The context for supply and demand of public online services in Latvia

Situated in north-eastern Europe with a coastline along the Baltic Sea, Latvia is geographically the middle of the three former Soviet Baltic republics. It has a population of 2.3 million at an area of 64.589sq km. The country's government has a two level structure: Central (National Government) and regional/local (7 municipalities containing the larger cities, plus 26 counties in the rural parts of the country). The municipalities are an independent part of the public government.

Latvia has language links with Lithuania to the south and historical and ecumenical ties with Estonia to the north. Not much more than a decade after it declared independence following the collapse of the USSR, Latvia was welcomed as an EU member in May 2004. The move came just weeks after it joined NATO. Latvia was under foreign dominion from the 13th until the 20th century. After the first world war it declared independence but only two decades later Latvia was absorbed into the Soviet Union. During the Soviet period Latvia underwent heavy industrialisation, and experienced a big influx of immigrants from other parts of the USSR, mainly Russia.

Around a third of the population is Russian-speaking and the rights of this section of society have been hotly debated since independence. Ethnic Russians who want to obtain citizenship have to undergo a so-called "naturalisation procedure" which includes tests of basic Latvian and of Latvian history. The government considers it essential for social inclusion that all citizens speak Latvian, because access for example to jobs relies on knowledge of the national language. Other ethnic minorities, together accounting for around 13% of the population, include Belarussians, Ukrainians and Polish.

Key figures about Latvia[1]

	Latvia	Ø EU15	Ø EU25
Old age dependency ratio	23.6	25.5	24.5
Population density	36.5	119.8	116.3
GDP per head	45.3	108.6	100
Growth 5 year average	7.31%	1.85%	1.92%
Unemployment rate	9.8%	8.1%	9.0%
Inequality index	34[2]	30	29

Like its Baltic neighbours, in the 10 years since independence Latvia has made a rapid transformation to embrace the free market. In spite of strong growth in recent years, Latvia's GDP per head is still the lowest in the EU25. Unemployment is high at 10%, and social cohesion difficult to preserve in the face of a widening income divide between those Latvians who are well of, and those who are not. The share of the population at risk of poverty is very high compared to other EU countries (43% before social transfers[3]). The country has also been burdened by a sizeable budget deficit which limits the possibilities for redistribution policies.

Information Society indicators[4]

	Latvia	Ø EU15	Ø EU25
Internet penetration	15%	45%	42%
Broadband penetration	1.5%	7.6%	6.5%
ICT expenditure	7.3%	3.2%	2.6%
Digital Divide Index	40.4	53.0	50.1

Latvia´s performance on the UN Telecom Index[5]

Naturally given the low national income per head when compared to the other EU member states, Latvia is technologically lagging behind with regard to computer and Internet penetration (especially when bandwidth is considered) in private households. Because of high costs in relation to household incomes, a high share of users access the Internet not from home but from a public Internet Access Point (PIAPs).

In recent years, Latvia showed high rates of ICT expenditure, which reflects the ambition of the country's government as well as certain parts of the government to modernise Latvia's infrastructure. Thus prepared, the country aims to exploit the possibilities opened up by EU membership, such as attracting foot-lose foreign direct investment by means of low labour costs. The country can already be said to perform well with regard to ICT infrastructure: the UN's Telecom Index shows that it has a more developed technological base than Hungary, Slovakia, and Poland - all of which are richer than Latvia.

eHealth in Latvia

Latvia has not as yet introduced any significant policy initiative in the area of eHealth development. While the amount of health-related information available online in Latvian language is growing fast, this has not been integrated in any proper way, which means that the value from users' point of view is severely limited.

Latvia's healthcare system suffers from a number of general shortcomings which means that at the moment, main attention of the stakeholders is on solving the most pressing problems rather than exploiting the new possibilities opened up by ICTs. When compared to the rest of Europe, the country has a very high prevalence of long-term illness and a low rate of persons who feel good about their own health. Health expenditure is very low, too, in spite of a high number of doctors per inhabitant.

Key figures about the Latvian Health System[6]

	Latvia	Ø EU15	Ø EU25
Percentage satisfied with own health	62.8%	82.5%	79.8%
Prevalence of long-term illness	27.5 %	13.8 %	20.0%
Doctors per 100,000 inhabitants	278	233	251
Health expenditure as percentage of GDP	2.7 %	7.4 %	7.3 %

There is also an insufficient awareness on the part of healthcare professionals about the potential contribution ICTs could provide for the modernisation of health services. For the time being, of course, the overall low penetration of the Internet among private households means that Internet-based services will not be able to reach the large majority of Latvians.

The lack of progress in eHealth service development is partly due to the fact that there are no significant policies or initiatives which could encourage the provision and usage of eHealth services for the public. At the moment, eHealth services developed by private organisations (such as www.dr.lv) are more advanced than those offered by central government and municipalities.

