –phthisiatria was introduced. As a result of social transformations and wide realization anti-tuberculosis measures by the end 1930-th morbidity and mortality from tuberculosis in the country sharply had decreased.

During Great Patriotic war (1941-1945) incidence of tuberculosis had been increased in connection with mass evacuation of the population from occupied territories and mobilization to the army of the doctors – phthisiatrists. In the year 1943 the decision of government: “About measures on struggle with tuberculosis” was accepted, in which the development was provided of new tuberculosis hospitals, night sanatoriums at the enterprises, children’s sanatorium gardens, wood schools.

In after war years anti-tuberculosis service in the country proceeded to be improved. Already at the beginning of 1948 the number of anti-tuberculosis establishments in the country has exceeded prewar (1941) level. The tuberculosis patients received not only the right on long free-of-charge treatment, but also housing and other privileges. In 1987 in the country has a total about 1100 tuberculosis dispensaries.

The decrease of incidence, mortality, infectiousness testifies that the method of anti-tuberculosis struggle in USSR was theoretically and practically proved. Maintenance by the state budget, the close connections of anti-tuberculosis organizations with anti-epidemic and public institutions give large positive results and the liquidations of tuberculosis as the mass disease.

Social and economic changes at the beginning of 1990 in Russia were accompanied by insufficient financing of public health services, compelled migration and deterioration of social protection of the population. The above mentioned factors acting together have caused growth of all epidemiological parameters of tuberculosis, as they became the same as in 1960. It once again testifies that the tuberculosis is not simply infectious disease, but complex social – biological phenomenon connected with the reduction of life level, local military conflicts, deprivation of the people of social guarantees can react to deep economic recession. At the same time, presence well organized phthisatric service in Russia, even at insufficient financing, under all adverse conditions, have not allowed tuberculosis to spread everywhere.

Ethical and legal bases of tuberculosis treatment.

In Russian Federation several basic normative documents are acting and regulating relation of the tuberculosis patient with the state.

To these documents concern:

  1. Constitution of Russian Federation.
  2. Basis of the legislation of Russian Federation about protection of health of the citizens (№ 5487-1 from 22.07.1993).
  3. Law of RSFSR “about sanitary – epidemiological well-being of the population (1991).
  4. Law of Russian Federation “About prevention of tuberculosis spread in Russian Federation” from June 18, 2001 № 77-ФЗ.

The law of RF «About prevention of tuberculosis spread in Russian Federation» № 77 from 2001 establishes legal bases of state policy realization in the field of the tuberculosis prevention Russian Federation with the purposes of citizens health protection and maintenance of sanitary – epidemiological well-being of the population. As it follows from the law definitions anti-tuberculosis help is joint medical, sanitary – hygienic and anti-epidemiological measures directed on revealing, examination and treatment, including obligatory examinations and treatment, dispensary supervision and rehabilitation of the tuberculosis patients in conditions of in-patient and out-patient care. The regulations of the law are applied to the citizens of Russian Federation at providing to them anti-tuberculosis treatment and are applied to the legal and physical persons rendering anti-tuberculosis help in territory of Russian Federation. The foreigners and persons without citizenship also receive anti-tuberculosis treatment according to this law. The providing of anti-tuberculosis help to tuberculosis patient is guaranteed by the state and is carried out on the basis of principles of legality, observance of the rights of the man and citizen, free of charge, general accessibility. Anti-tuberculosis help is provided to the citizens at their voluntary address or their consent. At the same time, dispensary supervision over the tuberculosis patients is established irrespective of the consent of such patients or their lawful representatives.

The patients with infectious forms of tuberculosis, repeatedly breaching sanitarian-epidemiological regime, deliberately avoid examinations for tuberculosis or tuberculosis treatment, based on court decisions could be hospitalized in specialized medical anti-tuberculosis establishments for compulsory examinations and treatment.

The supervisors of medical organizations and citizens engaged in private medical activity, are obliged to inform the appropriate bodies on the tuberculosis patients, revealed in the appropriate territories, and about everyone suffering from tuberculosis exempted from prison.

The tuberculosis patients requiring for anti-tuberculosis help, receive such help in medical tuberculosis organizations having the appropriate licenses. The persons being in contact to the active tuberculosis patient now or in past must be examined with the purposes of revealing of tuberculosis.

Tuberculosis patients supervised by dispensary, at rendering for them anti-tuberculosis help have the right on:

  1. the validation and human relation;
  2. receiving information about the rights and duties of tuberculosis patients, about character of disease which they have and used methods of treatment;
  3. preservation of medical secret;
  4. diagnostics and treatment;
  5. sanatorium and health resort treatment;
  6. stay in anti-tuberculosis inpatient medical organizations, during time necessary for examination and (or) treatment.

The persons who are registered in connection with tuberculosis or as tuberculosis patient in dispensary, are obliged:

  1. to execute prescribed by the medical workers treatment and sanitary measures;
  2. to follow the internal hospital rules of during stay at these anti-tuberculosis organizations;
  3. to carry out sanitary – hygienic rules established for the tuberculosis patients in public places.

For citizens who have temporarily lost work capacity in connection with tuberculosis, the place of work (post) is preserved for them for the term of, established by the legislation of Russian Federation. At the discharge from work (post) in connection with tuberculosis the patient is provided with the welfare payment of state social insurance, according to the legislation of Russian Federation. The patients, who are under tuberculosis dispensary supervision in connection with tuberculosis, are provided with free-of-charge drugs for tuberculosis treatment.

The patient with infectious forms of tuberculosis, have the right to improve their housing conditions, in view to reduce epidemiological danger for those around and additional person, inhabited area, according to the legislation of Russian Federation. Medical, veterinary and other workers directly participating in rendering of anti-tuberculosis help, and also workers of organizations on manufacture and storage of animal products serving the tuberculosis patients, agricultural animals, have the right on:

  1. additional paid leave;
  2. reduction of working hours;
  3. extra pay in connection with harmful working conditions (danger of MBT infection);
  4. ensuring in the prime order by the permits for sanatorium-resort treatment in case of development of tuberculosis as a result of execution of the official duties.

Violation of the of Russian Federation legislation in the field of the tuberculosis control attract disciplinary, civil-law, administrative and criminal responsibility according to the legislation.

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