3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
Measures to reconfigure service delivery in an effort to increase treatment capacity include reorganisation and increasing hospitals’ capacity for treating COVID-19 patients and assuring sufficient medical equipment and treatment.
Initially no specific hospitals were determined for treating COVID-19 patients. The first MoH’s ordinance on reorganisation and increasing hospitals’ capacity in districts with confirm cases was issued on March 11. On March 27, the Minister of Health issued an ordinance determining hospitals, hospital wards and the number of beds determined for treatment of COVID-19 patients in each district, divided into two groups depending on the severity of cases and intensive care needs. The number of hospital beds assured for moderate cases is 7,391 in the country and another 1,324 beds are assured in the ICU. There are 230 hospitalized COVID-19 patients (3% of capacity), 36 of them in ICU (2.7 %), as of April 13.
Another ordinance stipulates compulsory registration, notification and reporting of COVID-19 cases and determines 5 laboratories in which cases to be confirmed (25.03.2020). The list of laboratories was extended to 7 on April 10. Two of the laboratories are private.
In addition, the export of quinine-containing drugs, PPE and disinfectants was prohibited. As of April 13, there are 15,000 doses chloroquine phosphate sufficient for full-course treatment of 16,000 COVID-19 patients.
Patients have been advised to contact their GPs in case of COVID-19 symptoms using phone and avoid personal contact. Based on a MoH’s ordinance issued on March 17 GPs and the Regional Health Inspectorate (RHI) HIs provide consultations and medical surveillance during the quarantine period. GPs are responsible for surveillance and home treatment of confirmed cases and for referring patient to a hospital if necessary. Bulgarian citizens and citizens of another country who have not a GP are served by the respective RHI.
Although the number of daily registered COVID-19 cases started to increase since the last week of April, the health system capacity is still far below health needs. As of May 15, there are 1491 active cases, 321 of which are hospitalized (4 % of the capacity), 49 of them – in ICU (3.7 % of the capacity). The number of laboratories assigned to perform COVID-19 PCR-testing has gradually increased to 25, 8 of which are private.
Sources and links:
Ministry of Health orders regarding COVID-19; https://www.mh.government.bg/bg/informaciya-za-grazhdani/informaciya-otnosno-noviya-koronavirus-2019-ncov/