MELNIKOVO, Russia � Yevgeny Kalashnikov runs the 104-bed hospital in this farming village on the western edge of Siberia, overseeing the 30 physicians who provide primary health care for 20,000 people in the district. Until a few years ago, people outside town would have to make their way to the central hospital for routine medical care. But now, thanks to a new program funded largely by the national government, Kalashnikov has been able to open five local clinics in areas that are far from town. �SThis has become the first point of contact for sick people,⬝ he said while standing outside of one of the new clinics with Tatyana Uvarova, a physician�"s assistant or feldsher. These college-educated medical aides are a key component of the Russian health care delivery system. They serve as a low-cost option for providing routine medical services like screening exams, vaccines, and injecting drugs when necessary. The collapse of Russia�"s once-proud health care delivery system and the precipitous drop in longevity after the fall of Communism remain a major national embarrassment. Late in his presidency, Vladimir Putin began pouring additional resources into the system, helped by taxes from the booming oil and gas sector. These satellite clinics are a key part of the program, which is known as Health, and, based on what Kalashnikov told me, it is producing results. Over the past three years, the mortality rate in the district as been reduced by 50 to 60 percent, he said, led by the decline in deaths from the region�"s No. 1 killer: cardiovascular disease. The government has also instituted an incentive system to encourage women to have more babies. The birthrate has increased 30 percent over the past three years. Where total deaths exceeded total births for most of the past decade, now the two rates are about equal. Kalashnikov, a hulking bear of a man, admitted the improved outcomes had little to do with minor innovations in health care delivery. Putin�"s form of authoritarian democracy may not win many admirers in the West, but, as nearly every Russian I have spoken with on this trip has pointed out, his tenure has led to a major turnaround for the battered post-Soviet Russian psyche. �SIt is the psychology of people⬝ that is behind the declining death rate, the physician said. �SLife is much more positive in Russia now. People are optimistic about the future.⬝ But in Siberia, with its long, cold winters and limited economic opportunities, alcoholism is still rampant. Unemployment is also quite high, judging by the number of young men idling away the middle of the day at a rural housing complex I visited. The condition of many of the Soviet-era apartment blocs in the poorer sections of Tomsk, the regional capital, and the surrounding villages was far worse than anything I�"ve ever seen, even in the most dilapidated public housing projects in America. Back in town, the hallways of the central hospital were lined with middle-aged men whose reddened skin and shabby dress reminded me of the homeless alcoholics who dot the streets of many American cities. �SAlcoholism is our No. 1 social problem,⬝ admitted Oleg Maykov, the elected administrative head of the district. A successful businessman before entering politics (construction, restaurants and cafes), he�"s also a slick politician quick to blame people for their own problems. Unemployment? Zero, he said. There are 240 jobs going begging in town. �SIn the past, every person was cared for by the state,⬝ he said. �SI think over the next 20 years alcoholism will go down as people look to developing their own lives.⬝ But Putin�"s ruling party and its local apparatchiks (Maykov keeps a portrait of Putin and his handpicked successor, Dmitry Medvedev, on the wall behind his desk) obviously believe it's good politics to provide basic services. The five satellite clinics set up in this district were clearly designed to show the benevolent hand of the state in the farthest reaches of Siberia. The one I visited just after closing time had seen 23 patients that day, including two tuberculosis patients, who must take a daily regimen of at least four antibiotics for a year or more. Under World Health Organization guidelines, the antibiotics must be taken every day under the watchful eye of trained medical personnel or their surrogates to avoid breeding resistance to the drugs. �SIf the TB doctor prescribes treatment, we provide it,⬝ said Uvarova, the physician�"s aide. �SWe give the pills; we give the injections; we even give additional food to build up their strength.⬝ It may not end the TB epidemic in this remote region, which is what I am here to write about. It certainly won�"t provide jobs for the unemployed. But it does give people hope, and that�"s the stuff from which political dynasties are made.