Geographical Locations - Bulgaria

• (Statistical) Number of Inhabitants per Doctor: 320
• CIA World Factbook : Bulgaria

Organisations and Networks

UN and Multinational

• WHO
  - WHO Country Profile - Bulgaria
  - WHO - Tobacco control: country profile - Bulgaria
  - WHO - Environmental Burden of Disease: Country Profile – Bulgaria
  - WHO – Progress in the Prevention of Injuries in the WHO European Region: Bulgaria
• WHO - Regional Office for Europe (EURO) in Copenhagen (Denmark)
• UNDP in Bulgaria
• UNHCR Bulgaria
• Delegation of the European Commission to Bulgaria - Available in English and Bulgarian

Government

• Bulgarian Drug Agency
• Ministry of Education and Science
  - National Science Fund
• Ministry of Environment and Water
• Ministry of Health
• Ministry of Labour and Social Policy
• National Center of Health Informatics - "a health institution in the structure of the National Healthcare System dealing with the problems of public health."
• National Center of Public Health Protection (NCPHP) - provides consultative and expert advice to government, conducts training in various aspects of public health education, and undertakes activities associated with public health issues.
• National Statistical Institute (NCHI) - collates information on the activities of all health and healthcare facilities in the country

Non-Government

• Assistance Centre for Torture Survivors Bulgaria - "The Assistance Centre for Torture Survivors - ACET is a Bulgarian non-governmental, non-profit foundation established in 1995. Its main goal is to eradicate the practices of torture and other cruel or inhuman treatment."
• Association for Integration of Refugees and Migrants - "The Association for integration of refugees and migrants is a legal entity registered on 22 July 2004 as a civil initiative under the Law for non-profit legal entities. It operates as a non-profit, non-political organization, for the promotion of social and cultural integration of recognized refugees and migrants in Bulgaria."
• Bulgarian Gender Research Foundation - "The Bulgarian Gender Research Foundation is an NGO of public utility that promotes social equality and women’s human rights in Bulgaria through research, education and advocacy programs. The BGRF was founded in June 1998 in Sofia. The team of the Foundation consists of lawyers, academics, experts in advocacy, education, monitoring violations of human rights, lobbying for legislative changes, preparing publications, networking."
• Bulgarian Red Cross
• Bulgarian Helsinki Committee - The Bulgarian Helsinki Committee is an independent non-governmental organisation for the protection of human rights
• Caritas Bulgaria - "Caritas Bulgaria is a charity, non-political, independent public organization working in close partnership with the Catholic Church to develops its activities locally and internationally. .."
• Center for Independent Living - "The Center for Independent Living – Sofia (CIL) is a Bulgarian non governmental, non profit organisation of disabled people. CIL has been working for a change in the governmental policy in the area of disabilities since 1995 by actively promoting the values of Independent Living and the application of the Social Model of disabilities. "

Academic Institutions

• International Center for Minority Studies and International Relations - The International Center for Minority Studies and Intercultural Relations (IMIR) was founded in April 1992 in cooperation with the Center for the Study of Islam and Christian – Muslim Relations (CSIC), Birmingham, UK and the Center for Research in Ethnic Relations (CRER), Warwick, UK. IMIR is a private, non-political, non-profit and non-governmental organisation, studying the relations and the interaction between different cultures, ethnoses and religions in Bulgaria and the wider Balkan region in order to help the development, preservation and integration of all minority communities
• Medical University Pleven
• Medical University Sofia

