The salaries of midwives and nurses in the Latvian healthcare system have long been overlooked, said Linda Veidemane, president of the Latvian Midwives Association, to the LETA agency.
The association has repeatedly urged the Ministry of Health to revise the regulation of midwives' salaries, including establishing a pay category for them that is similar to that provided for occupational therapists and physiotherapists, with a higher legally established minimum hourly rate.
However, over all these years, no significant progress has been made. The current minimum rate of €7.41 per hour is one of the lowest in Europe, emphasized Veidemane. This level is comparable to Romania and Bulgaria, while in neighboring countries - Estonia and Lithuania - the rate exceeds €10.
Commenting on the pilot project for midwives' visits scheduled for this year, Veidemane noted that its implementation will start a little later than planned. Initially, it was expected that mandatory midwives' visits would begin in the spring, but after reviewing the service's provisions, the association requested several clarifications. The association emphasizes that the priority of the service should be the health and well-being of the mother and child - this is the main reason why the project is supported.
According to Veidemane, all stakeholders are currently working on refining the provisions so that the service aligns with previously developed algorithms and goals. The association hopes that the pilot project will launch in late spring or, at the latest, early summer.
The association pointed out the principle of regional coverage included in the provisions, which provides for equal payment for visits regardless of distance. At the same time, in the regions, midwives will have to cover much greater distances to patients and back than in Riga.
According to the association's estimates, although the calculations formally comply with regulatory requirements, there are concerns whether the stipulated tariffs will cover all real costs, as the cost of services in the healthcare system is often lower than the market rate.
Nevertheless, the association is ready to participate in the pilot project to assess in practice whether the service can be provided at the proposed tariff. According to the association, the most important task in implementing the project remains ensuring the well-being of the mother and child.
As previously reported, within the framework of the pilot project "Home Visit by a Midwife," this year one visit will be provided in the third trimester of pregnancy and two visits to the young mother and newborn after childbirth, according to the Ministry of Health's report on the project's progress.
The project will cover 729 mothers in Riga and the regions, with a budget of €100,000 allocated for it.
As stated in the report, the goal of the project is to timely identify psycho-emotional and social risks, improve care for women and newborns, and strengthen the role of midwives during pregnancy and after childbirth. During the prenatal visit, the midwife will assess the health status of the pregnant woman and her needs, and after childbirth - the health of the mother and child, the breastfeeding process, living conditions, and possible risks, including violence and lack of social support.
The first visit is planned to take place in the third trimester of pregnancy, the second starting from the tenth day after discharge from the hospital, and the third - up to six weeks after childbirth, taking into account previous visits. The prenatal visit will last 60 minutes, each of the postnatal visits will last 90 minutes. Co-payment for the service will not be applied.
During the visits, the midwife will assess the psycho-emotional state of the woman using screening questionnaires for depression and anxiety, and if necessary, refer the patient to a psychologist, psychiatrist, or psychotherapist. In case of suspected violence or lack of social support, the midwife will notify the municipal social service or other competent authorities. If necessary, the family doctor will also be informed to ensure an interdisciplinary approach.
The report emphasizes that currently the only specialist monitoring the family's condition after the birth of the child remains the family doctor. A woman is entitled to one visit to a gynecologist within six weeks after childbirth, during which a wide range of issues must be discussed in a short time. Systematic assessment of the psycho-emotional state of young mothers and breastfeeding skills is not provided for in the current healthcare system.
According to the results of a pilot survey conducted in 2023, almost one in eight mothers - 13.2% - reported physical, verbal, or emotional violence during childbirth. Among the serious problems, women indicated a lack of clear and understandable information, absence of staff representation, and insufficient explanations of upcoming procedures. In terms of the quality of care for mothers and newborns, Latvia ranks 13th out of 22 countries that participated in the pilot survey.
According to the report, the cost of one prenatal visit by a midwife is €39.02, and each of the two postnatal visits costs €49.10. The total amount for one patient for three visits is €137.22. The total budget for the pilot project for 2026 is €100,000.
The selection of midwives for the project will be carried out by the National Health Service, which will assess education, certification, completed training programs, and practical readiness to provide home visits. Service providers must ensure that patients have accessible contact information for appointments and be able to respond to individual needs.
The report also outlines the expected outcomes: each participant in the project should receive three visits, including the administration of the depression screening test PHQ-9, as well as an assessment of mothers' and other family members' satisfaction with the service received.
After the completion of the pilot project, it is planned to evaluate its results and prepare proposals for the further implementation of the model, as well as possible sources of its permanent funding.
The project will be implemented until December 31.
