1990s in Russia are characterized as the period of reforms of the state, social and economic structures. Their pace and depth have had a notable impact on the demographic situation and health conditions of the population and put the whole system of health care in the very difficult position. Nevertheless, in spite of all the difficulties of the transitional period health care of Kalmykia continued its work in all the strategic directions with the main objective of preserving and strengthening health of the republic's population.

In this period the republic's Ministry of Health Care formed a state system coordinating the public health issues, joined the work of the related inter-departmental republic's commissions at the office of the Government of the Republic of Kalmykia:

• Minors' affairs commission,
• Summer recreation of children and juveniles commission,
• Traffic safety commission,
• Sanitary and anti-epidemic commission,
• Prevention and prophylaxis of tuberculosis commission,
• Illegal drug traffic commission,
• Prevention of drug abuse and drug traffic commission.

In the last three years the Ministry of Health Care of the Republic of Kalmykia has formed a multi-channel system of medical equipment and medicines supplies on the basis of the trilateral Agreement of the Russian Ministry of Health Care, Fund of Mandatory Medical Insurance and the Govern ment of the Republic of Kalmykia of the issues of health care provision. This agreement stipulates that up to 300 residents of the republic are annually eligible for highly technological (expensive) medical care in the leading institutes and centers of Russia, up to 5000 men including children are eligible for provision of facilities in sanatoria and health resorts.

Several key laws on health care have been accepted:

• "On prevention of disease caused by the virus of Acquired Immunodeficiency Syndrome (HIV)" #39-1-3, 20.02.96;
• "On anti-tuberculosis care and tuberculosis protection of the population" #73-1-3, 12.05.97;
• "On civil health care" #91-1-3, 30.10.97;
• "On donors of blood and its components" #103-1-3, 09.03.98;
• "On immunoprophilaxis of the infectious diseases in the Republic of Kalmykia" #398-П, 22.06.01.

A positive point in the development of the republic's health care and medical insurance system, meeting the constitutional rights of citizens for health protection is the development and adoption in 1999 of the territorial "Program of state guarantees for provision of free health care services to the citizens of the Republic of Kalmykia".

During the last several years over 20 children with inborn heart disease have been treated in the leading French clinics according to the Contract signed between the Ministry of Health Care of the Republic of Kalmykia and the French associations "Chain of Hope" and "France - Kalmykia".

In 1997 the government of Russian Federation has approved "The development concept of health care and medical science in Russian Federation" and adopted the plan of top-priority measures for its realization. These years have been marked by the conceptual structural reform of medical services: reorganization of hospital services and reform of the primary medical aid by implementing the low-cost hospital-substitution technologies.

These measures allowed to reduce the number of local hospitals by 40 (from 51 to 11), the number of beds by 865 (18,7%).

The reduction of the hospital base of the republic allowed to create the republican clinical and diagnostics centers, asthma center and asthma school, diabetes center, occupational diseases center, family planning and reproduction center, rehab center for handicapped children, center of medical and psychological aid. They all are the new forms of health care organization. The period was also marked by the introduction of medical service for war veterans offered by the hospital of war veterans and such services as "Catastrophe medicine", hemodialysis center, etc.

The hospitals were oriented to intensification of the treatment process.

Much attention was paid to the ambulance system. Developed and approved was the republic's targeted program "Perfection of ambulance and first aid" that scheduled equipping of 3 regional ambulance stations with the new ambulance vehicles and the creation of cardiology group.

The period of 1996-2001 and the first half of 2002 were marled by the development of the fundamental normative acts in strategic directions of the health care development, republic's targeted programs:

1. "Children of Kalmykia" (Decree #70-a, 30.04.96) includes the subprograms:
   • Health protection of women and children in the Republic of Kalmykia (1996-2002)",
   • "Family planning",
   • "Handicapped children",
   • "Summer recreation of children and juveniles",
   • "Orphans",
   • "Gifted children",
   • "Refugee and forced migration children".
   
   
2. "Prophylaxis and prevention of socially conditioned diseases (2002-2006)" (Government resolution #145, 28.05.2002) includes the subprograms:
   • "Diabetes"
   • "Urgent measures against tuberculosis in the Republic of Kalmykia"
   • " Vaccine prophylaxis"
   • "On the development of cancer aid "
   • "On the prevention of sexually transmitted diseases"
   • "Urgent prevention measures against the disease caused by the virus of Acquired Immunodeficiency Syndrome (HIV) "
   • "Improvement of the republic's service of catastrophe medicine"

40 various medical institutions have been build or repaired during the last several years, including:

• surgery, therapeutic, pediatric and gynaecologist departments of the polyclinic of Priyutnensky region,
• central regional hospital in Bolshoi Tsaryn,
• surgery and reanimation, pediatric детское and gynaecologist departments of the central regional hospital of Tselinny region,
• republic's isolation hospital,
• republic's psychoneurology clinic in Priyutnoye,
• republic's anti-tuberculosis department in Elista.