National Policy and Related Documents

Reports, Guidelines, and Projects

• Access to Health Care in Bulgaria: Marginalisation of Roma
  "In a decision made public this year, the European Committee of Social Rights (the Committee) has for the first time found a violation of the European Charter on Social Rights (the Charter) due to a failure to provide adequate medical assistance (Article 13(1)). In its decision in ERRC [European Roma Rights Centre] v. Bulgaria, the Committee found that Bulgaria failed to protect the health of its Roma population in particular (Articles 11(1), (2) and (3) in conjunction with Article E)." [Roma Rights Journal, number 1, pp.59-61, 2009]
• Bulgaria Country Report: EU partnerships to reduce HIV & public halth [sic] vulnerabilities associated with population mobility
  "The free movement of people, goods and services is perceived to be a pillar of the sustained development of the European Union. At the same time Europe is facing continuous ageing of the population, and increased immigration flows over the last decade, which have become driving forces for the demographic changes, especially in EU. Furthermore, population mobility naturally entails challenges from the common strategy and policy, legislation, human rights and public health. Migration increases vulnerability to infectious diseases, and in particular HIV and Tuberculosis. Therefore, HIV and migration should be brought to EU agendas as part of broader public health and social policies. Bulgaria, as a new member state and external EU border, also faces these challenges as it is expected that mobility will increase in two directions – internal (within the EU, mainly by young people emigrating from Bulgaria) and external (people from third countries immigrating to Bulgaria)." [International Organization for Migration, August 2007]
• Bulgarian UNGASS Country Progress Report – 2010
  "Bulgaria is at crossroad of two epidemics with different dynamics and different driving forces. According to UNIADS [sic], the epidemic in the region of Eastern Europe and Central Asia is the most rapidly growing one, and 62% of the new infections in 2006 are among injecting drug users. At the same time, the epidemic in Central and West Europe continues to grow mainly among men who have sex with men, who represent 29% of new HIV infections in 2006, and the number of newly registers cases has doubled between 1996 and 2006. Bulgaria is still a country with low HIV prevalence in the general population. However, the country faces a great challenge related to the possibility of rapid development of concentrated epidemics in separate group identified as most-at-risk. There is already such epidemiological and behavioural evidence for the groups of injecting drug users, men who have sex with men and sex workers. The risk is also related to the possibility of transmission of the infection to the general population, where the main mode of transmission is the heterosexual one, and where a generalized epidemic can develop. Therefore, now is the time to implement effective national policies aimed at preventing such epidemics in the country.” [Republic of Bulgaria]
• Cervical cancer screening in Bulgaria – past and present experience
  Background: In Bulgaria the previously (1970-1985) existing population based cervical cancer screening was replaced in the early 1990s with an opportunistic model due to political and socioeconomic reasons. As a result, in the last 20 years, cervical cancer incidence and mortality rates steady increased. The objective of the EUROCHIP project in Bulgaria was to evaluate the readiness of the health system as well as health providers’ attitudes to implementation in the country of a population based screening program for cervical cancer. Methods: Using a structured questionnaire, a convenience sample of medical specialists representing different actors involved in cervical cancer prevention, treatment, financing and policy were interviewed. Results: The majority of interviewed practitioners worried that organization and implementation of an effective population-based cervical cancer screening program is not possible in the current unstable health system. A nostalgic attitude to the cervical cancer screening, performed in the past and pessimistic view on the capability of the current health system to cope are strong. As main barriers to implementation of an effective program were pointed financial and organizational ones. Motivation for gynecologists to perform smear test should include better information, organization and payment. Discussion: Medical specialists in Bulgaria are aware of the alarming rates of cervical cancer incidence and mortality in the country. However, due to the insufficient communication and interaction between policy makers and front-line health care staff, they do not have enough information on the ongoing programs. Absence of health policy regarding screening is considered as main barrier for implementation of an effective screening program. [author abstract] [Tumori, 96: 538-544, 2010]
• Education in and the Practice of Dental Public Health in Bulgaria, Finland, and the United Kingdom
  The aim of this review paper is to describe and compare specialist education in and practice of dental public health (DPH) in Bulgaria, Finland, and the United Kingdom (UK). These countries are the only three member states of the European Union in which the specialty is officially recognised. In each country, DPH is included in the undergraduate curriculum. Postgraduate specialist education is provided at universities and lasts for three years in Bulgaria and Finland and four years in UK. The training programmes in DPH are a mixture of academic and practical training. The academic studies cover oral health needs and demands assessment, use of information technology, commissioning and evaluating oral health services, promoting oral health and research, together with other related areas. The practice of DPH includes: leadership and management of health organisations, teaching, training, research, advising and evaluating. This paper discusses the rationale for a specialty of DPH at a time of changing oral health need and give examples of problems that have arisen when such advice has not been sought or has been ignored. [author abstract] [OHDMBSC, Vol. VIII, No. 2, pp. 30-37 - June 2009]
