The Bulgaria 2012 Review: Health and Healthcare

Health |Author: Maria Guineva | January 7, 2013, Monday // 20:00|  views

Bulgarian Health Minister Desislava Atanasova has been repeatedly criticized for her work. Photo by BGNES

Bulgaria's 2012 health news were marked once again by doctors and patients disgruntled over healthcare budget cuts and poor conditions at healthcare facilities.

The health care sector continues to faces huge problems - understaffing, supply shortages, braindrain, bribes to doctors and nurses to ensure better treatment, high debts and chronic lack of money.

After years of lumbering reforms in Bulgaria's health care system, hospitals and the health insurance fund have reached the point of quickly running out of cash, dooming patients to suffering. A number of governments have failed to implement reforms, a series of major reshuffles at the health ministry over the last few years have failed to make a difference and plug the holes in the system.

When struck by a severe condition, wealthy Bulgarian regularly go abroad for treatment. The less fortunate have more sinister stories to tell.

Hospitals across the country are forced to suspend planned operations and reduced admission of emergency cases. Some even switched into a war-time regime, tapping into the reserves, meant to be used in case of natural disasters and wars.

The health news in 2012 were also topped by the introduction of the long-postponed full smoking ban.

Full Smoking Ban

The full smoking ban in Bulgaria became effective on Friday, June 1, at midnight.

In April, after heated debates, Bulgaria's Parliament passed on first reading a bill banning smoking in closed public spaces.

The changes in the Law on Public Health mandate that smoking is fully banned in all work places, restaurants, bars, public transportation, cinemas, movie theaters, all hotels, near administrative buildings, in the yards or nearby daycare centers and schools, on playgrounds, at outdoors children events, open air performance venues, and sports facilities, while airports can be furnished with completely closed smoking chambers.

According to the latest data, approximately 39% of Bulgarians are smokers. Some 30% of Bulgarian women do not quit the harmful habit even after they get pregnant. Bulgaria ranks second after Greece in the EU in terms of number of regular smokers as a percentage of the population, according to a Eurobarometer survey. More than 50% of Bulgarians are said to be in favor of the introduction of a full smoking ban in enclosed public spaces.

The full smoking ban was voted by the previous Parliament and was supposed to become effective on July 1, 2010, but the new majority of the Citizens for European Development of Bulgaria (GERB) party amended the ban and adopted new rules providing for partial smoking restrictions. The restrictions became effective in December 2010, and owners of small establishments were supposed to decide if the facility would be smoking or non-smoking while those of larger ones were mandated to have separate smoking and non-smoking spaces.

Ireland was the first country in Europe to introduce the full smoking ban in 2004.

Bulgaria's crack-down on smokers date back to 2005, when a partial smoking ban was introduced only to be widely ignored.

Health inspectors began checks of restaurants and bars at midnight on June 1, and issued the very first fines, but health authorities in Bulgaria have consistently admitted that they lack the needed capacity and enough authority to sanction the violators, who include both owners of establishments and customers. There are a total of 650 inspectors for the entire country, and they also deal with noise, and hygiene.

As the weather got colder the controversy over the ban flared with full force with owners of bars and restaurants insisting they are facing bankruptcies while both smokers and non-smokers staged several protest rallies in Sofia.

Amendments that would reinstate the segregated smoking areas in bars, restaurants and other establishments were discussed and rejected by the parliamentary health and economic committees as the protests took place.

The proposal was put forth by MPs from center-right ruling party GERB between the first and second reading of the new Tourism Act.

Bulgarian Prime Minister Boyko Borisov declared in December that GERB was totally against the abolition of the full indoor smoking ban despite the fact that he had suggested one week earlier that smoking could be allowed in bars and restaurants after 10 p.m.

Borisov went so far as to declare he would "file his resignation" if the full smoking ban was lifted. Bulgarian Health Minister, Desislava Atanasova, has been a very vocal opponent of easing the ban. Only Economy and Energy Minister, Delyan Dobrev, supported easing the full smoking ban, stating that more "flexible" rules should be introduced, but also rejecting the proposed reinstatement of segregated smoking areas in establishments.

Bulgarian Health System in Statistics

One third of Bulgarian Children Are Overweight

Some 30% of Bulgaria's children aged between 6 and 19 are overweight, according to a survey conducted by the Sofia Medical University and the National Center for Public Health and Analyses, released in January.

Nearly 12.7% of the Bulgarian schoolchildren are obese, the survey has shown. 20.4% of Bulgaria's children eat chips eat chips each day, while 32.2% consume pastry foods on a daily basis. Every fifth Bulgarian child drinks beverages containing sugar more than once a day, while 7% enjoy energy drinks every day. Some 34% of the overweight Bulgarian children rarely eat fresh vegetables.

Only 24% of the children in Bulgaria are physically active for at least an hour each day. 35% have admitted that they are physically active less than two days a week.

Study Finds Majority of Bulgarians 'Health Illiterate'

The majority of Bulgarians, 61%, are ignorant when it comes to their health, according to a study of the Public Health Department of the Sofia Medical University, released in February.

Those with higher health culture or the so-called health literate have college degrees and/or reside in the country's largest cities. People aged 55 or over have twice more difficulty to understand what doctors are telling them, compared to young Bulgarians – between the ages of 15 and 24.

Meanwhile, the high social status and education determine a higher health culture with 71% of the people in these groups being health literate. Experts point out that health literacy in Bulgaria is an untapped resource, which can lead to economic profits and to the increased quality of medical help.

According to the study, which was conducted in 8 EU Member States, Bulgaria ranked last among them in health culture.

Majority of Bulgarian Doctors Eye Jobs Abroad

The large majority of Bulgarian doctors are willing to change their work place, including working abroad.

The flash estimates come from a poll on the satisfaction of local doctors with their jobs, conducted by the international online project between March 2 and 14.

Half of the polled say they want to change jobs, while 78% are considering the option of working abroad. 90% of the respondents are strongly dissatisfied with the reforms in the healthcare sector, while 44% would never recommend the medical profession to young people. Based on this data, healthgrouper estimate that about 5 000 from a total of 35 000 working in the country's healthcare would quit immediately given other opportunity.

