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CHILDREN AND DISABILITY IN LATVIA

Co-ordinators: Edmunds Vaskis and Anita Švarckopfa

Central Statistical Bureau, Riga

MONEE Country Analytical Report 2002

The opinions expressed are those of the authors and do not necessarily reflect the policies or views of UNICEF.

UNICEF Innocenti Research Centre Piazza SS. Annunziata, 12 50122 Florence, Italy webs i te : www.unicef - i cdc .org


MONEE ANALYTICAL REPORT 2002

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CENTRAL STATISTICAL BUREAU OF LATVIA

MONEE COUNTRY ANALYTICAL REPORT

2002


RIGA 2002



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The report “Children and disability in Latvia” was prepared by the staff of the Central Statistical Bureau and Ministry of Welfare:

Daina PodziĦa Solveiga SiliĦa

Baiba Zukula Dace Krievkalne

Editor and Publisher in Chief Anita Švarckopfa Responsible for the English translation Zane Ozola

Explanation of symbols

- Zero

… Data not available or too uncertain for presentation



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CONTENT

INTRODUCTION............................................................................................................................ 4

PART I. CHILDREN WITH DISABILITY : WHO ARE THEY?................................................................ 6

PART II. GOVERNMENT RESPONSIBILITIES FOR CHILDREN WITH DISABILITY ............................... 10

PART III. INSTITUTIONAL AND PUBLIC CARE OF CHILDREN WITH DISABILITIES ............................. 15

PART IV. CHILDREN WITH DISABILITY IN FAMILIES AND IN COMMUNIT IS ..................................... 17

ANNEX ...................................................................................................................................................... 24



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CHILDREN AND DISABILITY

INTRODUCTION

In the last eleven years since the restoration of independence Latvia has achieved striking results in the creation of an economic system that would suit the independent state in its transition to a market economy. Now we are on the threshold of joining the EU and NATO and this means that our progress in the development of the state, society and economy has won international recognition.

Economic changes have made a deep impact on the daily life of every inhabitant. At the same time society is not in the least unanimous in the assessment of the results achieved. At present the most important problem in society is the contradiction between the low level of satisfying the social needs and the limited resources of the society. Unfortunately there are objective grounds for that as despite the most rapid growth rates in recent years the gross domestic product still represents only ¾ of its level in 1990. At the same time the country had to increase financing for the creation and maintenance of government institutions as well as for defence as befits an independent country.

Like other countries, Latvia has declared as one of its principles “equal opportunities to all”. Is this really so? To evaluate a system usually the weakest link in the chain is tested. In Latvia, families with children represent such a link. But one of the most sensitive segments in this link is a child with disability.

On one hand, much has been done in Latvia to put the declared promises into practice. The reform of welfare in Latvia was initiated in 1996. Latvia is one of the few countries that have adopted a special law on the protection of the rights of disabled persons, which in equally the same way applies to disabled children. Additional norms protecting the rights of disabled children are included in the Law on the Protection of Children’s Rights. Article 54 of this Law lays down that “a child with special needs like any other child shall have the same right to an active life, the right to develop and obtain general and vocational education in accordance with his or her physical and mental abilities and wishes as well as the right to participate in the life of the community”.

Within the framework of state programmes medical aid to children with disability is provided free of charge. Children with certain disease and diagnosis groups are also granted 2nd stage medical rehabilitation services free of charge.

Have the norms included in the laws been really able to ensure equal participation of disabled children in the life of the community? It is not possible to give a definite answer. Like in the society as a whole, the implementation of law-guaranteed measures quite often is not only adequate to legislation but also to the real possibilities of the society. In other words, conceptions and state programmes are adopted but as a result there is not a firm guarantee that a family with a disabled child will have a possibility to make use of them.

No optimum model for the distribution of responsibility and financing has been found in the country for the implementation of social programmes. There is a range of care institutions for disabled children part of which are subordinated to the central government and the other part to local governments.

Local governments, in turn, are often not only short of resources but their institutions are not adapted to the needs of children with disability and there is a lack of qualified workers for fulfilling these functions. The distribution of social care services in central and local government institutions create a situation where local governments are interested to make decisions about the provision of services in a state institution thus reducing their expenditures for care.



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Emphasis in the care of disabled children is traditionally laid on the institutional care that is not always economically substantiated and does not either foster integration of disabled children into society. The alternative forms of care of children with disability are underdeveloped. It is necessary to develop the institution of guardianship and foster families that would specialise in the provision of care to children with disability.

The level of medical and social rehabilitation is on the whole not appropriate to the needs of children with disability. The provision of medical rehabilitation services to disabled children with limited possibilities to receive these services creates difficulties, moreover their parents have to pay for the stay at the medical rehabilitation centres and quite often this is beyond their financial possibilities.

The integration of children with disabilities into general schools creates difficulties. Many children who graduate from the institutions of special education confront problems with mastering their speciality.

For the solution of these problems experts suggest that co-ordination should be improved among the social care institutions, various public organisations and local governments. No separate institution set up solely for the protection of the rights of disabled children has been established. All issues are solved within the framework of the existing institutions (medical rehabilitation centres, social care services and custody (pagasts) courts, the Children’s Rights Protection Centre, the Board of School Administration, the Human Rights Bureau and others). It should be noted that the co-ordination of work among these institutions might have been better. Within the sector of non-governmental organisations the process of founding public organisations is still under way.

In practice no system has been formed that would foster co-operation both between various interested institutions and between the institutions and parents. The complicated structure of institutions and insufficient information in families lead to the fact that families with disabled children are insufficiently informed about the possibilities to solve their problems as well as about treatment opportunities which are of particular importance in rural areas.

Meanwhile the number of children with disabilities tends to go up year by year. By the type of disability, severe pathologies predominate in the number of registered children with disability.

No comprehensive database of disabled children has been built as a result of which complete statistics for the evaluation of this problem are not available. Information on the living conditions of families with children and their economic resources is also lacking.

These are the matters that demand solution. The way to the solution of the situation is to get information about the existing problems. Due to the compilation of all available information in the country, this report provides an insight into the problem and it is hoped that it will allow the government together with local governments to better co-ordinate their work aimed at the solution of problems of children with disability.



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Part I

CHILDREN WITH DISABILITY: WHO ARE THEY?

One of the basic legislative acts applying the term “disabled child” is the Constitution of the Republic of Latvia (article 110 in the chapter “Basic Human Rights”), which lays down that “the government provides particular support to disabled children who are left without parental care or who have been victims of violence”.

The precise definition of and comment to the term “disabled child” are not given in any of the legislative acts. Article 4 of the Law on the Medical and Social Protection of Disabled Persons says that “a disabled person is an individual who due to a functional bodily disorder caused by a disease”, injury or congenital defect needs additional medical and social assistance and whose disability has been determined by this Law or any other normative act in the established order whereas article 5 of the same Law “The Concept of Disability” states that disability is a lasting limitation of physical and mental abilities within the human body (not related to advanced age) hampering the individual’s integration into society, fully or partly depriving that individual of the ability to work and to take care of himself/herself. In this Law the term “disabled child” is not used save for the fourth part of Article 10, which lays down that “disability of children of up to 16 years of age is determined by the attending doctor. After reaching 16 years of age disability is determined in the established order of the Law. Thus the concept of disabled person is also attributed to children with disability and the Law does not specify the status of a child with disability but employs the general concept.