• Health and the Roma Community: analysis of the situation in Europe – Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain
  "The Roma community is the largest ethnic minority in Europe and is characterised primarily by the situation of social exclusion and wide-ranging poverty experienced by a significant proportion of its members. Inadequate access to housing, education, employment and other needs, along with the existence of barriers to Roma access to health services and an ineffective use of these services due to their lack of adaptation and even to discrimination, all contribute to a range of avoidable injustices suffered by this community with regard to their health situation. These health inequalities are not reflected in reliable and up-to-date statistics or data, a fact which further hinders the planning of targeted interventions designed to reduce and ultimately eliminate inequality. The European project “Health and the Roma Community, Analysis of the Situation in Europe”, promoted by the Fundacion Secretariado Gitano, was implemented in 2007 to analyse the health situation of Europe’s Roma community, to address social inequalities in the area of health and to suggest policies and actions based on reliable knowledge designed to improve the health status of Europe’s Roma community and to reduce inequality. This project, funded by the European Union within the framework of the Public Health Programme, was implemented in seven European Union countries (Greece, Spain, the Czech Republic, Slovakia, Portugal, Romania and Bulgaria) with the participation of public and private entities from the different participating countries and under the coordination of the Fundacion Secretariado Gitano." [EFXINI POLI – Local Authorities for Social, Cultural, Tourist, Environmental and Agricultural Development. Greece; FSG – Fundacion Secretariado Gitano. Spain; Office of the Council for Roma Community Affairs – Czech Republic; PDCS – Partners for Democratic Change Slovakia; REAPN – Rede Europeia Anti-Pobreza/Portugal; ROMANI CRISS – Roma Center for Social Interventions and Studies. Romania; and THRPF – The Health of Romany People Foundation. Bulgaria, Madrid 2009]
• Healthcare Reforms in Bulgaria: Towards Diagnosis and Prescription
  The paper studies the policy response to the market failures and challenges of healthcare in transition. Bulgaria chose a halfway shift from healthcare services provided entirely by the state to a system with private providers of outpatient services and public providers of inpatient services, both sectors financed mainly by state-run compulsory payroll insurance system. The paper shows the evolution of this reform path to low compliance by both customers (contributors) and service-providers (contractors with the National Health Insurance Fund), which leads to excessive regulations and control, and crowding out of the private sector. The outcome is a system that is increasingly driven by administrative controls at the expense of market incentives. Based on this analysis it identifies the relevant policy implications and opportunities for moving the stalled health reforms out of the institutional impasse. [publication abstract] [MPRA [Munich Personal RePEc Archive] Paper No. 999, May 2006]
• Health Care Systems in Transition - Bulgaria
  The Health Care Systems in Transition (HiT) profiles are country-based reports that provide an analytical description of a health care system and of reform initiatives in progress or under development. The HiTs are a key element of the work of the European Observatory on Health Care Systems.
• Health expectancy in Bulgaria
  "This report is produced by the European Health Expectancy Monitoring Unit (EHEMU) as part of a country series. In each report we present: (a) Life expectancies and health expectancies at age 65 based on activity limitation (HLY) for the country of interest and for the overall 25 European Union member states (EU25), using the SILC question on long term activity limitation for 2005, 2006 and 2007. As the SILC has been only recently initiated, to document trends we provide previous HLY series based on the disability question of the 1995-2001 European Community Household Panel (ECHP); (b) health expectancies based on the two additional dimensions of health (chronic morbidity and self-perceived health) for the country of interest, based on SILC 2007; [and] (c) a global analysis of health expectancies of European countries, based on the SILC 2007." [European Health Expectancy Monitoring Unit (EHEMU) and its current project European Health and Life Expectancy Information System (EHLEIS)]
• Hospital reform in Bulgaria and Estonia: What is rational and what not? – Final report
  "The research undertaken in the framework of this project sought to contribute to the understanding of hospital reform in Bulgaria and Estonia by means of a detailed analysis of some policies implemented in both countries aimed at rationalising the provision of hospital services. An analysis of the theoretical and practical aspects of the hospital reforms in the two countries was performed. A study collecting primary data on the views and attitudes of hospital managers and stakeholders concerning the achievements and challenges in the reform of hospital care was conducted. A range of specific topics were selected to address the issues subject to research: a) review of health and hospital reform strategies in Bulgaria and Estonia; b) hospital service delivery, decentralization and level of hospital autonomy; c) measures for improving hospital efficiency." [Local Government Initiative Fund of Open Society Institute, Budapest, January 2007]
