Policy responses for Latvia - HSRM


Policy responses for Latvia

5. Governance

5.1 Governance

The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.

Due to rising infection rates in autumn 2020, the Latvian government declared a state of emergency throughout the country for four weeks, from 9 November to 6 December 2020. The detailed measures are described in Section 1.2 Reimposition of stricter measures: Physical distancing. Further, all municipalities are obliged to provide free reusable face masks to socially protected groups. 

The Cabinet of Ministers extended the state of emergency until June 9, at the same time deciding on the gradual abolition or reduction of certain restrictions.
From 12 May, restrictions will be eased in the areas of education, sport, the organization of various events, transport and tourism. (see “Transition measures: measures in other sectors)
The Parliament (Saeima) has adopted a Law on Measures to Overcome the Crisis caused by Covid-19, in force from 10.06.2020. (https://likumi.lv/ta/id/315287-covid-19-infekcijas-izplatibas-seku-parvaresanas-likums)
The purpose of the law is to restore the general legal order after the end of the state of emergency (on June 9) by providing appropriate measures to overcome the crisis caused by the Covid-19 infection and special support mechanisms and expenditures to improve the economic situation and promote economic stability. (see “Transition measures: measures in other sectors)
In the future, the regulations of the Cabinet of Ministers will focus on individuals who work with patients, social care centers and children in schools or kindergartens, who will have to observe special precautionary regulations. If they are designated as a contact person or have to comply with self-isolation, they will have to inform their employers and they will be prohibited from going to work.

• The Prime Minister, who chairs the Crisis Management Council for the Spread of Coronavirus, is providing the governance of COVID-19 at national level. The Minister of Health chairs the National Commission for Operational Medicine (NCOM), which meets on regular basis and takes decisions according to the current situation. NCOM is a consultative and coordinating body whose purpose is to ensure the coordination of health institutions in the case of an emergency medical situation and a public health emergency. NCOM is made up of representatives from Ministry of Health, National Health Service, Emergency Medical Service, Riga Eastern Clinical University Hospital, Center for Disease Prevention and Control, Pauls Stradins Clinical University Hospital, State Agency of Medicines, National Blood Donor Center, Health Inspectorate, National Forensic Medicine Expertise Center and Children's Clinical University Hospitals.
• The health system’s functionality during emergency situations had already been set by the National Disaster Medical Plan and Hospital Disaster Medical Plans. Usual guidance documents of health care institutions related to hygiene and epidemiological surveillance (supervised by the CDPC and Health Inspection) lay down requirements for premises, hand hygiene, staff, use of personal protective equipment, treatment of medical devices and materials, organization of the circulation of laundry, and guidelines for the epidemiological surveillance of infections in the establishment. Each institution in health system has algorithms of action in case of emergency situations, including pandemic, which have been activated and up-dated according to the situation related to COVID-19. 
• Specific processes have been initiated by the Emergency Medical Service (EMS), which initially had the leading role in detecting infection cases. The processes of the EMS have been regularly redesigned to deal with the scale and geographical distribution of the current pandemic outbreak. Initially the EMS made calls to people who have flu-like symptoms and who had recently been to China or have been in close contact with someone who has been there, tested suspected cases at home and sent tests to the National Reference Laboratory. As the situation evolved, the EMS introduced an additional hotline (8303) in addition to the direct line 113, for which citizens can apply for testing. The EMS continues to register the patients for testing in mobile points, but the EMS team continues to visit patients with severe COVID-19 symptoms.
• Due to national emergency situation, goods and services to control the spread of the COVID-19 outbreak can be purchased without a procurement procedure. This applies to State Owned Companies, Emergency Medical Service, National Security Agency, State Police, National Fire and Rescue Service, State Border Guard, Ministry of Interior Information Center, State Revenue Service, Ministry of Foreign Affairs and Ministry of Defence.
• The main bodies coordinating the monitoring and surveillance are Ministry of Health, CDPC (reporting to the WHO and EU, tracing contacts), EMS (coordinating testing) and the NHS (organizing central procurement of medical devices and goods).