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
By order of the Minister of Health, relevant immunisation points have been designated. In February 2021, there were 318 immunisation points throughout the country, organised by outpatient and inpatient health care establishments and the Regional Health Inspectorates. Until the beginning of March 2021, their capacities were expanded with an additional 80 health care establishments, providing vaccination against COVID-19, as well as mobile teams for hard-to-reach and remote settlements.
At the end of February 2021, shortages of vaccines were reported due to delayed deliveries. Thus, the immunisations were temporarily suspended except for those who were scheduled to receive their second doses. The Council of Ministers decided to request an additional 2,897,694 doses of the Pfizer-BioNTech vaccine and 460,000 doses of the Moderna vaccine.
On March 4, 2021, a system for online registration for COVID-19 vaccinations was launched. Users are able to book appointments at a chosen immunisation point throughout the entire country. Everyone who is vaccinated with the first dose is registered in the system for the second dose. The system covers only immunisation points established to health care establishments and RHIs and does not include general practitioners.
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.
At the end of July, the Minister of Health issued an order for hospitals to guarantee hospital beds and intensive care beds for COVID-19 patients. The order specified the hospitals and the number of beds that must be provided in three different scenarios of the spread of the disease. The Regional Health Inspections were given authority to take additional actions for planning and organizing health services provision regarding COVID-19 and to apply measures to the healthcare establishments in their respective regions. Based on this order, in mid-November, 20 % of hospital beds in each district were determined for treatment of COVID-19 patients.
In November, due to rapidly and significantly increasing cases (the newly registered cases increased from 2,815 during the week of 5-11 October to 22,275 during 9-14 November, with nearly 40 % of the PCR tests being positive), some regions experienced acute shortages of medical staff and hospital beds for treatment of COVID-19 patients. The problem with the availability of medical personnel was further intensified by the number of COVID-19 cases among professionals (more than 4 % of all registered cases as of 8.12.2020).
The number of laboratories assigned to perform COVID-19 PCR tests has been gradually increased, reaching 81 at the end of November as well as the centers collecting convalescent plasma). After the first cases successfully treated with COVID-19 convalescent plasma at the end of April, the number of centers which collect plasma increased from one to six in December.
In December, the Government approved plan for voluntary and free of charge vaccination against COVID-19, defining five priority groups (see 5.1 Governance).
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/