Although the law designates paediatric healthcare as a priority, no system has been established in practice to ensure this priority is upheld. The state has not defined which outpatient healthcare services must be available in different parts of Latvia. Funding is planned without assessing adequately whether medical facilities can actually accommodate children, and information regarding service availability does not always reflect reality. Consequently, children across Latvia have unequal access to medical care, with faster access often depending on their parents’ ability to pay. The shortage of state-funded services in the regions is partially offset by donation-funded charity initiatives.
A media briefing will be held at the State Audit Office of Latvia on 16 September 2026 at 10:00 a.m. featuring Auditor General Edgars Korčagins, Council Member of the State Audit Office Maija Āboliņa, Minister of Health Hosams Abu Meri, Ombudsman Karina Palkova, and Valts Ābols, Chairperson of the Board of the Children’s Clinical University Hospital.
IN BRIEF
- Paediatric healthcare is a priority in name only; the country lacks a clear service network, and access to medical care varies.
- In 2024, the state spent 93 million euros on outpatient paediatric healthcare while families paid at least another 14.5 million euros for paid services.
- Funding does not guarantee service availability; an audit of five regional paediatric programs revealed that medical facilities did not actually accept children in 71% of cases.
- 69% of paediatricians work in Riga; one in four children living outside Riga receives state-funded secondary outpatient care in the capital.
- There is no consensus within the sector regarding which doctors may treat children and to what extent; paediatricians are involved in outpatient healthcare insufficiently.
In 2024, the state spent 93 million euros on outpatient paediatric healthcare. At the same time, families paid at least another 14.5 million euros for paid healthcare services for their children. However, access to services for children is not ensured equitably, nor it is faster than for other population groups, nor it is provided to sufficient extent.
“In Latvia, a child is a priority patient, yet the audit reveals that this priority has largely remained on paper. If there is no decision regarding where and which services should be available, and who will provide them, we cannot speak of equality. Currently, a child’s place of residence and the family’s ability to seek solutions on their own play too large a role,” emphasised Ms Maija Āboliņa, Council Member of the State Audit Office of Latvia.
Service is planned but a child cannot get to a doctor
Planning of paediatric services is fragmented and lacks sufficient information regarding needs and available medical staff. It is left to each healthcare facility to decide which of the various services to provide to specific patient groups, that is, children and/or adults. As of 2026, 14 separate secondary outpatient healthcare service programs for children have been established. However, the audit has concluded that the mere allocation of funding does not guarantee service availability. In the five regional programs examined, healthcare facilities failed to actually provide the relevant service to children in 71% of cases.
Parents trying to find a doctor experience this very directly. For instance, when searching for a paediatric cardiologist, the website rindapiearsta.lv listed 12 healthcare facilities, even though only one actually accepted paediatric patients. Some doctors do not treat children at all while others impose age restrictions. Furthermore, the information on the website is updated only once a month with a time lag, which means that the listed waiting times do not always match reality. The planning principle itself is problematic: service extent is largely determined by the number of services previously provided rather than by the actual needs of children and the capacity of healthcare facilities to deliver them.
Paediatricians are concentrated in Riga
69% of Latvia’s paediatric specialists work in Riga where they provide 79% of the state-funded secondary outpatient healthcare services for children. In several medical disciplines, there are no paediatric specialists in the regions at all. Consequently, services are often provided by general specialists there, for example, a cardiologist instead of a paediatric cardiologist.
Families bear the consequences: around 350 children from Latvia’s regions travel to Riga to receive state-funded secondary outpatient healthcare on an average workday. A trip to the doctor entails more than just the journey itself because it involves expenses for transport and meals, and sometimes accommodation, as well as missed work for parents and missed school for children.
While the structure of paediatric specialties in Latvia is similar to that of other countries, planned residency positions often stay vacant and no positions in some specialties are planned at all despite forecasts of a future shortage of specialists. International practice supports narrower specialization for paediatricians while emphasising the need for broad-based training to ensure the ability to meet the needs of all patients simultaneously.
The audit concluded that paediatricians were engaged in outpatient healthcare insufficiently, as only 17% of children consulted a paediatrician directly when ill even though paediatricians possessed the broadest expertise in paediatric care and were the most accessible doctors for children outside Riga. The system should be structured to safeguard that essential specialists and paediatricians are available to children in the regions while concentrating complicated and rare treatments in locations where the necessary experience and quality can be guaranteed. Currently, no such clear service network exists.
Charity fills the gaps in state services partially
Since 2015, the Mobile Health Care Centre of Foundation “Ronald McDonald House Latvia” travels across Latvia’s regions. In 2024, it made 136 trips to 54 locations and provided 6,077 consultations to children. Consultations with ophthalmologists, paediatric allergists, and paediatric neurologists were the most frequently required services. The volume of services provided by the Mobile Centre is increasing year by year. Moreover, for some children, such a visit represents virtually the only opportunity to see a specialist including having their vision or hearing checked for the first time, even at school age.
