Policy responses for Bulgaria - HSRM


Policy responses for Bulgaria

2.2 Workforce

Bulgaria has faced the epidemic with a high density of physicians (4.2 per 1,000 inhabitants in 2018) compared to other European countries and a severe nursing staff shortage with the second-lowest patient-to-nurse ratio (4.4 per 1,000 inhabitants in 2018) and doctor-to-nurse ratio (approx. 1:1) in the EU. There are marked regional disparities in the distribution of all health care personnel. Although Bulgaria has had above-average density of physicians in general, there is a shortage in some specialities important for managing COVID-19 outbreak, including epidemiologists, infectious diseases specialists, ICU specialists and nurses with a specialisation in ICU care pre-existing the pandemic.

At the beginning of March, there was an initial call upon medical students and retired health professionals to work in clinical practice, and many of them have declared an interest. Currently, no information is available on centralised measures to increase the availability of health workers, redeploy medical professionals from other specialities or affect the placement of medical and nursing students. Some initiatives are undertaken at a regional and local level, such as campaigns for recruitment of volunteers for social services; the RHI in Varna, for instance, has appealed for help to medical students and retired health professionals, but these initiatives are not coordinated across settings, professions or cities, yet. The growing number of infected medical personnel has raised concerns – 36 confirmed cases as of April 13.

The government approved flat-rate monthly premium of BGN 1,000 (EUR 511) for medical and non-medical professionals of hospitals treating coronavirus patients, centres for emergency medical care, RHIs and the National Centre of Infectious and Parasitic Diseases. The total amount of BGN 70 million (EUR 30.68 million) is provided by the Operational Program "Human Resources Development 2014-2020" and will be allocated until the end of the year. The project activities envisage ensuring additional payment and provision of PPE for medical and non-medical personnel involved in monitoring, diagnostics and treatment of COVID-19.

Some hotline services were set up to provide psychological assistance to healthcare professionals during the COVID-19 outbreak. Moreover, the Ministry of Labour and Social Policy and some municipalities have established call centres for psychological support for persons in self-isolation, elderly, disabled, mothers and children.
In the last weeks, the National Operational Headquarters put a particular focus on capacity losses due to infected health workers. As of April 22, 83 confirmed cases were reported or above 8% of all COVID-19 cases in Bulgaria. The newly infected medical workers have raised concerns, particularly in one district hospital and physicians with different specialties have been redeployed to COVID-19 ward. As a result, some emergency non-COVID-19 patients have been admitted to another hospital, located in the same district.

The government announced that besides medical workers, the police officers will be rewarded with a BGN 650 (approx. EUR 332) bonus in recognition of their efforts and due to suspension of their annual leaves during the epidemic.

As of May 7, 192 infected medical professionals (or above 13% of all COVID-19 cases in Bulgaria) were reported. According to the National Operational Headquarters, the majority of newly infected medical workers have not been employed at COVID-19 wards. At the beginning of May, the first two deaths were registered among medical professionals. Several district hospitals are experiencing particular difficulties due to capacity losses in the result of infected health workers. The Minister of Health has appealed to volunteers from other health care establishments who can support the affected hospitals.

Although the physical capacity has been assessed as sufficient, particular concerns have been raised regarding the workforce capacity. As of August 21, the number of infected health professionals exceeded 820, which reflected more than 5% of all registered COVID-19 cases in the country, and some hospitals have experienced difficulties due to infected medical specialists.

At the end of July, the government approved a transfer to the MoH’s budget for additional payments to health professionals involved in the monitoring and treatment of COVID-19 patients. The funds are to be spent on remuneration increases for medical and non-medical personnel (such as health inspectors to the Regional Health Inspectorates). In addition, medical specialists will be rewarded with a flat-rate premium in the form of vouchers for a holiday in the country. A monthly premium is also envisaged for other professionals engaged in the implementation of measures for containing the spread of COVID-19, such as police officers and border control officers.

During the second peak of the epidemic in the autumn, the surge in demand for health care services exacerbated low availability of medical professionals. The situation was further aggravated by the losses due to infected health workers. Since the beginning of the COVID-19 epidemic, more than 4,300 medical professionals have been tested positive for the virus. Enhancing the hospital capacity dedicated to COVID-19 patients was partly restricted by the shortage of medical staff. Many hospitals called for volunteers – medical students or retired health care professionals – due to concerns about medical personnel running short. In several hospitals, medical students have been employed as caregivers and are entitled to additional monthly premiums granted to medical professionals. Some municipalities also appealed for help, providing free housing for medical professionals from other districts. No information is available on centralised measures to redeploy medical professionals from outpatient care or affect the placement of medical students.

In November, a transfer to the MoH’s budget was approved, intended for payment of the general practitioners. All GPs have to receive a flat-rate monthly premium of BGN 1,000 (EUR 511) such as the medical professionals involved in the treatment of COVID-19 patients. Besides, the government decided to allocate BGN 237 million (EUR 121.2 million) from the 2021 budget for a remuneration rise of medical professionals and auxiliary staff employed in hospital care.

Links and sources:

Council of Ministers; http://pris.government.bg/prin/default.aspx 
Informational Portal for COVID-19; https://coronavirus.bg/
Ministry of Health; https://www.mh.government.bg/bg/
National Centre of Public Health and Analyses. Healthcare statistics. Sofia, 2019; https://ncpha.government.bg/images/___NCPHA/__Publications/_Statistics/HealthcareStatistics_2019.pdf
Ministry of Health; https://www.mh.government.bg/bg/novini/aktualno/