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Health Inequities in Bulgaria – Action and Challenges. Svetlana Spassova, MD Ministry of Health, Bulgaria Chisinau 07.11.2008. WHO's health system performance framework . The Health System in Bulgaria. Addressing inequalities in Bulgaria. Addressing the particular health needs of:

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Health Inequities in Bulgaria –Action and Challenges

Svetlana Spassova, MD

Ministry of Health, Bulgaria

Chisinau 07.11.2008



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The Health System in Bulgaria


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Addressing inequalities in Bulgaria

Addressing the particular health needs of:

  • Uninsured people;

  • People with low income;

  • Disabled people;

  • Vulnerable groups: children, youth, elderly;

  • Minorities;

  • People, suffering from specific diseases.


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Addressing inequalities: Stewardship

  • Legislative provisions: The Law on Health and secondary by-law guarantee access to certain healthcare services, regardless of insurance status;

  • The National Health Strategy: putting the issue of addressing inequalities on the political agenda;

  • National strategies and programs targeting disadvantaged groups: focus on information, disease prevention, provision of services and treatment;

  • The EU-Pre-accession instruments (the PHARE-program) and the Structural funds


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Addressing inequalities: Investment and training

  • Availability of qualified human resources- specialization system financed by the state;

  • Investments in infrastructure and facilities – state financed investment policy provided by MoH, projects financed under the pre-accession and Structural funds; municipal budgets

  • Access to pharmaceuticals – legislation on pharmaceuticals and medical devices; control of prices of prescription drugs linked to external and internal reference and inflation; positive drug list


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Addressing inequalities: Service delivery

  • State budget financed access to emergency healthcare, midwifery care, organ transplantations and follow up treatment, central procurement of pharmaceuticals for cancer diseases, rare disease, blood disorders, transplants and dialysis; immunization and vaccines, neonatal screening of genetic diseases; access to national, regional and community programs, transportation, mobile structures and outreach programs.

  • National programs, targeting:

  • disadvantaged groups: minorities, people with mental disorders, people with rare diseases, etc.

  • diseases, representing significant socio-economic burden: cancer, tuberculosis, HIV/ AIDS, etc.


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Addressing inequalities: Financing

National budget spending on:

  • health services for uninsured;

  • health services for specific vulnerable groups;

  • national, regional and communal programs.

  • infrastructure

    External funding:

  • EU fund spending on specific projects, targeting minorities or diseases, affecting predominantly vulnerable groups.

  • The Global Fund to fight AIDS, tuberculosis and malaria

  • infrastructure, regional development, strengthening of human resources and administrative capacity;


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Strengthening health system - performance and challenges

Improving health in equitable way requires:

  • Functions of the health system, related to reforms

  • Reform plans, oriented towards goals

  • Overall goals, split into specific objectives

  • Measurable intermediate objectives, leading to achievement of national objectives


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Addressing inequalities: Challenges

  • Defining and implementing reforms and investments, aimed at those most in need of care;

  • Balancing competing demands and setting clear policy priorities

  • Creating awareness in order to prevent conflicts between different members of society

  • Developing programs, that deliver added value and have defined measurable outcomes

  • Ensuring the availability of qualified health force; creating incentives for medical professionals

  • Developing PPP


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Addressing inequalities: Challenges

  • Financial restrictions require prioritizing

  • Reducing financial barriers which hinder access to needed care

  • Ensuring continuity: a stable flow of resources

  • Reaching the disadvantaged people; monitoring the responsiveness of services

  • Evaluating the impact of service delivery strategies.


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Measuring Outcomes: Conclusions

Measures aimed at addressing inequalities strengthen health system performance, if resulting in

  • Better health throughout the entire population;

  • Responsiveness of the system to specific needs and vulnerabilities;

  • Sufficient funding and optimal redistribution so as to enable universal access to health services.



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