The project groups top problems of Bulgarian doctors in five categories, based on the same data: low pay and the way the National Health Insurance Fund, NZOK, finances the sector, bureaucracy and partial and confusing reforms, lack of vision for the development of the sector, public and media attitude, and corruption in the sector.

Cancer Cure Medication Prices in Bulgaria Skyrocket by 386%

Prices of eight cancer cure medications in Bulgaria have increased with an average 386% just in the course of one year.

The information was published in March in the form of a comparative table by the municipal councilman and former candidate for mayor of Sofia from the opposition left-wing Bulgarian Socialist Party, BSP, Georgi Kadiev.

The table showed that in 2011, after the National Health Insurance Fund, NZOK, took over the signing of the contracts, which was previously under the authority of the Health Ministry, prices of each of the eight medications skyrocketed between 254% and 497%, compared to 2010, leading to losses for the State in the amount of BGN 8.7 M.

Kadiev insisted this price hike had led to huge profits for pharmaceutical companies, the distributors, and the ruling, center-right Citizens for European Development of Bulgaria party, GERB, and the later uses the profits to feed its "black treasury" and buy votes. The Socialists further stressed that the losers are the cancer patients and their families, who are forced to strain their budget or purchase fewer medications. The scandal cost the post of the third GERB Health Minister, Stefan Konstantinov.

18 Bulgarian Districts Offer Dangerous Drinking Water

18 out of Bulgaria's 28 districts have substandard drinking water, according to an analysis of the country's water resources, requested by the Ministry of Environment and Water and released in June.

Under EU legislation, the supply of water from contaminated sources should be banned. Since Bulgaria's accession to the EU in 2007, bans have been issued for four drinking water sources (Merichleri, Tatarevo and Poibrene), according to data of the Health Ministry.

Water quality is worst in the southern district of Pazardzhik, where the 5% norm for deviations from the standard recommended by the World Health Organization (WHO) has been exceeded over two-fold. Water pollution has also increased in the districts of Kyustendil and Plovdiv, which previously reported no problems.

Some rural areas have even registered manganese contamination and contamination with cancerogenic compounds of chromium, arsenic and lead. The situation is worst in the northwestern district of Pleven, where 14 villages report heavy metal contamination.

The analysis further mentions aluminum, pesticides and benzene as contaminants in isolated cases. The experts also warn about substantial nitrate contamination, with norms being exceeded two-to-five-fold. This type of contamination is characteristic of agricultural districts using shallow drinking water sources. The most serious problems are in the districts of Yambol, Shumen, Ruse and Veliko Tarnovo, which need to find alternative sources because there is no way to remove nitrates from the water.

Microbiological contamination has been registered in 11 districts. As a result of poor disinfection, 357 smaller water-supply systems have been found to contain e.coli bacteria, which are strongly toxic and their presence is an indicator of a fecal contamination.

Tests in 65 zones have yielded enterococci bacteria. A total of 82 underground sources of drinking water in Bulgaria are problematic, the majority of them located in the region of the Danube basin. In this area, serious contaminations with nitrates, ammonium and phosphates have been registered near Sofia, Dobrudzha, Ruse, Silistra, and the Pleven region. Similar results have been registered in the Black Sea regions of Varna, Nesebar and Burgas and in the basins of almost all Black Sea rivers.

Every 5th Pregnant Woman Immediately Fired in Bulgaria

Approximately 19% of all pregnant women in Bulgaria are fired by their bosses upon revealing their pregnancy, according to a study conducted by the Global Alliance for Child's Health and Nutrition in Bulgaria, released in July.

Over 20% of all Bulgarian mothers have been forced to stop breastfeeding their children due to lack of understanding on behalf of their employers, the study also shows. Even though the World Health Organization recommends exclusive breastfeeding until a baby is six months old, 65% of all Bulgarian mothers are forced to stop in the third month.

Bulgaria Makes It Midway in Global Healthiest Country Ranking

Bulgaria has made it to the unflattering spot 73 out of 145 nations in a ranking of how healthy nations are, compiled by financial data agency Bloomberg, released at the end of August. The survey was commissioned by the World Health Organization, the United Nations and the World Bank.

Singapore was named the healthiest country after scoring 89.45% of the maximum 100 points, closely followed by Italy, Australia, Switzerland and Japan. Thirteen of the countries in the top 20 are European.

The report used three main indicators for countries with a population of at least one million to tabulate its total health score. Ten per cent was placed on life expectancy at birth and infant mortality. Another 10 per cent went to survival to 65 years and life expectancy at that age.

In determining the rankings, the Bloomberg report used a "health risk penalty" on countries with populations that led unhealthy lifestyles. These indicators included the percentage of the population that smokes, has high blood pressure and high cholesterol, is infected with HIV or does not exercise. It also included environmental factors such as sanitation and pollution.

Record Number of Bulgarians Hospitalized in 2012

A record number of Bulgarians have been hospitalized in 2012, the Head of the country's National Health Insurance Fund, NZOK, Plamen Tsekov, reported in December, saying that 1.7 million people have been listed in hospitals across the country in 2012.

According to him, 40 000 of these patients have cost NZOK nearly BGN 50 M, while expenditures for medications were up 4%, compared to 2011, reaching BGN 520 M. There have been also more doctors' referrals than planned. Tsekov says control on them will be tightened since many of these referrals have been paid by NZOK, but actually never reached the patients.

The Plight of Bulgarian Patients

Blood Transfusion Nightmares

Bulgarian Ministers Rush to Donate Blood in Urgent Campaign

In October, members of Bulgaria's government responded to an urgent call for blood donors as unusually high number of surgeries in the Bulgarian capital Sofia depleted hospitals' reserves.

The most acute shortage was for blood type A and 0, the Health Ministry and the National Transfusion Centre alarmed in a joint statement.

Deputy Prime Minister and Interior Minister Tsvetan Tsvetanov, Economy Minister Delyan Dobrev and Education Minister Sergey Ignatov were among the first to show up on Friday morning and donate blood.

The number of blood transfusions has risen sharply due to large number of surgeries in Sofia and Western Bulgaria, as well as the treatment of people suffering from grave hematology illnesses. Relatives and friends of people in need of blood transfusion are usually the only blood donors in today's Bulgaria. Those who cannot rely on relatives to donate the needed blood, fall an easy prey to the black market dealers.