In the area of education the term “ a person with special needs” is applied. Article 7 of the Law on Education specifies that one of the main target groups in education is formed by persons with special needs; article 42, part (1) of the special education programme says that a person with special needs can obtain special education in an education institution if this institution ensures a possibility to obtain appropriate education in accord with the state of health and the nature of developmental disorder. (2) Special education programmes are implemented considering the state of health of the learner. Article 49 of the Chapter VIII “Special Education” says that (1) special education programmes ensure the acquisition of general practical labour skills and vocational education to learners with mental and physical disorders and special needs (henceforth learners with special needs). The term “person with special needs” covers not only disabled children but also those persons whose disablement has not been established.

In Latvia, there is another term “child with specific needs” used in legislative acts. Article 53 “The concept of a child with specific needs” in chapter VIII “Child with specific needs” of the Law on the Protection of Children’s Rights lays down that “a child with specific needs is a child who due to a functional bodily disorder caused by a disease, injury or congenital defect needs additional medical and social assistance regardless whether disablement has been assigned in the established order laid down by the Law or not”. At the first glance the definition is identical to the concept of disabled person as given in the Law on the Medical and Social Protection of Disabled Persons, however, there is a substantial difference. Any child who needs additional medical or social assistance (for example, children with chronic diseases) can be considered as a child with specific needs although such children are not recognised as disabled. To a certain degree, there is a contradiction in some norms of the Law on the Protection of Children’s Rights (specifically in Articles 53 and 55 (part 2) as part 2 of Article 55 says that “the central or local government helps the child with specific needs to integrate into society and provides medical and social services in accordance with the Law on the Medical and Social Protection of Disabled Persons. The latter law, in turn, refers to persons who have been assigned disability in the established order of the Law.



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According to the Law on the Medical and Social Protection of Disabled Persons adopted on 29 September 1992 (amendments on 3 October 1996), the disability of children aged up to 16 years is determined by the attending doctor on the basis of medical indications, which are confirmed by Regulation No. 424 dated 27 December 1999 of the Ministry of Welfare “On medical indications for establishing disability of children aged up to 16 years”. For children at the age of up to 16 years disability is established by a single doctor on the basis of health criteria.

After reaching 16 years of age, disability is determined through expert assessment made by the general and special profile Physicians` Commission for Health Control and Professional Capacity Experience in accordance with Regulation No.263 of the Cabinet of Ministers “The procedure of expert assessment of disability by the Physicians` State Commission for Health Control and Professional Capacity Experience”.

Discussions have started in society on whether it is necessary to match the child’s age with the UN Convention on Children’s Rights and the definition therein that a child is a person who has not reached the age of 18 years. In the 2nd half of 2002 the Ministry of Welfare prepared and the Government accepted amendments to the law that envisage a uniform order of the establishment of disability for children aged up to 18 years. Beginning on 1 July 2003, the Physicians` Commission for Health Control and Professional Capacity Experience will decide on the disability of children but at the same time the previous procedure whereby the severity of disability for children aged up to 16 years will not be indicated remains unchanged. After reaching the age of 16 years the severity of disability is determined and it will also be done in the same way in the future: severe disability (disability groups II and I) and moderate disability (group III). In compliance with the normative acts, after reaching the age of 16 years the cause of disability is indicated and in almost all cases it is “disability since childhood”.

Official statistics on disabled persons is incomplete and fragmentary. Within the limits of information at their disposal, several institutions make records of disabled children. The Register of disabled children that is being built by the National Rehabilitation Centre “Vaivari” contains records of disabled children at the age of up to 16 years. However, the data of this register are incomplete as physicians from several regions of Latvia have not submitted their conclusions about the state of health of the disabled children and in regard of children aged 16-18 years there is no directive about the necessity of these conclusions.

The following information is available at the institutions that are under the supervision of the Ministry of Welfare:

- the number of disabled children in the institutions of social care comprising also the 19-year olds and older;

- the number of disabled children aged up to 16 years for which additional payment to the state family allowance has been granted; the analysis in the current report is based on this information.

Unfortunately it is not possible to include in the total number of disabled children those children whose age is from 16 to 18 years and who receive the social security allowance (due to the accounting problems it is not possible to separate these children from the total number of beneficiaries). Imperfections in the accounting of disabled children emerge in comparing information from the above data sources (Table 1).



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Table 1 Number of disabled children,

at the end of the year

1995 1996 1997 1998 1999 2000 2001 Number of disabled children in the institutions of social care

723

748

735

798

795

805

760

Number of disabled children for which additional payment to the state family allowance was granted

6467

7028

7342

7835

8378

8697*

8965 Total 7190 7776 8077 8633 9173 9502 9725 For reference: number of disabled children in the Register of Disabled Children

6637

7690

8007

8628

8461

8591

8556 * Data on 01.10.2000.

According to statistics (Table 2), the number of children with disability tends to increase year by year. The years 1990-1993 were particularly noteworthy when the increase in the number of children with disability was particularly pronounced. The increase can be explained by the adoption of the Law on the Medical and Social Protection of Disabled Persons and the elaboration of the list of medical diagnoses (by supplementing the list of diseases and pathological conditions from the soviet era on the basis of which the disability of children was determined).

Table 2 Number of disabled children,

(in families that were granted additional payment for a disabled child) at the end of the year

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

2612 3874 4847 5445 5923 6467 7028 7342 7835 8378 8697** 8965 * Source: State Social Insurance Agency. ** Data on 01.10.2000.

The Register of Disabled Children provides information on the kinds of disability.

At the end of 2001 there were 8556 children recorded in the Register of Disabled Children. Upon reaching the age of 16 years, other conditions come into force for assigning disability. Beginning with full 16 years of age, the Physicians` Commission for Health Control and Professional Capacity Experience examines the patients and assigns the disability group. In 2001 774 adolescents were examined; of these 643 were assigned one of the disability groups. Disability was not assigned to 131 adolescents representing 17% of all examined children during the year. This indicator tends to go up (Table 3).

Table 3 New cases of disability established at the age of 16 years

Of which Of which Disability group Disability not established

Patients examined,

total males females I II III 0 group

1995 488 274 214 75 242 149 22 1996 526 299 227 72 232 187 35 1997 534 308 226 74 229 193 38 1998 679 397 282 76 292 251 60 1999 720 402 318 79 249 313 79 2000 784 453 331 96 274 309 105 2001 774 431 343 86 253 304 131

Disability of children aged up to 16 years is determined on the basis of the list of diseases and pathological conditions in compliance with the International Statistical Classification of Diseases and Health Problems, Rev.10 (ICD 10). Although not yet completed, updating of the Register of



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Disabled Children is gradually improving. To some extent the blame can be laid on the family doctors and paediatricians who do not send the respective documentation on disabled children to the Register of Disabled Children. There are also faults with putting the database in order after the children have reached the age of 16 years (removal of children from active care). These are the reasons why certain caution is needed in analysing the number of newly registered children as well as the breakdown of these children by groups of diagnoses.

