Financing of services is a significant issue for palliative care in the Russian Federation. One commentator has identified the following problems in palliative care, many relating to funding issues: a shortage of funds needed to run the current services, a gap which has to be met by charitable subvention; the difficulties in obtaining certain drugs free of charge to patients, such as Fentanyl; difficulties which doctors have in prescribing opioids for home care; low salaries among those working in hospices coupled with high workloads, and leading to 'burn out'; a lack of volunteers.5
Some services have official funding; e.g. Lomintsevsky Hospice, on the outskirts of Tula, which is funded from the Tula Region Health Administration budget; and hospices in St Petersburg, where the construction of freestanding hospices and development of home care services has been funded from the city budget. Other institutions have benefited from charitable funding, such as Yaroslavl hospice, which was established with the help of 3 grants from Charity Know How, followed by the award of a Tacis Lien grant to open a day care centre. In Samara, a number of agencies came together: government, business and non-commercial organisations resulting in the recognition of the hospice as an independent, non-statutory, non-profit making organisation and medical institution.6
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