Medical Care For Children Research Articles

The social hygienic evaluation of condition of system of maternity and childhood care at the regional level

The maternal and child welfare system development is the priority target for state social policy. The strategic objectives of health care are targeted to preserving health of mother and child and are implemented through complex activities of various state institutions of maternity and childhood protection system with predominant focus on medical social and economic efficiency. The purpose of study is sociological hygienic evaluation of actual state of maternity and childhood health protection system at the Trans-Baikal Territory. The study used sanitary-statistical, sociological, structural, organizational, expert methods. The estimation of reliability of difference of dependent samples with qualitative indicators was carried out on the basis of the calculation of the non-parametric Cochran test. According to the results of expert assessment, the most significant problem areas in the system of maternity and childhood health protection at the regional level were identified: material and technical equipment of medical organizations, scarce staffing of medical organizations, lack of legal regulation, inadequate organization of medical care of children within the framework of implementation of procedures of provision of medical care, limited availability of medical care, declarative nature of the order of interdepartmental interaction of medical organizations with state social institutions in the system of maternal and child health protection. The established problem areas have negative impact on medical and demographic indicators, coefficients of health of the population in the region and result in decreasing in medical, social and economic efficiency of health care system. The current situation requires adoption of organizational and managerial decisions by executive authorities.

The hospital-substituting technologies: condition and strategic tasks of their development

The program of state guarantees of free medical care of citizens for 2019 and up to 2020-2021 plans to reduce volume of inpatient medical care through development of hospital-replacing technologies. The economic feasibility of hospital-replacing technologies is in significantly lower cost of medical services in a day hospital as compared with twenty-four hours hospital (UPC). However, the existing legislative framework and the lack of proactive financial mechanisms do not stimulate development of hospital-replacing technologies. The purpose of study is to analyze reporting data and results of SWOT analysis of rating of factors affecting introduction of day hospitals, On the basis of analysis the strategic objectives of development of hospital-replacing technologies are formed. The study applied statistical analysis, direct observation, sociological survey, SWOT analysis. The analysis was applied to data from forms of Federal statistical observation No. 14 and industrial statistical monitoring No. 14 for 2009-2018. Based on results of SWOT analysis, experts were interviewed by the heads of health care authorities and medical organizations regarding development of strategy of medical care of children with disabilities. The expert survey was carried out with health care managers in Moscow, the Moscow oblast, Orenburg, Chelyabinsk, Samara, Ivanovo, Ryazan oblasts and the Republic of North Ossetia-Alania. The analysis established that in 2018 the number of medical care organizations increased up to 6495, including medical institutions providing outpatient medical care (41.4%) and in-patient medical care (58.6 %). The analysis demonstrated that percentage of treated patients in day hospitals out of the total number of hospitalized patients (in hospitals was 29,1% in 2018, while in 2009 this percentage was significantly lower - 15,6%, which indicates the intensification of the use of the bed fund of the UPC, which to some extent is associated with increased development of hospital-replacing technologies. The results of SWOT analysis demonstrated that the strategic objectives of development of hospital-replacing technologies should be targeted to develop financial stability of health care, active position of the heads managers of health care institutions and medical organizations and introduction of innovations if needed. It is necessary to develop modern management methods, rational application of health care resources, implementation of economic incentives in all components of health care system, ensure functioning of the system, including effective contract.

Modern approaches to correction of dental and speech disorders in children with motor disorders

Relevance. An important modern medical and social problem is child disability, as it is one of the most important characteristics of public health and social well-being of the country, and also serves as an indicator of the health of the child population and the quality of medical care for children and their mothers. The specificity of children's disability is that the limitations of life arise in the period of active formation of higher mental functions, assimilation of knowledge and skills, in the period of formation of personality. Purpose. To improve the quality of comprehensive rehabilitation of children with motor disorders, having dental and speech disorders, based on the introduction of improved standards of medical and social rehabilitation and habilitation services. Materials and methods. The cohort of patients included in the study was represented by 120 disabled children with motor disorders in the form of spastic forms of cerebral paralysis, having dental anomalies and speech defects, the average age was 8.7 years ± 1.2 years. In the course of an open controlled prospective clinical study, neurological and dental status, psycho-speech development in the dynamics before and after treatment and rehabilitation measures were evaluated. Results. Data on the frequency and structure of dental anomalies and speech disorders in children with different clinical variants of spastic forms of cerebral paralysis were obtained. Conclusions. It is shown that contemporary approaches to correction of dental and speech disorders in children with motor disorders give a positive result and should be carried out continuously from an early age until the maximum possible correction of lost functions is achieved.