Lingering around the National Transfusion Centre, groups of gypsies may look like any other Roma men who roam along the suburban streets of the capital, but their real purpose is trading blood for money. The Roma charge from BGN 100 to BGN 400 for the priceless document that proves one of them has donated at least 450 ml of blood.

The black market for blood has recently seen some upgrade with the dealers starting to do business online, which only cemented their status as a staple, though stark, example of health care reminiscent more of a third world country than an EU Member State.

It is only after the start of the transition period that Bulgarian hospitals became chronically short of blood for transfusion. Under the communist regime hospitals disposed of sufficient amounts of blood reserves as blood donation campaigns were obligatory. The number of blood donors shrank dramatically since the fall of communism, leaving patients with yet another psychological obstacle to overcome beside the disease itself and the hospitals' insufficient capacity.

Data shows that Bulgaria lags far behind international standards for blood donation – 23-25 donors per 1 000 people against the required 50 donors per 1 000 people. Poor economic conditions and low living standards top the list of reasons, together with the fact that blood donation costs time, some pain, and occasionally unpleasant consequences.

Blood Transfusion Centers Survive after Wage Upping

The thirty eight doctors and nurses from the Regional Blood Transfusion Center in Bulgaria's Black Sea capital Varna, who decided to quit at the beginning of November because of low salaries and poor work conditions, announced at the end of the month that they were withdrawing their resignations.

The medics said they have received an official assurance from the municipality that more funds will be slated for the blood transfusion center, prompting them to reconsider their earlier decision. The first pledge was delivered on November 15 by Varna Mayor, Kiril Yordanov, who, after a meeting with Health Minister, Desislava Atanasova, announced the monthly wages of the doctors and the nurses will be upped by BGN 100 by the end of 2012, with the funding secured by the Varna City Hall. With the municipal funding, the salaries at the center reached their 2011 level, and the medics expect another increase of 7% to 10% from January 1, 2013.

In mid-October, all six doctors and half of the nurses and lab staff at the Regional Blood Transfusion Center in Bulgaria's Stara Zagora quit because of low salaries, but a month later they also withdrew the resignation after being assuaged by the Health Ministry that their wages will be increased in November.

Bulgarian Cancer Patients Seek Salvation in Turkey

Cancer sufferers in Bulgaria, in need of urgent chemotherapy, are often forced to wait for weeks and even months due to shortage of experts and equipment, doctors alerted in October.

"We have no choice but to make waiting lists for patients because Bulgaria suffers from a chronic shortage of oncology experts – no more than 100 for all oncology units in the country," leading oncologist Konstanta Timcheva said at an event that set up the Bulgarian Association for Medical Oncology.

More than 6200 Bulgarians every year undergo chemotherapy treatment after being diagnosed with cancer. Bulgarian cancer sufferers and their families often feel abandoned in their struggle to cope with the illness, both in terms of treatment and emotional support.

Unlike other European countries, whose health care systems do their best to fund extra services to support these people and their relatives through the darkest of times, those who have been diagnosed with cancer in Bulgaria face a chronic shortage of life-saving medicines.

Not to mention the lack of support they need to cope with the emotional turmoil of the illness, which is of crucial important when the cancer patients are children.

Nearly two thousand Bulgarian cancer patients have sought help and hope in neighboring Turkey over the just several months in 2012, turning it into the latest hot spot in what has become known as "health tourism". Experts attribute the trend to the modern equipment Turkish oncology clinics boast and the attractive price list, which – though too costly for the average Bulgarian – is still cheaper than the EU average.

Oncology clinics in Turkey are also capitalizing on the sad fact that Bulgaria is the only EU country, which marks an increase in the number of people diagnosed with and dying of cancer. To top it all off, most Bulgarian patients do not trust the doctors they meet here and the diagnoses they hear. That's why when struck by a severe condition, those who can afford it, go abroad for treatment.

Bulgarian oncology experts and doctors however have called on cancer patients not to fall for what they see as Turkey's ad trick, assuring they are perfectly qualified to diagnose cancer diseases and treat them.

The lack of funding in Bulgaria's problem-ridden and facilities-short health system however is continuing to force hundreds of cancer patients in Bulgaria to seek treatment abroad.

The last hope for the less fortunate lies with their own family and the patients' organizations, who are struggling to make Bulgaria a full member of the global cancer awareness campaign.

Estimates of patients and doctors show that at least BGN 300 M per year is needed to cover the costs for cancer medication in Bulgaria. The cash-strapped country finds it more than difficult to find the money. The treatment of Bulgarian cancer patients is exclusively an obligation of the state, but another problem is that Bulgaria remains the only European country, whose biggest hospitals do not have a foundation affiliated to them to help financially in times of austerity.

Bulgaria's health minister tried to assuage cancer patients' concerns, saying the European Union has allotted EUR 150 M for improving their treatment, but declined to disclose further details about the absorption of the funds.

Dead Girl Turns Angel Bringing Hope for Bulgarian Cancer Kids

In 2012, Bulgarian parents, whose kids are suffering from cancer, have enthusiastically embraced the idea for a new specialized hospital, pledging their support and help to the generous donor.

The parents complained they face many problems in terms of treatment, attitude and red tape. The surge in optimism that there is a way out of the vicious circle came in the wake of a generous donation by a wealthy Bulgarian businessman, whose little daughter died of cancer a few years ago.

The tragic story of the little girl named Lia and her father, who has made it imperative to remain anonymous, emerged from a transcript of the government's meeting in August and moved the whole country.

Lia was a promising talented ballet dancer, who was forced to bid adieu to the stage after being diagnosed with cancer at the age of 10. She died at the age of 15 and had one final wish – she did not want any more children to die of cancer. The tragic events left an incurable trauma on her father, who set up a foundation for saving children from cancer and named it after her late and beloved daughter.

In 2012, the man announced plans to donate BGN 5 M for constructing a new and modern hospital for children with cancer and his dream is about to come true. The new hospital will be designed to meet the highest international standards in the treatment of children, suffering from cancer. It will be located in the campus of Lozenets hospital in the eponymous district in the capital Sofia, where Lia spent her last days.

