When auditing annual consolidated financial statement for 2022, the State Audit Office of Latvia has concluded that with the additional funding of 846,682 euros allocated to the Ministry of Health (MOH) as part of a priority measure last year to ensure state-paid healthcare services for children with autism spectrum disorders (ASD), the planned results have not been achieved in practice, namely, 82% or 696,208 euros of the allocated funding was redistributed to pay for other healthcare services, by providing services for children with ASD in a significantly smaller amount than planned, and their availability outside Riga was very limited.
BRIEFLY
- 82% or 696,208 euros out of additional 846,682 euros allocated to the Ministry of Health (MOH) as part of a priority measure last year intended for healthcare services for children with ASD were redistributed to other services.
- There is a critical lack of various support services for children and families in the country as a whole; particular service availability restrictions in regions of Latvia.
The auditors consider that setting achievable performance indicators and requesting funding for the introduction of state-paid healthcare services for children with ASD, the Ministry of Education has not evaluated sufficiently whether the set indicators are actually possible to achieve. “Nowadays, ASD is being talked about increasingly openly in society. Early ASD diagnosing, treatment and rehabilitation is an opportunity to reduce the manifestations of these disorders, promote the child's development and improve his or her functioning and inclusion in society. Unfortunately, this situation clearly demonstrates that the reason for the lack of services is not always funding, as it does not solve the problem by itself, it is important to use it for the specific purpose, therefore the ministry should get involved in time so that the progress takes place and this goal is achieved within the planned period,” indicated Ms Maija Āboliņa, Council Member of the State Audit Office.
One must emphasize that there is a critical lack of various support services for children and families in the country as a whole. For example, during audit "Problematic children: a mirror of adult inertness", one has found that children with behavioural disorders or the risk of developing them and their families do not have access to sufficient services neither before a child has developed behavioural disorders, nor when behavioural disorders have already arisen, moreover, comprehensive services for this have been found only in Riga. Here is the data collected by the auditors of the State Audit Office on the (in)availability of services in all local and regional governments in Latvia https://lrvk.gov.lv/lv/revizijas/problemberni-powerbi.
In addition, one should note that the State Audit Office of Latvia detects cases during financial audits year by year where a part of the allocated but unused funding is redistributed to other measures during a year. "Such action is not oriented to achieve the goals set during budget planning but serves as a "tool" to increase available funding in an industry as a whole. We evaluate this critically, especially if the problems that one initially commits to solve within the framework of priority measures have been unresolved for a long time and are significant in society,” explained M.Āboliņa.
Within the framework of the priority measure, the funding was intended to provide both state-paid services for children with ASD such as diagnosing and psychosocial rehabilitation, as well as clinical methodical management. However, in 2022:
- ASD diagnostic services for children are provided to 395 unique patients, or 47% of the planned amount, moreover, 86% of services are provided in one medical institution in Riga;
- Psychosocial rehabilitation services for children with ASD began to be provided only in the second half of the year and only in one medical institution in Riga, where they were provided to 30 unique patients, although the operation of 15 specialist offices was planned in 2022.
Unfortunately, state-owned limited liability company "Children’s Clinical University Hospital" was the only institution that provided psychosocial rehabilitation services for children with ASD. This situation clearly demonstrates the limitations of service availability in the regions of Latvia.
Although measures have been taken in 2022 to ensure state-paid services for children with ASD, their availability is still limited even at the beginning of 2023. Also, there is no publicly available information about the possibilities of receiving state-paid psychosocial rehabilitation services for children with ASD or duration of waiting list.
As the Ministry of Health has informed after the audit, the National Health Service plans to announce the selection of medical institutions to provide psychosocial rehabilitation services for children with ASD also in other medical institutions, and the program of the mentioned services will be implemented based on the concept developed by state-owned "Children's Clinical University Hospital" Ltd within the framework of a methodological work contract. On the other hand, state-paid ASD diagnostic services are available in 8 medical institutions in 2023, and services are planned to be provided in two more institutions.
State Audit Office recommendations #PēcRevīzijas
After the audit, the Ministry of Health was made one recommendation to improve the healthcare of children with ASD, which would enable children to develop communication and selfcare skills to fit into society.
Additional information
- Autism spectrum disorders (ASD) is one type of developmental disorder that belongs to the broader group of neurodevelopmental disorders. Clinically, this syndrome is characterized by difficulties in social communication, social interaction, stereotyped behaviour patterns, and restricted interests. With an average global prevalence of around 1% in both children and adults, ASD is a lifelong disorder that affects the way a person communicates with others and sees the world around them. Early diagnosing, treatment, and rehabilitation of ASD improve further psychosocial prognosis significantly.
- Audit report summary, recommendation implementation timeframe, etc.
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 Organization of Supreme Audit Institutions INTOSAI (ISSAI), whose recognition in Latvia is determined by the Auditor General.
100 years of AUDIT STRENGTH
On 16 August 2023, the State Audit Law will turn 100 years old. With the adoption of this Law, the State Audit Office from a formal de facto institution founded on 2 December 1918 became a de jure independent, collegial supreme audit institution of the Republic of Latvia. The State Audit Office is one of the independent state institutions enshrined in the Satversme (Constitution) of Latvia. The Constitution was signed by Roberts Ivanovs as the secretary of the Constitutional Assembly, who was then confirmed as the Auditor General. He worked as the first Auditor General for 12 years. His signature confirmed the text of our Constitution alongside that of Jānis Čakste.
Additional information
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