Pediatric Resident Perception and Participation in End-of-Life Care

Despite advances in medical care, pediatric deaths are still an unfortunate reality. Most of these deaths occur within a hospital setting. End-of-life care is an important part of medical care for children with serious illnesses. Despite the importance, pediatric providers report a lack of comfort surrounding end-of-life care. To assess categorical pediatric residents' perceptions and participation in providing end-of-life care to dying children and their families. This is a survey-based, descriptive, mixed-methods study. Survey was sent to categorical pediatric residents at Indiana University School of Medicine in June 2018 to obtain both quantitative and qualitative information on resident perception and participation in end-of-life care. Surveys were sent to 100 residents with a response rate of 68%. Pediatric residents at Indiana University School of Medicine. The comfort and participation in end-of-life care are limited in all levels of pediatric training. Residents do not feel comfortable with 19 of 22 questions related to end-of-life care. Only 32% of residents felt their education prepared them to participate in end-of-life care. Almost one-fifth (19.5%) of residents report participating in zero aspect of end-of-life care. Themes discussed by residents include education, experience, communication, social norms, emotions, self-care, comfort, and family. More formalized education and training is needed to increase resident comfort with and participation in end-of-life care. Such future interventions should focus on communication surrounding difficult conversations and providing guidance for families.

Pediatric endocrinology in Ukraine. Analysis of specialized medical care for children in 2019

The article provides information and analyzes statistical indicators on the status of endocrinological care for children in 2019 in general in Ukraine and in different regions, its dynamics over the past 5 years. Data on the status of inpatient care for children with endocrine diseases are provided; about disability due to endocrine pathology, which in recent years has been growing steadily; about the incidence and prevalence of malignant diseases of the endocrine glands in children. Also data from database of children with diabetes mellitus (DM), including its various forms, with pathological short stature and disorder of sexual differentiation (DSD), are included. The problematic issues of specialized medical care for children with diseases of the endocrine system are highlighted.It is noted that according to the database of children with DM in 2019, 9962 patients under the age of 18 years (13.14 per 10,000 children) were registered, including 9866 children on insulin therapy, 36 patients with type 2 DM, 106 — with monogenic DM, including neonatal DM was confirmed in 66 children and MODY in 40 patients. The prevalence of DM among children under the age of 18 years has increased over the past 5 years by 21.1 %.According to the database of children with DSD (n = 95), there were 17 children with chromosomal DSD, 65 patients with 46,XY DSD and 13 patients with 46,XX DSD.It is reported that in 2019 in Ukraine, 1613 children with dwarfism under 18 years of age were registered who need growth hormone treatment, including 1147 children with pituitary and pituitary­cerebral dwarfism, 303 children with Turner syndrome, 73 children with Russell — ­Silver syndrome, 46 children with Prader­ — Willi syndrome, 13 children with short stature who were born small for gestational age, as well as 16 children with dwarfism due to chronic renal failure. Each year, the number of such patients increases by an average of 10 %. These children are treated for state budget funds.

Modern approaches to improving the quality of medical care for premature children in Moscow health care

This article is devoted to the issue of nursing and further monitoring of children born with very low and extremely low body weight. The article presents the data of international statistics and seven-year experience of the Rehabilitation Center for children born with very low and extremely low body weight, based on a large multidisciplinary children’s hospital. The authors pay particular attention to improvement of medical care of children born with very low and extremely low body weight.

