Various guidelines, programs, and conceptual reports are approved since 2005, which are designed to make the medical staff working in Latvia accessible in the number and of the qualification relevant to demand among patients, but the State Audit Office has established that this goal is far from being reached.
Although the number of doctors in Latvia corresponds to the density of doctors per 1,000 population in Europe determined by the World Health Organisation, the reality shows that doctors with certain qualifications are not available to patients, especially in regions, at all or are available in very limited numbers.
Planning documents have been developed, but the provision of human resources is still inadequate
The audit concluded that the goal set by the Ministry of Health more than a decade ago that is to provide the health care system with an appropriate number of human resources with qualification according to the demand was not reached. The problems identified at that time are still topical now inter alia insufficient number of nurses, the disproportion of doctors and nurses, large inequalities in the placement of medical practitioners in regions and Riga, insufficient level of remuneration, and inefficient alternation of generations.
The proportion of medical professionals in Riga and Greater Riga is increasing, but their lack in the regions is observed in all specialities. The measures by the Ministry of Health to attract residents to work outside Riga have not changed the situation significantly. Therefore, the State Audit Office believes that the Ministry of Health, together with local governments, should find new solutions for improving the situation because the responsibility for access of the local population to health care services is also the responsibility of local governments.
The analysis carried out in the audit shows that the sector lacks at least 3.5 thousand nurses and about 300 midwives. Only 65% of young professionals who have obtained a qualification remain in the labour market of Latvia after graduation, and only 52% of nurses and 54% of midwives start working in Latvia after completing their studies. Alternation of generations is not efficient either as 55% of medical professionals, and medical staff are over 50 years old.
Remuneration is an essential aspect to encourage young people to pursue careers in the healthcare sector and to maintain existing human resources. Therefore, the Ministry of Health planned a substantial increase in average wages for medical practitioners already in 2009. However, there were the first significant steps taken to increase wages only in 2018. Such prolonged negligence has led to a shortage of medical practitioners and has affected the prestige of the profession negatively.
The development of medical school education does not sufficiently address the human resource problems in the sector
Industry-specific regulation of professions is the basis for developing the education system. The audit found that there were twice as many regulated professions in the health sector in Latvia as in Lithuania and Estonia, while there were about 1.5 times more specialities, sub-specialities, and additional specialities.
Coordinated and industry-needs specific planning of basic study places is still not being implemented in the country, as higher education institutions preparing doctors are subordinate to two agencies – education and health, while planning of resident study places is under the responsibility of the Ministry of Health. Consequently, the situation is not eliminated when the number of graduates of health care basic education financed by the state budget is higher than the number of residency study places, and the targeted use of the limited state budget funds available for education has not been achieved.
The auditors point out that the young doctors are entering the labour market later in Latvia. The duration of residency studies in many medical specialities exceeds the minimum duration of the studies stipulated in the Directive on the Recognition of Professional Qualifications in Latvia, while it matches the minimum duration of studies in most cases in Lithuania and Estonia.
The complicated system of acquiring and certification of nursing profession hampers the entry and mobility of nurses in the labour market. The nursing education system trains nurses of different levels of education, and the specialisation of nurses is fragmented. In the future, the Ministry of Health plans to improve nursing education by creating the basic speciality of nurse profession – nurse responsible for general care.
Certification and recertification – transparent and requiring significant improvement
In order to practice in a particular speciality independently, a medical practitioner should not only register with the Register of Medical Practitioners but also obtain a certificate certifying a person’s professional qualifications.
However, the auditors point out that the initial certification procedure for medical practitioners who want to obtain a certificate in a particular specialty immediately after obtaining a professional qualification is a formal and unnecessary burden, as the theoretical and practical training and experience gained are not different at the moment of the graduation examination at the end of the studies and at the time of certification examination, but young professionals must pass two exams.
The medical practitioner must renew the certificate every five years, meaning re-certification. However, the established recertification requirements are formal; they are partly or even systematically disregarded because not all certification bodies check the information provided by the medical practitioner on the experience in the speciality and the evaluation criteria of professional activity have not been developed for all the specialities of the medical practitioners.
The auditors draw attention to the fact that it is currently not possible to revoke a certificate of medical practitioner in the event of a serious breach of the laws and regulations governing professional activities and code of conduct, as there is no cooperation and exchange of information between the Health Inspectorate finding such a breach and the certification bodies that are entitled to revoke issued certificates.
The State Audit Office has provided 19 recommendations to the Ministry of Health for improving the area of human resources development, improving access to healthcare services, review of the regulation of professions and specialities, improving medical school education, improving certification and recertification organisation, and meaningful use of the Register of Medical Practitioners and Medical Support Professionals.