Note: the texts under all the headings, with the exception of 'Results achieved', describe the situation before the start of the project.
Home Care Services
Increasing life expectancy in Bulgaria means that there is now a larger number of older people in the country. To enable these people to remain at home in a familiar environment even at an advanced age, this project has introduced a home nursing service in Vratsa districts. Home nursing by qualified teams enables patients to maintain a degree of independence and improves the quality of life of chronically ill or disabled elderly people.
Improving social security
Social services for specific target groups
- 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
- Swiss Red Cross
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.
|Directorate/federal office responsible||
Swiss Contribution to the enlarged EU
|Budget||Current phase Swiss budget CHF 2'418'187 Swiss disbursement to date CHF 2'418'000|
Phase 1 01.07.2011 - 31.12.2017 (Completed)
The average age of Bulgaria's population is increasing. By contrast, the birthrate is low and young Bulgarians are now either emigrating or moving to larger towns. As a result, many older people in Bulgaria are now isolated, both in medical and in social terms. The project provides home nursing services and assistance and thus improves the quality of life of chronically ill or disabled elderly Bulgarians, including members of the Roma community.
Assistance and care at home - the Spitex service
People who need medical care either go to a doctor or to a hospital. There are numerous hospitals in Bulgaria. However, this form of treatment is not always ideal for elderly or marginalised people suffering from chronic illnesses or disabilities. An efficient and effective health system must also provide home care for those who need it. This reduces the pressure on hospitals and on the target groups.
This home nursing system is known in Switzerland as Spitex and is a genuine alternative for the Bulgarian health system. In Switzerland over 200,000 people a year benefit from Spitex services and over 15,000 full-time Spitex staff provide the necessary care.
Maintaining independence until an advanced age
The project has established four contact points for domestic care in four districts in the Bulgarian region of Vratsa. The service provides home nursing for over 350 people. This means that older people can continue to live at home in a familiar environment. They receive regular visits from staff trained to provide care and help with housework. This promotes the independence of the patients concerned until an advanced age.
Another advantage is that this method reduces costs, as home nursing is cheaper than hospital care. This method of treatment also creates jobs for the local population and helps to stem the tendency to move away from rural areas.
Possibility of future services at the national level
The project will also develop national quality standards for home care, with clear definitions of who is responsible for which tasks in the field of home care. The question of whether the offer for the Roma population and other minority groups in Bulgaria needs to be adapted will also be clarified, to enable care methods for these groups to be implemented in a targeted and efficient way.
Finally, on the basis of experience and results, proposals and recommendations for the national level of the health service will be made in order to drive forward health service reforms that have been initiated. The home nursing system will be established at a national level. In future it could also be offered throughout the country, so that demographic and socio-economic challenges in the health system can be tackled in an effective and modern manner.