In 1864 the government of Alexander II revolutionised the management of the countryside in Russia. The establishment of the Zemstvos marked the beginning of a decentralised system of organisation at a time when the health situation of the Empire was catastrophic. The decentralisation also affected the health system. The new organisation led to a focus on prevention. Doctors and their assistants (feldshers) began to travel out to where the patients were. Their action marked the beginning of free and equal care. At the same time, the development of public health was aiming to fight epidemics, monitor factories, schools and water quality.... However effective it was, the system didn't survive Alexander II's death. But it was on these foundations that public health in the USSR were built.