Совершенствование качества организации и оказания медицинской помощи детям с травмами с целью снижения их инвалидизации

Совершенствование качества организации и оказания медицинской помощи детям с травмами с целью снижения их инвалидизации

Нормативно-правовая база, регулирующая оказание медицинской помощи детям с ревматическими заболеваниями в Российской Федерации

Objective. To analyze legislation regulating medical care for children with rheumatic diseases in the Russian Federation. Materials and methods. We analyzed regulatory documents of the Ministry of Health of Russia, including the rules of medical care for children with rheumatic diseases, the resolution regulating the distribution of medicines at a discount or for free, and regional legal acts regulating routing of children with rheumatic diseases. Results. The legislation regulating medical care for children with rheumatic diseases is imperfect and needs to be updated. We identified shortcomings in the system regulating preferential provision of certain groups of patients with medicines. The results of our analysis can be used as a rationale for changes and amendments to existing regulatory legal acts and for the development of new regulatory documents. Conclusion. This analysis of legal documents allows us to suggest amendments to the existing legal framework in order to reduce tensions (including legal tensions) associated with distribution of preferential medicines, reconsider establishment of disability in patients with juvenile idiopathic arthritis, expand opportunities to prescribe biologicals for non-disabled patients with systemic scleroderma, juvenile dermatomyositis, and systemic vasculitis in regions. We justified detailed description of regional legal documents regulating distribution of preferential medicines among patients with rheumatic diseases. Key words: rheumatic diseases in children, regulatory framework, health care organization, drug provision

THE FACTORS IMPACTING ATTITUDE OF MEDICAL COMMUNITY TO GENETIC RESEARCH AND MEDICAL CARE OF CHILDREN WITH INHERENT IMMUNITY ERRORS

The purpose of the study is to investigate factors influencing medical community's attitude to genetic research and medical care of children with inherent immunity errors and to develop recommendations for representatives of medical community (immunologists and allergists). Today, genetic research technologies and medical care provided on the basis of diagnostics are not considered as elements of health care management system in the Russian Federation. The factors (legal, ethical, organizational, etc.) affecting genetic research and medical care of patients with congenital immune errors are analyzed. The results of the expert survey carried out in sampling of allergists and immunologists of the Sverdlovsk Oblast are presented. Based on the results of survey, recommendations have been proposed for developing and implementing genetic research technologies and medical care. The conclusions are made concerning necessity of minimization of medical and social risks through introduction and regulatory consolidation of genetic research technologies and consulting technologies based on diagnosis of severe combined immunodeficiency; joining administrative and professional efforts in professional training in the field of genetic counseling, including other specialists in health care.

Some results of the organization assessment of outpatient aid to children’s population in a municipal area

Primary health care for children is the mainstay of the system of medical care for children and includes measures for the prevention, diagnosis, treatment of diseases, medical rehabilitation, the development of healthy lifestyles and sanitary and hygienic education for the children. Medical organizations located in rural areas have particularities in the system of providing medical care to the population. This concerns the type, capacity, disposition of medical organizations, their provision with qualified medical personnel, and the possibility of obtaining qualified medical care. In order to assess the state of outpatient care for children under the conditions of municipal health care, data was taken out of the federal statistical reporting “Information on medical organization” form 30 “Information about the number of diseases registered in patients living in the area of service of the medical organization” form 12 for 2015-2017. The research was based on the Toksovo District Hospital, a state budgetary health care institution in the Leningrad Region. In the course of the study, pediatric staff were evaluated for pediatric staff, indicators of outpatient care for the children, indicators of the burden of pediatricians and morbidity rates for the treatment of children. It was found that in the years under study there was a high level of provision of pediatricians with an attached pediatric population, an increase in the number of district pediatricians and a decrease in the part-time ratio. The increase in the workload of pediatricians conducting outpatient admissions, including district pediatricians, associated with an increase in visits for diseases in 2015-2017, indicates a deterioration in the health of the children’s population, as evidenced by an increase in the overall morbidity rate for outpatient using the child population.