UN Report Shows Decreased Heroin Availability in Bulgaria

The availability of heroin in Bulgaria has decreased but new cases of HIV infection and the spread of HIV among people injecting drugs have increased, according to the annual report of United Nations Office on Drugs and Crime (UNODC) released in October.

In 2011, Bulgaria, Greece and Romania registered a significant increase in the number of new cases of HIV infection and HIV spread among people injecting drugs. Traditional producers of cannabis like Albania, the Netherlands, and the UK reported decreased volumes of seized cannabis, while Bulgaria, Turkey, Central Europe, the Iberian Peninsula, and parts of Scandinavia registered increased volumes of seized cannabis.

According to UNODC data on Europe, the use of cannabis in countries like Bulgaria, Estonia, Finland, and Sweden, increased, in other countries in Eastern and Southeastern Europe it remained unchanged, and in Western and Central Europe it decreased. In most European countries, including France, Germany, and the UK, drug use among women was at least half less frequent than among men.

Only three (Italy, Bulgaria, and Norway) out of a total of 28 European countries surveyed reported comparatively small differences in drug use among men and women.

In the past, the illegal production of amphetamine-type stimulants in Europe was mostly concentrated in the Netherlands and to a smaller extent in Belgium and Poland, but it has already spread to a number of countries, including Germany, Bulgaria, the Western Balkan countries, and the Baltic countries.

According to the UNODC report, the Netherlands, Belgium, and Poland continue to occupy leading positions by production of amphetamine-type stimulants in Europe.

Bulgarian Health Fund Found Guilty of Discrimination

In November, Bulgaria's Supreme Administrative Court, VAS, ruled against the National Health Insurance Fund, NZOK, on charges of discrimination against people suffering from multiple sclerosis.

NZOK was found guilty of discrimination because it provides funding for treatment only to patients who have 65% disability, while the rest are left to deal with the suffering on their own, according to the VAS rule. It was announced after a 3-year-long battle of an employee of the Council of Ministers, Desislava Rayanova, against a NZOK decision to provide the very expensive medication (nearly BGN 2 000 a month per patient) only to those with 65% disability from multiple sclerosis.

In January 2010, Rayanova filed a claim with the Commission for Protection against Discrimination, which in July 2011 won the case against NZOK, per the rule of the Sofia Administrative Court, SAS. NZOK filed an appeal, leading to the Supreme Court confirming the rule of the lowest instance.

Rayanova said that thanks to the expensive treatment she feels well and can work full time at the office of Prime Minister, Boyko Borisov. She witnessed before VAS that 5 000 Bulgarians are diagnosed with the debilitating condition, mostly young people, and cannot afford the medication.

The woman, 43, has been diagnosed at the age of 33. In October, she won another battle – to ban employers from firing or laying off people who suffer from multiple sclerosis.

Bulgaria's Hospitals with BGN 350 M Debt

In December, Health Minister, Desislava Atanasova reported that Bulgaria's public hospitals have a total debt amounting to BGN 350 M. According to Atanasova, this includes BGN 283 M in debt of State hospitals, and BGN 67 M debt of municipal hospitals.

The minister said that the overdue debt of State hospital amounts to some BGN 50 M, but "almost all" of those hospitals have adopted a payment plan.

Atanasova has also announced that a total of 13 hospitals in Bulgaria will undergo upgrading and improvement works worth over BGN 147 M because the Health Ministry had won a project under the Regional Development Operational Program for repairs and upgrades at the medical facilities with an emphasis on diagnosis and treatment of oncologic diseases.

Repair and construction activities already started at 8 out of 13 hospitals and the procedures for the delivery of cutting-edge equipment are also underway. Part of the money would go to the conversion of eight homes for medical and social care for children into social support centers for r families with children aged up to three years.

Healthcare, Politics and Legislation

Bulgaria Goes Ahead with Plan for Crack-Down on Miracle Healers

In 2012, Bulgaria's Health Ministry finally proceeded with plans to distinguish charlatanism from therapy and translate them into a law. An ad hoc body, established at the initiative of Health Minister Desislava Atanasova, proposed that alternative medical therapy should be practiced only by people who have been educated in this field, while their work – monitored by the health ministry.

But experts fear that the legislation wouldn't do much to put an end to the booming business of clairvoyants and miracle healers because too many Bulgarians believe in their services. Numerous psychic programs of clairvoyants, soothsayers, fortune-tellers and astrologers with special powers have turned into a social phenomenon in Bulgaria. The business of miracle healers is booming as never before on the back of the economic crisis, Bulgarians' despair and their predilection for mysticism and superstitions.

These pushy women can be seen standing in front of hospitals, their ads feature in newspapers and on the internet. It is hard to avoid meeting them even in downtown Sofia. More often than not, following these sessions, the patients end up with double-digit bills, rather than a solution to their problems.

The promise to solve virtually any problem whether it's regarding love, career, finance, stress or illness however have made the miracle healers so popular in Bulgaria that they successfully compete with the medics from the health care sector, left in tatters after the collapse of the communist regime.

According to social analysts the fear of the unknown, the feeling for being helpless when faced with corruption, the insecurity and instability that marked the period of big changes in the country, makes people seek refuge in superstitions.

Notorious MP Appointed to Head Bulgaria's National Health Fund

In March, Bulgarian ruling GERB party MP Plamen Tsekov was expectedly selected by the Parliament to become the next head of Bulgaria's National Health Insurance Fund, NZOK.

Tsekov was appointed after the resignation of Neli Nesheva as NZOK Director in the wake of a resonating scandal with sizeable bonuses being given within her institution, including to herself. Before that, Tsekov was the Vice-chair of the parliamentary Committee on Health, as well as chair of the group for friendship with Switzerland.

Plamen Tsekov gained notoriety back in 2010, when he had to leave as Deputy Chair of the Parliamentary Health Committee after a lobbyist scandal involving an amendment to the Law on Drug Substances which appeared in the State Gazette without the President's signature or a vote on the part of Parliament.

Bulgaria Lifts Cap on Funds for Treatment of Sick Children

In March, Bulgaria's Health Ministry proposed to the cabinet to lift the cap of BGN 180 000 for the medical treatment of children. Prior to that, Health Minister, Desislava Atanasova vowed on several previous occasions to bring these changes after parents and NGOs alarmed that the limit hurdles the treatment of sick children with the use of resources from the Fund.

