fortunately the public health strategy for focussing on perinatal and neonatal health mental health cardiovascular and oncological diseases as earlier mentioned allocates considerable financial resources for health promotion and prevention activities from both eu funds and state budget while latvia has already reduced acute hospital beds and closed a number of hospitals and emergency departments more changes will be needed in order to secure highquality care that represents good value for money difficult decisions and compromises will need to be made continuing to balance the priority of assuring appropriate access to services for all latvians and the need to close hospitals with lower activity rates to promote quality and efficiency gains a starting point would be a comprehensive mapping of services hospital outpatient community and primary including service volumes to assess where there is slack in the system