| The total number of population serviced by the Bragin Territorial Medical Association (TMA) as of 1 January, 2002, was 17,597, of them 3,392 children, 559 adolescents (in the district centre around 3,500, urban population - about 5,800, rural population - about 11,600, industrial workers - about 100, farmers - about 2,900). Figure 1 shows the dynamics of demographic indicators for the district: low birth rate, high mortality rate, negative natural population growth, and high infant mortality.  Figure 1. Dynamics of demographic indicators for the Bragin District (per 1,000 population).
Among causes of infant mortality are respiratory organ diseases, infectious diseases, perinatal conditions, and congenital developmental disorders. High infant mortality rates reflect the level of primary health care provided to the population. Causes of death among adult population are cardio-vascular diseases, neoplasms, intoxications and injuries, symptoms, signs and unidentified symptoms. It is necessary to take into account that the population structure includes many elderly and single persons, and low-income people. They fall ill and die on a more frequent basis. Medical services are provided to the population of the district by 19 medical institutions: - CDH (Central District Hospital) (Bragin) rated for 130 beds,
- DH (District Hospital in the settlement of Komarin) rated for 60 beds,
- ROU (Rural Outpatient Units) - 4 (3 are understaffed),
- PHU (Primary Health Units - 13 (4 are understaffed),
- Krivchanskaya precinct hospital (rated for 10 social beds).
Number of therapist precincts: 2.5 urban precincts and 3.5 precincts at the place of residence; paediatrics precincts: 1.5 urban precincts and 1.5 precincts at the place of residence. Over the last 10 years, the number of primary health units has not changed. The provision of health staff in the year 2001 was 15.4 per 10,000 population (for the Region, the figure was 38.8); the provision of middle-level health personnel was 89.7 per 10,000 population (114.1 for the Region). All doctors and middle-level health personnel work on a contractual basis. The Bragin TMA badly needs the following specialists: therapists - 8, of them 4 general practitioners, surgeons - 2, anaesthetics and resuscitation doctors - 2, obstetric gynaecologists - 2, paediatricians - 3, dentist - 1, ophthalmologist - 1, autopsist - 1, laboratory doctors - 2, X-ray doctor - 1, chief doctor - 1 (for Komarin DH - 2,) deputy chief doctor for the preventive treatment institutions network) - 1; emergency aid doctors - 2 persons. In 2001, there was an increase in medical staff turnover. In particular, this regards doctors: for every 5 newly hired doctors, there were 9 dismissed doctors. Among middle-level health personnel, there were 8 hired for 8 dismissed. The housing problems remained unresolved. In 2001, middle-level health staff received 2 dormitory apartments for 4 persons. Not a single apartment was provided to doctors. The number of staff in need of housing accommodations: 8 doctors and 15 middle-level personnel. 18 medical workers need better living accommodations (more living space). For the year 2002, 44 apartments are planned for vacant positions. In the district, there is the district state register of persons affected by the Chernobyl NPP accident. Annually, 98-99% of the affected population are examined by personnel of the National Territorial Medical Association, as well as by travelling teams of the National Centre and Gomel Regional Outpatient Facility. Medical institutions of the district are essentially provided with modern medical equipment, although much is to be replaced or upgraded. The list of required equipment includes 10 items: mobile X-ray diagnostic unit; a fully-equipped device for artificial respiration "Stephan"; anaesthetic device "Anemat № 8 mini" manufactured by СHIRANA-PREMA; 2 blood analysers; a general urine analyser, multi-purpose analytical strips; an electrolyte analyser BABL-70; a set of different endoscopes; ultrasound multi-functional diagnostic devices - fixed and portable; a WBC device (Aloca type), portable and fixed. It is required to modernise electronic computer machines for the register group and to set up a local network allowing for its enhanced use. To address issues of the future implementation of the Programme on Minimization of the Consequences of the Chernobyl NPP accident, the district needs financial support not only for purchasing equipment and medicines, but also a minivan required for a travelling team of specialists to organize examination of the population. It is necessary to purchase a mobile dentist's station to provide dentist care to children in kindergartens and schools of the district. One of the most important problems of the local health services is access of the population to medicines. Supply of drugs in 2001 constituted 88.2% (including humanitarian aid). There are cases when vaccines are temporarily unavailable. Morbidity analysis among children and adults shows that over the last 3 years there has been a trend demonstrating that the district indicators for primary and total morbidity are nearing the average indicators for the Region. Alongside the reduced morbidity as regards skin diseases, subcutaneous cells, osteomuscular and connective tissue, injuries and intoxications, symptoms and signs and unidentified conditions, primary neoplasm and congenital developmental disorders, it is necessary to note a stable level of perinatal pathology, a growth of endocrinal diseases (mostly simple goitres). One of the main reasons for this was lack of resources for iodine prevention. Newly identified anaemia cases have grown in number, most often among young children (alimentary). The number of nervous system disorders and disorders of sense organs has increased because of a better diagnosis of eye diseases following the inclusion of an eye doctor on the travelling teams. The rate of children with disabilities at the age of 18 has increased due to severe injuries, congenital disorders undetected by ultrasound, cancer pathology of thyroid glands, children cerebral palsy and epilepsy. Families of all of such children live in the contaminated areas. The general rate of infection with worms has increased. | 
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