A Finnish village health centre has reopened in Karjalohja, southern Finland, after a residents’ association and an entrepreneur doctor created a new local model to restore primary care services that had been closed by the regional wellbeing authority.
Karjalohja’s health centre returns under a rare village-led model
The health centre in Karjalohja, a small village now part of Lohja in western Uusimaa, reopened on 4 May under an arrangement described by Yle as the only one of its kind in Finland. The facility had previously been closed by the Western Uusimaa wellbeing services county, leaving residents with longer journeys for basic healthcare.
The new model brings together three actors: the local residents’ association, the municipality-owned building, and doctor Mamurkhon Akrami, who is operating as a self-employed practitioner. Karjalohja’s residents’ association is set to buy the former health centre building from the City of Lohja for one euro and lease it to Akrami, who then sells medical services to the Western Uusimaa wellbeing services county.
Finland’s wellbeing services counties became responsible for organising healthcare, social welfare and rescue services at the beginning of 2023, when these duties were transferred from municipalities and joint municipal authorities. The reform aimed to improve equality of services and curb cost growth, but it has also made local access a sensitive issue in smaller communities.
The result is a local solution to a wider Finnish problem: how to preserve primary healthcare in small communities when regional authorities are trying to centralise services and control costs. For residents, the change is practical as well as symbolic. The trip from Karjalohja to central Lohja takes around half an hour by car, while using public transport can turn a medical visit into a half-day journey.
Why local healthcare matters in ageing rural communities
Akrami told Yle that services need to remain close to residents because many people in the area are elderly and may otherwise avoid seeking care. On the first Monday after the reopening, appointment slots were already full and the phone was ringing continuously, according to the Finnish broadcaster.
The centre, locally known as Terkka, is expected to open five days a week. This marks a clear change from the previous arrangement, under which the health centre was closed during the summer. Akrami has said he intends to keep it open also in the summer months, when Karjalohja’s population grows because of seasonal residents and holiday cottages.
That flexibility is one of the main arguments for the Karjalohja model. According to Akrami, the staff can organise shifts according to demand: working more during busy periods and less when activity is lower. The aim is to avoid the autumn backlog that can follow a summer closure.
A legal and administrative test for Finland’s welfare services
The experiment also shows the limits of Finland’s current healthcare framework. According to Western Uusimaa’s acting service area director Anu Mustakari-Ilovuori, Finnish legislation does not yet fully recognise primary healthcare produced by an individual self-employed practitioner in this way, which made the launch more complicated.
Mustakari-Ilovuori said the model could be copied by other small localities, provided that a doctor with an entrepreneurial profile is willing to run the service. The residents’ association sees the reopening as the result of a long administrative effort. Its chair, Jussi Leppänen, described the process as difficult but said the village had been waiting for the reopening for a long time.
The building may also host other healthcare providers. In addition to Akrami’s practice, a dentist and a foot care provider are expected to move in, while the wellbeing services county’s maternity and child health clinic (neuvola) will continue as a tenant. The residents’ association plans to cover maintenance costs primarily through rental income.
A Finnish answer to a broader Nordic healthcare challenge
Although the model is new in Finland, Yle notes that similar examples exist in other countries, including the United Kingdom, Denmark, Norway and Estonia. A cooperative-run health centre in Offerdal, central Sweden, is one Nordic comparison.
The Karjalohja health centre is therefore more than a local story. It reflects a tension visible across the Nordic welfare states: public services are expected to remain universal and accessible, but demographic change, labour shortages and budget pressures are pushing many healthcare systems toward larger units and more centralised provision.
For small villages, this can mean a loss of services that affects daily life, local attractiveness and trust in public institutions. Karjalohja’s experiment does not replace the public welfare system; it depends on a contract with the regional wellbeing services county. But it suggests that local associations, public authorities and healthcare professionals may be able to design more flexible ways to keep basic care close to residents.
Whether the model becomes a reference for other Finnish villages will depend on law, funding and the availability of doctors willing to work independently. For now, Karjalohja has turned a closed health centre into a test case for the future of rural healthcare in Finland.
