TALLINN, 8 July 2005 - The State Audit Office draws the attention of the Ministry of Social Affairs to the need for paying more attention to the organisation of the healthcare of preschool children, because according to the school healthcare service reports gathered by the Health Insurance Fund, 42% of children of the first year who have been prophylactically examined suffer of a health problem (e.g. posture disorders, being over- or underweight).

However, upon interpretation of the figures it must be taken into account that they are gathered as of 2004 and their submission has not been harmonised in full yet. It must also be taken into account that the analysis covers approximately half of the children of the first year, because only the results of the second half of the year were available.

Nevertheless, the State Audit Office recommended that the Ministry of Social Affairs investigate why such a portion of the pupils has a health problem and in what age these problems have occurred. In his reply the Minister did not inform the State Audit Office whether the Ministry of Social Affairs plans on investigating the reasons of the health problems among the pupils of the first year. He assured that there is no plan for central collection of the general health indicators of preschool children. The Minister referred that in 2008 the Electronic Health Record (EHR) programme will be launched, creating better opportunities for collection of the health indicators of children and it will be the source from where it is possible to receive aggregate information according to the needs.

According to the State Audit Office the large portion of children with health problems refers to the fact that the healthcare promoting the health of preschool children and preventing illnesses among them needs to be organised more effectively. If the health problems are not detected at an early age and they deepen, their treatment may cost the state considerably more in comparison with sums spent on prevention.

The audit also pointed out a threat arising from the fact that family doctors have not examined all children of their service area periodically. The medical examination of children is performed first and foremost by family doctors and advisory guidelines have been developed for that purpose. Since the guidelines are not compulsory, the Health Insurance Fund has a difficult time monitoring adherence to them. There is currently no overview of how many children have been examined pursuant to the guidelines.

Comparing the number of children who are 7 years of age and the number of treatment invoices submitted by family doctors in 2003 it can be claimed that on average 90% of the children have been examined by a family doctor during a calendar year. The situation will be improved by the family doctors' additional remuneration applied as of 2007, which makes the medical examination of children of up to 2 years of age and children who are about to attend school a priority as well as allows for better supervision over adherence to the guidelines. The State Audit Office finds that it is nevertheless necessary to promote regular medical examination of children aged 3-5 as well.

People have got used to the healthcare professional of the childcare institution monitoring the health of their child in addition to the family doctor. However, there is no healthcare professional in 40% of childcare institutions, because it is not mandatory. Healthcare professionals have been given tasks by law, but it has not been regulated whether these tasks have to be fulfilled upon absence of a healthcare professional and who should fulfil them. Due to such vague liability some healthcare tasks remain unfulfilled primarily in childcare institutions where there is no healthcare professional.

In the future the number of healthcare professionals in childcare institutions will fall even further: a quarter of the existing healthcare professionals are of retirement age and young people do not usually come to childcare institutions. Some childcare institutions may give up their healthcare professional because of the lack of money relating to the minimum salary requirement. Therefore, the tasks of healthcare professionals should be revised critically and it should be decided which of them need to be fulfilled and also establish a clear liability of the childcare institution for fulfilling them.

According to the State Audit Office, the provision of qualified healthcare service in childcare institutions is currently not ensured, because most of the healthcare professionals of childcare institutions have graduated from an educational institution a relatively long time ago (54% of them more than 30 years ago), the healthcare professional of childcare institutions receive little in-service training and over a half of them do not meet the official qualification requirement.

In his reply the Minister of Social Affairs declared that the Ministry of Social Affairs will attend to the issues pertaining to preschool childcare institutions in 2006 when the entire health promotion, health protection and healthcare organisation in preschool childcare institutions will be revised.

In its audit the State Audit Office examined the healthcare organisation of preschool children, focusing on the issue of health promotion and disease prevention. To that end the main strategic documents serving as the basis for organisation of planning in the field were analysed. As for the practical side of the organisation, the examination of the health of preschool children by family doctors and the issues related to healthcare professionals of childcare institutions were investigated, because most of preschool children attend a preschool childcare institution (e.g. a crèche, a nursery school).


Toomas Mattson
Communication Manager of National Audit Office
Telephone: 6400 777
Mob: 51 34900
E-mail: [email protected]

• Posted: 7/8/2005 12:00 AM
• Last Update: 9/22/2015 8:46 AM
• Last Review: 9/22/2015 8:46 AM