In regard of the kind of disability, nervous and sence diseases (30.2% of the total registered children) predominated in 2001 in the number of registered disabled children, followed by congenital malformations, deformations and chromosomal abnormalities (27.4%). Mental and behavioural disorders comprised the third largest group of diseases (13.9% of the total number of the registered children). Disability with the diagnosis retarded mental development was established to 90% of children within this disease group (Annex Table 5). It is worth noting that in general problems persist in the treatment of mental disorders that are investigated by the Latvian Centre of Psychiatry and institutions under its subordination such as the hospitals of mental and neurological diseases and health centres. In order to solve the problems, the experts suggest that improvements should be made in the co-ordination of institutions of social and health care, various public organisations and local governments.

With the objective to investigate the problems related to disabled children, a survey “Disabled children in Latvia” by the order of the Ministry of Welfare was conducted in 1993 (implemented by the JSC “Viedoklis”). As a result of the survey the following problems were identified:

- There is no uniform social policy including solution finding to the problem of disabled children in the country; the medical and rehabilitative level on the whole does not correspond to the needs of the disabled children;

- Among the needs for services, the most important are the material (including financial) and medical needs. The level of satisfying these needs is not adequate to legislation and pretty often does not correspond to the real possibilities of society.

- It is not possible to say clearly how many disabled children are covered by the current system of education and vocational training; in practice there is no vocational training system with an appropriate material base for the children with disability; information on home training and education is practically non-existent;

- There is a lack of qualified experts for the implementation of medical rehabilitation of children with disability (including experts in the management of social work); the issues about working out a theory on social work and its practical implementation are also of vital importance to Latvia as is the improvement of curricula and methodology for the education and vocational training of children with disability;

- The rights of children with disability as well as specifics of these rights in the legislation of the Republic of Latvia are not covered in full. The majority of legislative norms are oriented toward adult disabled individuals. In the areas of education and employment the rights of children with disability are most defective.

- There is no comprehensive database in Latvia on disabled children and their problems. The existing information is incomplete, contradictory and very often it is accumulated and used only in the framework of one department.

- The families of children with disability are poorly informed about the possibilities of solving their problems.

The majority of problems mentioned in the survey are solved by means of legislative acts adopted by the government.



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Part II

GOVERNMENT RESPONSIBILITIES FOR CHILDREN WITH DISABI LITY

All those rights that are mentioned in the Law on the Medical and Social Protection of Disabled Persons apply to a disabled child - the right to medical aid, the right to social assistance, the right to receive assistance in matters of employment, the right to receive assistance for fostering social integration and the right to material assistance.

The Law on the Medical and Social Protection of Disabled Persons, the Law on Social Assistance, the Law on General Education and other laws define the responsibility of central and local governments. Article 3 “The Medical and Social Assistance Programmes” of the Law on the Medical and Social Protection of Disabled Persons lays down that the medical and social programmes for disabled persons are financed from the state budget while disability treatment, rehabilitation of disabled persons and social protection are the responsibility of all-level local governments or their institutions with financing coming either from the resources of the central government basic budget or local government budgets. The Law gives the right to social assistance to children with disability, that is, the assistance necessary to eliminate disability or curb its progress, reduce the influence of disability so that the individual can take care of himself / herself and occupy a position in society that would align with the individual’s wishes and abilities.

The Law gives to persons with severe disability the right to use public transport without charge, the right not to repay interest on loans if the loan was granted for the adaptation of the dwelling. The same article lays down the rights of local governments to allocate cash and in-kind benefits and provide other social assistance in keeping with the laws and other normative acts and local government budgetary resources.

The responsibilities between the central and local government are divided in the following way: - central government is responsible for health care and rehabilitation as well as social assistance

that includes state social benefits, social care, alternative care, social rehabilitation services - provision with auxiliary technical aids and vocational education.

- local governments are responsible for social work with the family, execution of the individual rehabilitation programme, educational possibilities and their implementation, integration possibilities including the opportunity to take part in cultural and sports events.

A more detailed division between central and local government responsibilities is laid down by special laws.

Medical aid includes outpatient treatment at home or inpatient treatment in a hospital or the use of medication and methods and provision with technical auxiliary devices, which this law has defined as “prostheses, hearing aids and other auxiliary devices including the means of transportation, namely, wheelchairs”.

In the provision of assistance for fostering social integration the state is responsible for the design of buildings for general use and new public transportation systems taking into account the needs of disabled persons whereas local governments are responsible for the provision of educational possibilities supplying education institutions with specially adapted inventory and auxiliary technical devices for disabled persons, assistance in improving the conditions in the household including the living conditions, solution of everyday problems, care of immobile disabled persons and activities aimed at fostering and alleviation of communication of disabled persons with the rest of the community, assistance in attending cultural events and organising sports contests.



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On 4 May 1990 Latvia signed several international documents that regulate the rights of disabled persons: the UN Declaration of 20 December 1971 on the Rights of Mentally Retarded Persons and the UN Declaration of 9 December 1975 on the Rights of Disabled Persons. On 30 June 1998 the Cabinet of Ministers of the Republic of Latvia (protocol No.34) accepted the Conception “Equal Opportunities for All”; the conception was worked out with the participation of representatives from various ministries, institutions and public organisations. Several factors accounted for the necessity of the Conception:

- the law “On the Medical and Social Protection of Disabled Persons”, - reorganisation of the social security system that was commenced in 1995 and exerted profound

influence on disabled persons, - the possibility of problem solving for disabled persons under the changing socio-economic

conditions.

The Law on Medical Treatment and the subordinated legislative acts lay down the following general issues:

- the right of parents to freely choose the attending doctor; - exemption of children (including children with disability) from patient’s and membership fees; - the right to recompensed pharmaceuticals;

In view of economic difficulties (lack of resources), the most acute problems in the health bloc are related to the possibility of receiving rehabilitation services (quotas established by the State Compulsory Health Insurance Agency on state budgetary resources, lack of rehabilitation experts, the number of rehabilitation institutions, their location and accessibility).

The Law on Social Assistance draws a clear-cut distinction between the responsibilities of central and local governments concerning the social care of children (including children with disability) and other services.

According to Articles 6 and 7 of this Law, central government is obliged to pay state social benefits and implement government programmes, maintain children whose parents are not known, provide a possibility to receive social care and rehabilitation services at the homes and centres for children with mental disorders, orphanages and provide a possibility to receive social rehabilitation services to children who have been victims of violence.

Local governments are obliged, depending on their possibilities, to broaden the range of social assistance services to the population.

