摘要：The Russian health care system historically has not relied on medical evidence to guide practice, uses centralized management, and is burdened by overspecialization. In 1999, a community health partnership was established between Sarov, Russia, and Los Alamos, NM, 2 cities linked by their nuclear weapons histories. Health problems addressed include asthma and diabetes, pediatric dental caries, low prevalence of breastfeeding, and adolescent drug abuse and sexually transmitted diseases. A community-oriented primary care approach was adopted that includes (1) implementing a “train the trainers” strategy to educate health professionals and lay people, (2) adapting established clinical practice guidelines based on local resources, (3) restricting use of expensive or limited resources, and (4) securing commitments from local government for expendable supplies and medications. HEALTH CONDITIONS IN RUSSIA began to deteriorate in the late 1960s, and the fall of the Soviet Union in 1991 left a failing health service, a short supply of medications, a shrinking population with a decreasing life span, increasing mortality, and a declining birth rate. 1– 4 Health funding in Russia is only 3% of the gross national product, with less than 30% for primary care. 5– 8 The Russian health care system does not emphasize the use of evidence-based clinical practice, has a centralized management structure, and is burdened by a compartmentalized specialist-based system. Open in a separate window Figure Above: Sarov Monastery, Sarov, Russia. Since 1992, the American International Health Alliance (AIHA) has sponsored programs to improve Russian health care through partnerships between US and Russian communities. The partnership between Los Alamos, NM, and its sister city, Sarov, Russia, a “closed nuclear city,” began in 1996. In 1999, AIHA awarded the partnership a grant with the overall goals of (1) enhancing the health of children and (2) improving the treatment of chronic diseases in Sarov. Community-oriented primary care (COPC), a process that includes 5 logical steps to address problems in communities, 9 was used to develop specific programs. In this preliminary report, we summarize the key aspects of the Los Alamos–Sarov medical partnership.
