Formation of the public health and medical service system in the baikal-amur mainline regions (The 1970‒1980s)

Abstract

The paper presents the results of a study of the public health system of cities and towns on the western section of the Baikal-Amur Mainline (BAM) during the all-union Komsomol shock construction projects. The local network of RSFSR medical institutions, which was developing at a painstakingly slow pace, was initially intended to shoulder all the burden of providing medical service. Departmental health care, coordinated by the BAM Medical and Sanitary Service under the Ministry of Railways of the USSR, was organised to allow the swift delivery of medical care to construction workers. Despite the rapid deployment of the network of new medical institutions, the needs of the soaring population in the construction areas could not be fully met. Hospital and clinic capacity was two to three times below the required level. The current state of affairs was due to the priority given to the construction of transport infrastructure, the residual nature of funding the social sector, uncontrolled labour migration to the BAM area, and the peculiarities of the region. Public health officials faced manpower shortages, high staff turnover, and massive return migration volumes. The selfless work of health workers in the under-construction cities and towns enabled them to provide the public with the necessary level of medical care. The peculiarities of the formation of the public health system in this region led to numerous challenges after the completion of construction. The low profit margins of the road and the disbandment of the Baikal-Amur Railway branch meant most of the departmental medical institutions had to be handed over to local authorities. This was despite the local public health system lacking the necessary resources to ensure their functioning. As a result, the public health network in the BAM regions was drastically scaled back, which affected the quality of care.