The responsibilities of local governments in the provision of social assistance to children are as follows:

- assessment of the family income and property, - payment of local government social benefits, - social assistance to orphaned children and children left without parental care and, if necessary, placing

them in institutions for upbringing of children, - provision of a possibility for children with disability to receive social care and rehabilitation services,

home care to persons with mental or physical disorders, - provision of a possibility for persons with mental disorders to receive the services of day care centres, - provision of service apartments to those persons who are in need of special social care obliging local

governments to conclude contracts with other providers of services if the given local government has not the respective institution.



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On the basis of the principle that everyone must respect the needs of other members of society and that everyone has the right to see his needs respected, the objective of the conception “Equal Opportunities for All” is to delineate the basic viewpoints to create equal opportunities for all members of society to take on that role that depending on the age, gender, social and cultural factors is normal for each individual. The practical side of the conception is to determine the actual steps and measures to preclude the hampering factors and materialise this objective in life – to create a society with equal opportunities for all, including disabled persons. The Conception was worked out for the period of up to 2010 and as a result of its implementation:

- the system of social security will be upgraded; - a system that will ensure uninterrupted rehabilitation process will be created, - irrespective of the age, status and other factors, an individual will be able to receive the

necessary services, - self-confidence and self-determination of people with disability will be restored, - possibilities for the people with disability will be raised allowing them to perceive themselves as

full-fledged members of society and ensuring as far as possible for them a full and active life, and taking into account the severity of disability, the needs and wishes of disabled individuals.

After confirming the Conception “Equal Opportunities for All”, the Cabinet of Ministers obligated the National Council of Disabled Persons` Affairs to follow the introduction and implementation of the Conception. The aim of the Council is to promote equal and full integration of disabled persons into the economic, political and social life of the society. Its main tasks are to foster the development and implementation of laws, legislative acts, programmes and individual projects and to follow and evaluate the activities of those legal and natural persons whose areas of competence are medical and social care of disabled persons, medical, social and professional rehabilitation as well as provision of services to disabled persons and to submit proposals for the improvement and perfection of activities, to evaluate the problems of disabled persons in the country and to provide the respective information. The interests of children with disability in this Council are represented by the public organisations.

The reform of welfare in Latvia was initiated in 1996. To achieve the objectives of the reform, the Ministry of Welfare developed a conception the purpose of which was to find a solution of how to satisfy the customers` needs effectively taking into account the fact that the majority of social care services are offered in the form of institutional care. The lack of diversity in local government services is often motivated by a lack of resources for the introduction of new services.

The task of the Ministry of Welfare of the Republic of Latvia is to create the country’s social security policy and to draft and introduce legislation for the implementation of this policy:

1. To work out the country’s policy in the area of social security and health care.

2. To have a good knowledge of and by means of political, economic and legal instruments seek solutions to:

- the issues of social insurance, social care and social assistance, - the issues of health care and protection as well as those of public health and pharmacy, - problems related to labour and labour protection and employment and unemployment.

3. To work out the country’s demographic policy and to co-ordinate its implementation; to promote the co-ordination of the national legislation in social security as well as its harmonisation in compliance with the requirements of the European Council and European Union.

4. To ensure the satisfaction of claims as laid down by the Law on the Budget and Financial Management regarding the compilation and submission of the budget proposal, budget performance and the control of the effective and economic use of budgetary resources.



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In regard of the social care institutions for children the Law on Social Assistance lays down the responsibility of the central and local governments for the social care institutions for children. The central government assumes responsibility on and finances children at the age of up to 2 years, children with disability at the age of up to 4 years, the social care institutions and the specialised social care centres for children with severe mental disorders at the age of up to 18 years. Local governments establish and finance institutions for children beginning from 2 years of age and children with disability from 4 years of age up to 18 years (children’s homes-shelters). Although this is defined by the Law as the responsibility of local governments, part of these institutions are under the supervision of the district local governments.

To ensure qualitative social services, on 12 September 2000 Regulation No.313 “On the requirements to providers of social assistance services” of the Cabinet of Ministers was adopted defining the requirements to the social care institutions in respect of qualified personnel, observance of children’s interests and rights, support to the child in seeking solutions to his or her problems, creation of the necessary conditions for ensuring all-round development and education as well as the adequacy of the environment. The Regulation envisages that selected requirements become valid as of 1 January 2002 since considerable funding is needed for the implementation of these requirements.

The division of responsibilities between the central and local governments in the currently valid legislative acts has created a variety of problems in the provision of social care services that need to be both qualitative and adapted to the individual needs of children with disability. Problems are first encountered when a child with a physical disability reaches the age of 4 years. Local governments whose child has been under the financing of the central government refuse to place the child in a local government-financed institution basing their refusal on the fact that it is the state’s duty to take care of disabled children and that local government institutions are not adapted to the needs of children with disability and that there is a lack of sufficiently educated specialists. The division of social services between central and local government institutions creates a situation where local governments are interested to make decisions on the provision of services in a central government institution thus reducing their expenditures for care. As a consequence, the network of alternative social care services is growing slowly and inadequately. There is a lack of professional social workers in local governments and the qualification of those employees that evaluate the necessity of social care services is not high enough (Table 4). All this worsens the possibility of disabled children and their families to receive services.

Table 4 Number of employees in social assistance service

1998 1999 2000 2001 Employees in social assistance service, total 833 863 869 985 Employees with vocational education 63 75 89 139

- secondary 23 17 32 28 - higher 40 58 57 111

Employees without education in social work 298 788 780 843

In some cases social care services in institutions might be necessary. To promote the development of alternative social care services in local governments, a short-term and precisely targeted state financial support is needed because the largest financial resources are needed just at the start of providing alternative services. Concerning families with disabled children, this would mean establishing the post of assistant; assistance in seeking solution to family problems would mean getting foster families to disabled children for a certain period of time giving the parents a short rest at weekends; assistance may be necessary during the vacation leave or in unforeseen cases (hospitalisation of one parent, business trips, etc.).



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For the solution of the above problems in upgrading the social care service system the Ministry of Welfare has worked out a conception according to which responsibility for the provision of all social services will be delegated to local governments beginning in 2004; this conception is also supported by the Cabinet of Ministers. The conception contains a mechanism of financing maintaining state funding for those persons that have been placed in social care centres by 1 January 2002.

To prevent disability and its progress or to lessen the implications and influence of disability on the child’s development medical aid is of vital importance. According to the Law on the Medical and Social Protection of Disabled Persons the state programmes of medical aid, treatment at home or in hospital and provision with auxiliary technical devices are financed from the state budget. Within the framework of state programmes health care is free of charge. According to the Regulation of the Cabinet of Ministers pharmaceutical products to children with disability are also free of charge. Regulation No.428 of the Cabinet of Ministers “The Order of Compensation for Medicaments, Medical Devices and Other Goods Intended for Out-patient Treatment” lays down that for disabled children medicaments and selected medical goods are free of charge. The Law on Medical Treatment and the related regulations of the Cabinet of Ministers adhere to the principle of free health care: children aged up to 18 years are exempted from the patient’s fee (there is a uniform direct payment the patients pay to the health institution for a health service as required by the respective health institution within the framework of the State Healthcare Programme and the minimum of healthcare services.