In addition to eliminating the cap, the project proposed to the Council of Ministers to secure additional financing for the Fund in order to provide all necessary amounts needed for the medical care of Bulgarian children.

Bulgaria Extends In Vitro Time with State Funding

In April, Bulgaria's authorities extended by six months the time for conducting an in vitro procedure with State funding.

Thus, women who have been approved for artificial insemination by the Bulgarian Fund for Assisted Reproduction had an entire year to carry out the procedure. Experts explained that many Bulgarian women who are between their second and third attempts need a surgery or a hormonal treatment before they can get down to the in vitro procedure, and six months were not enough for all this.

The amendment will help about half of the women that apply for State funding for in vitro procedures. The Bulgarian State funds up to three in vitro attempts for women below 43 years of age. The Fund for Assisted Reproduction was set up in April 2009, and since then 1 500 babies have been born with its support. The success rate of the in vitro procedures is about 25%. The "I Want a Baby" Foundation insist on greater privileges for women aged 42 because they have a last chance before turning 43, and after that are no longer eligible for state in vitro funding.

Bulgarian Min to Ban Drivers Licenses for Health-Uninsured

In April, Bulgaria's Health Minister, Desislava Atanasova, at the time just appointed for the post, added drivers licenses to the list of IDs that would not be provided to those who do not pay health insurance contributions. Days before that, Atanasova declared that Bulgarians who do not pay health insurance may be deprived of certain administrative services, including receiving identity cards,

She stressed that such measure would be way more effective than legal sanctions, including jail. Atanasova also insisted that the debt of Bulgarian hospitals for years back was due mainly to the treatment of people without health insurance.


In April, Bulgaria's Deputy Health Minister, Kiril Dobrev, became the latest senior health official to submit his resignation, which came on the heels of mass reshuffles at the institution and the entire healthcare sector.

They were triggered by a scandal with skyrocketing prices of medications in the country and the huge bonuses received by the leadership of the National Health Insurance Fund, NZOK. The reshuffles included the resignation of Health Minister, Stefan Konstantinov, the dismissal of his Deputy Gergana Pavlova, and the resignation of NZOK Director, Neli Nesheva.

Konstantinov's replacement, Desislava Atanasova, is the fourth Health Minister in the cabinet of the ruling Citizens for European Development of Bulgaria party, GERB.

On March 31, the first GERB Health Minister Bozhidar Nanev reiterated his conviction that he had been tried in a Court of law for serving Bulgaria and following the law.

Nanev was acquitted on first and second instance (in December) of charges of inflicting damage in the amount of over BGN 2.4 M for the State and the Health Ministry. The amount was the difference between the price offered by the British National Health Services through the British Embassy in Sofia and the price negotiated by the Ministry with "Roche Bulgaria" for the antiviral medicine Tamiflu.

The former Minister reiterated he did not feel at all as a person who had deprived his country, but as someone who had rescued it from damages of about BGN 6 M. He grounded it on the facts that the British offer has been cheaper but the deal had been impossible to realize; the medicine had shorter expiration date and a longer delivery time.

Nanev resigned at the end of March, 2010, after prosecutors indicted him for concluding the unfavorable deal with "Roche Bulgaria."

Commenting on the very frequent replacements and ousting of health ministers in Bulgaria, he explained that the healthcare system is way too complex and charged, overloaded with many difficult to solve problems, but added he still did not understand what had generated having 4 such ministers already during the GERB term, since the problem was not in any single individual, but in the entire policy in the sector.

Health Minister Sacks Sofia Emergency Hospital Board

In June, Bulgaria's Health Minister, Desislava Atanasova, appointed a new Board of Directors of the emergency hospital "Pirogov" in the capital Sofia, one of the busiest emergency hospitals in the country.

Dr. Chavdar Marinov and Prof. Danail Petrov were released from duty but were to still be held responsible about any inflicted damages. The CEO of the emergency hospital, Prof. Dimitar Radenovski, kept his post only to be dismissed by the Minister in November over public procurement violations.

According to media reports, based on information from unnamed government sources, the violations committed by Prof. Dimitar Radenovski were established by the Public Financial Inspection Agency (PFIA) and just one of the irregularities incurred damages worth over BGN 710 000. The interim head of the Pirogov hospital in Sofia is the head of the Reanimation Unit, Prof Stoyan Milanov.

Radenovski's resignation was also demanded in connection with an investigation of the prosecuting authority launched in the summer over malfeasance in office and large-scale embezzlement at Pirogov. The Prosecutor's Office was notified about the violations in a report of the Medical Audit Executive Agency's (MAEA).

In the summer, Atanasova reported serious violations established by a financial probe she requested. The probe has found suspicious contracts such as for arranging books for BGN 5 400, for snow removal for BGN 7 000, for designer furniture, for financial services, dummy patients, and others. Problems have been found also with bonuses given to some staff, charity campaigns and public tenders.

Speaking for the media, then Chief Prosecutor, Boris Velchev, advised them to refrain from commenting on the audit and investigation report without having examined them. This was the very first such report on the top emergency hospital in Bulgaria, which is operating under deplorable conditions and chronic shortage of funds, medications, and consumables.

State Budget Use of Insurance Funds Ruled Illegal in Bulgaria

Redirecting health insurance funds to the State budget violates the Constitution of Bulgaria, the Constitutional Court ruled at the beginning of July.

The supreme magistrates declared unconstitutional the text in the Act for the Budget of the National Health Insurance Fund, NZOK, allowing the Health Ministry to cover expenses for medical activities, medications and medical supplies by using money from NZOK.

At the time, BGN 100 M in 2012 and 340 M in 2011 were already transferred from NZOK to the Health Ministry. The idea was the brainchild of Finance Minister, Simeon Djankov, who aimed at saving funds in the State budget by subsidizing the Health Ministry with money from health insurance contributions.

