Bulgaria faces recent demographic and socio-economic challenges where low marriage rate, low birth rates, increased urbanisation, increased mortality and intensive internal and external migration lead to a decrease of the population and population aging. The high rate of unemployment and extreme low incomes are usually the cause of miserable living conditions. All these factors contribute to worsen the health status of the population, especially among minorities and older people, who rely predominantly on the provision of care services.

The reform of the Bulgarian healthcare service started back in 1999 and was characterized by inconsistent policy and legislative amendments that complicated the relations among stakeholders. The provision of social assistance in Bulgaria was subject of a long lasting painful decentralization of services in favour of local community based facilities. One of the systematic drawbacks of the system in place is the lack of clear criteria for the selection of social services providers.

To address above challenges the proposed project endeavours a new approach thus combining delivery of health and social services to the citizens. Home care and assistance services will appear as an alternative to existing health and social cares.

The objective of the project is to improve quality of life of elderly people with chronic diseases and disabilities through provision of institutionalized home-based health and social care. The project will also address the special needs of those from the Roma community and from other vulnerable groups.

People older than 65 years including Roma with chronic diseases and disabilities in the region of Vratca

The project shall establish Home Care Centres in four municipalities in Vratsa District with poor socio-economic indicators and high Roma population. It will improve and maintain the health status, economic and social-well being of elderly, chronically-ill and disable people through direct service provision at their homes thus ensuring their independent living and social inclusion. At policy level the project will capitalize operational lessons in order to propose legislative adjustments ensuring institutional and financial sustainability of home care in health insurance packages covered by the National Health Insurance Fund (NHIF) and/or voluntary health funds.

Résultats obtenus:  

• 4 Municipal Home Care Centers piloted in the district of Vratsa
• Services available to 734 people (total number served during project cycle) in need in the poorest EU region, including patients from 13 small villages (count for approx 25% of all clients)
• First legal regulation of integrated medico-social services for various target groups at home adopted by the Bulgarian Parliament in September 2015
• New State Educational Requirements for the Social Assistant profession elaborated and adopted, building on their competencies and allowing the specialists in the social sphere to work in collaboration with medical professionals
• Effective integration of the Roma community in the project region achieved both as members of the staff of the HC Centers (25%) and as beneficiaries (15%)
• First cost-pricing and bench-marking analysis of integrated medico-social services for older people at home organized within the project; its data demonstrates the viability of the Swiss piloted model also by comparing financial parameters of similar services and also that the model significantly reduce public and private spending

Phase 1 01.07.2011 - 31.12.2017   (Completed)