Medical rehabilitation services to children with disability are provided free of charge taking into consideration the financial possibilities of the state. Following the consultations with the State Compulsory Health Insurance Agency about the possibility of providing the service, the attending doctor confirms the need for the service. Up until now the issue about the payment has not been not solved in those cases when parents stay at the rehabilitation centre together with their disabled child. In view of the fact that parents must pay for the stay at the medical rehabilitation centre, these services to families are not available. The problem is solved by local governments` paying part of the costs of the stay within the limits of their financial possibilities.

Problems of another kind are related to the possibilities of parents to receive information on treatment opportunities that are important not only in Riga but also in the countryside. The factors such as the possibility of parents to take their disabled child to specialists and to rehabilitation services, their ability to pay for the services may also be of great importance considering the high unemployment rate persisting in some regions, the access to rehabilitation institutions, the infrastructure of roads and other factors.



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Part III

INSTITUTIONAL AND PUBLIC CARE OF CHILDREN WITH DISAB ILITIES

If the diagnosis of a child with disability requires special care that cannot be provided by the family or if it is the initiative of parents or even state institutions, the child with disability is placed in special childcare institutions. This is an ultimate step and does not mean a solution to the problem but under the current socio-economic conditions in the country there is simply no other alternative.

There is neither any investigation nor separate recording of the reasons for placing children in an institution or the child’s age at that time. The overall statistics give the number of children coming from families and placed in an institution but no analysis has been made about the reasons.

At the end of 2001, 9.1% of the registered children with disability were in the state care institutions and the positive decreasing trend of this indicator is noteworthy. Since 1993, the total number of disabled children at social care institutions has been decreasing from 813 to 760. Statistics on the breakdown of disabled children by sex are available only beginning in 1998 and according to these data, the number of disabled boys is higher than that of girls.

The type of institution where the disabled child is placed depends on the age of the child and the severity of disability. Table 1 in the Annex shows the distribution of children with disability in all long-term care institutions.

437 459 438361 346 322

445350

0

100

200

300

400

500

1998 1999 2000 2001

Boys

Girls

In regard of a disabled child, the ground for placing a child in an institution is the parents’ application. The cases when the local government custody court (pagasts court) decides on the child’s placement in an institution refer to children whose parents have been deprived or adjourned of parental rights. The majority of children with disabilities are placed in state-financed childcare centres right after birth when severe health disorders are stated and parents decide to entrust the care of the child to the state. However, the majority of parents prefer to take care of their child themselves. There have been cases during the child’s lifetime when parents cannot ensure the necessary care and cannot cope with financial or other problems and decide to place their child in a social care institution.

Children left without parental care aged up to 2 years and children with health problems aged up to 3-4 years are placed in the social care centres for orphans, however, for various reasons there are also older children in these centres. Reaching 4 years of age, depending on the diagnosis and the severity of disability, children with disabilities are sent off to a local government children’s home or a specialised children’s social care centre.



17

The absolute number of children with disabilities in the social care centres for orphaned children is decreasing and this can be partly explained by the falling birth rates. The share of sick children in the total number of children in these institutions is within the range of 39-40% and in 2001 increased only by 1.3 percentage points compared with 1997.

All children in the specialised social care centres are disabled children with mental disorders. The reason for placing a child in the care institution is the child’s state of health. In 2001 the number of children with severe and heavy mental disorders increased and represented 66.3% of the contingent of children in this type of institutions. By contrast, the share of children with light and moderate disorders is decreasing year by year. The number of children who can attend general schools or study at home also goes down.

Table 5 Education of children in the specialised children’s social care centres,


1999 2000 2001

School-age children, total 391 378 348 of which attend general schools 18 0 7 learn at home 272 262 192 attend special schools 26 24 40 do not study 75 92 109

Children with disability at the specialised care institutions are provided with the necessary care, treatment, rehabilitation as well as training by special programmes. Expenditures at the specialised social care centres are higher than in the local government children’s homes and in 2001 were as high as LVL 233.04 per child (Annex, table 4).

Concerning the social care institutions for children, a decision has in principle been made beginning in 2004 to place the care institutions under the authority of local governments. Being aware of the fact that care services at institutions are more expensive than home care, placing of the service system in one hands would make local governments use their resources more rationally, promote the development of alternative services and evaluate the possibilities of co-operation with public organisations as the providers of services. At the same time it is necessary to develop the institution of guardianship and foster families with specialisation in providing care for children with disabilities.

In terms of percentages, the number of children with disabilities in the children’s homes is not high, nevertheless this number tends to go up over the years: only 1% of the number of children were disabled children in 1997 while the figure for 2001 was already 3%.

Children with mental and physical disorders at the age of 4-18 years or older are placed in the specialised social care centres. As can be seen in Table 3 in the Appendix, the number of children aged up to 16 years in the specialised social care centres is decreasing whereas the number of children over 16 years is going up.



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Part IV

CHILDREN WITH DISABILITY IN FAMILIES AND IN COMMUNIT IES

The analysis of the available statistical information allows drawing a conclusion that the majority of disabled children are cared for by their families. The state provides financial support to families with a disabled child. In addition to the state family support, families with disabled children (up to 18 years) are granted an additional payment. Beginning in 1998, the additional payment to the state family benefit for a disabled child is LVL 35 per month. Expenditures for this additional payment constituted LVL 3.8 mln lats from the central government basic budget.

Table 6 State social benefit to family with disabled child

1996 1997 1998 1999 2000 2001

Additional payment to the state family benefit for a disabled child (benefits) at the end of the year

7028

7342

7835

8378

8697**

8965

Average size of the additional payment to state family benefit for a disabled child per month, LVL

…

21.42

28.12

37.11

37.28

34.41

Expenditures for the additional payment to the state family benefit for a disabled child, thsd LVL

1935

2198

3227

3349

3701

3768

* Until 1996 the recipients of the state social security benefit and children with disability were allotted a social pension. ** Data on 01.10.2000.

According to the State Social Insurance Agency, in the period between 1991 to 2001 the number of recipients of this benefit (until 1996 children with disability received a social pension) tended to increase reaching 9 thousand at the end of 2001 (Table 2).

Until the adoption on 20 June 2002 of the amendments to the Law on Social Assistance a disabled child upon reaching the age of 16 years was granted the social security benefit. In 2001, the average size of the state social security benefit granted in case of a disability was LVL 32.70 per month. In May 2002 1010 children with disability aged from 16 to 18 years received this state benefit. The amendments to the Law on Social Assistance lay down that families with disabled child aged up to 18 years receive LVL 35 monthly as an additional payment to the state social security benefit. The state social security benefit is granted to persons who are disabled since childhood after they have reached the age of 18 years.