No health portal has been developed (yet) with financial support of the central government or the municipalities. Some healthcare information is available on the general government portal 'LVonline' under the heading 'Veselba (Health)', as well as on some other public websites such as the website of the capital city Riga (www.riga.lv).

From the private (commercial) sector, there is a website (www.dr.lv) which comes closest to the definition of portal, and which contains the most complete information regarding healthcare available online in Latvia including : a register of Latvian physicians and specialists, a list of professional associations and medical services in Latvia; a discussion forum; information on pharmaceuticals, insurance issues, providers of medical goods and pharmacies, and links to relevant websites.

On the website of Health Promotion Centre the 'Public health strategy' is outlined. A special website is available for people suffering from diabetes (www.diabets.lv). Most healthcare institutions (hospitals, policlinics, private physicians, etc.) have set up their own websites by now.

Satisfaction with National Healthcare System[7]

No health-related administrative transactions can be carried out online in Latvia. The same applies to the availability of online pharmacy services and online diagnosis in Latvia.

Because many physicians have e-mail addresses, consultation via e-mail is possible in principle, but it is not used to any significant extent in practice because preference usually will be given to interaction through the telephone or face-to-face. Specific policies or regulations with regard to telephone-based or online consultation do not exist in the country.

User orientation in eHealth services

The development of eHealth services in Latvia is still in its infancy. The attention paid to eHealth by the government is insufficient. The list of eHealth services offered to the public is rather poor and arguably does not properly address the needs of patients. Having said that, it should be noted that the present state of eHealth reflects the current situation of the country's healthcare system in general. Due to insufficient financing and inefficient management of the healthcare system, neither physicians nor patients are satisfied with the present state-of-the-art in the sector. Both groups ask for a reform of the healthcare system, in which ICTs can play an important role.

This may also explain the fact that in spite of low Internet penetration in general, in 2003 about 8% of the adult Latvian population already used the Internet to search for health-related information. Apart from dissatisfaction with the current state of the healthcare system, a number of other factors may in future encourage implementation and uptake of eHealth services. For instance, there is high interest among some forward-thinking physicians in ICT and ICT applications for the purpose of improving their work of and offering better services to their patients. Moreover, there is the possibility but also the willingness to gain from experience with eHealth services made in other countries, especially from the European Union.

Internet Use for Searching Health Information[8]

User orientation in eHealth services will have to take account of the main health-related concerns of citizens in Latvia. These include the lack of trust in the correctness of diagnoses by family doctors or other specialists; low satisfaction with the quality of medical treatment in general; high interest in finding information on self-diagnosis and self-treatment; strong demand for new generations of medication which have entered the market only recently; and strong demand for more choice with respect to practitioners.

eUser - the Project

The eUser study is funded by the European Commission's IST (Information Society Technology) programme. eUser is a major research and support project which has set out to provide solid evidence as to users' real needs regarding eGovernment, eHealth and eLearning offers, as well as providing data about their attitudes and the uptake levels of current public online services. The project supports the IST programme to achieve its key objectives of putting the user and his/her needs at the centre of IST developments. It provides empirical information on key public eServices domains -eGovernment, eHealth, eLearning - identified as priorities by the European Council, and assesses the demand/supply match in these fields.

The eUser Approach

To achieve its objectives, eUser addresses both generic user-related issues and domain-specific topics, and develops a globally accessible repository of evidence-based knowledge, methods and best practice examples. It pursues an extensive programme of active knowledge translation, transfer and dissemination supported by sophisticated online knowledge dissemination tools. The knowledge base will consolidate both existing knowledge and approaches, and novel data generated by the project through representative population surveys (demand side) in old and new Member States, and through comparative analyses of readiness to address user aspects of public eServices in each Member State (supply side).

The project is designed in two phases. Phase I - the preparatory phase - has developed a conceptual framework that systematically identifies and cross-references user issues and service characteristics in relation to online public services. An EU-wide population survey regarding the needs, experiences and requirements of both current and potential users of online public services has been carried out in early 2005. Concerning the supply side, information from national public sector environments has been collected, about the degree to which the European public sector pays sufficient attention to user-orientation of online services. Good practice examples regarding user-appropriate online public service provisions are being identified and described.

All these results build the basis and provide content for the eUser interactive online knowledge base and support service which is being set up as an online observatory on user issues. This constitutes the basis for active support services on user-centred topics which are being made available inside and outside the IST programme.

eUser Country Briefs

This document has been prepared by empirica based on information provided by a National Correspondent (Prof. Dr. Arnis Gulbis, Riga Technical University) as well as secondary data sources such as Eurostat and other Commission Services.

25 eUser eHealth Country Briefs are available in a common format, one for each member of the enlarged European Union. You can access and download these documents in PDF format (for free) from our website.

Notes About the Data Sources Used in This Document