On July 28, 2020, the Deputy Chairman of the Government of the Russian Federation, Tatyana Golikova, signed a new action plan to improve the quality and availability of palliative care in Russia until 2024.
The document aims to improve the quality of life of people in need of palliative care, and increase access to pain relief; to increase staffing of the service; to engage non-profit socially oriented organisations and to providе them with state support.
The roadmap is forecasting the development of educational modules for medical workers and guidelines for medical organisations on the provision of palliative care, social services, and provision of medicines and medical devices.
However, this significant step is not a surprise, but a result of enormous effort and many years of hard work of palliative care organisations – charitable foundations and professionals communities, and the Russian government and Ministry of Health.
Development of palliative care in Russia
The first hospices in Russia began to appear in the 90s. Small institutions consisting of visiting services and hospitals for 20-30 beds for cancer patients were opened in large regional cities due to the initiative of individuals and the support of local governors. These hospices are still the main platform of the hospice service, but now they are open both for cancer and non-cancer patients.
Facilities such as the First St. Petersburg Hospice and the First Moscow Hospice have started the entire palliative care movement in the country. The movement was seeded in 1991 by Viktor Zorza and Dr Robert Twycross by the very first course on palliative care for physicians in Russian. This has since provided guidance for Russian palliative services.
The most progressive development of palliative care in Russia began in 2011, at the time when Russian legislation has incorporated palliative care as a service line. Later on, the Russian Ministry of Health identified comprehensive procedures for providing palliative care to adults and children.
In addition, the Russian Ministry of Health appointed state and regional palliative care specialists for adults and children, thus initiating the reform of palliative care in all levels. Within the same period of time, Dr Diana Nevzorova, chief physician of the First Moscow Hospice, was appointed by the Ministry of Health as Chief Palliative Care Specialist in Russia.
Improving access to medications
In 2016, the Russian Government – based on World Health Organization (WHO) guidelines – developed an action plan to improve pain relief for palliative care patients. By 2020 the availability of opioids for the treatment of chronic pain has increased ten times. This was as a result of comprehensive measures and joint actions in coordination with WHO, taken by the Hospice Care Professionals Association, the Ministry of Health of Russia, the Ministry of Industry and Trade of Russia, non-profit charitable and public organisations and other federal executive authorities.
Legal red tape in palliative care availability was minimised. Due to the progressive changes in Russian healthcare, new lines of opioid medications were developed, such as short-acting morphine (tablets and oral solution drug formulations), transdermal therapeutic systems; clinical guidelines for the treatment of chronic pain syndrome were approved and became available for patients nationwide. Healthcare experts have received access to the electronic training modules on treatment of pain in palliative patients. The Russian Federation has become a nation that recognises palliative care as a healthcare discipline in its own right.
Government funding for palliative care
Starting 2018, the Government of the Russian Federation has allocated significant annual federal funding of more than 60 million euros per year for palliative care facilities throughout the country. The following year, the new legislation provided the appropriate legal infrastructure to protect the right of a patient to access to pain relief, including opioids, regardless of diagnosis, condition and location. This important step has led to the establishment of the Federal Scientific and Practical Centre for Palliative Care based at Sechenov University.
The Ministry of Health has approved the creation of the Centre with following responsibilities: clinical patient care, scientific research, development of methodological recommendations and guidelines, education in palliative care for healthcare professionals, organisational support for the regions of the country. One of the main focuses of the Centre is the quarterly monitoring of the quality of palliative care as well as pain relief in all of Russian regions. The centre operates in close collaboration with the Hospice Care Professionals Association which has made a significant contribution to the development of palliative care since establishment in 2014.
The Association has organised over 200 scientific and educational events and accounts near two thousand members. Also, the Association issues PALLIUM journal, a Russian scientific and practical periodical entirely devoted to different components of palliative care. The Federal Scientific and Practical Centre for palliative care and the Hospice Care Professionals Association work in cooperation with international experts on palliative care, including: Robert Twycross (Oxford University), Stephen Connor (Worldwide Hospice Palliative Сare Alliance), Eric Krakauer (Harvard Medical School), Sophia Michalson (American Eurasian Cancer Alliance), Tom Smith (Johns Hopkins Medical Institutions), Marcin Chwistek (Fox Chase Cancer Center), and Jim Cleary (University of Indiana). The joint continuous collaboration includes clinical case studies review, educational events, joint scientific publications, palliative care quality assessment council, and has a productive impact on Russian palliative service.
This international faculty has greatly contributed to the success of Russian palliative care development, initiating relations years ago and maintaining continuous engagement. The impact of the wide array of expertise presented by the faculty is tremendous, both from the public health and clinical perspectives.
Support for charitable organisations
In addition to new legislation and organisational support, the Russian government began to provide favourable conditions to charitable organisations in palliative care. A good example of such organisation is Vera Hospice Foundation (established in 2006), that became a centre of the hospice movement in the country, and its founder, Nyuta Federmesser, who is a public figure and tireless fighter for the availability of palliative care for critically ill patients. Another example is the Gift of Life Foundation, that also made a significant contribution to the availability of pain relief for children in need of palliative care.
Palliative care in Russia is developing at a rapid pace. Professionals, communities and charitable organisations initiated the palliative care movement and worked it through rough beginnings. Now, with the aid of international faculties and the Russian government, they are starting to establish proper palliative care services in all regions and to integrate it as an essential part of the healthcare system.