Within the limits of their possibilities local governments also support the parents, who take care of their disabled child. Families with a disabled child are one of the target groups of the social assistance service. In 2001there were 4133 children with disability in the families that had received social assistance benefit. Home care was provided to 27 children with disability, which represent only 0.4% of the number of persons to be attended. Local governments grant a benefit for care to the families where there is a child with disability if according to the resolution of the specialist physician such care is necessary. In recent years social assistance to families with a disabled child has improved. The system of social assistance presents an opportunity to families with disabled children to receive a variety of social services. Children with disabilities are provided with auxiliary technical devices free of charge. The choice of available auxiliary technical devices has become wider (various wheelchairs, care auxiliaries such as bath chairs and toilet chairs). At the same time there are queues for some auxiliaries, for example, orthopaedic footwear that can be explained by a lack of financial resources. Earlier the possibility to receive auxiliaries was for the most part restricted to Riga (the location of the Centre of Technical Auxiliary Services and the manufacturing enterprises) but already in 2002 there were subsidiaries of the Centre of Technical Auxiliary Devices operating in Rēzekne, Valmiera and Dobele allowing to receive auxiliaries as close as possible to the place of residence of the customers. The assortment of auxiliaries in the subsidiaries is the same as in Riga.



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With state financial support 12 day care centres for persons with mental disorders have been established since 1995 the clients of which are for the most part disabled children aged 16 years and over with severe disabilities (groups I and II) who do not attend education institutions and vocational rehabilitation centres. The development of these centres is an example illustrating the importance of state financial support for the development of new alternative services (in institutions providing long-term care). The Law on Social Assistance envisages a gradual decrease in the state funding ensuring financing from the local government budget. The initial proportion is intended at 80% from the state budget and 20% from the local government budget, reducing every year the share of the state budget and increasing financing from the local government budget by 20%. In five years the service will be fully financed from the local government budget. On some occasions the provision of services has been discontinued due to the lack of resources in local governments and to a certain degree this confirms the opinion that with divided responsibility for the provision of care services the choice of services by the principle of payment is fostered since social care of adult disabled persons is financed from the state budget.

The child’s further life depends on his or her ability and possibility to integrate into the community. For this reason education plays a very important role. In Latvia particular emphasis is laid on education at school. The situation of Latvia is characterised by a reduced number of pre-school establishments and the low number of special pre-school establishments in general although these establishments are of paramount significance for setting up the necessary service network. The same problems that persist in the ordinary schools - the environment, lack of qualified experts, lack of knowledge and communication skills as well as poor comprehension of the problems of disabled persons prevent the integration of children with disabilities into the ordinary kindergarten.

As was already mentioned earlier, the term “a person with special needs” is used in the area of education. The Law on Education determines the training of children with special needs.

The aim of special education is to provide persons with special needs with a possibility to gain knowledge in general education subjects, domestic and occupational skills, with special emphasis placed on the practical side of education. Special education prepares a person with special needs for integration into work and the community according to his or her health, aptitude and development level.

Pre-school special education is implemented at special pre-school education establishments and in special groups at the ordinary pre-school education establishments. The number of children in such institutions is decreasing (in 2001 7.4% less than in 1999).

Table 7 Special pre-school establishments and groups at other pre-school establishments

1999/2000 2000/2001 2001/2002

Pre-school special education institutions 29 31 29 Enrolment* 2589 2536 2316 Special groups in ordinary pre-school education

institutions 70 68 65 Enrolment* 1841 1813 1788

* 3 years and older.

The main types of disability of pupils in special pre-school education establishments are speech disorders (about 54% in 2001/2002) and eyesight disorders (about 15% in 2001/2002).



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Table 8 Children by type of disorder at pre-school establishments, in per cent

1999/2000 2000/2001 2001/2002 Total 100 100 100

Of which with: hearing disability 4 2 2 speech disorders 55 53 54 impaired eyesight 14 17 15 intellectual disorders 10 11 10 mobility disorders 8 7 10 tubercular intoxication 3 3 4 other 6 7 5

General special education (primary and secondary education). In the school year 2001/2002 there were 64 institutions of special education (Table 9). The number of institutions is rising proportionally to the increase in the number of children with mental and physical disorders. The particularly rapid increase in this type of schools in the past years can be explained by the fact that beginning with the school year 2000/2001 the boarding schools of sanatoriums are included in the number of special schools. The increase can also be explained by the inclusion in the educational system of those children that were previously regarded as not fit for training.

Comparing the school years 2000/2001 and 2001/2002, the number of special pedagogical staff (psychologists, speech therapists, social workers and physicians) at schools has increased (by about 8%). There were 1757specialists (306 psychologists, 403 speech therapists, 202 social workers and 846 physicians) employed at schools in the school year 2000/2001 but in the school year 2001/2002 their number was 1903 (384 psychologists, 475 speech therapists, 179 social workers and 865 physicians).

Table 9 Number and enrolment of general special schools,

at the beginning of the school year

1995 1996 1997 1998 1999 2000 2001 Number of schools 54 55 56 56 56 64 64 Enrolment, total 7820 8155 8284 8363 8475 10250 10169

The main problem is that pupils with special needs still cannot choose where and what to learn. Many general schools are not adequately equipped for such pupils. This hampers their entrance into the working life.

Vocational education (secondary and post-secondary education). There are only 2 vocational education institutions with 2 groups for students with special needs (about 16 students in total). These are the groups for the students with hearing disability. There are also other students with special needs who are studying in other vocational education institutions but data on these students are not available. Until 1 January 2002 disabled children with general education could obtain vocational education at 2 professional rehabilitation centres under the supervision of the Ministry of Welfare (288 places in total). There are no individual data on the children with disability whose age is up to 18 years.

Tertiary education. There are no special institutions or groups at higher education institutions for students with special needs. Nevertheless, work on finding financial resources for such groups is started.

Learning at home. Children whose state of health does not allow them to attend school every day can take lessons at home. The resolution of the Physicians` Commission is necessary to pursue studies at home.



21

The task of the Ministry of Welfare of the Republic of Latvia is to create the country’s social security policy and to draft and introduce legislation for the implementation of this policy:

1. To work out the country’s policy in the area of social security and health care.

2. To have a good knowledge of and by means of political, economic and legal instruments seek solutions to: - the issues of social insurance, social care and social assistance, - the issues of health care and protection as well as those of public health and pharmacy, - problems related to labour and labour protection and employment and unemployment.

3. to work out the country’s demographic policy and to co-ordinate its implementation; to promote the co-ordination of the national legislation in social security as well as its harmonisation in compliance with the requirements of the European Council and European Union.

4. To ensure the satisfaction of claims as laid down by the Law on the Budget and Financial Management regarding the compilation and submission of the budget proposal, budget performance and the control of the effective and economic use of budgetary resources.

The number of such children tends to decrease - 1448 children studied at home in 2001, 10% less than in 1995 (Table 10).