The opposition countered in parliamentary debates that there were no guarantees whatsoever that the said money will be spent only for health insured patients. The MPs who filed the claim insisted that this was an unconstitutional "confiscation of part of the resources of NZOK" with BGN millions given to the Executive Power represented by the Health Ministry, which is financed by the State budget. According to them, this meant that the NZOK budget financed the State budget, which they deem unacceptable.

The magistrates ruled that the text was in contradiction with the rule of law and the Constitution because the Executive Power is mandated to be subordinate in order to guarantee the predictability of its actions.

Bulgaria to Develop National Hepatitis Plan

It was announced in July that Bulgaria's Health Ministry and the European Liver Patient Association (ELPA) are to start the development of a National Hepatitis Plan in the Balkan country. ELPA's President Tatjana Reic estimated that there are over 500 000 people in Bulgaria affected by Hepatitis B and C all while stressing that the last official research dates back 15 years ago.

On July 5, a roundtable discussion with international experts on viral hepatitis took place in the Bulgarian Parliament. The roundtable brought together experts from different organizations, including the European Commission, ECDC, WHO the EASL, ELPA , experts from France and Scotland, EPF or WHA among others.

Bulgaria's Pleven to House New Medication Council

The headquarters of Bulgaria's future National Medication Council will be in the northern city of Pleven, Bulgarian Prime Minister, Boyko Borisov, announced in September. He grounded the decision on the facts the city has a medical university, good hospitals, and highly qualified healthcare professionals.

A week before the announcement, the Parliament decided to establish a National Council on Prices and Reimbursement of Medication Products with the statute of a State Commission. At the beginning of July, the cabinet adopted amendments in the Human Medicine Medications Act, which provided for the establishment of such Council.

About 30 people will be employed by the Commission with an average monthly salary of BGN 2 000 each. Until now, the Commission did not have its own administration and was not a permanent body.

Other Health Stories

Bulgaria's Stoichkov Makes Dream Come True for Teen Coma Survivor

In January, Hristo Stoichkov, Bulgaria's most internationally renowned football player, made the dreams of a very sick boy come true, when he surprised 13-year-old Tanyo in hospital, just weeks after his liver transplantation.

Tanyo Kostov was blessed with a second chance at life after Bulgarian authorities and Sofia-based hospital Lozenets pooled their efforts to rescue the boy from Athens, where he lives with his family.

Beset by the Wilson disease, a genetic disorder that prevents the body from getting rid of extra copper, the boy fell into coma at the end of 2011. The only chance for life was a liver transplantation, which however the Greek doctors refused to do since there were no matching dead donors.

Unlike Greece however Bulgaria makes liver transplantations from live donors, which is why the boy was urgently flown to Sofia with the assistance of Bulgaria's embassy in Athens and the government.

A team from Sofia-based University Hospital for Active Treatment Lozenets committed to the risky operation, a daunting task for any surgeon. The moral burden on the doctors' backs got heavier after the father agreed to become a donor so that his son may live. The chance for Tanyo to survive was less than 10%, but the medics decided to take the risk.

Less than a month after the lifesaving procedure, Tanyo, with a wide and welcoming smile on his face, stood before reporters at a press conference on January 18, next to his idol Stoichkov. Stoichkov had gotten wind of Tanyo's plight, and, hearing that his dream was to one day meet him, hooked up with the government and the hospital to make this dream come true.

In addition to spending a genuine amount of time with Tanyo, the football legend presented him with a few precious gifts that may ignite envy in any football fan - a T-shirt of the national team, a present from the great Pele, a football ball and shoes.

Bulgaria Bids Farewell to Brave Patient Rights Activist

In January, approximately 300 people gathered to pay their last respects to Teodora Zaharieva, the country's most fervent cancer patient rights activist.

Bulgaria's former EU Commissioner Meglena Kuneva, Sofia Mayor Yordanka Fandakova, then Health Minister Stefan Konstantionov, former Health Minister Ilko Semerdzhiev and Bulgaria's Ombudsman Konstantin Penchev were among those who attended the event. As the coffin was brought out of the capital's Sveta Sofia church by Zaharieva's relatives, it was applauded by the people who had gathered around.

Teodora Zaharieva passed away from cancer on January 7 after more than 10 years of fighting her illness, as well as the apathy of the institutions.

In 2007, after a trial that protracted over 3 years, Zaharieva managed to win a claim of BGN 100,000 against the Ministry of Health for having failed to provide her with the needed treatment. She used the funds from the case to invest in a patient organization to protect not only those suffering from cancer, but all ill people in the country.

In 2009, the activist was bestowed by the Bulgarian Helsinki Committee with the title Human of the Year. In 2010, she was given the Civil Courage Award of the Panitza Foundation.

Expired Medicines on Sale at Sofia Flea Market

Dangerous medicines of unknown origin and past sell-by dates are being sold on the flea market in Sofia's Malashevtsi residential district. According to reports of private TV station bTV, aired in March, the drugs were displayed on the ground alongside plastic basins, slippers and books.

A strong anti-depressant, for instance, could be bought for BGN 1.50, despite the fact that the sale of the medication in Bulgaria has not been explicitly permitted and that the leaflet information is in Turkish. The seller of the anti-depressant was unaware about the method of application of the anti-depressant.

The flea market in Malashevtsi also offered children's syrups, antibiotics, anti-infection sprays, pills for diabetics and asthma inhalers priced at BGN 5, despite the fact that they are fully reimbursed by the National Health Insurance Fund. A pharmacist said that a large portion of the medicines that are being sold on the flea market (some 80-90%) are past their sell-by date and were simply rubbish.

Fines for illegal sales of medication amount to 4-digit sums. These medications are supplied through break-ins of pharmacies and theft from hospitals. The batch numbers enable the authorities to track each medicine back to a certain trader or a warehouse. What makes the situation more complicated is the fact that the regime for the disposal of medications that have passed their expiration dates is very outdated. Under current legislation in the sphere, expired drugs cannot be thrown away in the garbage, but there is no authority in charge of the ordinance's implementation.

Bulgarian Health Fund Secures Discounts for 25 Drugs

It was reported in March that the Bulgarian National Health Insurance Fund, NZOK, has secured discounts for 25 medications used for hospital treatment. The new prices to be paid by the Fund became effective on March 16th.