Do patients of integrative anthroposophic pediatric inpatient departments differ? Comparative analysis to all pediatric inpatients in Germany considering demographic and clinical characteristics

BackgroundIntegrative medicine (IM) is a patient-centered, evidence-based, therapeutic paradigm which combines conventional and complementary approaches. The use of IM in pediatrics has increased in the past two decades and parents’ demand for it is growing. An IM whole systems approach is anthroposophic medicine. Considering the growing demand for integrative approaches in children, it is relevant from a public health perspective to find out which kind of children use IM in Germany and whether they differ from the entirety of pediatric inpatients in Germany. Moreover, it would be interesting to known, whether these patients are willing to travel a longer distance to gain integrative treatment.MethodsThe present study investigates the standard ward documentation datasets of 29,956 patients of all German integrative anthroposophic pediatric inpatient wards from 2005 to 2016 and compares them systematically to collect data of the entirety of all pediatric inpatient wards in Germany. Apart from patients’ age and gender, and the ICD-10 admission diagnoses, the geographical catchment area of the hospitals were analyzed.ResultsSociodemographic characteristics of pediatric inpatients in the integrative anthroposophic departments (IAH) did not differ from the entirety of all pediatric inpatients. Regarding clinical characteristics, higher frequencies were found for endocrine, nutritional and metabolic diseases (IAH: 7.24% vs. 2.98%); mental, behavioral, and neurodevelopmental disorders (IAH: 9.83% vs. 3.78%) and nervous diseases (IAH: 8.82% vs. 5.16%) and lower frequencies for general pediatric diseases such as respiratory diseases (IAH: 17.06% vs. 19.83%), digestive diseases (IAH: 3.90% vs. 6.25%), and infectious and parasitic diseases (IAH: 12.88% vs. 14.82%) in comparison to the entirety of all pediatric inpatients in Germany. The IAH showed a broad catchment area, with most patients being from former, Western federal republic of Germany. Large catchment areas (> 100 km) for the IAH are merely covered by severe and chronic diseases.ConclusionPediatric inpatients of IAH do not differ from the entirety of pediatric inpatients in Germany regarding sociodemographic characteristics but show differences regarding clinical characteristics. Parents are willing to travel further distance to get specialized integrative anthroposophic medical care for children with severe and chronic diseases.

The satisfaction of parents with ambulatory polyclinic care of children in conditions of the region

To identify the most effective areas of out-patient care of children, an in-depth sociological study was carried out in the Kabardino-Balkaria Republic. The questionnaire allowed to get answers on satisfaction of parents with the quality, volume and availability of out-patient care, as well as to study the social status of respondents. The survey included 495 mothers aged of 18-45 years. Out of them, 70.0% had 1-2 children, 30.0% had 3 or more children. The orientation of the majority of families to the birth of 1-2 children formed one of the lowest in the republics of the North Caucasus total fertility rate of 1.61. The results of the study of parental satisfaction with the level of medical care of children in out-patient settings established that the main problem is sufficiently correlated with the data of similar studies in different regions of Russia. According to the data obtained, 61.0% of the respondents were satisfied with the overall health care in the clinic, and only 12.0% of the respondents were fully satisfied. At the same time, a quarter of the respondents expressed their dissatisfaction with various aspects of medical care. The main reasons for dissatisfaction are the low level of examination, organizational issues that need to be addressed, a significant workload of doctors, often the lack of doctors of narrow specialties. According to parents opinion, the clinic is lacking continuity in the work and dynamic monitoring of a sick child, as well as awareness of patients about the ongoing therapeutic and preventive measures. The low efficiency of preventive work is established. The dissatisfaction with the availability and quality of medical care of children is the basis for the necessary measures to improve functioning of the children's clinic, including introduction of new and effective organizational and medical technologies, improvement of material and technical equipment, improvement of the professionalism of medical personnel. The prerequisite for the success of the clinic is also compliance with ethical principles in Pediatrics. The results obtained on the basis of the analysis of the parents' opinion are valuable for development of the perspective programs of development and improvement of primary health care of children in the Republic of Kabardino-Balkaria.

