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Introduction of home care services in Bulgaria – a chance for transformation of the primary health care system


Nadezhda Dimitrova Todorovska ,

Bulgarian Red Cross, BG
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Siana Tsvetanova Karsheva

Bulgarian Red Cross, BG
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Introduction of home care services in Bulgaria – a chance for transformation of the primary health care system

Summary: In the context of constantly increasing ageing population and a rise in chronic morbidities, comorbidities and disabilities, the existing health care system in Bulgaria has faced difficulties in providing the necessary continuity of care called for. Unmet care needs within the elderly population, resulting from a narrow scope of services, hospital-oriented health care system and exclusion of supportive social services, became increasingly evident.

Inspired to address gaps in services delivery for elderly patients, the Bulgarian Red Cross initiated development of a home care model for Bulgaria despite the concept of home care being nonexistent in the country. Home care services actually represent an integrated model for providing professional community-based health and social services tailored to the needs of the patients. Financial and technical input from the Swiss Red Cross and Spitex Association helped kick-start the initiative. The first home care centre was launched in 2003 and began offering services to the local elderly population; 9 additional centres have since opened and provide home care services across the country.

The introduction of these services, however, challenged existing laws that previously required nurses to be supervised by a physician and prohibited payment for the delivery of nurse-led services in homes. Besides, the integrated health and social services used to lack any definition and regulation in the Bulgarian legal framework.

In 2012, in response to increasing needs, the Bulgarian government prioritized the formalization of this effort through a collaborative project with the Bulgarian Red Cross supported by the Swiss Agency for Cooperation and Development. The partnership formed with the Ministry of Health, the Ministry of Labour and Social Policy and the Swiss Red Cross in this project is currently serving to develop system conditions required to take the initiative forward and fully integrate home care services within the health and social systems.

How is home care designed?

Home care services include basic medical services performed by nurses as well as social assistance provided by home-helpers to support the patients in their everyday life. A needs assessment is conducted for each patient upon enrolling for home care services. This ensures care plans are adapted to an individual’s needs. Services are provided in patients’ homes in strict observance of quality criteria developed by the Bulgarian Red Cross, based on the Swiss Association Spitex model and in constant collaboration with family doctors and other medical specialists. An important aspect of the activities of home care centres is their support of patients’ capacity for self-care and independence.

Target group: Older people with chronic diseases and permanent disabilities over the age of 65.

Main outcomes: Integrated health and social services in the community are recognized for the first time in Bulgaria      and are included as a priority in national level policy documents;

10 home care centres have been established across the country, providing services to over 800 elderly patients;

First legal regulation ever of integrated medico-social services was adopted in 2015;

New educational programs for the staff engaged in the provision of social services at home have been elaborated;

Cost-pricing and costs-effectiveness analysis of home care services is performed.

Results from external evaluation /October 2016/

Recommendations have been made towards enlargement of the scope of the services towards other target groups like people at all ages with chronic diseases and disabilities, pregnant women and children as well as towards establishment of a national level platform to work together on the quality and financial sustainability of integrated home care services.

Moving forward: The Bulgarian Red Cross is working with the government and other expert stakeholder groups to finalize the development of a political, legal and financial framework which will support the full integration of home care services delivery in the health and social systems. Once accomplished, this will ensure sustainability and allow standardized, high quality care to be provided to elderly patients in home settings across Bulgaria.

How to Cite: Todorovska ND, Karsheva ST. Introduction of home care services in Bulgaria – a chance for transformation of the primary health care system. International Journal of Integrated Care. 2017;17(5):A602. DOI:
Published on 17 Oct 2017.


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