Table 10 Learning at home (number of learners)

1995 1996 1997 1998 1999 2000 2001

1601 1632 1532 1489 1317 1410 1448

In its Regulation No.388 the Ministry of Education and Science of the Republic of Latvia confirmed on 30 May 1997 the Conception of the Development of Special Education (basic concepts of the special education policy of Latvia). Although this document deals with the educational problems of children with special needs, nevertheless taking into account that this term is applied to children with either congenital developmental disorders or disorders acquired due to unfavourable natural or social environment, the said document may also apply to children with disabilities. The document describes the problem, suggests a solution to it, lays down the right to special education, the management of special education and implementation of special education programmes at education institutions. The government policy in providing the right to obtain special education is as follows:

1. The state ensures a possibility to persons with special needs to obtain education in conformity with their interests, aptitudes and state of health;

2. Special education shall be integrated into the official system of education and it shall - be organised on the national scale and accessible to all persons with special education needs irrespective of the distance from the place of residence and mobility problems; - correspond to the needs of each individual and to his or her state of health; - be integrated presenting an opportunity to persons with development disorders to study at

any education institution, taking into account their special needs; - have its content of education oriented toward the child’s general development and practical

application of the educational work with main attention paid to the development of working skills and abilities;

- be comprehensive taking into account the needs of all persons and provide adequate possibilities of implementation;

- be implemented on a professionally high level;



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- align with the current demands and take into consideration the trends in the world’s special education attempting to implement these trends in compliance with the country’s possibilities.

3. In order to provide a possibility to improve their health, obtain general and vocational education and to participate in employment the government guarantees tax relief, transport allowances and other allowances to persons with mental and physical development disorders.

4. The acquisition of special education is organised as a special education programme at an appropriate education institution. Education of seriously ill persons or those who are ill for a long time is conducted at home or in a health institution;

5. Education of persons with special needs is financed from the state budget in the order established by the Cabinet of Ministers regardless whether this person is studying at a special or general education institution;

6. To implement the general principles of this conception, the Ministry of Education and Science shall work out the necessary legislative acts.

In the same year the experimental programme “Integration of children with severe physical disorders into the 66th special secondary school of Riga” was confirmed by Order No.526.

Currently efforts are targeted at the creation of a base that would enable children with special needs to be integrated into general and vocational education institutions.

It should be noted, however, that the integration of disabled children into general schools is in some respect problematic because of the lack of sufficiently trained professional teachers just for this work and due to the inadequate environment that has not been adapted to the needs of disabled persons. Another obstacle is the different amount of financing per child in the general and special school. Many children who graduate from special education schools confront problems with the mastery of profession. Vocational education institutions refuse to enrol these children although their developmental disorders are not severe enough to confirm disability allowing them to receive the state social security benefit that could ensure them at least some sort of financial support.

Up until now no institution that could assess the degree of development disorder and prognosticate the child’s further development and follow its changes has been established in Latvia. Currently the attending doctor on the basis of medical considerations determines disability. Upon reaching the school age, the development disorders are initially determined by the teacher if the child has started to attend school but afterwards the pedagogical-medical commission evaluates these disorders. The resolution of this commission is only of a recommending nature that nevertheless serves as a basis for enrolling the child in a special education institution. However, for the majority of children that attend special education institutions disability has not been determined. Although the commission consists of teachers, speech therapists and doctors, there is no practical co-operation with the child’s attending doctor. Occasionally enrolment of the child in a special education institution depends on whether there is an appropriate education programme at all on the basis of which the child could study. In practice no system has been created that would foster co-operation both among various interested organisations and between these institutions and parents. It is important for the parents to get exhaustive information on the severity of the development disorder of their child, the possibilities of further development and consultations about what to do. Another hampering obstacle is the lack of individual education programmes. Currently there is no institution in Latvia that could work out, introduce and assume responsibility for these programmes and alterations therein.



23

In recent years new laws and amendments to the already existing laws have been adopted delegating to the Cabinet of Ministers the issuance of selected legislative acts, for example, on the pedagogical medical commissions and enrolment provisions in special schools.

The analysis of various legislative acts identifies a problem encountered by the parents of disabled children. The law lays down the right of the parents to choose the education institution in the proximity of their place of residence. At the same time the parents do not have any information whether it is possible for a child with disability to attend this concrete institution. Upon their initiative (information from the doctor and other parents) parents can apply to the pedagogical medical commission that in practice is convened twice a year (shortly before the beginning and at the end of the school year) and whose main responsibility is to evaluate the state of the child’s health, his or her learning problems and suggest the best education programme and the education institution that implements this programme. To parents the resolution of the pedagogical medical commission is of a recommending nature although in reality there is no other way to choose the education institution since on the basis of this resolution, which is obligatory to the education institution the child is enrolled in the concrete education institution. If the programme is of a specific type the child will probably have to be taken to another administrative district and this would mean separation from the family and the usual environment. If in addition the child needs medical rehabilitation services this again creates additional problems.

No surveys have been taken of the living conditions of children with disabilities, their problems and possibilities of receiving the necessary services. Some public organisations express an opinion that the quantity of services is insufficient mainly because the services are either non-existent or not available at the place of residence or it is impossible to cover the costs of these services. The families cope with all this within the limits of their resources, getting in some case assistance from the social assistance services and public organisations. Some families apply to mass media asking for donations to enable their child to undergo treatment abroad.

Actually the entire family life is subjected to the satisfaction of the needs for care, education possibilities and rehabilitation services of the disabled child.

In recent years the situation concerning the adaptation of the environment to the needs of disabled persons is improving. Laws and other normative base have been adopted but the real situation is different as the adaptation of the environment is time-consuming and expensive. In co-operation with the Association of Disabled Persons and their Friends “Apeirons” the Ministry of Environment Protection and Regional Development has initiated an active campaign for educating experts in the problems of disabled persons. Publications have been released on the accessibility of the environment to the needs of disabled persons.

Along with the central and local government institutions, public organisations are also working actively. In regard to children with disabilities, it is difficult to identify those public organisations that represent solely the interests of this group. The majority of public organisations in the area of healthcare and social protection represent the interests of

- children with disabilities and children and their family (for example, the Latvian association “Rūpju bērns” (A Child in Trouble),

- socially vulnerable children (for example, the Children’s Foundation of Latvia, the public organisation “Glābiet bērnus” (Save the Children),

- disabled adults and children, sick children and their families linked up by a specified diagnosis (for example, the Union of Persons Suffering from Bronchial Asthma, Association of Disabled Persons Suffering from Mucoviscidosis and their Parents, Latvian Association for Children with Dawn’s Syndrome, Latvian Association of Parents and Friends of the Children with Hearing



24

Disability and the Latvian Association of Protection of Disabled Children Suffering from Cancerous Diseases and their Families, etc.),

- patients and professionals (physicians), for example Martin’s Foundation.

Public organisations differ by their numerical size and experience. The range of their activities is very broad. As an organisation with wide experience, the Children’s Foundation of Latvia organises every year the summer and winter camps for children with disability and with the support of local and foreign sponsors provides material assistance both to children with disability and their families and to central and local government organisations (for example, to medical and social rehabilitation centres). The public organisation "Save the Children” provides legal aid, financial assistance and various consultations. The majority of public organisations that have been founded on the principle of diagnosis, provide assistance in different ways, organise various events and inform the society about their problems. The Latvian association “A Child in Trouble” is engaged in rendering services to children with mental disorders. “The Child in Trouble” has founded several day centres for persons with mental disorders.