ESTIMATION BY PARENTS OF ACCESSIBILITY AND QUALITY OF MEDICAL AID PROVIDED TO CHILDREN IN OUT-PATIENT CONDITIONS

Introduction. In modern conditions, the population’s satisfaction with medical care, including the urban and rural population, is one of the main criteria for the quality and accessibility of medical care. The goal. Subjective assessment of the organization of medical care for children in the conditions of the children’s polyclinical department of a medical ambulatory. Materials and methods. The study was conducted by random sampling using an anonymous questionnaire of 312 parents of children receiving medical care on an outpatient basis in the children’s department of the New Devyatkino village clinic in the Vsevolozhsky district of the Leningrad Region. Results. Preventive examinations, treating acute diseases, and testing when being under observation were established to be the main reasons for contacting the pediatric ward of a polyclinic are. Most of the parents spent an average of 24.5 ± 0.07 minutes on the way to the medical organization. Most often, parents choose to make an appointment with a doctor through a call center, the Internet and through an electronic record. The majority of parents (73.6%) believe the schedule of work of doctors to be convenient. More than half of parents (53.6%) believe that in the children’s outpatient department there are no specialists of the profile they need. In the opinion of parents, the most difficult is to arrange a visit to an ophthalmologist, otolaryngologist, and surgeon. In general, 65.3% of parents were satisfied with the organization of the children’s outpatient department, 28.9% were not completely satisfied, 2.3% were not completely satisfied. The main reasons for parents dissatisfaction are long queues at the registry (20.5 ± 0.08 minutes), to the pediatrician (average 22.7 ± 0.09 minutes) and highly specialized doctors (average 23.5 ± 0.09 minutes), difficulties in obtaining expert advice, and passing the examination. Conclusion There is a need to improve the availability and quality of medical care for children provided on an outpatient basis.

KOVRIGINA MARIYA DMITRIEVNA «IS PERSONALLY RESPONSIBLE FOR THE HEALTH OF THE COUNTRY’S CHILDREN AND WOMEN» DURING THE GREAT PATRIOTIC WAR

There is shown the role of the USSR People’s Health Committee in solving one of the most important tasks facing the Soviet state during the war years to preserve the health of children and women. The personal contribution of the prominent health care organizer M.D. Kovrigina in protecting the health of children and women during the Great Patriotic War is highlighted. Despite the dire consequences of the first years of the war, the People’s Commissariat of Health of the USSR was able to prevent the development of epidemics among children and gradually restore the children’s health care system in the rear and in the territories liberated from occupation. M.D. Kovrigina actively participated in the development and implementation of the most important decrees of the party and Soviet bodies on the protection of the health of children and women. Thanks to the establishment of strict control over the implementation of legislative decisions and decisions of the People’s Commissariat of Health of the USSR M.D. Kovrigina managed to restore the district system and raise the level of medical care for children.

Первые результаты реализации Национального проекта «Здравоохранение» на территории Липецкой области

The article describes the organization of the system of providing medical care to the population of the Lipetsk region according to the main sections of the National project «Health care».
 The main reasons for the failure to achieve the results of the projects "Cardiovascular diseases", "Oncology", "Primary health care", "Providing medical care for children" and, as a consequence, influence on the demographic indicators of the Lipetsk region are given.

Obesity and overweight among children, diagnostic criteria and statistics of prevalence

Objective: to conduct an analysis and synthesis of scientific literature and modern recommendations regarding the criteria for diagnosing overweight and obesity in children, international and national statistical databaseson the prevalence of overweight among children,legalactson the diagnosis of obesity and the detection of overweight in children in Ukraine.
 Methods. bibliosemantic, epidemiological, contentanalysis.
 Results. The international statistical data bases,results of the cross-national studies of WHO, current recommendations and strategies of prevention of obesity of children have been studied. According to the data of the official branch statistics the current scope of spreading of obesity among children’s population of Ukraine. The analysis of the normative documents regulating the order of organization and main components of the obligatory preventive medical examinations of children in Ukraine, the scheme of their periodicity, criteria of evaluation of physical development of children and record of results of medical examination of a child with evaluation of his/ her physical condition have been conducted. Figured out the disadvantages of the existing system of prevention of obesity of children: discrepancies between branchstandardsthatregulateapproachestotheevaluationofharmonyofphysicaldevelopmentofachildanddocumentsthatregulatestoringofresultsofthepreventivemedicalexaminations of children which is the reason for absence of statistics of obesity of children in Ukraine; lowlevel of diagnostics of obesity of children and identification of the excessbody weight that is conditioned by the lowlevel of knowledge a mongprimary medical caredoctors, providing medical careto children,of indicators of excess body weight of children.
 Conclusions. A conceptual solution to this problem can be achieved by organizing a continuous, systematic process of detection and registration of children with overweight and obesity, analysis of the environment where the child is from the standpoint of social characteristics and behavioral characteristics.