Problems begin as early as the general practitioner level
A general practitioner (GP) is the first point of contact in paediatric healthcare by making this the place where health and developmental issues should be detected early. During their first year of life, 95% of children received preventive check-ups. However, the picture changes significantly thereafter: between the ages of 1 and 18, only 56% of children undergo an annual preventive check-up. Approximately one-third of newborns did not receive the scheduled home patronage visit during their first month of life. Furthermore, early childhood development assessments still lack a standardized approach, and only one in four or five children depending on age receives one actually. The goal of preventive check-ups is to identify issues while timely intervention is still possible, rather than waiting until the child has already been referred to a medical specialist.
The situation could be exacerbated in the future by a shortage of GPs. By 2030, 156 GP practices, representing 13% of the total, plan to terminate their contracts with the National Health Service of Latvia, and no replacements have stepped forward to take over these areas. More than 32,000 children are registered with these GP practices.
There is no consensus on who may treat children
The shortage of paediatric specialists in the regions highlights another systemic issue. In Latvia, a distinct paediatric specialty exists alongside the general specialty for more than ten medical disciplines, for instance, cardiologist and paediatric cardiologist, or surgeon and paediatric surgeon. No such distinction exists in other disciplines such as ophthalmology.
An audit revealed that the sector itself lacked a common understanding regarding the extent to which general medical specialists might treat children. The healthcare department considers that general medical specialists can also treat children whereas universities and professional organizations hold a different view. At the same time, in almost all the medical fields assessed, general medical specialists acquire both theoretical knowledge and practical skills in paediatric healthcare during their residency training.
The audit has also found that access to state-funded eye examinations for children could be improved if optometrists, in addition to ophthalmologists, were permitted to perform them, a practice they already effectively carry out at the Children’s Clinical University Hospital of Latvia and in the private healthcare sector. Meanwhile, the waiting time to see an ophthalmologist at the Children’s Clinical University Hospital reached one and a half years in early 2025. However, under the planned state-funded healthcare model, optometrist services are envisaged only as part of a team that includes an ophthalmologist.
Payment terms do not always encourage the treatment of children, either. A general medical specialist may receive the same payment for the healthcare of a child and an adult even though a consultation with a child often requires more time. Consequently, prioritizing children is not integrated into the payment system consistently.
There is insufficient funding for dentistry even to meet current demand
In 2024, the state spent 33.5 million euros on paediatric dentistry. However, only 36% of children received state-funded dental hygiene while 38% received dental treatment. In the regions, the average waiting time for dental treatment ranges from 35 to 100 days, though it extends to a year or longer in some cases. Families are buying the missing services themselves. According to the estimates of the State Audit Office of Latvia, covering the cost of the private dental services actually received by children would require at least additional 12 million euros in 2024. Moreover, this calculation does not account for the needs of children who received no dental care at all. Although only the initial orthodontic consultation is state funded for most children, access to these specialists is heavily concentrated in Riga and is often unavailable in the regions. Unlike the neighbouring countries, no targeted measures to improve the situation are evident in Latvia.
“The shortage of specialists is not always determined solely by the number of doctors; it can be exacerbated artificially by overly narrow boundaries of professional competence. We observe that in ophthalmology where the expertise of optometrists is underutilized and in orthodontics where dentists could be more widely involved in simpler cases. Such boundaries must be defined based on medical justification while also taking into account the availability of services across Latvia,” noted Ms Maija Āboliņa.
Recommendations of the State Audit Office of Latvia #PēcRevīzijas
The State Audit Office of Latvia has issued six recommendations to the Ministry of Health. These call for improving preventive check-ups for children in general practitioner practices and enhancing access to dental care; establishing a network of secondary outpatient health services based on children’s needs; more clear definition of the scope of medical competence regarding paediatric treatment; strengthening the role of paediatricians; and improving access to vision screenings for children. Results are expected by the end of 2031.
The goal is to ensure that the care a child needs is available as close to his or her home as possible while concentrating complicated and specialized services in locations where appropriate expertise and quality can be guaranteed.
Additional reading: audit report summary, infographics.
About the State Audit Office of Latvia
The State Audit Office of the Republic of Latvia is an independent, collegial supreme audit institution. The purpose of its activity is to find out whether the actions with the financial means and property of a public entity are legal, correct, useful and in line with public interests, as well as to provide recommendations for the elimination of discovered irregularities. The State Audit Office conducts audits in accordance with International Standards of Supreme Audit Institutions of the International Organisation of Supreme Audit Institutions INTOSAI (ISSAI), whose recognition in Latvia is determined by the Auditor General. Upon discovering deficiencies, the State Audit Office of Latvia provides recommendations for their elimination, but it informs law enforcement authorities about potential infringements of the law.