Several days earlier, the management of the Fund sent letters to 62 companies holding licenses for 284 such medications, inviting them the offer discounts for the prices paid by NZOK. The price reduction was between 0.04% to over 37%, while the medications are used for the treatment of different types of cancer, diabetes, asthma, schizophrenia, and in cases of transplants, among others. Under the new contract, NZOK was expected to save over BGN 4.5 M in the course of one year.

NZOK can negotiate discounts only for medications for which it pays 100% and that have no alternative. Pharmaceutical companies can, on their initiative, offer discounts for unique drugs that are paid 25%, 50% or 75% by NZOK, but no firm so far has undertaken such initiative.

It emerged at the beginning of 2012 that NZOK had paid BGN 6 M more for medications in 2011, compared to 2010, when the signing of the contracts was under the authority of the Health Ministry. Some of the medications had a price that skyrocketed 10 or more times in 2011. Deputy Health Minister, Gergana Pavlova, who was in charge of the medication policy of the institution, was dismissed as result and the Chief Prosecutor ordered a probe in the case.

Tsvetan Raychinov Reelected Chair of Bulgarian Doctors Union

In March, the Chairman of the Bulgarian Doctors Union, Tsvetan Raychinov, was reelected at the post at a forum of the organization, held in the northern city of Pleven. Raychinov was able to keep the post after a runoff. He collected 212 out 340 votes.

EP Urges Stricter Breast Implant Safety Checks, Bulgaria Affected Too

In June, the European Parliament called for a breast implant registry and stricter safety checks in a bid to prevent a recurrence of the PIP defective breast implants case.

In a resolution adopted by a show of hands, MEPs argued that the PIP case "has shown a malfunctioning at European and national levels, notably a lack of cooperation (...), and a lack of traceability of raw material used for medical devices".

An estimated 400 000 implants made by the French manufacturer Poly Implant Prostheses (PIP) have been sold worldwide. These implants were widely used in the UK, France, Spain and Germany. However, the number of women who have received them is unknown. According to unofficial data, tens of thousands of women in some 65 countries across the world, mainly in Western Europe and Latin America, may have been affected by the hazardous product.

The faulty breast implants were imported to Bulgaria too. By the middle of January 2012 nearly 150 Bulgarian women rushed to remove the potentially faulty silicone breast implants supplied by PIP. Bulgarian experts say the French company is the only one to blame for the adverse effects since after initially meeting the requirements, it started using silicone that was not meant for medical use. As a result the PIP implants had a higher rate of rupture than other implants and may cause breast cancer.

Israeli Doctor Praises Burgas Colleagues over Terror Attack Reaction

The hospital in the Bulgarian city of Burgas reacted well to the July 18 terror attack emergency, according to Gabi Barbash, an Israeli MD.

The July 18 terrorist attack in Bulgaria's Burgas, also known as the Burgas Bus Bombing, killed 5 Israeli tourists and a Bulgarian bus driver at the Sarafovo Airport near Burgas.

Dr. Gabi Barbash, the CEO of the Tel Aviv Sourasky Medical Center, headed the Israeli medical delegation to Burgas.

"Post factum, it is important to acknowledge that the medical response of the hospital in Burgas to a complex situation it had never before encountered was outstanding. Its conversion from a resort town's first response medical station to a "triage" medical operation was excellent. The staff correctly evaluated the clinical situation of each casualty, and capably orchestrated the immediate evacuation of the three most severely injured among them to tertiary hospitals in the capital city of Sofia, thus almost certainly saving their lives," Barbash said in a Jerusalem Post article.

The Israeli doctor described in detail the evacuation of Israeli tourists from Bulgaria in the wake of the bus bombing. Israel's chief of the military Medical Corps Gen. Itzik Kryce also praised the work of Bulgarian medics in saving the lives of those who were injured in the grave terrorist attack in Burgas.

Meanwhile, Bulgarian Prime Minister Boyko Borisov, true his controversial style, made headlines when calling a "tough butcher" one of the key doctors who helped the wounded Israeli tourists. His words were met with a slight embarrassment and smiles by the doctors at the award ceremony at the Council of Ministers. In a more serious tone, Borisov expressed his gratitude to the medics, pointing out that their response was extremely professional.

The Special Merit Award of the Bulgarian Health Minister was granted to Dr. Asen Kardzhiev from the Emergency Medical Center in Burgas, Dr. Georgi Mitev, Manager of the Burgas Hospital, and Dr. Georgi Pazderov, head of the Regional Health Inspectorate in Burgas, BTA reported.

Another 15 doctors from the Pirogov Emergency Center in Sofia and the Military Medical Academy in Sofia were awarded, as has been MP Galina Mileva, a forensic from Burgas who took part in the autopsies. More than 200 medics joined the medical rescue efforts after the Burgas Bus Bombing.

Woman Gives Birth after Cervical Cancer Surgery in Bulgaria

On August 21, the first ever case of a woman carrying out a successful pregnancy after cervical cancer surgery was recorded in the city of Pleven, northern Bulgaria. A 32-year-old woman that had undergone the surgery gave birth to a healthy child after in vitro insemination at the Pleven Medical University Hospital.

The baby-girl was however born well ahead of the term, which was in October, and weighted just 1 200 grams, which required incubator care.

Up to now, in the world there have been only 16 cervical cancer surgeries which have managed to preserve the patient's uterus, with 2 of them performed in Bulgaria. The post-cervical cancer mother in Pleven was among the more than 350 surgeries performed with the help of a Da Vinci robot at the Oncogynaecology Clinic. She had one ovary and one Fallopian tube removed, but her uterus was left intact.

Bulgaria Asks Israel for 'Emergency Medical Aid'

In September, the second joint sitting of the Cabinets of Bulgaria and Israel in Jerusalem, Bulgarian Health Minister Desislava Atanasova requested that Israel help Bulgaria with training in emergency medical aid.  Atanasova and Israel's Deputy Health Minister Yaakov Litzman signed a Plan for Cooperation in Healthcare and Medical Science.

Another matter that she discussed with Israel's Deputy Minister of Health Litzman was the opportunity for discounts in the treatment of Bulgarian citizens in Israeli hospitals. She has urged Israeli companies to invest in healthcare facilities in Bulgaria such as an in vitro fertilization clinic.

