E.A. Averchenko
Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky

Summary. An in-depth analysis of medical and demographic situation and morbidity among adult population revealed positive trends of increased fertility rates, decreased mortality and natural decline in the population within the territory in general along with the persisting significant territorial heterogeneity of demographic situation in urban and rural municipalities. A detailed analysis of cause-specific morbidity and temporal disability complemented information about health loses in DALY due to premature death. A comprehensive analysis of medical and demographic situation and health indicators helped zone the Territory in terms of health care needs based on population size, density, migration, share of rural population, morbidity and mortality (Krasnoyarsk, Central, South, East Forest Siberian, and Western zones).

A survey of 2,400 people from all territorial zones identified social (pertaining to living conditions) and behavior risk factors among adult population including low rates of service utilization.

Audit of the current healthcare system within medical and territorial zones and expert review of care quality and accessibility showed that low utilization of medical services is associated with internal system problems including insufficient resources (network and staff), underdeveloped organizational procedures and technologies (care accessibility and completeness at all levels of care delivery), low priority of public health at the municipal level as viewed by the local authorities rather than lack of self-protecting behavior. Results served ground for developing a territorial health strategy based on the following four priority actions:

• invest in health at all stages of life;
• address most pressing issues;
• strengthen client-centered health systems; and
• empower local communities and develop enabling environment.

Keywords. Protection of public health of adult population; medical and demographic analysis; health care system management; expert review.

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