Effects of the home-based educational intervention on health outcomes among primarily Hispanic children with asthma: a quasi-experimental study

BackgroundChildhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities.MethodsThe study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome.ResultsWhen comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children’s Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children’s age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance.ConclusionsThis study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.

THE SOCIAL RESPONSIVENESS OF HEALTH CARE SYSTEM: THE REGIONAL ASPECTS

According to the WHO, social responsiveness is associated with non-medical indices of health care system functioning. The integral index of responsiveness of health care system at providing specialized medical care to children in rural areas of the region was applied for assessing the degree of concordance of regional health care system to expectations of population. The most positive appraisals of respondents were given to indices of social responsiveness determined by professionalism of the medical personnel of the Oblast children hospital. The survey results demonstrated that main problem of respondents is transport accessibility of specialized medical care for children in rural areas of the region.

ACADEMICIAN ALEKSANDR FYODOROVICH TUR (ON THE 125TH ANNIVERSARY OF THE BIRTH OF THE TEACHER)

The article is dedicated to the 125th anniversary of the birth of the outstanding Russian pediatrician, Academician Aleksandr Fyodorovich Tur and the 75th anniversary of the lifting the siege of Leningrad in the Great Patriotic War. Professor A.F. Tur directly participated in the organization of medical care for children in the besieged city of Leningrad, for 10 years he was the chief pediatrician of the city. The experience of the work of children’s polyclinics in Leningrad on the basis of a single pediatrician subsequently became the property of the whole country. A.F. Tur made a huge contribution to the protection of children of the besieged city, directed the Children’s Nutrition Board, proposed original methods for combating alimentary dystrophy, helped to create a system of rigorous provision of children with food, shelter, fuel, organization of the correct regime in shelters, and continuous monitoring of vaccinations for children. The Society of Pediatric Doctors headed by Prof. Yu.A. Mendeleva and A.F. Tur was one of the first to renew its meetings in the besieged Leningrad. The name of A.F. Tur is associated with the establishment of domestic dietetics, neonatology, pediatric hematology, pediatric endocrinology. Among his students, there are more than 110 candidates and 28 doctors of medical sciences. In peacetime, A.F. Tur was awarded two orders of Lenin, in 1970 he was awarded (jointly with G.N. Speranskii and Yu.F. Dombrovskaya) the title of the Laureate of the Lenin Prize “... for a series of works on the physiology and pathology of young children, contributing to a sharp decline in morbidity and mortality among them».

ON THE OCCASION OF 90-TH ANNIVERSARY OF THE UNION OF PEDIATRICIANS OF RUSSIA

There is presented a brief analysis of the history and development of pediatric societies of Russia, there are shown the main stages of the establishment of the Union of pediatricians of Russia. There are reflected peculiarities of the legislative, educational, publishing, international, scientific and tutorial activities of the leading professional association of Russian pediatricians, concrete examples of their efforts to protect the children’s rights and health are given. Scientific substantiation of the state system of children’s health, which has proven to be highly effective, was both repeatedly discussed and improved on Congress and Convention of the Union of pediatricians of Russia, was shown to be historically important. The basis of the new children’s health care system was consisted of the state nature, preventive orientation, the priority of primary medical care for children as a pediatrician according to the district scheme. Particular attention in the article is paid to efforts of pediatricians of Russia on construction of an effective system of health and social care for children’s population.