It is noteworthy that the process of founding public organisations is still going on. Every year new organisations are registered at the State Enterprise Register. A new feature is the tendency of the public organisations to merge with the aim to attain common goals.



25

ANNEX

Table 1 Number of institutions of social care for children and children living there

at end of the year

Social care centres for

orphans Children’s homes

Specialized social care centres for children

1995 1999 2000 2001 1995 1999 2000 2001 1995 1999 2000 2001

Number of institutions 6 6 6 6 38 48 48 49 3 3 3 3 Number of children at institutions 791 719 740 672 1618 2456 2412 2478 446 462 453 419

Of which:

disabled children … 286 291 270 … 47 61 71 … 462 453 419 school children … 34 35 30 … 1956 1967 1905 … 316 286 239

Table 2 Mental status of children at social care institutions


Social care centres for orphans

Children’s homes Specialized social care centres for children

1998 1999 2000 2001 1998 1999 2000 2001 1998 1999 2000 2001

Number of children at the institution - total 797 719 740 672 2386 2456 2412 2478 456 462 453 419

Of which: number of mentally healthy children 128 100 111 98 1651 1703 1797 1803 - - - - number of children with social

disability 201 342 330 346 79 484 413 427 - - - - number of children with mental

disabilities 468 277 299 228 294 269 202 248 456 462 453 417 Of which: light degree 156 60 56 18 205 213 149 183 62 57 40 18 median degree 104 52 64 31 80 53 48 59 140 178 142 121 serious degree 116 102 102 116 9 3 4 4 71 94 124 129 deep degree 92 63 77 63 - - 1 2 183 133 147 149 Other - - - - 62 - - - - - - 2



26

Table 3 Children at social care institutions by age


Care centres for children-orphanes

Children’s homes Specialized social care centres for children

1998 1999 2000 2001 1998 1999 2000 2001 1998 1999 2000 2001

Total number of children 797 719 740 672 2386 2456 2412 2478 456 462 453 419

Of which: under 2 years 480 381 441 410 28 15 13 18 - - - -

3 to 7 years old 227 254 215 164* 618 512 420 344* 67 63 57 27*

8 to 15 years old 88 83 81 89** 1485 1620 1589 1643** 232 261 245 229*

16 to 18 years old 2 1 3 8 229 273 323 408 98 109 103 119

19 years and over - - - 1 26 36 67 65 59 29 48 44 * Children aged 3 to 7 years (exclusive). ** Children aged 7 (inclusive) to 15 years.

Table 4 Financial resources spent per one child

Children's homes Care centres for children - orphans

Specialized social care centres for children

1998 1999 2000 2001 1998 1999 2000 2001 1998 1999 2000 2001

Financial resources spent per one child, total amount in LVL per month 140.53 142.74 158.59 163.49 193.18 253.79 233.71 242.68 183.91 209.42 205.59 233.04

Financial resources spent for feeding per one child per day, LVL 0.99 0.96 1.00 1.05 0.91 0.98 0.98 1.00 1.01 1.04 1.04 1.07

Financial resources spent for purchase of medicaments per one child per day, LVL 0.05 0.05 0.05 0.05 0.11 0.11 0.11 0.11 0.11 0.13 0.12 0.13

Financial resources spent for purchase of clothes, bedchlothes and toys per one child per year, LVL 34.07 31.13 36.68 43.06 5.35 21.96 16.30 22.30 7.17 24.41 26.56 18.65



27

Table 5 Disabled children aged 0-15 years


1994 1995 1996 1997 1998 1999 2000 2001 Total number of disabled children at the end of

the year 6145 6637 7690 8007 8628 8461 8591 8556 Neoplasms 213 237 274 276 310 296 308 339 Endocrine, nutritional and metabolism diseases, immunity disorders 367 405 454 467 485 451 454 353 of which: diabetes mellitus 224 246 269 281 282 238 228 206 Mental disorders 1145 1206 1337 1352 1470 1285 1311 1192 Nervous and sence diseases 2491 2659 2921 3114 2794 2643 2570 2581 Respiratory diseases 278 314 420 466 539 523 513 491 of which: asthma 258 293 384 412 484 476 471 455 Congenital anomalies 1097 1194 1508 1482 2116 2199 2315 2346 Diseases of the skin and subcutaneous tissure 26 28 30 33 35 35 38 34 Traumas and poisoning 18 19 22 27 36 33 34 40 Other diseases 510 575 724 790 843 996 1048 1180

Per hundred thousand population of corresponding age

Total number of disabled children at the end of the year 1108.4 1230.5 1471.8 1586.4 1776.7 1817.3 1922.8 1996.5 Neoplasms 38.4 43.9 52.4 54.7 63.8 63.6 68.9 79.1 Endocrine, nutritional and metabolism diseases, immunity disorders 66.2 75.1 86.9 92.5 99.9 96.9 101.6 82.4 of which: diabetes mellitus 40.4 45.6 51.5 55.7 58.1 51.1 51.0 48.1 Mental disorders 206.5 223.6 255.9 267.9 302.7 276.0 293.4 278.2 Nervous and sence diseases 449.3 493.0 559.0 617.0 575.4 567.7 575.2 602.3 Respiratory diseases 50.2 58.2 80.4 92.3 111.0 112.3 114.8 114.6 of which: asthma 46.5 54.3 73.5 81.6 99.7 102.2 105.4 106.2 Congenital anomalies 197.9 221.4 288.6 293.6 435.7 472.3 518.1 547.4 Diseases of the skin and subcutaneous tissure 4.7 5.2 5.7 6.5 7.2 7.5 8.5 7.9 Traumas and poisoning 3.2 3.5 4.2 5.4 7.4 7.1 7.6 9.3 Other diseases 92.0 106.6 138.7 156.5 173.6 213.9 234.7 275.4

Table 6

Social assistance pensions for disabled children

1995* 1996* 1997 1998 1999 2000 2001

Number of children receiving social assistance pension**, average per year 6467 7028 7091 7648 8378 8064 8965 Expenditure, per year (ths.Ls) 1629 1935 2198 3227 3349 3701 3768 Expenditure per one disabled child, per month 21.90 25.00 26.25 33.75 35.00 35.00 35.00 * Data for 1995, 1996 at the end of year. **Till 1995 - social pension for a disabled child aged less than 16 years, since 1996 - additional payment to the family state benefit for a disabled child.

Table 7

Number of disabled children in public institutional care

1993 1994 1995 1996 1997 1998 1999 2000 2001

Total number of disabled children in publicinstitutional care 813 742 732 748 735 798 795 805 760

Number of children in institutions for physically/mentally disabled 488 442 446 437 448 456 462 453 419

Per 100 000 population of corresponding age 128 120 120 127 128 144 148 154 151

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