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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

Health Inequities in Bulgaria –Action and Challenges

Svetlana Spassova, MD

Ministry of Health, Bulgaria

Chisinau 07.11.2008

addressing inequalities in bulgaria
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.
addressing inequalities stewardship
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
addressing inequalities investment and training
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
addressing inequalities service delivery
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.
addressing inequalities financing
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;
strengthening health system performance and challenges
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
addressing inequalities challenges
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
addressing inequalities challenges13
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.
measuring outcomes conclusions
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.

Thank you for your attention!

Svetlana Spassova, MD

National Health Policy Director,

Ministry of Health - Bulgaria