Under the Cooperation Plan, Bulgarian and Israeli medical authorities are supposed to cooperate in public health, health promotion, control of contagious diseases, and HIV and AIDS prevention, among other fields.

In the frame of the same sitting, Bulgarian Minister of Social Policy and Labor Totyu Mladenov met with his Israeli counterpart and reported that Israel, which has rich experience in helping the elderly population, may invest in the construction of nursing homes in Bulgaria, to be built on a public-private partnership basis.

Qatar Checks Out Bulgaria's Rehabilitation Centers

A Qatari delegation including representatives of the Hamad Medical Corporation arrived in Bulgaria in October to look at the rehabilitation potential of local hospitals. The delegation visited medical rehabilitation centers in the mineral water resort town of Hisar.

Bulgarian experts presented specialized rehabilitation programs for the treatment of osteoporosis, coxarthritis, ankylosing spondylitis and arthritis.

The Qatari delegation also visited specialized rehabilitation hospital in Bankya, where Bulgarian experts presented a program for the rehabilitation of children with cerebral palsy. The delegation met with Bulgarian Health Minister Desislava Atanasova.

Bulgarian Doctors Demand FinMin's Sacking

In December, the Bulgarian Doctors Union, BLS, at its annual meeting, demanded unanimously the resignation of Deputy Prime Minister and Finance Minister, Simeon Djankov. The Bulgarian Medical Association and other professional and patients' organization have also requested Djankov's resignation.

BLS issued a declaration stating Djankov has violated repeatedly Bulgarian laws, redirecting funds from citizens' health insurance contributions to the State budget. In the last 3 years these redirected funds have reached the amount of BGN 2 B, the declaration claimed.

Medical professionals further say they want the Minister's sacking over his statements that there is lack of reform in the healthcare sector, hinting "greedy" doctors and pharmacists are responsible for it along with four unsuccessful health ministers in the last four years. According to them, National Health Insurance Fund, NZOK, is being nationalized and its management is in competent and dishonest.

Demands for Djankov's resignation and of the Head of NZOK were joined by Bulgaria's right-wing Blue Coalition has demanded the resignations of Finance Minister Simeon Djankov. Right-wing MPs insist the Minister has turned NZOK into his "personal piggy-bank," while NZOK Head, Plamen Tsekov has "failed to defend the interests of health insured Bulgarian citizens."

Blue Coalition lawmakers also reminded that VAT on medications in Bulgaria is the highest in the European Union, which results in very expensive medications.

Bulgarian Christmas Charity

In December, the 'Bulgarian Christmas' charity, which was set up by former President Georgi Parvanov in 2002 to give sick children a hope, was launched for the tenth time and with boosted expectations by his successor Rosen Plevneliev.

The charity collects funds each year to pay for the treatment of sick children abroad and for purchasing medical equipment for children hospitals and clinics.

For the first time this in 2012, the campaign focused primarily on children with neurological diseases. The choice was made after it emerged that most of the applications submitted for 2011 were related to the treatment of children with such problems. By December 20th, the campaign collected a total of BGN 1.5 M.

Similarly to previous years, a Christmas concert marked the culmination of the initiative. Short text messages and phone calls to number 1117 for all three mobile operators in Bulgaria at the cost of EUR 0.5, as well as donations made to the bank account opened for the initiative will contribute to the amount collected.

The phone lines were left active until January 2. After that donations can be made only to the bank accounts opened for the initiative.

Parvanov, who has been the charity's patron throughout the years, has attributed the success of the Bulgarian Christmas to its transparency, honesty and noble cause.

The first eight editions of the 'Bulgarian Christmas' raised over BGN 18.1 M, which enabled the medical treatment of 1066 children, while 139 pediatric hospitals and clinics have received ambulances and medical equipment. Plevneliev has vowed to keep alive the initiative, which Parvanov famously described as one of the biggest achievements he would leave to his successor.

Bulgaria Takes Part in Global Health Days

On February 4, Bulgaria joined many countries across the globe in marking World Cancer Day, dedicated to raising awareness of cancer and to encourage its prevention, detection, and treatment

A day before Bulgaria banned smoking in all enclosed public spaces, the country and the world observed on May 31 the No Tobacco Day to draw global awareness to the widespread prevalence of smoking and its negative health effects.

On September 29, Bulgaria marked the World Heart Day with series of events and free exams in hospitals to raise awareness of cardiovascular diseases, which are the country's largest killers....

On November 15th, the third Thursday in November, many countries, including Bulgaria, marked the International Smoke Free Day (Great American Smokeout).

On December 1, Bulgaria joined many countries all over the world in marking World Aids Day for the ninth consecutive year.

World AIDS Day is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection. Government and health officials observe the day, often with speeches or forums on the AIDS topics. Since 1995, the President of the United States has made an official proclamation on World AIDS Day. Governments of other nations have followed suit and issued similar announcements.

Globally an estimated 34 million people have HIV, half of them women. More than 25 million people between 1981 and 2007 have died from the virus, making it one of the most destructive pandemics in history.

In Bulgaria, the first case was discovered in 1986 in a student from Tanzania. According to the Bulgarian Healthcare Ministry, there were 139 newly discovered cases in 2012 (108 men and 31 women). 45% of these cases are young people, under the age of 39. 70% of the newly-registered were infected through sexual intercourse.

The Bulgarian Healthcare Ministry has launched a nation-wide informational anti-AIDS campaign aiming to promote safe sex among the country's population, as well as a more tolerant attitude towards those who are living with AIDS.

Mobile HIV testing clinics were made available on December 1 at several key spots in downtown Sofia. The Bulgarian Red Cross youth organization staged a "flash mob" of information kiosks at metro stations in the capital to distribute brochures and condoms. Mobile teams also distributed informational materials. A candlelight vigil was held in the evening in the park at the National Palace of Culture, NDK.

On St Valentine's Day, Bulgarians were able to get free testing for HIV and AIDS in 38 stations across the country.

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Tags: smoking ban, National Health Insurance Fund, National Health Fund, healthcare, health care, health, Health Ministry, health minister, Desislava Atanasova, doctors, nurses, medicines, cancer, cancer patients, Bulgarian Christmas, blood transfusion, Blood Transfusion Center


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