• Patients’ Informed Consent in Dental Practice in Bulgaria
  Introduction: Patients’ informed consent is a legal regulation and a moral principle, determined by legislation in Bulgaria and the European Union. It represents patients’ rights to take part in the clinical decisions concerning their treatment. The authors report research showing informed consent’s more important aspects related to daily relationships between dentists and patients. Aims: The main aims of this study were to investigate the use of patients’ informed consent and the extent to which it is provided in Bulgarian dentists’ practice. Methods: A questionnaire, which included questions on various aspects of the use of informed consent, was used to collect data from a convenience sample of 102 dentists working in the Medical University of Sofia, Faculty of Dental Medicine and the Military Medical Academy, Sofia, Bulgaria. Completed questionnaires were returned anonymously. Results: Eighty dentists completed the questionnaire. Seventy-eight (97.5%) replied that they thought informed consent was necessary. Seventy (87.5%) dentists reported that they took informed consent for all types of treatment. Of the remainder, 10 reported taking informed consent prior to surgical interventions, eight before orthodontic treatment and seven before prosthetic treatment. However, only 64 (80%) respondents reported that they always obtained informed consent from their patients. Thirty-seven (46.25%) dentists responded that they obtained the oral form of informed consent, 30 (37.5%) that they obtained written informed consent, and 13 (16.25%) that they obtained both forms. Surgical treatment was the most frequent case in which the written form was obtained. Almost all participants (70; 87.5%) reported that they should always take informed consent when they treated children. Forty-one (51.25%) reported that they obtained informed consent from all patients but 21 (26.25%) did not obtain it when treating colleagues, 29 (36.25%) from relatives, 15 (18.75%) from friends, and 10 (12.5%) from long-time patients. Conclusions: From the current survey, it can be concluded that the dentists as staff members of leading training and healthcare facilities may well have demonstrated greater awareness about questions concerning patients’ informed consent than most other Bulgarian dentists. Informed consent plays a major role in the daily practice of the majority but many are not using written consent as a routine procedure. However, even though almost 100% of the dentists thought that it is necessary to get informed consent, only 80% of them obtained it in practice. [author abstract] [OHDM, Vol. 10, No. 2, pp.80-87 - June, 2011]
• Public Health Statistics: Annual, Bulgaria, 2005
  Provides statistics on: Population and vital statistics; Morbidity and mortality by causes; Health facilities; Health personnel; Activities of the health facilities; Economic indicators of the health facilities; Review by regions; and International review.
• Reemergence of Human and Animal Brucellosis, Bulgaria
  Bulgaria had been free from brucellosis since 1958, but during 2005–2007, a reemergence of human and animal disease was recorded. The reemergence of this zoonosis in the country highlights the importance of maintaining an active surveillance system for infectious diseases that will require full cooperation between public health and veterinary authorities. [publication summary] [Emerging Infectious Diseases, Vol. 15, No. 2, pp. 314-316, February 2009]
• Social dialogue in the health sector: Case study Bulgaria
  "This paper on social dialogue in the Bulgarian health sector identifies the key problems related to its development, describes its main successes and best practices and suggests measures for its future improvement." [Working Paper 235, Sectoral Activities Programme, International Labour Office, Geneva, 2005]
• Workplace violence in the health sector – Case study: Bulgaria
  "As shown by most public opinion surveys, most Bulgarians live with the feeling of danger, insecurity, helplessness and pessimism in the conditions of economic and spiritual crisis in the Bulgarian society. These feelings are generated by the higher crime rate and impunity of the criminals. Robberies at home and in the street, assaults, rape, murders to settle accounts are almost a daily phenomenon. Even more alarming are the ever more frequent cases of unmotivated violence and sheer outburst of aggressiveness when innocent unknown people are beaten or murdered at schools, barracks, soccer playgrounds, discos and on the street. It may sound exaggerated, yet we could say that violence has, in one form or another, entered all Bulgarian homes. Yet even now in the conditions of democracy violence in the Bulgarian society is perceived with tolerance and is still shrouded in silence. Police officers, judges, investigators, chiefs, teachers, parents ignore the truth about violence committed in the social groups to which they belong. The approach of the institutions is much similar. Failing to interfere, they tacitly encourage and legitimise violence. The victim is blamed that she/he is responsible for what happened and subjected to victimisation." [WHO, Geneva, 2003]

Educational Resources

• CDC - Travel Information : Eastern Europe and the NIS
• HIV - web Bulgaria - The main purpose of this Bulgarian-based website is to provide easy access to comprehensive HIV/AIDS information on the Internet. The website contains 584 pages.
• Library of Congress, Country Study: Bulgaria