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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
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 • 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 • 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 • 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 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 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 • 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: 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 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 sspassova@mh.government.bg