Health Inequities in Bulgaria Action and Challenges

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Health Inequities in Bulgaria Action and
Challenges

• Svetlana Spassova, MD
• Ministry of Health, Bulgaria
• Chisinau 07.11.2008

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WHO's health system performance framework
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(No Transcript)
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The Health System in Bulgaria
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Addressing inequalities in Bulgaria

• Addressing the particular health needs of
• Uninsured people
• People with low income
• Disabled people
• Vulnerable groups children, youth, elderly
• Minorities
• People, suffering from specific diseases.

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Addressing inequalities Stewardship

• Legislative provisions The Law on Health and
  secondary by-law guarantee access to certain
  healthcare services, regardless of insurance
  status
• The National Health Strategy putting the issue
  of addressing inequalities on the political
  agenda
• National strategies and programs targeting
  disadvantaged groups focus on information,
  disease prevention, provision of services and
  treatment
• The EU-Pre-accession instruments (the
  PHARE-program) and the Structural funds

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Addressing inequalities Investment and training

• Availability of qualified human resources-
  specialization system financed by the state
• Investments in infrastructure and facilities
  state financed investment policy provided by MoH,
  projects financed under the pre-accession and
  Structural funds municipal budgets
• Access to pharmaceuticals legislation on
  pharmaceuticals and medical devices control of
  prices of prescription drugs linked to external
  and internal reference and inflation positive
  drug list

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Addressing inequalities Service delivery

• State budget financed access to emergency
  healthcare, midwifery care, organ
  transplantations and follow up treatment, central
  procurement of pharmaceuticals for cancer
  diseases, rare disease, blood disorders,
  transplants and dialysis immunization and
  vaccines, neonatal screening of genetic diseases
  access to national, regional and community
  programs, transportation, mobile structures and
  outreach programs.
• National programs, targeting
• disadvantaged groups minorities, people with
  mental disorders, people with rare diseases, etc.
• diseases, representing significant socio-economic
  burden cancer, tuberculosis, HIV/ AIDS, etc.

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Addressing inequalities Financing

• National budget spending on
• health services for uninsured
• health services for specific vulnerable groups
• national, regional and communal programs.
• infrastructure
• External funding
• EU fund spending on specific projects, targeting
  minorities or diseases, affecting predominantly
  vulnerable groups.
• The Global Fund to fight AIDS, tuberculosis and
  malaria
• infrastructure, regional development,
  strengthening of human resources and
  administrative capacity

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Strengthening health system - performance and
challenges

• Improving health in equitable way requires
• Functions of the health system, related to
  reforms
• Reform plans, oriented towards goals
• Overall goals, split into specific objectives
• Measurable intermediate objectives, leading to
  achievement of national objectives

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Addressing inequalities Challenges

• Defining and implementing reforms and
  investments, aimed at those most in need of care
  
• Balancing competing demands and setting clear
  policy priorities
• Creating awareness in order to prevent conflicts
  between different members of society
• Developing programs, that deliver added value and
  have defined measurable outcomes
• Ensuring the availability of qualified health
  force creating incentives for medical
  professionals
• Developing PPP

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Addressing inequalities Challenges

• Financial restrictions require prioritizing
• Reducing financial barriers which hinder access
  to needed care
• Ensuring continuity a stable flow of resources
• Reaching the disadvantaged people monitoring the
  responsiveness of services
• Evaluating the impact of service delivery
  strategies.

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Measuring Outcomes Conclusions

• Measures aimed at addressing inequalities
  strengthen health system performance, if
  resulting in
• Better health throughout the entire population
• Responsiveness of the system to specific needs
  and vulnerabilities
• Sufficient funding and optimal redistribution so
  as to enable universal access to health services.

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Bulgaria
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• Thank you for your attention!
• Svetlana Spassova, MD
• National Health Policy Director,
• Ministry of Health - Bulgaria
• sspassova_at_mh.government.bg