As reported, during the audit "Is priority and equal access to outpatient medical services ensured for children?" the State Audit Office concluded that in many regions, medical services for children are effectively not provided, and the planning of funding for outpatient medical service programs does not yet ensure their actual availability. In response to the conclusions of the State Audit Office, the Ministry of Health acknowledges that significant improvements are still needed in the field of children's health care, especially in terms of service accessibility in regions, reducing waiting times, and ensuring specialists. However, according to the ministry, the issues identified during the audit coincide with problems previously identified by the ministry itself, and work to address them has already begun. The conclusions of the State Audit Office's audit are planned to be included in the maternal and child health plan and other program documents developed by the ministry. The ministry emphasized that a child's place of residence or the family's financial capabilities should not determine the ability to receive necessary medical services. The minister promised to take the audit's conclusions into account when implementing measures outlined in the maternal and child health plan, to strengthen the role of pediatricians, to implement health assessments for children, and to develop service accessibility. It is also planned to create a clear system so that parents of young patients understand where to turn when a pediatrician or another specialist is needed, how quickly help will be available, and what the next steps will be. Moreover, necessary medical services for children should be fully funded by the state so that their receipt is not limited by the family's financial capabilities. The Ministry of Health informs that state funding for children's health care amounts to 182 million euros per year, including 103 million euros allocated for outpatient services. To increase the number of pediatricians, pediatrics has been designated as a priority area for residency, and the number of training places in pediatrics and related specialties has also been increased. To improve service accessibility outside of Riga, mobile dental services have been implemented in all regions of Latvia, a pilot project for the accessibility of vision correction means has been realized, the content of preventive examinations has been improved, and early detection of the risk of cardiovascular diseases in children has begun. Since this summer, ophthalmologists who can prescribe state-funded optical devices for children with certain visual impairments and eye diseases are available not only at the Children’s Clinical University Hospital (CCUH) but also at the Vidzeme Hospital, Daugavpils Regional Hospital, Jekabpils Regional Hospital, and North Kurzeme Regional Hospital. In the future, the Ministry of Health plans to establish unified standards for children's health services, continue to develop the children's health care network, strengthening cooperation among family doctors, pediatricians, regional hospitals, and CCUH, as well as developing telemedicine. The ministry will also focus on prevention and early detection of diseases, improving preventive examinations, vision screening for children, early health risk assessments, and the work of multidisciplinary teams in the regions. As reported, during the audit, the State Audit Office concluded that in 71% of cases, healthcare institutions do not actually provide the relevant services to children. The audit showed that child health protection in Latvia is a priority only in name: the country has not created a system that ensures this priority in practice. The state has not defined which outpatient services should be available in different parts of Latvia. Services are planned fragmentarily, without sufficient information about children's needs and available medical personnel. Each healthcare institution has been left to decide which services and to which patient groups - children, adults, or both - to provide. The State Audit Office also notes that the volume of services is largely determined by the number of services previously provided, rather than the actual needs of children and the capabilities of healthcare institutions. In 2024, the state spent 93 million euros on outpatient medical care for children, while families paid at least another 14.5 million euros for paid services for children. At the same time, services for children are not available on equal terms, are not provided faster than to other population groups, and are not offered in sufficient volume. Member of the State Audit Office Council Maya Abolinya notes that a child in Latvia is a priority patient, but the audit shows that this priority has largely "remained on paper." According to her, without a clear definition of where and which services should be available and who will provide them, one cannot speak of equality. Currently, too much is determined by the child's place of residence and the family's ability to seek solutions independently. The State Audit Office notes that 69% of children's doctors in Latvia work in Riga, where 79% of state-funded secondary outpatient services for children are provided. In several medical fields in the regions, there are no children's doctors, so services for children are often provided by general practitioners. On average, about 350 children from the regions travel to Riga every working day for state-funded secondary outpatient care. For families, this means expenses for transportation, food, and sometimes accommodation, with parents having to miss work and children missing school. The audit also showed that pediatricians are insufficiently involved in outpatient healthcare. Only 17% of children with illnesses consulted a pediatrician, although pediatricians have the broadest competence in children's health care and are the most accessible children's doctors outside of Riga. According to the auditors' estimates, it is necessary to provide children in the regions with basic specialists and pediatricians, while more complex and rare services should be concentrated where the necessary experience and quality can be ensured. Currently, there is no clear network of services. The State Audit Office provided the Ministry of Health with six recommendations. They include improving preventive examinations for children by family doctors, enhancing the accessibility of dental care and vision checks, creating a needs-based network of secondary outpatient care for children, more clearly defining the competencies of doctors in treating children, and strengthening the role of pediatricians. Results should be achieved by the end of 2031.
