Though a bit slowly, birth rate in Bulgaria over the last 4 to 5 years has started to pick up. It hit all-time lows in the late 1990s when the country was struck by a major economic turmoil. Today despite of the global economic crisis, the country has managed to keep birth rate levels close to the European average. The abortion rate has also declined. Nevertheless the country still sees negative population growth and ageing population. In the meantime Bulgaria faces another problem that has to be fixed: providing equal access of Bulgarian mothers and children to quality and up-to-date healthcare. Fact is that small towns and especially villages have to wrestle with the lack of qualified medical staff, including pediatricians. Child diabetes levels are up, while neurosis, aggressive behavior, high blood pressure, asthma and cardio-vascular conditions have become more common. To make things worse all this is coupled with a major decline in the quality of medical services, experts are alarmed. “Maternal and child mortality in Bulgaria is twice as high as the one in most of Europe”, pediatrician Dr Eva Borissova says.

“This mirrors poor quality of medical services delivered to those two groups. There are many problems. The first one has to do with the accreditation of Bulgarian hospitals. It is inadmissible to accredit a hospital that has got no infant incubator available, and to expect doctors or the community to raise funds for buying one. There are basic services that the state should guarantee under its domestic standards.”

“The reforms of Bulgarian healthcare and the upheavals in the system have impaired maternal and child healthcare”, Associate Prof. Vladimir Pilosof, Deputy Chairman of the Bulgarian Pediatric Association explains. The association presses for declaring child healthcare a priority thus making sure it will be subsidized by central government. Child healthcare also suffers from the lack of a large national pediatric hospital. To improve all this, doctors insist that children aged up to 14 should get health care service from a pediatrician, not from a GP, as is the case at present. The problem however is that pediatric specialists in Bulgaria are on the verge of extinction. Pediatrics is not an attractive major for medical students, since it is not likely to earn them good incomes in the future.

“Clinical paths in maternal and child healthcare are strongly undervalued”, Dr. Borissova says further. “Their number is small too, and this distorts child health statistics. For quite a few parents compliance with the mandatory inoculations is problematic. No wonder then that diseases such as TB and German measles that we had long forgotten, have made their comeback.”

One particular challenge is how to finance expensive treatment of children with serious diseases. When treatment abroad is advisable its cost is reimbursed by the Medical Treatment of Children Abroad Fund. Very often however, expensive treatment in Bulgarian hospitals should be paid by parents – either fully or in part. A good chance for children with serious diseases is the traditional Bulgarian Christmas campaign held under the aegis of the president. It raises charities for expensive treatment of children and for buying new equipment for hospitals.

English version Daniela Konstantinova